India’s Continued Impasse With Child Under-nutrition: Many Jolts And A Ray Of Hope

India has observed a gigantic increase in the dedication, efforts, and momentum to reduce the burden of child under-nutrition, and on the other hand, the outcomes are showing a reversal trend.

Child under nutrition is an important marker of growth and development. All major national and international developmental commitments such as the Sustainable Development Goals (SDGs 2030) or the Global Nutrition Targets 2025 emphasise on improving child nutrition. 

In the last few years, the Union and the State Governments in India have stepped up efforts to accelerate reduction in child undernutrition. The POSHAN Abhiyaan, in particular, turned out as the watershed moment for child undernutrition in India. The nutrition agenda was set rolling with much-needed policy momentum and ever-greater community participation.

Recently, the Ministry of Health and Family Welfare (MoHFW) has released the National Family Health Survey (NFHS 2019-20) estimates on child undernutrition prevalence in 22 States / UTs in India. The estimates are rather baffling as there is very little headway made on nutrition. A comparison with NFHS 2015-16 reveals the many setbacks for several States/UTs.

Increase in Child Stunting and Underweight  

The prevalence of child stunting and underweight has increased between 2015-16 and 2019-2 0 in 13 and 17 States/UTs, respectively. Highest increase in stunting prevalence is noted in Telangana, followed by Tripura and Himachal Pradesh with average annual increase of 2.7%, 1.7%, and 1.5%, respectively. It is uncommon to see increase in stunting especially among economically better-performing States. The increase in prevalence of child stunting in some major States such as Maharashtra, Gujarat, and West Bengal will severely jolt national progress. The prevalence of underweight among children showed a massive increase from 17% to 27% in Nagaland. In Jammu & Kashmir the underweight prevalence increased from 16% to 21%. 

It is disappointing that in 12 States/UTs both indicators depict a reversal trend since NFHS 2015-16. These trends come as a shocker to the nutrition community as speculations are rife as to what led to such uncommon reversals in nutritional gains. Nevertheless, not all is bad. Some States / UTs managed to stay on course even though the magnitude of progress falls short of the envisaged POSHAN Abhiyaan targets of achieving 2 percentage points reduction per year.

9 States/UTs and 6 States/UTs observed a reduction in the prevalence of child stunting and underweight, respectively. Highest reduction in stunting prevalence was observed in Sikkim (from 30% in 2015-16 to 22% in 2019-20). Highest reduction in underweight prevalence was in Bihar (44% in 2015-16 to 41% in 2019-20).

While every state in India experienced a decline in the prevalence of child stunting and underweight between 2005-06 and 2015-16, the trend has now reversed in 6 states between 2015-16 and 2019-20. These states/UTs are Andhra Pradesh, Assam, Jammu and Kashmir, Karnataka, Manipur, and Sikkim. Among these, the sharpest reversal was observed in Sikkim where prevalence of child stunting declined annually by 0.83 percentage pints between NFHS 3 and 4 but increased by 2.43 percentage points annually. In case of child underweight, Bihar and Meghalaya have reversed their trends with substantial improvements between NFHS 3 and 4, but an upward trend in last three years. 

On one hand, India has observed a gigantic increase in the dedication, efforts, and momentum to reduce the burden of child undernutrition, and on the other hand, the outcomes are showing a reversal trend. There seems to be a surprising situation of regressive progression in India. It is a matter of deep concern that despite a myriad of initiatives along with mission-mode strategies, and action plans, the progress in terms of numbers is substandard. The nutrition profile describes several social, economic and policy changes that affect child well-being through households. These estimates are particularly worrisome for major states/UTs like Maharashtra, Gujarat, and Karnataka. The present situation is also a wake-up call for policy makers to synchronize nutrition agendas with broad-based actions and more effective targeting strategies. In addition, an explicit focus on understanding and prioritizing important  determinants such as dietary patterns and behavioural change warrants urgent policy attention. 

Further, with the gloomy economic situation of the country, it will not be easy for government to increase the public spending on direct nutrition interventions. In fact, the current anticipations are rather high towards a budgetary cut in almost all development sectors which could further intensify the burden in future. The present estimates suggest a greater role of central health and nutrition schemes in supporting states/UTs towards fighting child undernutrition. It is also crucial for flagship programmes like POSHAN Abhiyan to scrutinize and enhance their targeting strategy with specific focus on direct nutrition support to poor and deprived sections. A revisit of quality and efficacy of some of the major health and nutrition programmes such as the National Health Mission (NHM), Integrated Child Development Services (ICDS) and Mid-Day Meal (MDM) schemes assumes urgent policy salience. 

While the survey is currently ongoing in remaining States / UTs, it will be safe and prudent to presume that the status of child nutrition in these States/UTs could be further disappointing because of wise-spread disruptions due to COVID-19 pandemic. The estimates for remaining states especially Uttar Pradesh, Rajasthan, and Madhya Pradesh will be significant from policy perspective. However, since the commencement of NFHSs, it is a first for India to experience a backward trend in the burden of child undernutrition despite notable increase in the policy efforts.

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