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Socio-economic and Developmental Impact of Malnutrition in India

The first 1,000 days of a child’s life - from conception through age two - is a critical window of opportunity to ensure child survival, optimal growth, cognitive development, and lifelong health.

Prevalence of underweight, stunting and wasting among children under five years old in India (Source: NFHS 4)

Every child throughout the world can reach their growth potential if they are nurtured in enabling the environment and their mothers and caregivers follow recommended health, feeding and care practices. If these enabling environments are not provided and there are suboptimal practices children become malnourished. Child undernutrition or malnutrition refers broadly to the condition in which food intake does not meet the needs of physiological function, growth, and the capacity to respond to illness. Despite substantial progress in preventing and treating child malnutrition in the last three decades, it remains one of the major public problems. Undernutrition encompasses underweight, stunting (chronic malnutrition), wasting (acute malnutrition) and deficiencies of micronutrients (essential vitamins and minerals). Approximately 5 million annual deaths occur in children younger than five years worldwide, out of which malnutrition account for almost half of these deaths (Wells JCK et al Lancet Child & Adolescent Health 2019).

In spite of significant economic development, all forms of malnutrition are common in India (Figure-1) and our country is home to one of the largest populations of malnourished children in the world. India ranks 10th in terms of the prevalence of underweight children in the world and 17thin terms of the prevalence of stunting, according to “The State of the World’s Children 2016” Report published by UNICEF. At any given time, approximately 22 million wasted children and over eight million severely wasted children live in India (UNICEF, WHO and World Bank Group, 2018).

The first 1,000 days of a child’s life - from conception through age two - is a critical window of opportunity to ensure child survival, optimal growth, cognitive development, and lifelong health. During fetal life and the first two years after birth, both physical and brain growth

is very rapid. Nutritional requirements are high and if a child is exposed to nutrients deficiency, it has bearing on its physical and brain growth. The prevalence of wasting is highest at birth which is contributed by maternal undernutrition, anaemia, high indoor air pollution and other social factors. Suboptimal feeding practices in form of delayed initiation of breastfeeding, lack of exclusive breastfeeding during first six months, delayed introduction of complementary feeds, poor quality of complementary foods, lack of diet diversity, large family size, poor sanitation, hygiene and child-caring practices are some of important contributors to malnutrition after birth.

Children suffering from malnutrition begin their lives with a significant disadvantage. Children who are severely wasted have increased susceptibility to common childhood infections such as diarrhoea and pneumonia and have a higher case fatality rate as compared to normal children. These undernourished children suffer from frequent episodes of illness and take a longer time for recovery. Besides increasing risk of morbidity and mortality, malnutrition leads to growth retardation and impaired psychosocial and cognitive development. The degree of cognitive impairment is directly related to the severity of stunting and Iron deficiency anaemia. These further impact education attainment and eventual ability to contribute economically to their family and society.

Victoria et al in a review of cohort studies from five low-income and middle income countries (Brazil, Guatemala, India, Philippines and South Africa) concluded that small size at birth and child stunting were linked with short adult stature, reduced lean body mass, less schooling, diminished intellectual functioning, reduced earnings and lower birth weight of infants born to women who themselves had been stunted as children. Martorell et al reported that being stunted at 24 months was associated with a reduction in the schooling of 0.9 years, older age at school enrolment and a 16% increased risk of failing at least one grade in school after controlling variables such as sex, socioeconomic status and maternal schooling. Short stature has also been linked to lower economic productivity. A study from Brazil showed that taller men and women earned more even after controlling education and other factors. They reported that a 1 per cent increase in height results in a 2.4 per cent increase in wages. Thus above studies provide strong evidence that malnutrition increases the risk of mortality if untreated has an impact on economic productivity. Among women, if malnutrition not prevented and treated, it has an impact on the health and survival of their children. Scientific evidence has shown that if malnutrition is not treated in the first 2-3 years, then recovery is incomplete. This means that to break the intergenerational transmission of poverty and undernutrition, children at risk must be treated during their first two years of life.

Hon. Prime Minister Sri Narendra Modi Ji has launched a new programme known as Poshan Abhiyaan (PM’s Overarching Scheme for Holistic Nourishment) which is India’s flagship programme to improve nutritional outcomes for children, pregnant women and lactating mothers. Poshan Abhiyan through use of a targeted approach and convergence strives to reduce the level of stunting, under-nutrition, anaemia and low birth weight in children and also

focuses on adolescent girls, pregnant women and lactating mothers, thus holistically addressing malnutrition.



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