Time-constrained mother and expanding market: emerging model of under-nutrition in India

BMC Public Health, Jul 2016

Background Persistent high levels of under-nutrition in India despite economic growth continue to challenge political leadership and policy makers at the highest level. The present inductive enquiry was conducted to map the perceptions of mothers and other key stakeholders, to identify emerging drivers of childhood under-nutrition. Methods We conducted a multi-centric qualitative investigation in six empowered action group states of India. The study sample included 509 in-depth interviews with mothers of undernourished and normal nourished children, policy makers, district level managers, implementer and facilitators. Sixty six focus group discussions and 72 non-formal interactions were conducted in two rounds with primary caretakers of undernourished children, Anganwadi Workers and Auxiliary Nurse Midwives. Results Based on the perceptions of the mothers and other key stakeholders, a model evolved inductively showing core themes as drivers of under-nutrition. The most forceful emerging themes were: multitasking, time constrained mother with dwindling family support; fragile food security or seasonal food paucity; child targeted market with wide availability and consumption of ready-to-eat market food items; rising non-food expenditure, in the context of rising food prices; inadequate and inappropriate feeding; delayed recognition of under-nutrition and delayed care seeking; and inadequate responsiveness of health care system and Integrated Child Development Services (ICDS). The study emphasized that the persistence of child malnutrition in India is also tied closely to the high workload and consequent time constraint of mothers who are increasingly pursuing income generating activities and enrolled in paid labour force, without robust institutional support for childcare. Conclusion The emerging framework needs to be further tested through mixed and multiple method research approaches to quantify the contribution of time limitation of the mother on the current burden of child under-nutrition.

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Time-constrained mother and expanding market: emerging model of under-nutrition in India

Chaturvedi et al. BMC Public Health Time-constrained mother and expanding market: emerging model of under-nutrition in India S. Chaturvedi 2 4 5 6 S. Ramji 2 3 4 6 N. K. Arora 0 1 2 4 6 S. Rewal 2 4 6 10 R. Dasgupta 2 4 6 9 V. Deshmukh 0 1 2 4 6 for INCLEN Study Group 2 4 6 0 The INCLEN Trust International , F-1/5, Second Floor , Okhla Industrial Area , Phase-I, New Delhi , India 1 Narendra K. Arora , Executive Director , The INCLEN Trust International , New Delhi , India 2 Authors' information 3 Siddarth Ramji, Medical Superintendent and Professor, Department of Pediatrics, Maulana Azad Medical College , New Delhi , India 4 Acknowledgments We thank Ministries of Health and Family Welfare and Departments of Women and Child Development of Government of India and States of Uttar Pradesh , Bihar, Madhya Pradesh, Rajasthan, Orissa , and Jharkhand for facilitating the conduct of the study. INCLEN Study Group Vivek Adhish, Professor, Department of Community Health, National Institute of Health & Family Welfare , New Delhi; Anuja Aggrawal, Senior Dietician , Department of Pediatrics, All India Institute of Medical Sciences; Harish Chellani, Professor, Division of Neonatology, Department of Pediatrics, Safdarjung, Hospital and Vardhman, Mahaveer Medical College , New Delhi; A. P. Dubey, Professor and Head , Department of Pediatrics, Maulana Azad Medical College , New Delhi; Kalyan Ganguly , Deputy Director/Scientist E, Reproductive Health and Nutrition Division Social Behavior Research Unit, Indian Council of Medical Research , New Delhi; Kiran Goswami, Professor , Department of Community Medicine, All India Institute of Medical Sciences, New Delhi; K. Suresh, Public Health Consultant , New Delhi; R. M. Pandey, Professor and Head , Department of Biostatistics, All India Institute of Medical Sciences , New Delhi; M. S. Prasad, Professor and Head , Department of Pediatrics, Safdarjung Medical College , New Delhi; Prashant Mathur, Dy. Director General, Non Communicable Disease, ICMR, New Delhi; Arti Maria, Professor , Ram Manohar Lohiya Hospital , New Delhi , India; Manoja Das, Director Projects , The INCLEN Trust International , New Delhi; Neelima Thakur , Assistant Research Officer, The INCLEN Trust International , New Delhi; Deoki Nandan, (Site Investigator, Mathura, UP) Director , National Institute of Health & Family Welfare , New Delhi; J. P. Shivdasani, (Site co-Investigator, Mathura, UP) , Research Officer, National Institute of Health & Family Welfare , New Delhi; Shamim Haider, (Site Investigator, Gumla, Jharkhand) , Professor and Head, Department of Community Medicine , RIMS, Ranchi; Vidya Sagar, (Site 5 Sanjay Chaturvedi, Professor and Head, Department of Community Medicine, University College of Medical Sciences , Delhi , India 6 Abbreviations ANM, Auxiliary Nurse Midwife; ASHA, Accredited Social Health Activist; AWW, Anganwadi Worker; CHC, Community Health Center; DHO, District Health Officer; DHS, Director of Health Services; DLHS, District Level Health Survey; DM, District Magistrate; EAG, Empowered Action Group; FGD, Focus Group Discussion; GOI, Government of India; ICDS, Integrated Child Development Services; IDI, in-depth interviews; INCLEN, International Clinical Epidemiology Network; India-CLEN, Indian Clinical Epidemiology Network; MNREGA, Mahatma Gandhi National Rural Employment Guarantee Act; MoHFW, Ministry of Health Women and Child Development; NFHS, National Family Health Survey; NFI, non-formal interactions; NGO, Non-Governmental Organization; PHC, Primary Health Centre; PI, Principal Investigator; RA, Research Assistant; U-5 MR , Under-Five Mortality Rate 7 INCLEN Study Group 8 Vaishali Deshmukh, Program Officer, The INCLEN Trust International , New Delhi , India 9 Rajib Dasgupta, Professor and Chairperson, Centre of Social Medicine and Community Health, Jawaharlal Nehru University , New Delhi , India 10 Sneh Rewal , Consultant, Child Nutrition, New Delhi , India Background: Persistent high levels of under-nutrition in India despite economic growth continue to challenge political leadership and policy makers at the highest level. The present inductive enquiry was conducted to map the perceptions of mothers and other key stakeholders, to identify emerging drivers of childhood under-nutrition. Methods: We conducted a multi-centric qualitative investigation in six empowered action group states of India. The study sample included 509 in-depth interviews with mothers of undernourished and normal nourished children, policy makers, district level managers, implementer and facilitators. Sixty six focus group discussions and 72 non-formal interactions were conducted in two rounds with primary caretakers of undernourished children, Anganwadi Workers and Auxiliary Nurse Midwives. Results: Based on the perceptions of the mothers and other key stakeholders, a model evolved inductively showing core themes as drivers of under-nutrition. The most forceful emerging themes were: multitasking, time constra (...truncated)


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S. Chaturvedi, S. Ramji, N. Arora, S. Rewal, R. Dasgupta, V. Deshmukh, . Time-constrained mother and expanding market: emerging model of under-nutrition in India, BMC Public Health, 2016, pp. 632, 16, DOI: 10.1186/s12889-016-3189-4