In today’s guest blog post, Ishu Kataria* talks about growth monitoring in India
The ABC of Growth Monitoring and Promotion: My experiences in the field
Growth refers to regular increase in the size of an organism. It is a continuous process that starts at the time of conception till adulthood, impacted strongly by the environment. India, being home to 1.26 billion people still has 46% stunting in children under five. In fact, 150 million children in developing countries are still malnourished. Therefore, child health and mortality is still a burning issue. Countries all over the world are making efforts to tackle this problem, and one of the easiest and feasible ways that is being followed is Growth Monitoring which involves weighing the child regularly to keep track of his/her growth.
But why weight? Weight gain is the most sensitive and accurate indicator of growth. Almost all countries follow the UNICEF method – weighing the child and charting the growth.
Is only charting enough? Only plotting weight of the child on growth chart is not sufficient, rather, it is of no use. Therefore, Growth Monitoring alone as a concept holds no significance unless another term “promotion” is included – Growth Monitoring and Promotion (GMP) is the ideal terminology. This includes along with regular weighing and plotting the weight of the child, interpreting it and discussing it with the mother to determine the future course of action.
My first experience with GMP was when I interned with the Ministry of Women and Child Development of India in their Integrated Child Development Services (ICDS) program. To tell you something about it, ICDS is a national program to combat malnutrition in India and GMP is an important component of the scheme. The aim of this program is to detect early growth faltering and communicate the health status of the child directly to the mother, as she is the primary care giver. In the Indian context, it is the mothers only who are responsible for raising and taking care of the children primarily. Under this program, it is essential to do regular weighing of children under five – weekly, for 1st month; monthly, till 3 years; and 3 monthly post that. I was allocated to work in an Anganwadi (courtyard shelter) in a resettlement colony of New-Delhi, India. It is basically through these Anganwadis all over India that the ICDS program functions. Here, along with GMP, early childhood education services are also provided. Supplementary nutrition is another branch of the program. But what caught my attention was the GMP component. Only because, it was being neglected. During my initial days as an intern I realized that mothers were not bringing their children for regular weighing and on further probing and discussion with the Anganwadi workers, I realized there were sensitization problems. Mothers did not know the benefit of regularly weighing the child or understood the concept of growth chart. So, it was decided to inform the mothers and the next day we requested all mothers with young children to come and get their children weighed. When they came, they were explained the importance of GMP which they understood and were very keen to get their child weighed and understand their growth pattern. Motivating the Anganwadi workers facilitated getting mothers to the Anganwadi, who then realized the importance of GMP. This experience as an intern was extremely valuable as it taught me that developing programs is important, but what is more important is the implementation factor.
Poor implementation, thus, has been one of the key reasons why in spite of being in operation since 1975, ICDS program has not been able to reduce malnutrition rates in the country. Various studies and evaluations have also pointed out that health workers are still not properly trained in social communication skills, are over-burdened, unpaid and mostly unskilled. There is no persistent effort on part of functionaries to get the community together – an activity that takes time and requires patience. Therefore, I feel creating awareness regarding health and nutrition among pregnant and lactating mothers, and mothers of young children is the need of the hour. ICDS is at a juncture where it needs restructuring and more efforts are required from the government to focus specifically on GMP.
*Ishu Kataria (@ishukataria3) is currently working as a Senior Research Fellow with the Department of Food and Nutrition, Lady Irwin College, University of Delhi, India, in the area of non-communicable diseases among young adults, with focus on behavior change communication.