Empowerment of rural women: Role of nutrition and health with special reference to North East India

Prof M Premjit Singh *

We give names of our daughters as 'Annapurna', 'Laxmi', 'Indira' and 'Kamala' which are other names of Goddess 'Mahalaxmi' who is in charge of storing of food, preparation of foods and distribution of food. We worship 'Maa Durga' who is the source of strength and power. Then why should we think about empowerment of rural women, particularly in the field of food and nutrition?

Women act as producer, processor, storekeeper and distributor as far as agriculture and food processing is concerned. There is hardly any activity in agricultural production except ploughing in which women are not actively involved.

She cooks, she serves, she thinks of other's satisfaction, works day and night, take care of present workforce and gives us future work force, plays prime role in the development process, but ignores very often her own needs, is ignorant about her nutritional requirement and very rarely aware about the indicators of health.

If we analyze the health status of women in India, the maternal mortality rate of India is 130, but is 237 in Assam, as per National Family health Survey (2015-16). Similarly as per the same survey, Infant mortality rate of the country is 29, but 48 in Assam and 40 in Mizoram.

Among the other north eastern states, Arunachal Pradesh has the lowest IMR of 24 while Manipur has 25. When we see the overall nutritional status of women in India, about 53% of women are anaemic and underweight (NFHS-4, 2015-2016).

These women often give birth to underweight children who are stunted. With regard to the data in North Eastern states, Meghalaya has got the highest percentage of anaemic women (56.2%) followed by Tripura (54.5%), Assam (46%), Arunachal Pradesh (43.2%), Sikkim (34.9%), Nagaland (27.9%), Manipur (26.4%) and Mizoram (24.8).

Thus women in these states are more prone to fatigue, weakness, breathlessness and eventually this affects their work performance as well. It is a well known fact that poor nutritional status often negatively affects the cognitive development of children and this gives rise to less cognitive active minds.

Thus, programmes and policies specifically focusing on the lives of the north Eastern women may be framed and implemented strictly in regions where the vulnerability of women is highest for malnutrition and other related problems.

In our culture, women usually take food after all family members eat. Very often the left over food is inadequate in quality and quantity. During pregnancy and lactation women need special care and nutritious food but they pay little attention to it.

Lack of education is a hindrance to development. Increase in educational level of girls will accelerate to achieve better health, upbringing of children in a scientific way, use of hygienic methods, use of nutritious food for the family, improving the status of women within the household will deliver significant improvement in the society. The religious traditions very often restricts the women to do number of rituals by restricting their food, particularly when they need special attention.

Further taboos in the society or food fads or not to take different types of vegetables or leafy vegetables, etc. affects the women's health which can be overcome by spread of nutrition education.

As in Indian culture, the guest is considered as God, whenever any guests comes, we compromise with the food of the family and the worst sufferers are the women. In this case, a nutri-sensitive garden in the backyard system and Integrated Farming System (IFS) can provide immediate solution as fruits, vegetables, mushroom, poultry and fish production, etc. will be available at the doorstep and can be used as emergency need.

The strategic use of various under-utilized fruits and vegetables needs to be strengthened in the families. In the North eastern region, use of 'sticky rice' and variety of green leafy vegetables in the daily diet is an important feature.

But some of the unhealthy food practices like regular use of sodium bicarbonate (synthetic soda) in the diet deteriorates health making people weak which can be avoided. It is worthy to mention that in some districts of Garo hills of Meghalaya usage of soda is banned now considering its harmful effects.

Teenage pregnancy is a common feature in North Eastern states. Most of the girls become mothers when their body is not ready for it which is associated with anaemia and poor health conditions thus adding to their problem.

In addition to this, frequent pregnancies with less interval also adds to the women's vulnerability. Higher total fertility rate, early births, lower rate of usage and knowledge of family planning methods, less institutional deliveries, use of unhygienic menstrual practices, poor reproductive health, lack of proper knowledge about menstruation and other reproductive health problems make the women compounded with the burden of unawareness and susceptibility to be infected with the so called 'Silent diseases of women.'

Home deliveries by untrained rural women is another cause of maternal and infant mortality. Government has introduced many programmes like Janani Suraksha Yojana, and incentives for institutional deliveries, posting of ASHA, distribution of iron, folic acid and vitamin A tablets and proactive role of Anganwadi workers but the rural areas require the active participation from the stakeholders sides. Therefore active participation of stakeholders is required to fight with incidences of infant mortality and maternal mortality.

Lack of access by women to nutrition education and training also has a profound impact on nutrition. A public survey on hunger, conducted in the year 2011, concluded that mother's education level determines their children's nutritional status and that the rates of underweight and stunted children were found to be significantly higher among mothers with lower levels of education.

Women comprise about 40% of the labour force and also take up maternal roles that is central to the development of the next generation. As the role of women in society continues to evolve, it is vital to help them be the best they can be, enabling both gender equality and the benefits of improved nutrition for future generations.

Women in North eastern states have a better social status as compared to the other parts of the country as evidenced in regions of Meghalaya, Mizoram, Arunachal Pradesh and Manipur where women are seen being active in other spheres of life. Still simple awareness programmes for food related items, conservation of nutrients, better cooking methods and increasing bio-availability of nutrients would surely result in some positive consequences.

The impact of climate change on food and nutrition security are worsening the existing inequalities in access to resources, especially for women who are primarily responsible for food production and for feeding their families. In view of the high risk of malnutrition and disease that women face at all the three critical stages of life – infancy and childhood, adolescence and reproductive phase, focused attention should be paid to meet the nutritional needs of women at all stages of the life cycle.

This is also important keeping in view the critical link between the health of adolescent girls, pregnant and lactating women with the health of infant and young children.

Empowerment is defined as the process by which one can have control and ownership of their lives through expansion of their choices. This is a process that moves through several stages from participation, decision making, action and ultimately to the capacity to take responsibility for those actions.

Empowering women is vital because it allows them to be better and strengthen their lives as well as the lives of their children. Women are the true mirror of social, religious, cultural and spiritual values and contributing in almost every firsts of life whether it is social, economic or political.

A holistic approach to women's health that includes both nutrition and health services should be adopted and special attention should be given to the needs of the women and the girl at all stages of life cycle. Special efforts need to be taken to tackle the problem of macro and micro nutrient deficiencies especially among the pregnant and lactating women as it leads to various diseases and disabilities. Widespread use of nutrition education should be made to address the issues of intra-household imbalances in nutrition.

Women play a decisive role in the food security, health and nutrition of their families and this should be taken into account in the design and targeting of policies. In recent times, Government of India has prepared a draft on National Policy for women empowerment (in the year 2019) with a priority on their education, food security and nutrition. It has identified the priority areas of food security, nutrition, education, economy, violence against women, governance and decision making.

Some of the strategies to incorporate essential nutritional interventions for mothers in the north eastern region of India are as follows:

* Improving the quantity and nutrition level of food consumed in the household.
* Preventing micro-nutrient deficiencies and anemia.
* Increasing women's access to basic nutrition and health services.
* Improving access to water and sanitation education and facilities.
* Empowering women to prevent pregnancies too early, too often and too close, together.

Thus, Nutrition justice will only be achieved when women are empowered and when policies and programs are gender sensitive. If we make efforts to educate girls and improve their nutrition level, we will be able to make our coming generations healthier and more prosperous. It is rightly said that we cannot end malnutrition, if we do not invest in women!!!