RUTF: Lack of policy only helps suppliers, not malnourished children

In India, there has never been a dearth of lofty declarations on 'eradicating malnutrition'. From former Prime Minister Dr Manmohan Singh to Narendra Modi, malnutrition as an issue continues to receive its fair share of ostensible but piecemeal attention.

Even the currently trending, rapist godman Gurmeet Singh of Sirsa, has weighed in on the issue. His website says, "The country’s future can be brightened only if educated and responsible citizens ensure that no child fall victim to malnutrition in the absence of means."

But no amount of lip service can make malnutrition, a deeply systemic malaise, disappear.

In 2005, India had about 80 lakh malnourished children. Today, that number has grown to 93.4 lakh. One of the main problem contributing to this rise is the lack of a clear policy on Ready to use Therapeutic Food (RUTF), also called ‘magic food'.

The commercial use of RUTF remains unaddressed even though Health Minister JP Nadda has sought to clarify his ministry’s position on the use of RUTF to treat malnutrition and Severe Acute Malnutrition (SAM) in the country.

Magic food isn’t the answer

In a reply dated 18 August to a letter written by health experts and activists in April this year, Nadda writes: “The Ready to use Therapeutic Food or home-augmented food for children with SAM is temporarily helpful in nutritional rehabilitation under proper supervision and support. However, RUTF may not benefit a common household in developing appropriate food habits for children as against home augmented food”.

One of the main objections raised by activists, which include former health secretary of government of India, Keshav Desiraju, was the fact RUTF is a high-sugar, high-energy and high-fat product with protein share of just 10-12%.

The activists also cite government’s own studies that prove that neither RUTF (often supplied by large corporations like Britannia, Pepsi, Cargill, Nutriset, Britannia, Unilever, Edesia, General Mills, Glaxo SKB, Mars, Indofood, Nutrifood, DSM, Amul, and Valid Nutrition) nor home augmented food like khichdi make any difference in sustained recovery from acute malnutrition.

Another risk cited by experts was the threat of water-borne diseases as most RuTF products need to be mixed with water to make them edible.

“In principle at least, the Health Ministry has agreed with our concerns. It does endorse the view that RUTF is not the solution for malnutrition in India but it is not enough as there is still no policy in the country on the use of RUTF," says Dr Arun Gupta, one of the signatories to the April letter.

A major fallout of the lack of a policy on RUTF is that states like Maharashtra and Rajasthan have gone ahead and adopted RUTF to tackle malnutrition. 

Maharashtra is implementing a Rs 100 crore plan to provide the coarse high-sugar paste to its poor malnourished children despite the results of a pilot test done over 14 SAM children, in which only two of them showed improvement.

An unconcerned government

The Union Health Ministry, on its part, pleads innocence and absolves itself of responsibility, calling health a ‘state matter’.

Nadda’s letter appears to wash its hands off the whole issue by saying that the anti- RuTF findings of its two studies, “… have also been shared with the nodal ministry in charge of nutrition, Ministry of Women and Child Development, who are required to take a view on the matter”.

Since Minister of Women and Child Development Maneka Gandhi was flayed by activists for advocating for packaged food as the solution for malnutrition in May this year, the WCD ministry has refrained from commenting on the issue.

The recently released National Health Policy 2017 is also silent on the use of RUTF.

Strident opposition

Frustrated by the inaction of the Ministry, Swadeshi activists like Ashwani Mahajan of the RSS-affilliate Swadeshi Jagran Manch (SJM) are now openly voicing their criticism.

Mahajan’s organisation is the latest to write a letter to Maneka Gandhi detailing its strident opposition to the use of RUTF for treatment of malnutrition.

The letter says, “The recent data indicates that number of SAM children is increasing in the country. This is alarming and appalling at the same time at a juncture when India is being projected as an economic power. It's critical to understand what is on our children's plate”.

Nadda's letter appears to wash its hands off the whole issue by pointing at Maneka's WCD Ministry

SJM joins other activists like Dr Arun Gupta in decrying the role of MNCs and agencies like the World Bank and UNICEF in promoting RUTF. The letter clearly calls out RUTF as a treatment that will only benefit the companies supplying the packaged food. 

It says, “Our concern is that the current drive of managing this problem (malnutrition) is only through 'treatment' of SAM children, that too with commercial 'ready to use therapeutic foods' (RUTF). This is an entry point for food industry and such packaged foods will satisfy the 'hungry for profits' food industry and not our children who need real food.”

The need for a policy

Swadeshi Jagran Manch’s vociferous protest is also raising the fears that their opposition is a ploy to facilitate the entry of Baba Ramdev-led Patanjali Food into the multi-million dollar RUTF industry. Mahajan though says that their concern is for the issue alone, “whether it is a local or a foreign supplier we don’t want RUTF. If Patanjali tries to enter this market, we will tell them not to do so. We want the Ministry to involve health practitioners and activists in drafting a policy on RUTF”.

Activists including leading paediatricians have repeatedly called for a holistic strategy that addresses difficult issues like sustainability, food security; promoting and supporting breastfeeding and optimal complementary feeding as well as augmenting the capacity of frontline workers; enhancing literacy; and improving water supply and sanitation.

But, in the absence of a clear policy, RuTF suppliers, in collusion with some state governments, are raking in profits, and wrecking the already fragile health of India’s malnourished children.