A more holistic approach needs to be adopted for India to overcome its malnutrition challenge.
Malnutrition affects human capital and, therefore, calls for immediate attention. According to the 2021 Sustainable Development Report, India has slipped from 117 to 120 ranking amongst 193 countries and lags in challenges concerning the goal of zero hunger, health, and well-being, safe drinking water, and gender equality to name a few. The pandemic has further pushed back the SDG implementation. The Sustainable Development Goals 2021 report findings indicate a rise in poverty by 7 percent, child malnutrition, halted or reversed progress in health, and shortened life expectancy. India is off track on three of the global maternal, infant, and young children nutrition (MIYCN) targets to address stunting, wasting, anemia, low birth weight, breastfeeding, and childhood obesity as per the 2021 Global Nutrition Report.
As per the 2021 Global Hunger Index, India is ranked 101 out of 116 countries and falls into the serious category of hunger. India has a 27.9 percent intensity and 45.9 percent incidence of multidimensional poverty with large numbers facing overlying deficiencies in health, nutrition, education, and living standards. Malnutrition has been prevalent for decades in India and is the primary cause of poverty and economic fallout.
The figure below shows unacceptably high levels of malnutrition in children, with 35.5 percent of children stunted and 32.1 percent of underweight children in India. According to the National Family Health Survey 5 (NFHS-5) data, there is more stunting in rural areas (37.3 percent) as compared to urban centres (30.1 percent), owing to the poor socio-economic situation in rural areas. It is important to address stunting through interventions starting from conception to the first 1,000 days of life. The data available on stunting tell us where to concentrate future programmes.India is off track on three of the global maternal, infant, and young children nutrition (MIYCN) targets to address stunting, wasting, anemia, low birth weight, breastfeeding, and childhood obesity as per the 2021 Global Nutrition Report.
In terms of geographical regions, Meghalaya (46.5 percent), Bihar (42.9 percent), Uttar Pradesh (39.7 per cent), and Jharkhand (39.6 percent have very high rates of stunting, while states/UT with the lowest rates include Sikkim and Puducherry at 22.3 percent and 20 percent, respectively. A comparison of NFHS-4 with NFHS-5 findings shows that few states (Madhya Pradesh, Uttar Pradesh, and Uttarakhand) have reported dea cline in stunting by at least 6 percentage points, and Rajasthan has recorded a decline of 7.3 percent. While nutrition has improved across all states, inter-state variabilities remain high. The two states that had the lowest stunting rates in children in 2015-16 (NFHS-4) but showed a substantial rise in stunting rate as per the NFHS-5 survey are Goa (from 20.1 percent to 25.8 percent) and Kerala (from 19.7 percent to 23.4 percent).
India’s rate of early breastfeeding within an hour is 41.8 percent, i.e., only two out of five women are able to begin breastfeeding within an hour of birth. Only 63.7 percent women exclusively breastfeed their infants for six months and complementary feeding rates after six months is 45.9 percent, with an alarmingly low 11.3 percent (one out of 10) children receive a minimum acceptable diet. The infant and young child feeding interventions have failed to improve over the decades in India. The 1,000 days period is a window of opportunity when feeding practices play a significant role in addressing malnutrition. Appropriate complementary feeding practices like the timely introduction of food at six months and giving an adequate diet needs to be reiterated and counselled to avoid growth faltering and are proven interventions for improving child survival, stunting, and wasting. Timely nutritional interventions of breastfeeding, age-appropriate complementary feeding, full immunisation, and Vitamin A supplementation have proven effective in improving outcomes in children. Evidence has shown that if nutrition-specific interventions are scaled to 90 percent coverage along with intensification of nutrition-sensitive interventions, a 20 percent reduction in stunting can be achieved. and sensitive interventions. Social protection and social safety nets enable families to meet basic needs to achieve health and nutrition. “Social safety nets can empower women by enabling them to have control over assets and participate in household decision-making and social activities”. India’s public distribution system and maternal cash transfer programmes help provide subsidised food and cater to the nutritional needs of those below the poverty line and vulnerable populations. India continues to struggle with high rates of malnutrition, despite the four-decade-old Integrated Child Development Services (ICDS) programme, the mid-day meal scheme since 1995, and the more recent POSHAN Abhiyaan in 2018. The biggest challenge of addressing undernutrition calls for a holistic approach and an inter-sectoral strategy. It is imperative to push for convergence of health and nutrition programmes until the child is five years of age. There is a need for effective monitoring and implementation of programmes to address malnutrition.Timely nutritional interventions of breastfeeding, age-appropriate complementary feeding, full immunisation, and Vitamin A supplementation have proven effective in improving outcomes in children.
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Dr. Shoba Suri is a Senior Fellow with ORFs Health Initiative. Shoba is a nutritionist with experience in community and clinical research. She has worked on nutrition, ...
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