India Needs to Rethink its Nutrition Agenda

Context: The Ministry of Health and Family Welfare has released data fact sheets for 22 States and Union Territories (UTs) based on the findings of Phase I of the National Family Health Survey-5 (NFHS-5).

Findings of NFHS-5: State of nutrition in India

• Findings: (in comparison to NFHS-4)
  • Prevalence of severe acute malnutrition: Increased in 16 states/UTs, only two big states (Karnataka and Kerala) have shown some marginal improvements.
  • Percentage of Underweight children (under five): increased in 16 out of 22 states.
  • Anaemia: increased among children and adult women in most States while declined only in four States/UTs (Lakshadweep, Andaman and Nicobar Islands, Dadra and Nagar Haveli and Daman and Diu, and Meghalaya).
  • Adult malnutrition (BMI of less than 18.5kg/m2): Increased in many states.
  • Overweight/obesity prevalence among children and adults: Most States/UTs saw an increase.
  • Childhood stunting: An indicator of chronic undernutrition and considered a sensitive indicator of overall well-being, increased in 13 of the 22 States/UTs.
    • There was a 10 percentage points (PP)decline in stunting among children under five (low height for age) between 2005-06 (NFHS-3) & 2015-16 (NFHS-4), from 48% to 38%, averaging 1PP a year.
    • The World Health Organization calls stunting “a marker of inequalities in human development”.
  • Positive trends: In determinants of malnutrition such as access to sanitation, clean cooking fuels and women’s status – a reduction in spousal violence and greater access of women to bank accounts.
• Government’s efforts to contain malnutrition:
  • Social protection schemes and public programmes: such as the Mahatma Gandhi National Rural Employment Guarantee Scheme, the Public Distribution System, the Integrated Child Development Scheme (ICDS), and Mid-Day Meal Scheme.
  • Poshan Abhiyaan(2017): aimed at achieving 2PP reduction in childhood stunting per year.
• Associated issues:
  • Underfunding and underutilization of funds: Only about 32.5% of the funds released for Poshan Abhiyaan from 2017-18 onwards had been utilised.
  • Slowdown in economic growth, stagnant rural wages and high levels of unemployment
  • Pandemic and lockdown-induced economic distress.
  • Inadequacy of diets in India both in terms of quality and quantity: ‘Hunger Watch’ survey shows high levels of food insecurity and decline in food consumption, especially among the poor.
    • Two-thirds of the respondents reported that the nutritional quality and quantity of their diets worsened in September-October compared to before the lockdown.

Way forward:

• Direct interventions: such as supplementary nutrition (of good quality including eggs, fruits, etc.), growth monitoring, and behaviour change communication through the ICDS and school meals must be strengthened and given more resources.
• Universal maternity entitlements and child care services: Enabling exclusive breastfeeding, appropriate infant and young child feeding as well as towards recognising women’s unpaid work burdens.
• Linkages between agriculture and nutrition: Both through what foods are produced and available as well as what kinds of livelihoods are generated in farming sector.
• Focus on basic determinants of malnutrition: like household food security, access to basic health services and equitable gender relations.

Conclusion: An employment-centred growth strategy which includes universal provision of basic services for education, health, food and social security is imperative to ensure nutritional security and sustainable development of India.