Can we not plea to the Govt to train local unemlpoyrdd educated middle aged graduate stadard XII passwomen as Food Counselor visiting a village fortnightly Can we not involve AHA workers and teachers(retd) too??

ROLE OF FOOD COUNSELLOR IN RURAL AREAS

. Continuous motivation of community is warranted: Unfortunately imparting knowledge cannot be equated with   community acceptance, awareness and practice. Fulfillment of gap between knowledge and practice   is possibly another key issue.

            Author strongly feels that it will take few decades to achieve food security by standard foods. Till then we can   educate and motivate the rural community to improve social acceptance of low cost locally available vegetables, food grains, fruits, proteins which are falsely believed not useful for human consumption and scientific cooking methods.

TAKE HOME MESSAGE

1). India being multi-linguistic, multi-religious and multi-ethnic population with varying food habits it is necessary to develop special programme to tackle the needs of different groups.

2) We have to check population growth & Role of newer contraceptives: As because India is already a food deficient country as most of agriculture is rain dependent , Additionally , if  we can’t improve agricultural production then we have to stabilize the population, But t how?  This can again be achieved by popularizing the use of more contraceptives so that there are minimal unwanted pregnancies and unplanned pregnancies in India. To increase the contraceptive options .Basket full of contraceptives so that population is stabilized before the projects year of 2045. Currently most  citizen of India are always keeping mind that there is annual growth of population at the rate of 1.9%Therefore, import / manufacturing of newer contraceptive is a high need charity, because any new contraceptive marketed will slow down the population growth. Incidentally some studies have shown that there is as high as 11% rise of C P R (couple protection rate) after a new contraceptive become available in a country.  At least 7 newer contraceptives ( new biodegradable implants  skin patch, progesterone only vaginal ring (PVR) , monthly inj (inj Lunelle) .  Newer cervical caps and diaphragms, and newer spermicidal) which are approved by different International agencies for last one or two decades back are unavailable in India even in 2009.   Unless these newer contraceptives  are available in our country in near future then  Married Women have no other choice but to select IUCD, Condom, Inj DMPA-3 monthly  and Combined OCP. PO is too costly and not supplied but Govt. 

  If population rises still at an escalating rate --then how can we achieve Food Security?
Can we really  improve nutrition unless we check population growth?

           

 It is the one of the most important barrier not only in implementation of different nutrition-based-programmes but also other programs run by Govt. of India and other NGOs.

. We should understand that long term habits acquired in a community setting is difficult to change and great patience is warranted.  

ROLE OF ATTITUDINAL   FACTORS   IN FOOD SELECTION TOO

 . if we are able to change the attitude of people towards present food habits and science of nutrition then much of the battle is won. By appropriate counselling we can overcome significant barriers to the adoption of nutritious foods that still exist amongst poor illiterate INDIAN men & women who suffer from malnutrition most.

 Contrary to commonly held assumption, particularly among policy makers and program managers in agriculture, attitudinal factors- such as ‘crave for certain foods’ which are neither ‘energy yielding’ nor ‘calorie yielding’ play an important part in the persistence of malnutrition in spite of some economic surge in our country.

Conditions.

In summary

Malnutrition is no longer viewed as a medical problem. Instead many issues need to address to eradicate MALNUTRIION.    Though   ensuring adequate food to citizen is a constitutional binding that is too often not done. Additionally, ensuring adequate food to citizen may not guarantee good health and maintainennance of NUTRITIONAL status unless other basic health measures are simultaneously implemented which may cost much and demand heavy budgetary allocation.

           

Women’s empowerment is essential for effective implementation of all Family Welfare which includes Birth Control Programmes as well .

            To be successful, family planning programmes need to be associated with social development and Women empowerment programmes, so that they (women) are in a position to take decisions that are in their interest and use available F.P. services accordingly.            

           

           

           

Globally ‘Branded Nutritional Foods’ are becoming more attractive to affluent persons. They often prefer branded food products which are more appealing than normal homemade foods.  How many rich persons consume Puffed Rice (murk, chiro, khai)? How many of us take GUAVA  or ATA(fruit), jamrul, jam, palang sakk, kumro, pepe and fresh vegetables which contains more fibres?

ROLE OF RURAL FOOD COUNSELOR - PERSONS WITH THREE MONTHS TRAINING ON LOCAL FOOD STUFF 

Scientific knowledge on low-cost but nutritious foods, balanced diet, rational cooking methods, and appropriate storage of food items and above all relevance of safe drinking water can however be impacted by Medical personnel, NGO or by Media people.

But are all such persons worried / devoted to such heavy burden of malnutrition? Are educated urban people committed to malnutrition of rural people or urban poor or those who have migrated from other states?

 How many NGOs are dedicated on the nutritional problems of Indian mothers and children???

Kishori Shakti Yojona Prakolpa (Govt. of India Programme) & "Beti Bacchayo and Beti Parroaw-If a country educates and make the young girls educated and healthy-Next generation will too be healthy

Kishori Shakti Yojona Prakolpa
(Govt. of India Programme)

Empowering girl child is important “- So that when they become responsible women or house wife they can establish not only their own health and rights but also enable to build up a healthy family with good nutritional status --> leading to Prosperous Nation. Reasonably free of malnutrition and ill health

Many believe that as a planner   women are superior to men. Author’s belief is also like that.

The “Girls Power Initiative” (GPI) - a NGO (recognized by Nigeria Govt.) has shown that this path have worked in their country in a big way.

GPI (a NGO) urges call to other countries to follow their principle of empowering & educating girl child to build up a prosperous nation. This is the latest view of poverty eradication which surprisingly many economists have now started approving.

 What next path of development and hunger reduction yet to come???     Don’t Know!!

Proper Care and Affection to Girl Child can not only remove poverty from India but also restore the missing sex ratio (0 – 6 year)

But, there is alyas a place of but i .e. Role of Attitudinal factor –
Knowledge Attitude & Practice (K.A.P.) in the development process and hunger reduction.

It is difficult to impart scientific knowledge to common people, particularly illiterate rural people of India.

It is a common observation that community often don’t listen to good words (polio vaccine). In case of malnutrition if the remedies are not accepted by the community then it is no point in discussing about good foods / unhealthy foods.

Knowledge Attitude & Practice (K.A.P.) in the development process and hunger reduction.

But does this mean it is irrelevant to discuss under nutrition to them? No. We should not be so pessimistic about them. Time has come to break the community barriers. We should understand that long term habits acquired in a community setting is difficult to change and great patience is warranted. Can we change Smoking overnight? Alcohol drinking?   Thus  is the attitude of the person concerned, We gynecologists have a very uphill path to educate people, women in particular.

The Applied Nutrition Program (ANP) of India also strive to make people conscious of their nutritional needs and to provide supplementary nutrition of children aged between 3-6 years and to pregnant and lactating mothers.

 What is exatcly meant by removal of attitudinal factor?

How to remove the barrier? A country with full of contradictions!

There should be at least one or more chapter in local language on fruits / vegetables / locally available nutritious food in the school curriculum.

The education should commence from standard IV, especially those belonging to socially disadvantage and marginalized communities who suffer most from malnutrition. The Applied Nutrition Program (ANP) of India also strive to make people conscious of their nutritional needs and to provide supplementary nutrition of children aged between 3-6 years and to pregnant and lactating mothers.

Path – 7: Attitude – Who will educate rural people? Social resistance and social prejudices are important challenges to improve nutrition

            Poor coking habits, improper food storage, selection of wrong food items, are the community ethics in rural India.

            Food is a subject of widespread customs, habits and beliefs, which vary from country to country, and from one region to another. The diet of the people is influenced by local conditions (e.g. soil, climate), religious customs and beliefs.

Vegetarianism is given a place of honor in Hindu society. Even among vegetarians, the pattern of food item selection is not the same; some do not take onions and garlic’s even   on religious grounds, not to speak of milk.

Can we not educate and train young local girls as 'Rural Food Counselor'

            There is none to counsel uneducated illiterate poor villagers about food selection and scientific way of cooking. Often these are carried out in an unscientific manner with much loss of nutritive value of foods.

                        The proposed ‘Rural Food Counselors’ will work at Block level. Author believes that they (Food Counselors) will succeed in changing the ‘Attitude’ of the rural people and thus be able to improve nutritional standard to some extent even with limited financial capability. Informations on locally available low cost food items which donor require much fuel to cook should thus be made known to the poor villagers.

How difficut it is to break ones belief ,ideas and above all Attitude to a custom which some one has lerant and viewed since infancy

Barrier 3:-WHAT IS THE ROLE OF ATTITUDINAL FACTORS   IN FOOD SELECTION, COOKING PROCESS, AND STORAGE OF COOKED FOODS?

Not only selection of healthy foods but mode of cooking and method of storage of food all counts so far as nutrition is concerned.

 Thus KAP – is very important. (Knowledge, Attitude and practice).

 The point is who will be going to villages and educates rural people about these? The ‘fire’ of ignorance lies there, not at metro cities. Who will devote time and explain them the relevance of easily available nutritious foods thus bell the cat???

Barrier No 4:-Language of Indian people differs in every six hundred Kim. Distance so also food habits

Ours is a vast land with varying resources. Different provinces have different food habits.  We have to formulate diet chart for different group of people. The have-nots should be made aware how to get adequate proteins from easily available local and cheaper foods e.g. dales (pulses), snails and scrab. A pint of milk is a day dream for them not to speak of fish or meat. The problem is will community accept?

Barrier No 5:-Role of Social customs Social resistance and social prejudices are important challenges to improve nutrition

To be fully effective, the principal objectives should not only include guaranteed food supply but also an intervention which should include lowering  ‘cultural and attitudinal barriers’ and thus increasing the habit of selection of locally available, low cost  healthy food items and scientific cooking procedures. To raise standard of nutrition - improvement of ‘cultural & attitudinal’ barriers   are more important than   subsidy on foods. A broad-scale intervention aimed at modifying the bad food habits among the poor by offering foods at subsidized prices or at no cost would be only partially successful. To be effective, the principal objectives should not only includes guaranteed food supply but also an intervention which should include lowering  ‘cultural and attitudinal barriers’ and thus increasing the habit of selection health food items and cooking procedures.

            Poor coking habits, improper food storage, selection of wrong food items, community ethics. Food is a subject of widespread customs, habits and beliefs, which vary from country to country, and from one region to another. The diet of the people is influenced by local conditions (e.g. soil, climate) religious customs and beliefs. Vegetarianism is given a place of honor in Hindu society. Even among vegetarians, the patter of eating is not the same; some do not take onions and garlic on religious grounds.

Barrier No 6. Will this programme of changing the Attitude & Social customs be at all successful?? If so who are the right counselor for this special type of education. – Who will educate rural people?

Although the motive is economic gain, a deep-rooted belief is also responsible for this practice, i.e., if pure milk is boiled, the milk secretion of the donor animal may dry up. Muslims observe fasts during Ramzan and Hindus on several occasions. These fasts are considered important adjuncts to religion. Hindu women often take food left over by their husband. In some societies, men eat first and women last and poorly. Some people do not eat unless they have taken a bath. (Source: K Park, PREVENTIVE AND SOCIAL MEDICINE, Published by M/s BANARSIIDAS BHANOT, 2002)

There are obvious Social resistance and social prejudices : These are important challenges to improve nutrition amongst Indian women.

h) What, then is to be done??? What will be game plan??

To be fully effective and operational of this scientific message  , the principal objectives should not only include guaranteed food supply but also an intervention which should include lowering  ‘cultural and attitudinal barriers’ and thus increasing the habit of selection of locally available, low cost  healthy food items and scientific cooking procedures.

Barrier No 1:-Role of Attitudinal Barriers in raising nutritional status & ACCEPTANCE OF modified food habits and cooking habits & food selection.

To raise standard of nutrition - improvement of ‘cultural & attitudinal’ barriers   are more important than   subsidy on foods. A broad-scale intervention aimed at modifying the bad food habits among the poor by offering foods at subsidized prices or at no cost would be only partially successful. To be effective, the principal objectives should not only includes guaranteed food supply but also an intervention which should include lowering  ‘cultural and attitudinal barriers’ and thus increasing the habit of selection health food items and cooking procedures.

Barrier No2.Attitude – Who will educate rural people

            Poor coking habits, improper food storage, selection of wrong food items, community ethics. Food is a subject of widespread customs, habits and beliefs, which vary from country to country, and from one region to another. The diet of the people is influenced by local conditions (e.g. soil, climate) religious customs and beliefs. Vegetarianism is given a place of honor in Hindu society. Even among vegetarians, the patter of eating is not the same; some do not take onions and garlic on religious grounds. But are all such persons worried / devoted to such heavy burden of malnutrition? Are educated urban people committed to malnutrition of rural people or urban poors or those who have migrated from other states? 

Indian womens Health and unhygienic cooking habits. What is AGE -Advanced Glycated End Products-a noxious agent present in badly cooked & recooked Foods and acts in human as Endocrine Disruptors as Pollutants do.

 H) 

F) How do urban women are sufferer of selection of and foods & cooking patterns?  As a corollary it will be not irrelevant to mention that urban men and women those who consume vegetables –they purchase from open market foods are full of insecticides & pesticides and environmental pollutants making the great dent on women’s health & nutrition. Additionally urban women and children too are, till date cannot come out of consumption of verities of tinned foods which contains many unhygienic unhealthy preservatives.

G) What is “AGE” in urban re-cooked Food items?  The growing habit of consumption of heat-treated foods amongst urban Indian adolescents containing high level of AGEs (advanced glycated end products) is a matter of concern as such type of diet are potent source of endocrine disruptor designates. It has been noticed that serum level of AGE is high in adolescents suffering from PCOS. Indian community needs to be educated on this issue.

Selection of nutritious but low cost easily available food items for rural women and person who will be be able to break the social barrier?

C) React Now:-Time is passing out and Hunger burden and Malntritionincluding over nutritionis becoming an epidemic in India too. Therefore, time has come when we should ask ourselves that are we (the persons on which women, health and wellbeing have been mostly bestowed) - the doctors doing justice to rural people? What about also duties & commitments by NGO & Nutrition specialists of India in improving notational standards women’ health and wellbeing??

D) What doctors will have to convey?

Scientific knowledge on low-cost but nutritious foods, balanced diet, rational cooking methods, and appropriate storage of food items and above all relevance of safe drinking water can however be impacted by medical personnel, NGOs or by media people. We have to formulate diet chart for different group of people. The have-nots should be made aware how to get adequate proteins from easily available local and cheaper foods e.g. dals (pulses), snails and scrab. A pint of milk is a “day dream” for them not to speak of fish or meat. But the main problem is whether such message communicated by gynecologists or say NGOs will be effective amongst illiterate poor villagers. Will such illiterate community accept such changes in age-old food habits & old cooling habits?

E) Why Gynecologist have to be involved in these socio-cultural aspects of Food selection, Food preservation & cooking techniques? Because the doctors,  gynecologists in particular are more acceptable to the womenfolk and whatever the such doctor will remark women will take it granted S APOLITICAL AND MORE SENSIBLE.  We have to understand that it is the illiteracy & attitudinal barriers which are preventing Indian rural persons to accept nutritious foods which are locally available in improving nutritional foods. Such food items are easily available at nearby in their courtyards / adjoining paddy / wheat fields close to residence.

“Improving Women’s Health” : The role of Indian Gynecologist

How best to educate the rural women??  How Gynecologists can involve in this programme? Gynecologists from metro cities  can take the responsibility of  counseling the rural women and educate rural people across the country about 1) habit of selection of locally available, low cost, healthy food items and above all 2) scientific cooking procedures.

If, Indian Gynecologists including dedicated NGOs are able to change the attitude of people towards present food habits and science of nutrition then much of the battle of poverty and malnutrition can be overcome in India.

. By appropriate counselling we can overcome significant barriers to the adoption of nutritious foods that still exist amongst poor illiterate Indian men & women most of whom suffer from malnutrition. But, such men & women are simply unaware of the fact that nutritious foods are very much available in nearby courtyard or paddy fields which grow abundantly even without much rain. Fertilizers and insecticides. (Say Banana, cucumbers dales (pulses), snails and scrab,).

C) React Now:-Time is passing out and Hunger burden and Malntritionincluding over nutritionis becoming an epidemic in India too. Therefore, time has come when we should ask ourselves that are we (the persons on which women, health and wellbeing have been mostly bestowed) - the doctors doing justice to rural people? What about also duties & commitments by NGO & Nutrition specialists of India in improving notational standards women’ health and wellbeing?? 

Improving Women’s Health” : The role of Indian Gynecologist-by imparting current Knowledge, Attitude & Practice on selection of popper nutritious food items & changing old bad cooking habits.

. A) What Gynecologists have to do? How best gynecologists can actively participate in improving poor nutritional status of Indian rural women? : What, we, the gynecologists (the primary care physician for women) can achieve on optimum nutritional status by spending additional 5 minutes time while examining the patients in hospitals or in private practice.  Indian gynecologists may also attend any far off villages twice a year and along with a dietician of metro city and can involve local community leaders of the village concerned including local physicians and politicians, local NGOs and opinion leaders of the locality to hold meetings and spread the message of selection about “low cost easily available but nutritious foods in rural areas”.

Adoption these are a step forward and in most cases such information will act as modifiable factor: Medical knowledge should not be limited to functions of proteins, Vitamins or Trace elements/Anti-oxidants. There are six internationally recognized paths of development aiming to reduce the prevalence of malnutrition.  Feasibility of implementation of all those paths in India has been discussed at length. But effective implementation of any path of development mandate not only heavy financial commitment but a determined political will as well.(contd.)