Nutritional penalty of motherhood: Can midday meals also save mothers of the children that receive them?

A mother and her child’s health are closely interlinked. Children are most dependent on their mothers for their nutritional needs - both as babies born to them and as children primarily cared for by them. In India, a mother’s height and educational attainment are strongly related to her children’s stunting levels. Yet, in the familial dynamics of Indian households, mothers, pushed by sociocultural expectations, conditionings, or norms remain the first to forgo consumption to help smoothen the effects of an economic shock. This has been acutely heightened during the COVID-19 pandemic and the ensuant food insecurity. 

The most recent National Family Health Survey (2019-2021) revealed that the incidence of anaemia among women aged 15-49 years increased to 57% from 53.1% since the last survey (2015-16). Expectedly, this came in tandem with a rise in the prevalence of anaemia among children up to 5 years of age to 67.1% from 58.6%. Per this survey, 35.5% children under 5 are stunted, 19.3% wasted, and 32.1% underweight. In May 2022, UNICEF alerted India as having the most malnourished children in the world - 5,772,472 children under the age of 5 in India are severely wasted.

School meals offer a tangible policy solution to address child nutrition

In 1995, following versions in select states, the midday meal scheme (now renamed as PM-Poshan) was officially launched in India. By 2001, a Supreme Court mandate had made it compulsory for government and government-aided schools to provide all children with a free cooked meal comprising at least 450 kcal and 12 grams of protein. An estimated 118 million children come under the ambit of this programme which is the largest school feeding programme in the world. While this policy was chiefly geared towards addressing children’s malnutrition, decades of research have uncovered a multitude of spillover benefits.

Research evidence has shown a 49% increase in the daily nutritional intake of programme participants and reductions in children’s protein, calorie, and iron deficiency; when double-fortified salt was used in preparing the midday meals it decreased anaemia among children; catch-up growth and compensation for the malnourishment of a child’s early years, increases in school attendance, especially among girls; overtime they improve math and reading learning outcomes. From a policy perspective, they not only provide a safety net to children safeguarding their health and education, but also provide employment to women from underprivileged backgrounds and promote social cohesion by having communal eating at its heart. These benefits can be instrumental in bringing about lasting change, not just in the child’s life as they grow into adulthood, but also in the wider community.

Benefits passed down and spilt over to mothers

A 2021 study has even uncovered intergenerational benefits of the midday meal scheme - mothers who benefitted from the nutritional support of the midday meal scheme gave birth to children with greater height-for-age z-score. They found that states which had greater coverage of the midday meal scheme in 2005 had fewer children who were stunted (up to five years of age) in 2016. The carry-over benefits of mother’s exposure to the midday meal scheme as a child were stronger for families from lower socioeconomic backgrounds. Additionally, the researchers attributed the midday meal scheme for a 13-32% gain in the height-for-age z-score in India over 2006 and 2016. 

Another benefit of midday meals is revealed through its absence. By virtue of how a family operates amidst food and financial constraints, and mothers being left with little choice but to be the primary caregivers of their children (and other dependent members of the household), there exists a nutritional penalty of motherhood. In times of scarcity, mothers, regardless of their health status or nutritional need, are likely to be the first to give up consumption. Therefore, by providing children with food, the state might be leaving more food at home for the mothers. While no known study on India’s midday meals investigates this, it has been studied in the context of the American Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The researchers find that when children cease to be eligible for the benefits of WIC, their nutritional intake doesn’t change, but instead is buffered by their mothers who consume less then. The researchers compare their result for symmetry with the evaluation of another programme that granted eligible families with children with a US$ 60 voucher to buy groceries. As expected, the voucher led to a reduction in the adult food insecurity by 18.5%. The spillover benefits and gains of such food assistance programmes, therefore, extend to other members of the family, and might be saving the mothers from falling into a nutritional decline.

Providing midday meals to not just save children but their mothers

The enrolment of children in governments has been increasing yet, this hasn’t been met with a commensurate rise in budget allocation for the midday meals. Despite plentiful research evidence on the many spillover benefits and need for the provision of midday meals in schools, the government slashed the budget for midday meals from INR 12,800 crore last year to INR 11,600 crore this year. Rising prices will further render this allocation insufficient. This raises obvious quantity and quality tradeoffs for the schools providing midday meals at a time when the country cannot afford to neither have any child go hungry nor be fed poorly. However the schools navigate these challenges, its consequences will reverberate to the homes of the children. Parents who are still recovering from the onslaught of the pandemic, will have to fill this gap and provide more for their children, and likely from their own plates. Mothers will be first to shield the impact of food insecurity for their children. As the caloric and nutritional intake of mothers deplete, incidence of anaemia and other deficiencies will rise, invariably passing on to their to-be-born children. And the cycle will repeat, entrapping the country in poor health and nutrition.