India: The Dual Battle against Undernutrition and COVID-19 (Coronavirus)

In normal times, India’s million plus army of anganwadi workers leads the country’s war against undernutrition. Today, these women have joined another battle - the battle against COVID-19.

With 1.3 billion people in lockdown, this vast cohort has swung into action. While their usual duty is to improve the nutrition of women and children across rural India, they are now going door to door, recording people’s travel history, noting flu symptoms and, where needed, even helping trace contacts.

Their mission is vital to ensure that every last corner of the country understands and acts upon the government’s guidance regarding COVID 19 - regularly beamed through radio and TV, as well as through the recently launched Aarogya Setu app.

“Caution is the only solution,” explained a confident Asha Tripathi, an anganwadi worker from Uttar Pradesh, one of India’s poorest states. “We are advising people not to violate the lockdown and to avoid crowded places.”

With cities shut down completely, and millions of out-of-work migrants returning home to their villages – many even walking long distances to get there - these women are helping with community surveillance as well.

“I have to inform the panchayat (village council) about any person entering the village from outside, meet that person and advise them to stay in quarantine for 14 days,” said Amrika, an anganwadi worker from Kawardha district, Chhattisgarh, another low-income state. 

A resilient workforce

Since they know their people well, this legion of anganwadi workers is extensively used by district administrations in times of dire need. Dealing with emergencies is therefore not alien to their cadre.  

During the coronavirus pandemic too, these women have formed a formidable front against its spread in rural India, along with other members of the rural health workforce - the local ASHA (Accredited Social Health Activist) and the Auxillary Nurse Midwife (ANM).

Great care is taken to remind these workers that their safety is equally important, and that they too must strictly follow physical distancing while meeting with people in the course of their work. Wearing their face masks while fulfilling their role, these women remain undeterred.

When Anita Devi, an anganwadi worker from Giridh district in Jharkhand - another of India’s low-income states - was asked whether she felt comfortable while working during this pandemic, she replied without hesitation, “If the doctors and nurses can leave their families and work day and night, why can’t we contribute in our own small way?”

“They are a resilient workforce and can adapt very quickly to difficult circumstances,” explained Mohini Kak, senior health specialist, who leads the World Bank’s support for India’s fight against malnutrition. “Today, they can be seen going about their villages performing their duties with immense strength and courage. When the war against COVID-19 is over, the contribution of these frontline workers will not be forgotten.”

Infant feeding practices and COVID-19

Although the anganwadi centers are closed, the anganwadi worker’s critical duties must continue. “Babies are still being born, pregnant women still need regular health check-ups, and new mothers still need to be supported with breastfeeding and feeding young children,” pointed out Deepika Chaudhery, senior nutrition specialist. “Given the dramatically altered needs of the times, the women have been given fresh guidance about breastfeeding and weaning practices.”

For instance, even if a mother or her baby has COVID-19 – whether suspected, probable or confirmed - they must remain together, especially right after birth, to initiate  breastfeeding. And even if a nursing mother has a fever, a cough or difficulty in breathing, breastfeeding must continue.  However, the mother should wash her hands with soap and water and wear a mask before beginning to breastfeed.

The importance of warding off hunger and undernutrition during times of economic disruption

In these difficult times, these women’s role in the battle against undernutrition has assumed even greater importance. Experience from past pandemics and times of economic disruption has shown that ensuring food security and nutrition becomes even more critical.  When food prices rise and supply chains break down, the earnings of the poor and vulnerable fall substantially. At such times, it is always the women and young children who are the hardest hit. Significant government intervention is then needed to ward off undernutrition and destitution, which can weaken the immune system and increase susceptibility to the disease.

The anganwadi workers therefore continue to distribute rations of rice and dal (pulses)  - and in some states eggs - to pregnant and nursing mothers and young children, to ensure that they receive their regular supply of nutrients during these critical periods of their life. The only difference now is that instead of distributing these at the anganwadi centers, they take them directly to the homes of vulnerable families.  

Anganwadi Worker Malti Janghel providing take home rations to a beneficiary. Birutola, Chhuikhadan, Rajnangoan District, Chhattisgarh, India. Photo by: Yogeshwari Deshlehra

“Across the world, community health workers are the key instruments for improving the health of the rural poor,” summed up Junaid Ahmad, the World Bank’s country director for India.  “In India, the anganwadi system serves as the backbone of the country’s fight against undernutrition - and now against COVID-19. The women’s safety through the provision of personal protective equipment is paramount and we hope it remains a priority for the government.”

The World Bank has supported India’s efforts to improve nutrition since 1980, with an overall investment of over $1 billion.  Since 2015, the current phase of support is targeting the critical 1,000 day window for nutrition, from pregnancy until the child is 2 years of age. It is also helping build the capacity of anganwadi workers, supporting behavior change communication, and promoting  use of mobile-based technology to reach families with young children, and pregnant and lactating mothers.