Undernutrition continues to be a major cause of concern for children below five years of age in India. It makes the child vulnerable to physical and mental illnesses and poses a threat to life in the early years. Therefore, it is considered to be a silent killer.
In 2018, an estimated 6 lakh newborns died in India. According to the UNICEF Report 2018, India is the worst place for newborn babies among middle-income countries. As per the National Family Health Survey (NFHS) Report 2019-21, 25 out of 1,000 newborns died in the first month of life, 35 out of 1,000 infants died in the first year of life and 42 out of 1000 new-borns died in the first five years. Current trends highlight the need to accelerate reductions in neonatal mortality as this constitutes nearly two-thirds of infant mortality and around half of under-5 child mortality. Since undernutrition is part of the zero hunger target (SDG 2) under sustainable development goals (SDG), it is crucial to improve the nutrition status of both children and adults. As per the WHO report on SDG, India is lagging in achieving nutrition-related global targets for the year 2025 (Table 1).
Footnote [1]
There are several drivers of undernutrition, but the consumption of adequate and quality food is key among them. The recent household consumption expenditure survey 2022-23 points to the status of food intake and shows that household consumption of cereal and food-related items as a percentage of monthly per capita consumption expenditure (MPCE) has decreased significantly. It has been reported that there has been a consistent decline in household consumption expenditure on cereal and food-related items since the year 1999-2000.
In rural areas, household consumption of cereal reduced by 78%, and overall food items reduced by 22% since 1999-2000. In urban areas, household consumption of cereal reduced by 71%, and overall food items reduced by 19% since 1999-2000.
While the determinants of declining consumption of overall cereal and food-related items need further investigation, it is useful to understand how undernutrition varies across income quintiles.
Utilisation of ICDS Institution Determining Undernutrition
Children (under age 5 years) in the poorest quintile are most affected by stunting (46%), underweight (43%), and wasting (23%) comparing their counterparts in the richest quintile.
A quintile wise analysis of NFHS data 2019-21 suggests that children (under age 5 years) in the poorest quintile are most affected by stunting (46%), underweight (43%), and wasting (23%) comparing their counterparts in the richest quintile. A detailed analysis of successive NFHS data suggests that even though nutrition status and prevalence of infection have improved among children in the poorest quintile. Other diseases such as ARI and diarrhoea which are determinants of undernutrition – remained higher compared to the richest quintile.
To curb undernutrition and subsequently child health outcomes, India has taken various measures in terms of distribution of subsidised food through the public distribution system, free supplementary ration for women and children, free immunisation for women and children, and free monthly health check-ups at schools.
According to the guideline issued by the Ministry of Women and Child Development, children between the ages of 6 months to 3 years must receive take-home rations monthly. And children between the ages of 3 years to 6 years are to receive cooked meals for 300 days in a year under the Integrated Child Development Services (ICDS) program. Besides this, they must receive monthly health check-ups as well.
An analysis of NFHS data (2015-2020) suggests that the overall utilisation of ICDS institutions has increased during the period 2015 to 2020. More than 50% of the poorest children have benefitted from the ICDS program during 2019-20[2]. However, it does not reflect the true scenario in terms of the frequency with which children had benefitted from the program.
Actual expenditure under the umbrella ICDS program (Aanganwadi services, Poshan Abhiyan, and Scheme for adolescent girls) shows that expenditure has reduced by 11.4% from 2015-16 to 2022-23
A further examination of NFHS data (2015-2020) suggests that less than 30 percent of the children across all the quintiles received either cooked meals or take-home rations almost daily. In terms of monthly health check-ups, less than 50 percent of the children across all quintiles received this service. Thus, even though overall, a large number of targeted children may be accessing these programs, regular uptake is low.
Further, an analysis of actual expenditure under the umbrella ICDS program (Aanganwadi services, Poshan Abhiyan, and Scheme for adolescent girls) shows that expenditure has reduced by 11.4% from 2015-16 to 2022-23 (Figure 1).
To sum up, the successive NFHS survey data (2015-20) indicates that the progress in improving the nutrition status of children below 5 years of age has been slow. Even though there has been improvement in the aggregate nutrition indicators, the disaggregated analysis shows that the nutrition status of poor and poorest children is dismal. One of the reasons could be the frequency of utilisation of ICDS institutions and the associated decline in actual expenditure.
References
IIPS. (2015-16). National Family Health Survey. Intenational Institute for Population Sciences.
IIPS. (2019-21). National Family Health Survey. International Institute for Population Sciences.
Lawn, J. E., Blencowe, H., Oza, S., You, D., Lee, A., Waiswa, P., . . . Cousens, S. N. (2014). Every Newborn: progress, priorities, and potential beyond survival. The Lancet, 189-205.
Ministry of Finance. (2023, May 27). Budget Highlights (Key Features). Retrieved from Union Budget
NSSO. (2024). Household Consumption Expenditure Survey 2022-23 (Fact Sheet). Government of India, Ministry of Statistics and Programme Implementation.
Sachs, J. D., Lafortune, G., Fuller, G., & E, D. (2023). Sustainable Development Report 2023: Implementing the SDG Stimulus (Includes the SDG Index and Dashboards). Dublin University Press, 2023.
FOOTNOTES
[1] The percentage of the population whose food intake is insufficient to meet dietary energy requirements for a minimum of one year. Dietary energy requirements are defined as the amount of dietary energy required by an individual to maintain body functions, health and normal activity. Due to uncertainty in the estimates, the lowest value FAO attributes to countries is 2.5% for the year 2030 (target).
[2] 64.3% children (below 6 years) in poorest quintile received supplementary food, 55% received immunization, and 57% received monthly health check-up anytime in 12 months before the survey (for the year 2020).
Alok Kumar Singh
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