Centre okays therapeutic food for malnourished children

New Delhi: In a major change in its nutrition policy, the Central government has decided that states are free to take a call on providing ready-to-use therapeutic food to children suffering from severe acute malnutrition.

The Centre had so far maintained that the use of ready- to-use therapeutic food (RUTF) was "not an accepted policy" and that "enough evidence" was not available for treating children suffering from severe acute malnutrition (SAM).

The move is likely to pave the way for the Maharashtra government to resume the procurement of RUTF, which it had to suspend following a petition in the Bombay High Court. The state government announced in September in the high court its decision to hold the purchase of RUTF until it received the Centre's clearance.

"For management of SAM children, the decision to provide RUTF may be left to the discretion of individual states," as per the minutes of a meeting in the prime minister's office (PMO) on November 4. The meeting was attended by officials from the PMO, the NITI Aayog CEO, and the secretaries of the women and child development (WCD) ministry and the health and family welfare ministry.

RUTF is a high-energy, micro-nutrient enhanced paste used to treat children under five years who are affected by SAM. According to the National Family Health Survey, over 93 lakh children in the country suffer from severe acute malnutrition (SAM), which is a condition where children have a very low weight for height or severe wasting or suffer from a nutritional oedema.

WCD Minister Maneka Gandhi, a strong votary of RUTF, held a meeting last month with PMO officials to push for the calorie-dense paste after a government committee rejected it in its draft nutrition guidelines. "Khaana nahi dena (don't give food), we give nutrition," Gandhi said at a conference of officials from 130 districts in September.

She advocated replacing hot-cooked food with RUTF and said that it should be given not just to children suffering from SAM but to all children coming to anganwadis. "Why should we wait for a child to become severely malnourished. We should give it (RUTF) to normal children so that they don't get into malnourishment at all," Gandhi added.

The PMO-led meeting earlier this month, however, decided that the practice of providing hot-cooked meals to children between three years and six years as well as take-home ration for children between six months and three years, pregnant women and lactating mothers "will continue as prescribed under the existing scheme of ICDS and as mandated by the NFSA (National Food Security Act)".

Under the Integrated Child Development Scheme (ICDS), 14 lakh anganwadi centres across the country provide a package of six services -- supplementary nutrition, referral services, immunisation, health check-up, pre-school non-formal education, and health and nutrition education.

The high-level meeting also decided that the ministry of women and child development "should take up pilot for direct cash transfer in lieu of take-home ration in select few districts, in consultation with the state government" -- a recommendation made by the government think tank NITI Aayog to check leakage.

In a notice in August, the WCD ministry asked states to stop providing RUTF, reiterating the government's stance that "RUTF for management of SAM children is not an accepted policy of the Government of India". It added, "Enough evidence is not available for the use of RUTF vis-a-vis other interventions for the management of SAM. Concerns have also been raised that the use of RUTF may replace nutritional best practices and family foods that children would normally be eating." The ministry asked the states to ensure "strict compliance" with its order.