Malnutrition in India: How can the Internet help?
India’s rapid economic progress has led to a double burden of malnutrition — the country sees growing rates of communicable diseases but hosts a third of the global burden of undernutrition.
With more than 5 million children in India dying every year as a direct or indirect result of malnutrition, tackling this multifaceted issue requires an uprooting of norms related to gender, food access, and sanitation and hygiene among others.
Major causes of malnutrition
Malnutrition is caused by multiple factors like early marriage, poor maternal health, incorrect handwashing and hygiene practices, and a lack of exclusive breastfeeding or eating dietary diverse foods. In India, 27% of girls marry before 18 years and 31% of them give birth by the same age which only increases the risk of a child being born underweight and malnourished.
There are various societal norms- from girls being seen as a burden and married early to feeding a newborn solid food for good luck — that perpetuate malnutrition and require changes in behavior over time. For example, only half of the children under 6 months are exclusively breastfed in India but breastfeeding within an hour of birth could prevent 20% of newborn deaths by protecting them from preventable illnesses like pneumonia and diarrhea.
Malnutrition also causes severe long-term effects such as delays in children’s cognitive and physical development which also holds back the country’s social and economic development. Multiple civil society and government programs have built support systems — from nutrition rehabilitation centers to health workers who deliver nutrition-related services — but change can only be driven by addressing the underlying causes of malnutrition and behaviors that drive them.
Efforts to tackle malnutrition
Over the years, there have been several government and civil society programs that tackle the various causes of malnutrition. A mid-day meal scheme in school has helped to retain children’s attendance while providing them with enough nutrients to make sure they are healthy and stay focused in school. Nutrition rehabilitation centers across the country equip caregivers with age-appropriate care and counseling for their children while a 5-year ‘Clean India’ Campaign helped build clean water sources and toilets in millions of households.
Along with these interventions, there is a continuous need to drive behavior change such as eating healthy foods when pregnant or targeting local champions to tackle malnutrition at institutional levels.
In the past, health campaigns have reached people through mass media and health workers such as Poshan Maah (Nutrition Month) and UMANG. Such campaigns raise awareness about malnutrition by promoting antenatal care, breastfeeding, anemia, and the importance of nutrition for girls.
At the same time, Internet access has catapulted people into the digital world where they can find health information at their fingertips. Quilt.AI set out to understand the digital ecosystem around people in India searching for information on nutrition to build healthy practices in their and their children’s lives.
The Digital Ecosystem: Nutrition
With half a billion Internet users in India and limited reach through mass media, there is a huge potential to reach millions of people online with messaging on safe healthy behaviors that informs and empowers them to make decisions about their and their families’ lives.
In order to understand the quality of social connections, content being consumed, and use of each digital platform, we analyzed 6+ million Google searches and 60,000+ data points across YouTube, TikTok, Twitter, Instagram, Facebook and news/blog posts. These numbers gave us an overview of what men and women are searching for nutrition and the types of health messaging that can lead to behavior change. We ran these through our Culture AI tools and derived the following insights:
In 3 years, awareness around malnutrition has increased in India, with the most interest in the effects of women and child malnutrition (+6% and +12% in search, respectively) followed by an exploration of treatment and prevention.
Across 45 cities of India, pregnancy and nutrition advice is being sought from the Internet. Top searches revolve around prenatal nutrition and its positive effect on mothers and children. This also shows that people are looking for additional information besides their doctor and see the Internet as a good way to educate themselves on the topic.
In Bihar and Uttar Pradesh, there is high curiosity focused on finding child nutrition support (65% and 61%, respectively) such as midday meal schemes, nutrition rehabilitation centres, and proper ways to breastfeed. Search interest is also increasing for topics like child development (+36%) and consequences of malnutrition (+15%).
On social media, awareness about nutrition programs and tips for mothers and children was posted by civil society, international organizations, and governments while Twitter focused on debates and critiques of nutrition programs.
Digital platforms were used differently to share nutrition-centred information. For example, YouTube hosted videos that were more informational with tips and awareness while Facebook had people sharing posts by international organizations on facts and events about nutrition.
Evolving the Digital Ecosystem
Once we understood how people navigated online platforms regarding nutrition-related content, we segmented them into clusters based on how they responded, shared, and searched for the content. By segmenting the audience, we can also target messages to scale the reach of health messages or build champions on malnutrition:
For example, community preachers make up 41% of the audience searching, posting, and consuming content on nutrition. They believe in building connections and empathy through personal experience by talking about their own experience with related products such as breastfeeding-friendly tops. In order to scale the reach of their health messages on child nutrition, they can be targeted with messages to learn more about solutions for child nutrition by looking for like-minded individuals or groups.
Another segment is rational skeptics who are critical of child nutrition programs and efforts to combat malnutrition. In order to transform people in this segment to proactively champion child nutrition is to show that not all government efforts have failed and give examples of positive, small changes, driven by data and led by institutions.
Reducing malnutrition in India means significantly reducing the global burden of malnutrition. For far too long, campaigning and behavior change efforts have been educational, pedantic, and even medicalized. While they have led to change on the ground, it is time to scale this change and at a fast pace.
Expanding our behavior change work on the Internet is critical to ensuring generations of women and children survive and thrive. By unleashing the potential of digital reach in India, whether it is ‘nudging’ parents to practice healthy behaviors or creating champions to tackle malnutrition, the ability to reach and impact 30% of the world’s most vulnerable children has never been greater.
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