15.8.10 The problem of child abuse and its manifestations will be studied in depth and its causes analysed so that effective measures can be taken. The burgeoning problem of abandonment and destitution, especially in big cities will receive attention. Suitable preventive and rehabilitative activities will be taken up for such children with special stress on the provision of non-institutional services like adoption and sponsorship. For children without homes, special programmes will be developed. Institutional care will be provided selectively. Training programmes will be organized to improve the quality of services.

15.8.11 Concerted efforts will be made to tackle the problems of social deviance, juvenile delinquency and juvenile crime through preventive, correctional and rehabilitative services. Greater attention will be paid to the promotion of non-institutional community-based services. The infrastructure for implementation of the Juvenile Justice Act, 1986 will be set up in all the States to provide care, protection, development and rehabilitation to neglected and delinquent children. Existing facilities and standards of services in the institutions will be improved. Diversified vocational training programmes will be developed and linked with the existing vocational training institutions.

15.8.12 The problem of child labour is an unfortunate manifestation of economic compulsions as well as socio cultural perceptions. While at the present stage of development it will not be possible to eliminate it altogether, programmes to combat the problem will be strengthened. Compulsory schooling and strong regulatory and administrative measures to prevent exploitation of child labour will be necessary. In areas where child labour exists on a large scale, efforts will be made to organise suitable literacy and vocational training for them after school hours. The enforcement of Child Labour Prohibition and Regulation Act, 1986 will be strengthened. More industries would be identified in which child labour is to be prohibited. In pursuance of the National Policy on Child Labour, specific projects will be undertaken in industries where the incidence of child labour is very high. Measures will be taken to cover families of child labourers under income generation schemes. Imparting of formal and non-formal education and setting up of special schools will be considered. Public opinion on the evils of child labour will be mobilised through investigative journalism, the use of electronic media and the support of activist groups.

NUTRITION

15.9.1 The nutritional status of a nation has close relationship with other indicators like the extent of economic growth, food adequacy and its effective distribution, levels of poverty, status of women, rate of population growth, and access to health, education, safe drinking water, environmental sanitation, hygiene and other social services. A multi-sectoral approach is, therefore, required to tackle the problem of malnutrition and other associated disorders.

15.9.2 In the earlier plans, malnutrition was perceived mainly as a problem of poverty due to which large numbers of the poor could not afford a 'balanced diet'. Ignorance about health and nutrition and frequent episodes of infections due to nutrition-related deficiencies were recog-

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nised as associated, as well as aggravating, factors. The importance of raising the purchasing power, increasing production of cereals, pulses, milk, eggs and green vegetables and their consumption, therefore, received attention. Vulnerability of children and pregnant and nursing mothers was recognised. The range of direct interventions expanded over the years to cover supplementary feeding of children and mothers, production of nutritious foods, fortification of foods and of salt, nutrition and health education of mothers, and prophylaxis programmes against identified nutritional deficiencies. In the Fifth Plan, supplementary feeding programmes were brought under the Minimum Needs Programme (MNP). Supplementary feeding also became a component of ICDS. Substantial increase in allocations for poverty alleviation programmes in the Sixth Plan was visualised as a means to increase the purchasing power of the rural poor and enhance food intake. Larger coverage of vulnerable sections of the population through public distribution system, expansion of health and other social services to reach the poor and increased coverage of specific programmes to tackle problems of nutritional deficiencies were other measures expected to raise the nutritional status of the population.

Review of Performance

15.10.1 In the Seventh Plan, programmes of poverty alleviation, population control, increased production of cereals, pulses, etc and expansion of social services, particularly health, water supply and housing, were expected to have an impact on the nutritional status of the population. Special programmes were implemented in different sectors for improving nutritional status through a combination of direct measures covering nutrition education and extension; de- velopment and promotion of nutritious foods; fortification and enrichment of foods; supplementary feeding; and prophylaxis programmes.

15.10.2 Nutrition education and extension activities were strengthened. A network of 34 Mobile Food and Nutrition Extension Units (MEU's) of the Ministry of Food imparted education on nutritive value of different foods and on how to choose a balanced diet through live demonstrations supported by lectures, film, slide shows and exhibitions. In the Seventh Plan, 6,633 training courses, covering 135,839 trainees were organised. In 1990-91, 870 courses were organised covering 22,671 trainees. Four Food Processing and Nutrition Centres in rural areas provided demonstration/training in the processing of fruits and vegetables at home level and nutrition education. The Integrated Nutrition Education Scheme was launched in 1988 to equip grassroot-level workers of different departments with basic knowledge on food, nutrition and health. Under this programme, 210 education camps/orientation training courses were organised in the Seventh Plan for anganwadi workers, multipurpose workers, auxiliary nurse midwives (ANM), lady health visitors, health education and adult education instructors and gram sevikas. The number of such courses organised in 1990-91 was 81.

15.10.3 In the area of development and promotion of nutritious foods, over 12.7 million litres of Miltone (a milk-like beverage based on 50 per cent groundnut protein and 50 per cent animal milk suitably enriched with vitamins and minerals) were produced. Five Ready-To-Eat (RTE) food plants produced 105,198 tonnes of extruded foods from cereals and pulses/oilseeds enriched with vitamins and minerals. About 73,673 tonnes of extruded energy food (non-extruded), a blend of cereal and pulse/oilseed flour, fortified with certain vitamins and minerals and sweetened with sugar or jaggery was produced in four energy food plants of the Government for the supplementary feeding programmes.

15.10.4 The scheme of fortification of milk with vitamin A was extended to 45 cooperative dairies in the country in 1990-91 from only 5 in 1985-86. About 3.35 million litres of milk were fortified with vitamin A daily in these dairies in 1990-91.

15.10.5 The fortification of salt with iron, to tackle the problem of iron deficiency anaemia, was continued in the plants in Tamil Nadu and Rajasthan. For the national goitre control programme, the production of iodised salt was stepped up from 7.72 lakh tonnes in 1986-87 to 22.56 lakh tonnes in 1989-90, through public and private sector units. Eighteen States/Union Territories completely banned the sale of noniodised salt. Resurveys done to assess the impact of the goitre control programme indicated the effectiveness of iodised salt in controlling goitre/iodine deficiency diseases. Some States

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decided to distribute iodised salt through the public distribution system.

15.10.6 A major programme of direct nutrition intervention was the Supplementary Nutrition Programme introduced in 1970-71. It aims at providing 300 calories with 10-12 g of protein to children below 6 years for 300 days in a year. Pregnant women and nursing mothers are provided 500 calories with 15-20 g of protein for 300 days a year. Coverage under SNP which was 11.57 million at the beginning of the Seventh Plan increased to 22.9 million at the end of the Plan.

15.10.7 The programme of Mid-Day Meals (MDM) for school going children initiated in the States in 1962-63 is meant for 6-11 year age group. Under the programme, supplementary food providing 300 calories and 8-12 g of protein per child is given for 200 days a year. Coverage of children under this scheme increased from 17.1 million at the beginning of the Seventh Plan to 21.1 million in 1989-90. In several States, supplementary feeding was assisted by food supplies from Co-operation for American Relief Everywhere (CARE) and World Food Programme (WFP).

15.10.8 A wheat-based supplementary nutrition programme for pre- school children and nursing, and expectant mothers was introduced in January 1986. The programme followed the norms of the existing Special Nutrition Programme (SNP). It covered 3.3 million benefici- aries by the end of the Seventh Plan.

15.10.9 Several studies of SNP and MDM have brought out certain drawbacks in implementation of the supplementary feeding programmes in regard to supply of food, discontinuity of feeding, pilferage and lack of community participation. The programme also suffered because several States found it difficult to provide adequate funds on a sustained basis for these programmes. As a result, less than the prescribed quantity of food and for fewer days was being provided. Even though there was a recognition of the need for an integrated ap- proach, convergence of supportive health and' other services in areas not covered by ICDS projects did not take place.

15.10.10 In the health sector, too, some nutriton intervention programmes were implemented. For prophylaxis against nutritional anaemia of mothers and children, a daily dose of iron and folic acid was given for a period of 100 days. In 1989-90, 19.5 million women and 21.7 million children were beneficiaries of this programme as compared to only 8.38 million women and 6 million children in 1977-78. Evaluation of the programme by the Indian Council of Medical Research (ICMR) listed several drawbacks. These related to insufficient coverage of beneficiaries, poor quality of tablets resulting in low bioavailability of iron, non-distribution of full course of supplements to the beneficiaries and poor knowledge of anaemia among the functionaries and the beneficiaries. A prophylaxis programme against blindness due to vitamin A deficiency was carried out, under which vitamin A was given to about 38 million children in 1-5 years age group in 1989-90. There were shortcomings in the implementation of the programme in regard to coverage of children from high risk groups. These related to irregular administration of the dose, method of dispensing, poor knowledge about the programme among functionaries, low community awareness and poor extension approach.

15.10.11 Nutrition and health education was stepped up through inputs in the school curriculum, training courses of medical and allied health professional and other field level functionaries, use of mass, folk and nonformal communication media, the maternity and child services network and specific programmes like ICDS. Nutritional needs of pregnant and nursing mothers and of pre-school children constituted the core of the messages.

Current Situation

15.11.1 Data on trends in nutritional status of children, women and other disadvantaged segments of the population are unfortunately not available. It is, therefore, difficult to make a precise statement on this subject in the absence of national level data. However, some inferences can be drawn from the studies carried out in some centres. Surveys by the National Nutrition Monitoring Bureau in 8 States showed that the prevalence of `severe' and `moderate' degrees of malnutrition among children based on Gomez classification has declined, while the proportion of `normal' children has increased.

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Data on nutritional status from ICDS project areas based on age-for- weight records of preschool children showed a significant increase in the percentage of children of normal and grade I nutritional status and a decline in the percentage of children in grades II, III and IV nutritional status. However, in a large number of slum areas and poor rural areas, only about one-third to two-fifths of the children were found to have normal nutritional status.

15.11.2 Various studies have shown that nearly one-third of infants are of low birth weight (less than 2.5 kg), largely attributable to poor maternal health and nutrition status. The incidence of anaemia among children of low income groups is reportedly high. Nutritional anaemia, mainly due to iron deficiency, therefore, continues to be a major public health problem among women in the reproductive age, especially during pregnancy and adolescence. Prevalence of anaemia, as reported by an ICMR Task Force (1989), does not appear to have declined during the last three decades. Nearly 88 per cent of pregnant women were estimated to be anaemic. This is a cause for concern since the status of maternal nutrition determines the course of intrauterine growth and development of the foetus, the birth weight of the infant, the lactation performance of the mother, and growth and development of the infants.

15.11.3 Vitamin A deficiency, especially among pre-school children from low income groups in backward, drought-prone and hill areas is still a problem. Incidence of Keratomalacia, an important cause of nutritional blindness, is reported to have declined and, according to some experts, is no longer a major public health problem as it once was. The national survey of blindness (1986-89) by the Government of India indicated that the prevalence rate of vitamin A deficiency in children 0-6 years was 6.54 per cent in rural areas and 4.77 per cent in urban areas.

15.11.4 There are other disorders like goitre. In India, nearly 54 million persons suffer from goitre and 167 million are living in the known endemic areas. Lathyrism is noticed in areas where kesari dal is consumed especially among landless farm labourers. Flourosis is found in regions with high flouride content in drinking water.

Eighth Plan Strategy

15.12.1 A major objective in the Eighth Plan will be to bring about an overall improvement in the nutritional status of the population. Since the major dietary problem leading to malnutrition is more of inadequacy of calories in the diet than of proteins, the overall strategy will be to bridge the calorie gap among various segments of the population. This will, to a large extent, depend on the success of the poverty alleviation and other developmental programmes in raising the incomes and consequently, the purchasing power of the people. In addition, nutrition education and access to different food items which provide the nutritional balance must be given priority.

15.12.2 The future strategy needs to emphasise the value of diversification and improvement of diets. Increased production of cereals and pulses, green leafy vegetables, fruits, eggs, fish, milk and their availability at an affordable price are important. The crop pattern in agriculture must reflect cognisance of the nutrition needs of Indian diets. The public distribution system needs to focus on areas and categories of the population most affected by price fluctua- tions in the market. Strict implementation of the Prevention of Food Adulteration Act will also be necessary so that the nutritive value of foods is not affected. Direct nutrition intervention programmes will need to focus on children below 6 years of age, adolescent girls, pregnant and nursing mothers belonging to the lower income groups, Scheduled Castes and Scheduled Tribes and those living in the drought prone areas, backward areas, hill areas and urban slums. Special attention will be given to tackle the nutritional problems of anaemia, vitamin A deficiency, goitre, lathyrism and flourosis.

15.12.3 Over-consumption of fats, salt, sugar and rich foods by the affluent sections needs to be discouraged through nutrition education. The designing of appropriate messages for prevention of obesity, coronary heart diseases, hypertension and diabetes would be necessary.

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15.12.4 There are certain area-specific nutritional problems. In Madhya Pradesh, Bihar, Uttar Pradesh and Andhra Pradesh, Lathyrism is prevalent in certain pockets. The cultivation of Lathyrus will need to be discouraged, although research efforts have also been intensi- fied to produce cultivars without the neurotoxic agents in Lathyrus Sativa. In certain parts of the country, where fluoride content exceeds 4 ppm in water, Fluorosis is a problem. Ways of providing safe drinking water needs to be explored in such regions. The goitre control programme, based on iodine fortification of common salt, will be carried out more effectively by preventing the entry of non- fortified salt into the endemic regions and ensuring the supply of iodised salt through the public distribution system.

15.12.5 A massive effort will be made to educate the community on nutrition needs and the ways of meeting them at an affordable cost.

15.12.6 Nutrition programmes will not make much impact on nutrition/health status unless some interrelated factors are simultaneously or concurrently taken care of. Control of infections, (particularly parasitic infestations) and gastrointestinal disorders would be essential, specially in case of children. Availability and use of safe, drinking water is a must for preventing water-borne diseases. The unhygienic habits of the people like washing soiled clothes and utensils near the source of water supply is a major cause of contamination of water. Basic water filteration techniques are not observed in rural areas. Therefore, education of the community (in consumption of safe water and keeping the environment clean would be necessary to improve health and hygiene.

15.12.7 Programmes in the area of nutrition have not succeeded to the desired extent due to apathy and lack of community participation. People perceive these as Governmental programmes, not of immediate relevance to them, specially since the benefits of preventive pro- grammes do not have high visibility. Unless the community is involved in the process of planning of these programmes right from the inception, it would he difficult to enlist their participation. Hence, considerable emphasis will be given to community involvement and participation of local level voluntary organisations and panchayati raj institutions.

Programmes: Supplementary Nutrition Programme

15.13.1 The, supplementary nutrition feeding programme for children below 6 years of age was primarily targetted in the Seventh Plan at the ICDS project areas though, in some States, beneficiaries outside the ICDS areas also received supplementary nutrition. In the Eighth Plan, with the opening of more the lCDS projects, most of the SNP programmes will he carried out in the lCDS project areas, as the convergence of services in these projects produces a much greater impact. Care will he taken to ensure that the full nutritional norm of supplementary feeding is observed, food is provided for all the 300 days, children below three years are duly covered and pregnant and nursing mothers and malnourished children get the food according to the higher prescribed norm. The mid-day meal programme will be continued in the States. Efforts will be made to involve the community in the implementation and monitoring of supplementary feeding to check pilfering and other forms of abuse.