Rural employment scheme is associated with less infant malnutrition, study finds

BMJ 2013; 347 doi: (Published 03 October 2013) Cite this as: BMJ 2013;347:f5916
  1. Tamoghna Biswas
  1. 1Kolkata

Infants from households participating in the Mahatma Gandhi National Rural Employment Guarantee Act are less likely to suffer from undernutrition compared to those from non-participating households, a recent study has found.1

The act provides for a guaranteed minimum of 100 days’ employment a year for those households in which the adults volunteer for unskilled manual work.

The study was conducted in the Dungarpur district of Rajasthan, India, using a mixed methods design comprising both cross-sectional study and focus group discussions. A total of 528 households and 1056 participants (infants aged less than 12 months and their caregivers) were included in the final sample, of which 281 households (53%) had participated in the rural employment programme between August 2010 and September 2011. The researchers compared the results of these 281 households with 247 households that did not (the control group).

Eleven focus group discussions were also conducted with 62 willing mothers to analyse the effects of the programme on infant malnutrition.

Households participating in the programme were more likely to belong to the lower socioeconomic status, were categorised as “below poverty line” households, and were less likely to have proper sanitation facilities.

Overall, looking at both groups together, infants in 50% of the households included in this study were underweight, while those in 39% and 24% of households were, respectively, wasted and stunted. Infants in only 23% of households received adequate infant feeding, while 39% received adequate vaccination.

Adjusting for other variables, the odds of an infant being underweight and wasted were 52% and 43% lower in households participating in the programme. There was, however, no significant difference in household food security among the two groups. Statistical modelling suggested that the effect of the programme was more likely to be indirectly via birthweight rather than directly via increased food security.

The study’s lead author, Manisha Nair, from the National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, told the BMJ, “Policies need to target the persistent problem of infant and child malnutrition prevalent in India through a convergence of economic, development, social, and nutrition policies and programmes. Policies such as MGNREGA [Mahatma Gandhi National Rural Employment Guarantee Act], if implemented effectively, could play a role. However, if a larger improvement in child nutritional outcome is desired, it may be worthwhile to invest the resources in addressing the intermediate sociocultural and behavioural risk factors such as lack of mothers’ knowledge about adequate infant feeding, and misconceptions related to cultural practices and norms, over and above improving the economic conditions of the rural population.

“MGNREGA is considered a landmark programme in the history of India due to its rights based and statutory framework. Although its immediate goals are to address deprivation, hunger, and food insecurity among the rural population in India, the results of this study suggest that MGNREGA could protect infants against malnutrition and thus support the various existing health and nutrition interventions targeting infant malnutrition.

“However, to achieve a sustainable impact on acute malnutrition and to protect infants and children against chronic malnutrition, a multifaceted approach will be required.”


Cite this as: BMJ 2013;347:f5916


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