Replacing hot cooked meals with packaged food mixes will affect children’s health, say nutritionists

What is better for a child? Freshly cooked meals prepared with locally-sourced ingredients or machine-dried, micronutrient-fortified packaged food mixes?

By throwing its weight behind packaged food mixes for three million children, Maharashtra government has reignited this long-running debate.

As reported by Scroll.in, the state has become the first in India to replace freshly cooked meals served to children aged between three and six at government-run creches called anganwadis with ready-to-cook meals. A tender issued on July 15 called for bids for the supply of micronutrient fortified ready-to-cook mixes under the supplementary nutrition programme of the Integrated Child Development Services, a four-decade old nationwide scheme that aims to boost the health and nutrition of children.

Right to Food activists say Maharashtra’s tender violates the National Food Security Act, 2013, which clearly mandates hot cooked meals be served to three-to-six-year-old children at anganwadis. But conflicting guidelines issued by the Centre have left room for state governments to push fortified packaged food. Activists are worried that this move will, yet again, allow private contractors to dominate a sector that the food security law has reserved for women’s self-help groups.

But the crux of the controversy is the nutritional value of the food being served to children.

Proponents of machine-made packaged mixes claim they constitute a more hygienic and practical food solution for large numbers of children, with additional nutrients whose quantities can be controlled and standardised. They say it is hard to ensure the quality of food being produced at millions of locations by small groups every day.

Nutritionists and activists, however, believe that hot cooked meals provide children with natural and culturally-native foods, which can also be prepared with the same levels of nutrition and hygiene as packaged mixes. They contend that the nutritional supplements provided through fortification cannot be effective till children also have a regular diet, which a lot of poor families cannot afford on their own.

Rejected by Planning Commission

Programmes under the Integrated Child Development Services aim to tackle malnutrition in India by providing supplementary nutrition to four categories of beneficiaries. Pregnant and lactating women and children between six months and three years of age are given “take-home rations”, which typically comprise ready-to-eat pastes and mixes fortified with specified amounts of calories and proteins. Malnourished children between six months and six years of age are also given take-home rations, with higher components of additional nutrients.

Children between three and six years are the only category that are required to be given hot cooked meals, a decision that central government committees have reiterated whenever it has been questioned in the past.

In 2008, then women and child development minister Renuka Chowdhury had proposed replacing hot-cooked meals in anganwadis with ready-to-eat packaged meals, but her proposal was categorically rejected by both the Planning Commission as well as the cabinet committee on economic affairs. While the Planning Commission claimed that packaged foods could lead to serious health risks for children by exposing them to excessive doses of micronutrients, the cabinet committee pointed out that centralised procurement of packaged mixes could lead to corruption.

Despite this, in 2015, the current women and child development minister Maneka Gandhi echoed Chowdhury and proposed replacing freshly cooked meals with packaged pre-mixes made in centralised kitchens to ensure “sanitary conditions”.

With its new tender, the Maharashtra government has become the first to actually move away from hot cooked meals towards packaged mixes for three to six-year-old children.

Other states have been taking steps in the opposite direction. Karnataka, for instance, has started the process of replacing take-home rations for pregnant and lactating women with a fresh-cooked meal that includes an egg. In Odisha, the authorities of Rayagada district are promoting the cultivation of a variety of local millets to curb high infant mortality rates, because they naturally have a high nutrition content that is good for pregnant women.

Natural versus processed

The government says the food supplied under the scheme is meant to supplement what parents provide at home. But, for many families struggling with extreme poverty, the anganwadi meal is the only wholesome meal their young children get to eat during the day. Replacing their hot cooked meal with a packaged mix, then, would lead to a significant alteration in their diets.

“Often, central government ministers have claimed that hot cooked meals are not efficient or hygienic, and that packaged foods are better because they are untouched by human hands,” said Dipa Sinha from the Right to Food campaign.

This view, however, has been repeatedly countered by activists, anganwadi workers and doctors who claim that nutritious, locally-made fresh cooked meals have a more positive impact on children’s health than pre-packaged, ready-to-use take-home rations.

“When you are rearing children, you can’t expect to do it in an aseptic environment untouched by human hands,” said Dr Vandana Prasad, a paediatrician and founding secretary of the Public Health Resource Network, who advocates a more commonsensical approach to hygiene and food safety. “Hygiene standards can be maintained at home, while cooking fresh local foods, instead of having to depend on packaged food from outside.”

The foundation of a child’s nutritional development is typically determined in the first year of birth, say doctors, and it is healthier for children to be introduced to hot home meals sooner rather than later.

“By age one, a child should ideally start eating foods that the adults at home are eating (suitably modified by making them soft and bland), so that they can get used to tastes and textures of local natural foods,” said Veena Shatrugna, a retired scientist at the National Institute of Nutrition in Hyderabad. “Processed mixes and pastes introduced at a young age can end up blunting their tastes for natural food. Do we really want a nation of children fed on factory-processed foods?”

‘Food-drug confusion’

Another concern is the inevitable use of preservatives in externally fortified nutrition mixes and pastes, which end up introducing chemicals into a young child’s diet. Pastes, says Shatrugna, are known to adversely affect teeth growth, jaws and motor processes.

“There is no dearth of evidence to show that processed food leads to obesity and other problems,” said Dr Arun Gupta, a paediatrician and regional coordinator at the International Baby Food Action Network, Asia. “Giving a child micronutrient-fortified food on an empty stomach is not healthy and cannot be considered a proper meal. The government cannot promote the consumption of junk food.”

Kirti Karwa, an activist from the Maharashtra Mahila Bachatgat Mahasangh, is equally concerned about the health implications of the ready-to-cook mixes. “Why give children dehydrated vegetables when you can give them fresh vegetables? Why give them food that contains the added preservatives to store those dehydrated vegetables?” said Karwa. “Why push vulnerable children towards fast food at a time when the government is trying to remove fast food from school canteens?”

Doctors also caution against the “medicalisation” of food by focusing excessively on fortifying natural foods with additional nutrients, particularly for healthy children under ICDS.

“We should not fall prey to the food-drug confusion,” said Dr Vandana Prasad. Children can be prescribed additional tablets or syrups if they are found to be deficient in specific vitamins or nutrients, but otherwise, says Prasad, they should be encouraged to eat natural food cooked fresh and locally. “Let food be produced and distributed as food, in a decentralised way.”

‘Not a viable model’

Some nutritionists, however, believe that the decentralised model of ICDS food distribution has been unfairly glorified without ensuring that it is working well on the ground.

“As much as we would like the system of hot cooked local meals to work, it doesn’t work as a viable model at a small scale,” said Rajan Sankar, senior nutrition advisor at the Tata Trust.

Sankar acknowledges that the production and supply of ready-to-cook mixes could fall prey to corruption and monopolisation by private contractors – problems that have plagued the supply of ICDS take-home rations in several states for more than a decade. However, he believes that the production of hot cooked meals is also riddled with problems.

Sankar claims that anganwadis in many parts of the country simply buy the food grains and condiments and outsource the cooking to small mothers’ groups. Because these groups are paid very poorly, they have little incentive to participate in the provision of hot cooked meals. “In some places the anganwadi just hands over the ingredients to individual mothers to cook at home,” said Sankar.

Both hot cooked meals and fortified packaged foods have their nutritional merits, says Sankar. But financially and operationally, he believes that production of packaged ready-to-cook mixes at a larger scale – for at least 5,000 children at a time – might be a better business model. “We shouldn’t assume that anything packaged is bad. There must be a good reason why the Maharashtra government is moving away from hot cooked meals.”

‘Natural foods are inherently fortified’

Vinita Bali, the chair of the Global Alliance for Improved Nutrition, a non-profit organisation, and the former managing director of Britannia Industries, agrees that packaged foods should not be summarily dismissed as unhealthy. She believes that the very framework of the ongoing nutrition debate is flawed.

“There is no question that children and women in anganwadis need hot cooked meals, but the question is, can we make these meals healthier than they currently are?” she asked. Hot food prepared in anganwadis needs to be cooked hygienically, with potable water and local food grains known to be energy-dense and nutritious – using bajra or jowar instead of just wheat, for example. “But even then, these will cover only the macronutrients and not the micronutrients, like vitamins and minerals, that are essential to meet the nutrition needs of children and women in anganwadis,” said Bali.

To this end, Bali believes it would be useful for anganwadis to use fortified ingredients – like iodised salt and fortified oil – to make hot cooked meals, while also supplementing these meals with other packaged foods. “Bakery products like biscuits and breads can be easily fortified. They are excellent carriers of micronutrients, easy to store, don’t need cooking and everybody loves the taste,” said Bali.

In 2007, as the managing director of Britannia Industries, Bali had led a bid by the biscuit manufacturers association to sell fortified biscuits to the government for the mid-day meal scheme in schools, as well as the ICDS. Many MPs were caught lobbying on behalf of the biscuit manufacturers. The move failed. The Global Alliance for Improved Nutrition has also faced criticism for advancing the manufactured food industry’s interests in the name of addressing malnutrition in India.

Shatrugna points out that most natural foods inherently possess a large number of nutritional components that externally fortified foods cannot really match. In its 2017 Indian Food Composition Tables, the National Institute of Nutrition studied the composition of more than 500 different foods eaten across India and found dozens of nutrients in varying proportions in each of them. Just bajra, for instance, contains more than 60 nutritional components, including 12 types of vitamins, 17 amino and organic acids, five kinds of sugars, four carotenoids and eight different organic chemicals.

“In comparison, how many nutrients can packaged fortified foods contain? Around five or ten at the most?” said Shatrugna, who objects to poor and marginalised children being made to eat such fortified food mixes. “If our children can eat natural foods, why not the poor? Why are we treating our poor so badly?”

What about malnourished children?

The debate over the nutritional value of fortified foods extends beyond Maharashtra’s decision to replace hot cooked meals with ready-to-cook mixes. In July, the Maharashtra government issued another controversial tender, one that seeks to replace regular take-home rations for malnourished children with “Ready-to-Use Therapeutic Foods”. RUTF packages typically comprise pastes made of energy-dense food like peanuts, milk, vitamins and high doses of micronutrients.

In recent years, the World Health Organisation and certain other organisations have been recommending RUTF mixes for children with Severe Acute Malnutrition. However, in this case too, many nutritionists argue that processed and chemically fortified therapeutic foods are unnecessary, more expensive to produce, potentially harmful and not as healthy as natural foods.

The next part in this series will look at the controversies surrounding Ready-to-Use Therapeutic Foods that the Maharashtra government is seeking to introduce for malnourished children.