India has a history of neglect in breaking the intergenerational cycle of malnutrition. About one in five women (18.7 per cent) of reproductive age (15-49 years) in India are thin, with a body mass index (BMI) of less than 18.5 kilograms per square metre.
India has a history of neglect in breaking the intergenerational cycle of malnutrition. About one in five women (18.7 per cent) of reproductive age (15-49 years) in India are thin, with a body mass index (BMI) of less than 18.5 kilograms per square metre. This proportion is higher in rural areas (21.2 per cent) than in urban areas (13.1 per cent). Almost a quarter of women (23.3 per cent) are married before turning 18.
Under-nourished women, in all likelihood, become under-nourished mothers with a greater chance of giving birth to low birth-weight babies more prone to infections and growth failure. In India, every third child is under-weight (32.1 per cent) or stunted (35.5 per cent) and 19.3 per cent children are wasted (weak), according to 2019-21 National Family Health Survey-5 (NFHS-5) data.
Despite impressive gains in the past decades in reducing marriages among children below 18, there is stagnation in early marriage and a marginal reduction in teenage pregnancies. This is a cause of concern. It indicates rise in complications at birth, low birth weight, and higher maternal and child mortality rates.
Under-nourished women, in all likelihood, become under-nourished mothers with a greater chance of giving birth to low birth-weight babies more prone to infections and growth failure.
Of concern is Tripura, showing a steep incline in child marriage (33.1 to 40.1 per cent), teenage pregnancies (18.8 to 21.9 per cent) and adolescent fertility rate (82 to 91 per cent) from 2015-16 to 2019-21 survey data.
Assam, Manipur and Punjab also show a rise in child marriage. Other than Tripura, Andhra Pradesh, Himachal Pradesh, Manipur, Sikkim, Punjab, Tamil Nadu and NCT of Delhi show a 0.8 to 1.3 percentage point rise in teenage pregnancies. Lakshadweep, at 1.1 per cent teenage pregnancies, has risen from zero percent in 2015-16 NFHS-4 survey.
Malnutrition trends across NFHS surveys since 1992-93 to 2019-21 show substantive decline in stunting and underweight, however, wasting rates are stagnated (Fig 1).
However, malnutrition trends across states/UTs are alarming, with thirteen states showing a rise in stunting in children under five - the highest being reported from Meghalaya (46.5 per cent), Bihar (42.9 per cent), Uttar Pradesh (39.7 per cent) and Jharkhand (39.6 per cent).
According to NFHS-5 data, India has more stunted children in rural areas (37.3 per cent) as compared to urban areas (30.1 per cent), possibly due to the low socio-economic status of households in those areas.
A comparison of NFHS-4 with NFHS-5 findings shows few states (Madhya Pradesh, Uttar Pradesh and Uttarakhand) reporting decline in stunting by at least 6 percentage points, with Haryana and Rajasthan declining by 7.5 and 7.3 per cent respectively.
While nutrition has improved across all states, inter-state variability remains extremely 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 per cent to 25.8 per cent) and Kerala (from 19.7 per cent to 23.4 per cent).
Underweight population is on the rise in 15 states/UTs. The threat of double burden of malnutrition is evident from the increasing trend in overweight prevalence in children under five years.
An incline in overweight children under-five has been observed in 33 states/UTs barring Tamil Nadu, Goa and Dadra & Nagar Haveli. From a low rise of 0.1 percentage point in Meghalaya to high of 9.4 percentage point in Lakshadweep has been reported.
Similar findings have been observed in percentage of women who are obese or overweight in 30 of the 36 states/UTs. Puducherry, followed by Chandigarh, have the highest percentage of women who are obese or overweight at 46.2 and 44 per cent respectively.
NFHS-5 data clearly indicate rise of anaemia in both children and women. Alarming 67.1 per cent children under the age of five are anaemic. About 60 per cent adolescent girls (15-19 years) and 57 per cent of women in reproductive age (15-49 years) suffer from anaemia.
Anaemia in children under-five has increased in 28 states/UTs, with a very significant rise in the states of Assam (32.7 percentage points), Mizoram (27.1 percentage points), Odisha (25.6 percentage points), Puducherry (19.1 percentage points), Manipur (18.9 percentage points), and Jammu and Kashmir (18.9 percentage points,) to name a few.
Anaemia in adolescent mothers has a lasting impact, posing the risk of maternal mortality, low birth weight and higher risk of anaemia in the newborn.
Anaemia in women of reproductive age (15-49 years) shows an incline in 23 states/UTs. Assam (19 percentage points), Jammu and Kashmir (17 percentage points), and Ladakh (14.4 percentage points) show the highest incline in anaemia levels.
Looking at trends for anaemia in adolescent girls (15-19 years), again 24 states/UTs show an incline. A sharp rise can be observed in Jammu and Kashmir (26.3 percentage points), Assam (24.3 percentage points), Chhattisgarh, Tripura and Ladakh with 15.9, 15.7 and 15.3 percentage points respectively.
The highest prevalence of anaemia is observed in Ladakh, with 92.5, 92.8 and 96.9 percent in children under-five, women in reproductive age (15-49 years) and adolescent girls (15-19 years) respectively.
Anaemia in adolescent mothers has a lasting impact, posing the risk of maternal mortality, low birth weight and higher risk of anaemia in the newborn.
A study on the associations between adolescent pregnancy and child under-nutrition in India clearly indicates the risk of under-nutrition in children born to adolescent mothers.
The risk of stunting and under-weight prevalence is 10 percentage points higher in children born to adolescent mothers, compared to adult mothers. Case studies from across India show how adolescents and young girls get consumed into the intergenerational cycle of malnutrition.
Several factors play a role, including early marriage, poor socio-economic conditions, lack of proper nutrition and lack of education.
NFHS-5 data indicate a wide variation on consumption of iron and folic acid supplementation by pregnant women, with Kerala at 67 per cent and Nagaland at 4.1 per cent. Various factors including level of education of mother and birth order influence the consumption of IFA among pregnant women.
On the infant and young child-feeding practices, exclusive breastfeeding has improved across states, with overall increase to 63.7 from 54.9 per cent.
The intergenerational cycle of malnutrition can be combated through robust interventions for both mother (pre- and post-pregnancy) and child, thereby, addressing the high burden of stunting.
However, early initiation of breastfeeding remains stagnant at 41.8 per cent and complementary feeding shows slight incline (42.7 in 2015-16 to 45.9 in 2019-21).
The nutrition sensitive indicators on water and sanitation show marked improvement with increased coverage across states/UTs.
Ante-natal care coverage has also improved across 23 state/UTs, with marked improvement in Uttarakhand, Madhya Pradesh, Odisha, Chandigarh, and Bihar, with Goa having the highest coverage at 93 per cent. Ante-natal care can help in reducing adverse health outcomes during pregnancy and childbirth.
The intergenerational cycle of malnutrition can be combated through robust interventions for both mother (pre- and post-pregnancy) and child, thereby, addressing the high burden of stunting.
Preventing early marriage, teen pregnancies and improving women's nutritional status can go a long way in breaking the inter-generational cycle of under-nutrition. It is time to invest in nutrition over life, as this has an impact over generations.
This commentary originally appeared in India Today.
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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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