Malnutrition
KEY TRENDS
• According to The State of the World's Children 2019 report, the proportion of children under 5 years who are either stunted, wasted or overweight was 54 percent for India in 2015, 49 percent for Afganistan, 46 percent for Bangladesh in 2014, 43 percent for Nepal in 2016, 43 percent for Pakistan in 2018, 40 percent for Bhutan in 2010, 32 percent for Maldives in 2009, 28 percent for Sri Lanka and 50 percent for South Asia region *19
• According to the Comprehensive National Nutrition Survey (CNNS), 35 percent of children under five years were stunted, 17 percent were wasted and 33 percent were underweight *18
• For several decades India was dealing with only one form of malnutrition -- undernutrition. However, in the last decade, the double burden which includes both over- and undernutrition, is becoming more prominent and poses a new challenge for India. From 2005 to 2016, prevalence of low (< 18.5 kg/m2) body mass index (BMI) in Indian women decreased from 36 percent to 23 percent and from 34 percent to 20 percent among Indian men. However, during the same period, the prevalence of overweight/ obesity (BMI > 30 kg/m2) increased from 13 percent to 21 percent among women and from 9 percent to 19 percent. Children born to women with low BMI are more likely to be stunted, wasted, and underweight compared to children born to women with normal or high BMI *17
• The India specific profile of the Global Nutrition Report 2018 shows that there is some progress made by the country to reduce the prevalence of stunting among children below 5 years. However, there is no progress (or there is been worsening) made by India to reduce the prevalence of wasting among children below 5 years, prevalence of anaemia among women of reproductive age (WRA), prevalence of both adult male and female obesity, and prevalence of both adult male and female diabetes *16
• According to the Urban HUNGaMA (Hunger and Malnutrition) Survey Report (released in 2018), in the 10 most populous cities of India, one in four children has stunted growth and development due to chronic nutrition deprivation *15
• The overall prevalence of underweight, stunting and wasting among urban children below 5 years during 2015-16 was 25.1 percent, 28.7 percent and 16.0 percent, respectively, as per the urban nutrition survey by National Institute of Nutrition (NIN) *14
• 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 *13
• The Global Nutrition Report 2016 ranks the country 114 for under-5 stunting out of 132 countries, 120 for under-5 wasting (acute malnutrition) out of 130 countries, 170 for anaemia out of 185 countries and 104 for adult diabetes out of 190 countries *12
• Stunting rates in under-three children declined by only 8 percentage points in more than a decade in this age-group -- from 53 percent in 1992-93 to 45 percent in 2006 -- reflecting an average annual rate of decline of 1.2 percent. During this period, wasting declined by 1 percentage point and underweight by 8 percentage points. However, the rate of progress accelerated since National Family Health Survey-3 (NFHS-3), and India's average annual rate of under-5 stunting decline between 2006 and 2014 has been 2.3 percent per year, compared with a rate of decline of 1.2 percent per year between 1992 and 2006 *11
• New government data show that nearly all Indian states posted significant declines in stunting rates from 2006 to 2014, and all showed strong increases in exclusive breastfeeding rates over the same period *10
• Nearly all states in India showed significant declines in child stunting between 2006 and 2014. However, three states with very high rates in 2006—Bihar, Jharkhand, and Uttar Pradesh—showed some of the slowest declines *10
• While most states show declines in wasting, not all do. Arunachal Pradesh, Maharashtra, Andhra Pradesh, Goa, and Mizoram show increases in wasting, although the increases for the first two are marginal *10
• The all-India rate of exclusive breastfeeding has increased from 46 to 65 percent. In 2005–2006 only five states had rates of 60 percent or higher. Now 17 states have breastfeeding rate of 60 percent or above *10
• Nearly all states in India showed significant declines in child stunting between 2006 and 2014. However, three states with very high rates in 2006—Bihar, Jharkhand, and Uttar Pradesh—showed some of the slowest declines *10
• While most states show declines in wasting, not all do. Arunachal Pradesh, Maharashtra, Andhra Pradesh, Goa, and Mizoram show increases in wasting, although the increases for the first two are marginal *10
• The all-India rate of exclusive breastfeeding has increased from 46 to 65 percent. In 2005–2006 only five states had rates of 60 percent or higher. Now 17 states have breastfeeding rate of 60 percent or above *10
• Despite various interim orders issued by the Supreme Court from time to time (based on a writ petition that was filed by People’s Union for Civil Liberties in April, 2001), the Government of India has failed to universalize the Integrated Child Development Services (ICDS) scheme *9
• Average dietary energy intake per person per day was 2233 Kcal for rural India and 2206 Kcal for urban India during 2011-12 (based on Schedule Type 2) *8
• At the all-India level protein intake per person per day was 60.7gm in the rural sector and 60.3gm in the urban sector during 2011-12 (based on Schedule Type 2) *8
• At the all-India level protein intake per person per day was 60.7gm in the rural sector and 60.3gm in the urban sector during 2011-12 (based on Schedule Type 2) *8
• Prevalence of stunting among children below 5 years age has reduced from 47.9% in 2005-06 (National Family Health Survey, NFHS-3) to 38.8% in 2013-14 (Rapid Survey on Children, RSOC). As a result, the population of under-five children affected by stunting has gone down from 5.82 crore in 2005-06 to 4.38 crore in 2013-14 *7
• Prevalence of wasting among children below 5 years age has reduced from 20.0% in 2005-06 (National Family Health Survey, NFHS-3) to 15.0% in 2013-14 (Rapid Survey on Children, RSOC). As a result, the population of under-five children affected by wasting has gone down from 2.43 crore in 2005-06 to 1.69 crore in 2013-14 *7
• Prevalence of wasting among children below 5 years age has reduced from 20.0% in 2005-06 (National Family Health Survey, NFHS-3) to 15.0% in 2013-14 (Rapid Survey on Children, RSOC). As a result, the population of under-five children affected by wasting has gone down from 2.43 crore in 2005-06 to 1.69 crore in 2013-14 *7
• In the Maharashtra state of India, the percentage of stunted children dropped from 39 per cent in 2005 to 23 per cent in 2012 largely because of support to frontline workers who focus on improving child nutrition *6
• Total number of malnourished children (Grade I, II, III and IV) exceeded the 40 percent mark in 10 states/ UTs (Andhra Pradesh: 49 percent, Bihar: 82 percent, Haryana: 43 percent, Jharkhand: 40 percent, Odisha: 50 percent, Rajasthan: 43 percent, UP: 41 percent, Delhi: 50 percent, Daman and Diu: 50 percent and Lakshadweep: 40 percent), as on 31 March, 2011 *5
• Poor hygiene and sanitation were noticed in the AWCs due to the absence of toilets in 52 percent of the test checked AWCs and non-availability of drinking water facility for 32 percent of the test checked AWCs *5
• India's 2012 GHI score is 22.9 (rank: 65) as compared to China's GHI score of 5.1 (rank: 2), Bangladesh's score of 24.0 (rank: 68), Pakistan's score of 19.7 (rank: 57), Nepal's score of 20.3 (rank: 60) and Sri Lanka's score of 14.4 (rank: 37) *4
• Children in the poorest households are more than twice as likely to be stunted as those in the richest households in India *3
• 48% of children in India are stunted. 450 million children will be affected by stunting in the next 15 years, if current trends continue *2
• Malnutrition is an underlying cause of the death of 2.6 million children each year–one-third of the global total of children’s deaths *2
• The HUNGaMA study (2011) shows that in the 100 Focus Districts, 42 percent of children under five are underweight and 59 percent are stunted. Of the children suffering from stunting, about half are severely stunted *1
• The HUNGaMA study (2011) conducted in the 100 Focus Districts shows that 66 per cent mothers did not attend school; rates of child underweight and stunting are significantly higher among mothers with low levels of education; the prevalence of child underweight among mothers who cannot read is 45 percent while that among mothers with 10 or more years of education is 27 per cent *1
19. The State of the World's Children 2019-Children, Food and Nutrition: Growing well in a changing world, released in October, 2019, produced by UNICEF, please click here and here to access
18. India: Comprehensive National Nutrition Survey 2016-2018, released in October 2019, Ministry of Health and Family Welfare (MoHFW), Government of India, UNICEF and Population Council, please click here to access
17. Food and Nutrition Security Analysis, India, 2019 (released in June 2019), produced by the MoSPI & WFP, please click here to access
16. Global Nutrition Report 2018: Shining a light to spur action on nutrition, please click here and here to access
15. Urban HUNGaMA Report: Nutrition and the City (released in February 2018), prepared by Naandi Foundation and others, please click here to access
14. Diet and Nutritional Status of Urban Population in India and Prevalence of Obesity, Hypertension, Diabetes and Hyperlipidemia in Urban Men and Women, National Nutrition Monitoring Bureau (NNMB) Technical Report no. 27, National Institute of Nutrition (NIN), please click here to access
13. Nourishing India: National Nutrition Strategy, NITI Aayog, please click here to access
12. Global Nutrition Report 2016[/inside], which has been prepared by International Food Policy Research Institute (IFPRI), Please click link1 to access, click link2 to access
11. India Health Report: Nutrition 2015 by Public Health Foundation of India, Transform Nutrition and UK Aid (please click here to access)
10. 2015 Global Nutrition Report: Actions and Accountability to Advance Nutrition & Sustainable Development by International Food Policy Research Institute (IFPRI), please click here to access
9. Public Accounts Committee (2014-15) report on ICDS Scheme of Ministry of Women & Child Development, PAC no. 2045, Fourteenth Report (presented to Lok Sabha on 27 April, 2015 and Rajya Sabha on 28 April 2015), Please click here to access
8. NSS 68th Round Report entitled Nutritional Intake in India, 2011-12 (published in October 2014) (Please click here to access)
7. Global Nutrition Report 2014: Actions and Accountability to Accelerate the World's Progress on Nutrition, IFPRI (Please click here to download)
6. UNICEF report titled: Improving Child Nutrition: The achievable imperative for global progress (April, 2013), please click here to access
5. Report of the Comptroller and Auditor General of India on Performance Audit of Integrated Child Development Services (ICDS) Scheme, CAG Report no. 22 of 2012-13-Union Government (Ministry of Women and Child Development), http://saiindia.gov.in/english/home/Our_Products/Audit_Rep
ort/Government_Wise/union_audit/recent_reports/union_perfo
rmance/2012_2013/Civil/Report_22/Report_22.html
4. 2012 Global Hunger Index-The Challenge of Hunger: Ensuring Sustainable Food Security under Land, Water, and Energy Stresses, produced by IFPRI, Concern Worldwide and Welthungerhilfe, please click here to access
3. The Nutrition Barometer: Gauging national responses to undernutrition (2012) by Save the Children and World Vision, please click here to access
2. A Life Free from Hunger: Tackling child malnutrition (2012), Save the Children, please click here to access
1. HUNGaMA: Fighting Hunger & Malnutrition (2011), Naandi Foundation, please click here to access
OVERVIEW
India’s story of attaining self sufficiency in food grain production is the stuff of the legend. But a proud India was soon to learn that self sufficiency did not mean food for every citizen, leave alone adequate nutrition. However, one must not undermine the value of self reliance, knowing well enough the sinister link between hunger and a country’s dependence on food imports. One must also remember that many developed countries where nutrition is not a problem happen to be big importers of food. Obviously, nutrition security depends on a large number of factors, many of which have nothing to do with food.
The issue of nutritional security is extremely complex. Many countries with similar per capita food consumption have vastly different rates of life expectancies and child mortality. Clearly, oversimplified statistical correlations and juxtapositions don’t work here. Jean Dreze and Amartya Sen have argued in their seminal work, Hunger and Public Action (OUP 1989), that we need to broaden our attention: a) from food-sufficiency to food-adequacy, b) from food adequacy to food entitlements, and c) from food entitlements to nutritional and related capabilities. The authors capture the big picture of nutritional security through many non-food factors like “medical attention, health services, basic education, sanitary arrangements, provision of clean water, eradication of infectious epidemics, and so on.”
If we want to know why one third of world’s underweight children (which comes to roughly 57 million) live in India, we only have to look at a child’s environment here. According to NFHS, two third babies are born anemic and about one third have stunted growth. Those who survive the lack of healthcare, immunization, sanitation or safe drinking water grow up as victims of human trafficking, child abuse or forced child labour. It is obvious that improving the nutritional security of its children is much more complex than achieving self-sufficiency in food production. True, the country is committed to achieving this through the UN Convention on the Rights of the Child and the Millennium Development Goals (MDGs) but its progress is agonizingly slow.
The issue of nutritional security is extremely complex. Many countries with similar per capita food consumption have vastly different rates of life expectancies and child mortality. Clearly, oversimplified statistical correlations and juxtapositions don’t work here. Jean Dreze and Amartya Sen have argued in their seminal work, Hunger and Public Action (OUP 1989), that we need to broaden our attention: a) from food-sufficiency to food-adequacy, b) from food adequacy to food entitlements, and c) from food entitlements to nutritional and related capabilities. The authors capture the big picture of nutritional security through many non-food factors like “medical attention, health services, basic education, sanitary arrangements, provision of clean water, eradication of infectious epidemics, and so on.”
If we want to know why one third of world’s underweight children (which comes to roughly 57 million) live in India, we only have to look at a child’s environment here. According to NFHS, two third babies are born anemic and about one third have stunted growth. Those who survive the lack of healthcare, immunization, sanitation or safe drinking water grow up as victims of human trafficking, child abuse or forced child labour. It is obvious that improving the nutritional security of its children is much more complex than achieving self-sufficiency in food production. True, the country is committed to achieving this through the UN Convention on the Rights of the Child and the Millennium Development Goals (MDGs) but its progress is agonizingly slow.