What's Inside

The key findings of the NITI Aayog report entitled Nourishing India: National Nutrition Strategy (please click here to access) are as follows:

• Nearly every third child in India is undernourished – underweight (35.7%) or stunted (38.4%) and 21% of children under five years are wasted as per National Family Health Survey-4 (NFHS-4) 2015-16.

• As evident, while stunting and underweight prevalence has gone down, trends in wasting show an overall increase in the last decade. The decrease in stunting has been from 48% to 38.4%, that is, by 1 percentage point per year. Similarly, underweight prevalence has reduced by 0.68 percentage points from NFHS-3 to NFHS-4. Recent data, especially for challenging states is promising, suggestive of acceleration.

• There has been a 16% decrease in the underweight prevalence among children below 5 years. Underweight prevalence in children under 5 years (composite indicator of acute and chronic undernutrition) has declined in all the states and UTs (except Delhi), although absolute levels are still high. Remarkable reductions are seen in Himachal Pradesh (by 41.9%), Meghalaya, Mizoram, Arunachal Pradesh (by 40%), Tripura (by 39%) and Manipur (by 37.8%); whereas Maharashtra, Goa, Karnataka, Uttar Pradesh and Rajasthan show near stagnation.

• Recent findings from NFHS-4 (2015-16) highlight that stunting in children under 5 years has reduced in all the states, although absolute levels are still high in some states.

• Most significant reductions in stunting are seen in Arunachal Pradesh (by 32.10%), Tripura (by 31.92%), Himachal Pradesh (by 31.86%), Punjab (by 29.9%) and Mizoram (by 29.6%). Reductions by more than 25% are also seen in the case of Chhattisgarh, West Bengal, Nagaland, Maharashtra and Haryana, Gujarat. While the overall prevalence of stunting has gone down, in terms of absolute values, it continues to remain high in Bihar, Uttar Pradesh, Jharkhand, Meghalaya, Madhya Pradesh and Dadra & Nagar Haveli, where more than 40% of the children remain stunted.

• Findings from NFHS-4 (2015-16) highlight that wasting in children under 5 years (weight-for-height) or acute malnutrition is still high, with levels above 25 % in Jharkhand (29%), Dadra & Nagar Haveli (27.6%), Gujarat (26.4%), Karnataka (26.1%), Madhya Pradesh (25.8%) and Maharashtra (25.6%). Significant reductions are seen in Meghalaya (by 50%), Mizoram (by 32.33%), Tripura (by 31.7%), Himachal Pradesh (by 29.01%) and Madhya Pradesh (by 26.28%); although absolute values remain high. Sharp increase in the incidence of child wasting is seen in Punjab, Goa, Maharashtra, Karnataka and Sikkim.

• As per NFHS-3, levels of severe wasting or severe acute malnutrition in children (0-5 years) were 6.4% for India. Data from NFHS-4 shows an overall increase in the levels of severe wasting to 7.5%. The level of severe wasting has increased in most of the states/ UTs and only 10 States/ UTs (Meghalaya, Madhya Pradesh, Tripura, Delhi, Himachal Pradesh, Bihar, Mizoram, Nagaland, Tamil Nadu and Jharkhand) have witnessed a decrease in the levels of severe stunting. States/UTs with the highest incidence of severe wasting are Daman & Diu (11.9%), Jharkhand (11.4%), Dadra & Nagar Haveli (11.4%), Karnataka (10.5%), Gujarat (9.5%) and Goa (9.5%).

• As per NFHS-3, every third woman in India was undernourished (35.5 % with low Body Mass Index) and every second woman (15-49 years) was anemic (55.3%). About 15.8 % were moderately to severely thin, with BMI less than 17. Bihar (45%), Chhattisgarh (43%), Madhya Pradesh (42%) and Odisha (41%) were the states with the highest proportion of undernourished women.

• Recent findings from NFHS-4 (2015-16) highlight that nutritional status of women and girls (in the age group 15-49 years) has improved for all states. Overall, there has been a decrease from 35.5% (NFHS-3) to 22.9% (NFHS-4) in the prevalence of women with low BMI. The decrease has been by almost 50% in the states of Tripura, J&K, Haryana, Tamil Nadu and Kerala.

• The level of anemia among women and girls has stagnated over the last decade from 55.3% in NFHS-3 to 53% in NFHS-4. In terms of percentage points, States which have witnessed maximum decrease in the levels of anemia are- Sikkim (24.6), Assam (23.3), Mizoram (15.6), J&K (11.7), Tripura (10.6) and Chhattisgarh by 24.6 (10.5). Alternatively, 8 States/ UTs (Punjab, Himachal Pradesh, Meghalaya, Delhi, Haryana, Uttar Pradesh, Tamil Nadu and Kerala) have seen an increase in the prevalence of anemia.

• Overall, the Total Fertility Rate (TFR) or the average number of children per woman has also gone down from 2.7 in NFHS-3 to 2.2 in NFHS-4.

• More and more women now give birth in health care facilities and rates have more than doubled in the last decade in some states like Chhattisgarh (by as much as 390%), Jharkhand (by 238%), Uttar Pradesh (by 229%), Bihar (by 220%), Assam (by 215%), Madhya Pradesh (by 208%) and Rajasthan (by 183%). However, in terms of absolute values, institutional births continues to remain extremely low in Nagaland (32.8%), Meghalaya (51.4%), Arunachal Pradesh (52.3%), Jharkhand (61.9%) and Bihar (63.8%), which are the bottom five states with respect to institutional births.

• The number of pregnant women receiving more than 4 Antenatal Care (ANC) visits has also gone up by 38.37% in the last decade, from 37% in NFHS-3 to 51.2% in NFHS-4. States which have shown remarkable improvement in providing ANC to pregnant women are Uttar Pradesh, Chhattisgarh, Assam, West Bengal, Odisha, Jharkhand and Rajasthan, although in terms of absolute values, the percentage of women receiving ANC continues to remain low. ANC visits have gone down in Uttarakhand, Tamil Nadu, Goa and Kerala over the last decade.

• There has been improvement in the early initiation of breastfeeding rate, from 23.4% in NFHS-3 to 41.6% in NFHS-4. The figure varies from 73.3% in Goa to merely 25.2% in Uttar Pradesh. Similarly, there has been an overall improvement over NFHS-3 levels in children under six months who were exclusively breastfed, from 46.3% to 54.9%. States which have shown maximum improvements in terms of percentage point are Goa (by 43.2%), Himachal Pradesh (by 40%), Madhya Pradesh (by 36.6%), Tripura (by 34.6%), and Haryana (by 33.4%); while Kerala, Arunachal Pradesh, Karnataka, Chhattisgarh, West Bengal and Uttar Pradesh recorded a decrease in the percentage of children under six months who were exclusively breastfed.

• Children aged between 6-8 months receiving solid or semi-solid food and breastmilk has gone down from 52.6% to 42.7%. In fact, most of the states/ UTs have witnessed a decrease in the percentage of children receiving solid or semi-solid food and breastmilk. States/ UTs that have recorded maximum dip are Kerala, Arunachal Pradesh, Bihar, Karnataka and Sikkim.

• NFHS-4 findings reveal that around 26.8 percent of currently married women in the age-group 20-24 years were married before attaining the age of 18 years.

• As per NFHS-4, 60.2% children aged 9-59 months received the six monthly Vitamin A supplement in the six months before the survey. However, inter-state variation in Vitamin A Supplementation for children aged 9-59 months continues with Goa at 89.5% and Nagaland at 27.1%.

• Anemia is a major health problem affecting 53% of women (15-49 years) and 22.7% of men in India as per NFHS-4. 50.3% of pregnant women were found to be anaemic, as per NFHS-4.

• As per NFHS-4, 93.1% households were using salt that was adequately iodized; others were using salt that was either inadequately iodized or was not iodized at all.

• As per NFHS-4, the percentage of children with diarrhea in the last 2 weeks preceding the survey who received zinc supplementation is found to be 20.3%. However, inter-state variation in the ‘children with diarrhea in the last two weeks who received zinc’ continues with Puducherry at 69.6% and Andaman and Nicobar Islands at 8.3%.

• In India, annually, it is estimated (as on 2011) that about 1.45 million children die before completing their fifth birthday (MHFW). Currently the mortality rate in children under 5 years is 50, as per NFHS-4. The Infant Mortality Rate is 37 i.e. 37 out of 1000 infants die in the first year of life as reported in SRS Report 2015. Current trends highlight the need to accelerate reductions in neonatal mortality- as this constitutes around two thirds of infant mortality and around half of under-5 child mortality. Maternal mortality also needs to be addressed as maternal mortality continues to be high with MMR at 167 (SRS 2011-13, RGI Special Bulletin on Maternal Mortality 2013).

• NFHS-4 (2015-16) shows that there have been promising gains in child health care. The immunization rates have gone up. The number of children aged 12-23 months who were fully immunized (BCG, measles and 3 doses each of Polio and DPT) has gone up from 43.5% in NFHS-3 to 62% in NFHS-4. In terms of percentage points, maximum increase is seen in Punjab, Bihar, Meghalaya, Rajasthan and Uttar Pradesh. However, the number of children receiving full immunization has gone down in Tamil Nadu, Himachal Pradesh, Haryana, Maharashtra and Uttarakhand.

• Prevalence of symptoms of Acute Respiratory Infection (ARI) has also gone down from 5.8% in NFHS-3 to 2.7% in NFHS-4. However, inter-state variation continues with Meghalaya at 5.8% and Sikkim at 0.3 with respect to the prevalence of ARI.

• Occurrence of diarrhea among children has slightly increased over the last decade, from 9% in NFHS-3 to 9.2% in NFHS-4. Interstate variation in the prevalence of diarrhea continues with 17% in Uttarakhand to 1.8% in Sikkim. States which have shown maximum improvements in curbing diarrhea are Uttar Pradesh, Meghalaya, Uttarakhand and Chhattisgarh. However, in terms of absolute numbers, diarrhea among children continues to remain a challenge in Uttarakhand, Uttar Pradesh, Puducherry and Meghalaya.

• NFHS-4 (2015-16) shows that families are now more inclined to use improved water and sanitation facilities. Over two-thirds of households in every State/UT (except Manipur) have access to an improved source of drinking water, and more than 90% of households have access to an improved source of drinking water in 19 states/Union Territories. More than 50% of households have access to improved sanitation facilities in 26 states/Union Territories. Similarly, in 20 States/ UTs, more than 50% households use clean cooking fuel, which reduces the risk of respiratory illness and pollution.

• Even today, it is estimated that 48% of India’s population defecates in the open. Out of the total of one billion people defecating in the open across the world, an estimated 59.7% (597 million) reside in India (Report of the Sub Group of Chief Ministers on Swachh Bharat Abhiyan 2015).

• As per Census 2011, the rural household toilet coverage stands at 32.7% and urban household toilet coverage stands at 87.4%. Open defecation is linked to the presence or absence of household-level sanitation infrastructure and the absence of household toilet coverage is presumed to be the percentage of Open Defecation. (Report of the Sub Group of Chief Ministers on Swachh Bharat Abhiyan 2015).

• As per Census 2011, 53.1% households did not have latrines as compared to 63.6 % households in Census 2001. As per the Base Line Survey conducted by MDWS in 2012, about 40.23% of Households were having ndividual Household Latrines (IHHLs). Only 28002 (i.e. 11.19%) against total number of 250292 Gram Panchayats in the Country had achieved the status of Nirmal Gram, whereas the 12th Five Year Plan had aimed at ensuring that 50% of the Gram Panchayats attain Nirmal Gram status by the year 2017.

• NFHS-4 reports that overweight/ obesity has affected almost 20.7% women and 18.6% men, mostly located in urban areas, in wealthier households and among older adults. It is seen that over nutrition is becoming an emerging issue, with Chandigarh and Lakshadweep indicating the prevalence of overweight women or obesity in women by more than 40%.


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