Anganwadi Centre Six in Sathegala village is airy and clean. The government-run crèche is also well equipped for the Mathru Poorna scheme. Launched in October last year as part of Karnataka government’s initiatives to combat hunger and malnutrition, the scheme offers freshly cooked meals to all pregnant and lactating women at lunch time. Anganwadis across the state, which so far served meals to children between the age of three and six, must now also feed young mothers.
To expand the capacity of the Sathegala anganwadi, the administration of Chamrajnagar district’s Kollegal taluk where the village is located, recently sent over a larger cooker, new and bigger plates, a double burner and a double cylinder.
But none of the 11 pregnant women and new mothers in the area come to the anganwadi to eat.
“There are caste problems here,” said Soumya S, the anganwadi worker. “I am from a Scheduled Caste but the majority of families here are Gowda. They make excuses like the anganwadi is too far or they cannot leave their housework and come here to eat.”
Sathegala is a large village with eight anganwadis. One of them is called the Gowda anganwadi since it is surrounded by the homes of Gowdas – a term that is used for the dominant Vokkaliga community.
The women here staunchly refused to eat the meals at the anganwadi even after they were told that the cooking was done not by the Scheduled Caste teacher but by the anganwadi helper, who belongs to the Vishwakarma caste that is classified as Other Backward Caste and placed higher up in the caste hierarchy.
“The people who run the anganwadis are of a different caste and we are of a different caste,” said Lakshmi, who lives down the street from the anganwadi and has a one-year-old child. “We cannot go and eat there just like that. In our homes, they do not allow that sort of thing.”
Caste is not the only hurdle.
“It is not in our practice to even allow a pregnant woman to go out of the house then will we let her eat outside?” asked Ratnamma, Lakshmi’s mother.
The Mathru Poorna scheme
Karnataka was among the first states to incorporate the Integrated Child Development Services programme that was launched across India in 1975 to reduce maternal and child mortality. The programme aims to improve the health status of children by providing nutritional support from the time a woman conceives till the time the child is six years old.
Ensuring a pregnant woman gains enough weight is crucial. It not only reduces complications during pregnancy and child birth, but also brings down the possibility of the baby having low birthweight.
A child born with low weight faces the risk of stunting, or low height for age. One of the main causes of stunting is poor nutrition. While wasting, or low weight for age, is more likely due to acute malnutrition, that is, a severe shortage of food in a short span of time, stunting occurs more due to longer and chronic undernutrition.
To improve the nutritional status of mothers and children, the ICDS programme provides cereal-based powdered mixes called take home rations for children below three years old, pregnant women and breastfeeding mothers. Children between the ages of three and six get a freshly cooked meal at midday at the anganwadi.
But reports from across the country show that the system of take home rations faces two problems. One, the ration provided for a single person is often shared by other members of the family. Therefore, the intended beneficiary does not get her recommended dietary allowance. Second, the distribution of the rations is often rigged, with middle men pilfering them or making money off them. Moreover, the rations do not cover as many food groups or provide as large a range of nutrients as a freshly cooked meal with fresh vegetables, milk and eggs does.
Karnataka’s maternal mortality and infant mortality rates are the highest among the five southern states at 133 deaths per 100,000 live births and 32 deaths per 1,000 live births respectively.
“Between the third and fourth rounds of the National Family Health Survey, there was a considerable reduction in child stunting but not a significant reduction in underweight,” said Uma Mahadevan, principal secretary for women and child development to the Karnataka government. “So we were wondering what we could do to improve the nutritional status of [women and] children in Karnataka.”
The model in other states
The Karnataka government set up a three-month pilot project in February 2017 in four blocks to test the operational challenges of serving hot cooked meals to pregnant and lactating women for six days a week. The project was modeled along the lines of hot cooked meal schemes that have been operational in Andhra Pradesh and Telangana since 2013 and cover more than 10 lakh women in the two states. The meal is designed to meet 40-45% of the daily calorie, protein and calcium requirement per day for pregnant and lactating women.
In 2017, Chhattisgarh, Gujarat and Maharashtra also launched similar schemes on smaller scales within specific geographies.
An analysis by UNICEF of the “one full meal” programmes in Andhra Pradesh and Telangana found that the enrolled beneficiaries came to anganwadis to eat the meal between 70% and 85% of the time in 2014. Pregnant women showed an average weight gain of 8.3 kg to 9.7 kg between the second and ninth month of pregnancy. This is higher than the average weight gain for pregnant women across India, which is seven kg. The recommended gain for normal weight women is between 11.5 kg and 16 kg.
The analysis also showed that less than 5% of the children whose birthweights were recorded were born with low birthweight – much lower than the 18% of children born with low birthweight in 2014.
Karnataka’s Mathru Poorna scheme that aims to reach 12 lakh women across the state is planned as a layered intervention for maternal health and nutrition with three elements. The first is the hot meal in which pregnant and lactating women are given milk, eggs, vegetables, dal and peanut jaggery chikki. Along with the meal, women are also given iron folic acid tablets to prevent or treat anaemia. Since the beginning of the scheme, the government has stopped distributing take home rations.
The second part of the scheme includes health interventions at the anganwadi like calcium tablets, deworming and tetanus injections, if required, that can take place as soon as a pregnant woman registers for the meal. The third part is counselling nutrition and feeding practices – a service that the state government plans to launch later in the year.
Superstition and social networks
Mathru Poorna has already reached close to eight lakh women, that is 70% of its intended beneficiaries, according to Mahadevan. “It has been more than six months since the launch of the scheme and we have reached a coverage of more than eight lakh women, who are actually receiving the benefits – more have been enrolled in the scheme,” she said. “I do not want to paint a very rosy picture because there are still challenges. We have yet to reach a lot of women among migrant and nomadic communities and in tribal areas that are hard to access.”
The other obstacle are the traditional practices restricting the movement of pregnant and breastfeeding women. An analysis by the Centre for Budget and Policy Studies in Bengaluru of the pilot programme in 2017 found that many people said the women should not go out to avoid being possessed by spirits or “catch dust ”, which possibly signifies that they may be susceptible to falling ill due to exposure to the elements.
Sheela lives 500 meters away from the anganwadi in Hosur village in Ramanagara taluk in Ramanagara district. “The anganwadi is far from here. It is outside the village. Who is going to go every day?” she asked.
None of the six potential beneficiaries in Hosur go to the anganwadi for their meal. The women have written letters to the administration saying that they find it inconvenient to come to the anganwadi for the meal and have asked instead that the government continue giving them take home rations, which were stopped since the launch of Mathru Poorna. Some of them have also written that pregnant and breastfeeding women find it impossible to visit the anganwadi because of a strict tradition where they are not allowed to leave the house and seldom even their rooms. These social norms also prevent women from eating their meals with other members of the family.
In the neighbouring village of Chowdeswarihalli, however, all five pregnant and breastfeeding women have been coming to the anganwadi to eat lunch. “The food is good – like home food only,” said Kumara Chaitra, who has just had her second child.
Another young mother, Pavithra Jagdish, explained why the women of Hosur might be staying away. “In villages like these, people are strict about pregnant and breastfeeding women not leaving their homes.”
Chaitra added: “In our houses, they don’t say anything but these rules are there in the community. We still come here to the anganwadi to eat.”
When the scheme started in October, she was initially reluctant to come to the anganwadi. “We felt it was better to get take home ration but that was stopped. Now, if we want to get this benefit we have no choice but to come to the anganwadi.”
But it wasn’t just the lack of choice. Said 22-year-old Bhanushree, who is eight months into her first pregnancy: “It is nicer to come here and eat with the other women rather than having to eat alone at home. I feel refreshed after spending time with the others here.”
With the Mathru Poorna scheme, anganwadis can be used as a space to to form women’s collectives, said Jyotsna Jha, director of the Centre for Budget and Policy Studies. “But these things will only work if the scheme itself is functioning well, and it can function well if there is basic infrastructure and commitment.”
It is understandable for some women to opt out of the scheme, said Jha. In a village like Hosur, where residents are land-owning farmers or run dairy businesses, families can afford to provide women adequate nutrition at home. Women in these families said they were happy to receive take home rations, but the lack of these rations did not make a big difference to them.
However, it does make a difference to Ratnamma’s family in Sathegala. “It is a problem for us that we don’t get the ration anymore,” she said. “We are a very poor family.”
Different centres, different problems
Anganwadi Centre One in Sathegala caters to Scheduled Caste families. The teacher and helper belong to the same community. Yet, here too, children play and eat at the anganwadi but women do not come to get their lunch.
The anganwadi is located in a building that also serves as a community centre. It has paint peeling off the walls and is cluttered with paraphernalia used for village events.
“If it was clean, we would consider going there to eat,” said Shweta, who had a one-year-old child and lives down the street from the centre.
Jha points out most welfare schemes face problems and what matters is how the state responds. “Even with the mid-day meal, there are issues from time to time but that does not mean you close the programme. The problems are so complex and so diverse that you cannot address them in one go. If you continue acknowledging them then there is hope but, if not, the same scheme can become useless.”
This is the first part of a two-part series on the hot cooked meal programme for women. The second part will examine how work for the anganwadi staff has changed with the introduction of this scheme.