The chicken-egg problem of Malnutrition

Our team member Anshika engaging with a teenage mother

What came first—the chicken or the egg? It feels like one of those never-ending debates. The same can be applied to malnutrition. Malnutrition is the cause or outcome of poor health. It's challenging to pin down because malnutrition forms a vicious cycle, constantly feeding into itself. Let us understand this with Radha's story (name changed).

Radha is a 16-year-old mother of a three-month-old baby. She had lost her first child during delivery barely a year ago when she was nearly 15. Within just 15 days of that loss, she conceived again. Currently, she weighs just above 30 kilograms, and both she and her newborn are severely undernourished.

So, what happened here? Did malnutrition play a role as a cause, or was it the effect? As my conversation unfolded with Radha, I asked her about the care she had received during her pregnancies—Did she take any nutritional supplements? Was there a special diet? Any antenatal check-ups? The answer to most of the questions was: "No."

I also spoke with her family members to gather further insights. They shared that they believed everything would have been fine if they had received timely care from their nearest government hospital. Well, the healthcare facility during labour is of significant importance in any delivery.

But do you think that was the only cause, and Radha had to lose her baby?

I believe not. There was much more to it, such as Radha's young age, her frail health, a poor diet, stress, and limited resources. All of them had already laid the foundation for poor health outcomes long before her delivery. Her second pregnancy, occurring so soon after the first loss, underscored a deeper issue—inadequate awareness, deeply ingrained social norms, lack of care during pregnancy, and much more.

ZealGrit team in conversation with young mothers

Radha's story helped me to see that this is how the cycle of malnutrition and poor health begins. During her pregnancy, Radha didn't get the healthcare she needed, which put her and her child's life at risk. Poor nutritional care and teenage pregnancy put her in a cycle of malnutrition. Unfortunately, her secondborn is also malnourished. However, the child can be protected with immediate care until his second birthday. The first 1,000 days are critical, as care during this period shapes the health and future of the mother, the child and entire families and generations, making it essential to address malnutrition from the very start. It's not just about improving nutrition; it's about overcoming deep-rooted barriers—poverty, lack of healthcare, and entrenched social norms that leave families caught in a cycle of vulnerability.

In districts like Supaul, the region where we operate, this cycle is alarmingly common. According to the National Family Health Survey-5, in Supaul, only 30% of pregnant women had at least the recommended four antenatal check-ups, and only 13% of the women consumed iron folic acid for 100 days or more when they were pregnant. These figures paint a concerning picture of healthcare access and nutritional care during pregnancy. However, there are multiple examples where you can find the real situation even more disturbing, adding to these staggering data points. Here is one of those from my field experiences.

I remember having a focused group discussion with a group of women, each sharing their experiences of their pregnancy and motherhood. One of them said, "Hamare toh four bacche ho gaye, jisme se 1 khatam ho gaya, lekin ek bhi baar ultrasound nahi karwaye" (I have given birth to four children, one of them died, but I never had an ultrasound during any of my pregnancies). Sadly, she wasn't alone. Several women shared the same narrative—no check-ups, no ultrasounds, no recommended nutritional supplements, and hardly any special care. They cited the reasons as the lack of money, the absence of proper healthcare facilities, and a belief that such care wasn't necessary. "Sarkari me suvidha achhi nahi hoti"(Government facilities are not good), some women said. For many women and families here, pregnancy was not seen as a phase that required special care but rather as a routine part of life.

The gap is glaring, but this is just one angle of the picture which we saw from the community's lens. There are many other factors in this much broader issue of malnutrition.

Stay tuned as we explore the many layers of malnutrition and maternal health and work to uncover sustainable solutions. Subscribe to zealgrit.org to read more such ground stories.