India has become home to a burgeoning malnourished population when, ironically, it also boasts of a rich demographic dividend, all at the same time. According to UNICEF, one in three malnourished children in the world is Indian and it is estimated that reducing malnutrition could add some 3% to India’s GDP. Child undernutrition rates have been declining, first at a slow rate between 1992 and 2006, at an accelerated pace since 2006. Between 2006 and 2014 India’s stunting rates for children below Under 5 declined from 48 to 39 per cent.

Union Minister for Health and Family Welfare and Union Minister for Women and Child Development released the “India Health Report: Nutrition 2015” and “Global Nutrition Report’’. The report was released during an event “Made in India: Good Nutrition for All: Implications of the Global Nutrition Report and the India Health Report for Nutrition Security in India” organized by Public Health Foundation of India (PHFI) and the International Food Policy Research Institute (IFPRI). The India Health Report (IHR), 2015, offers a critical analysis of nutrition at the national and State levels. The IHR compared nutrition levels among children in 28 States and Delhi. This report surveys the trends in maternal and child undernutrition in India. The report’s ultimate goal is to deepen and focus the policy dialogue in India, raise awareness about the multi-sectoral nature of under-nutrition and highlight areas for action at the state level.

In this report which highlighted that the rate of improvement in nutritional status has not kept pace with India’s significant gains in economic prosperity and agricultural productivity. As per data, 39% of children under five in India are short for their age (stunted). Uttar Pradesh and Bihar have made the least progress over the 2005-2014 periods that had the worst stunting rates in 2005-06. The global rate is 24%.

The main drivers and factors as per the report for the malnutrition in India are: 

At globally, Global Nutrition Report (GNR) points out that, diet choice which affect the Green House gases (GHGs) and that climate change, affect the nutrition status. In India, main factors are as follows:

1. Malnutrition in uterus.

Low status of women, education, underweight during pregnancy and anaemia affect her health leads to low birth weight, birth defects and hemorrhage of the new born.

2. Micronutrient Deficiencies.

Deficiencies in vitamins and minerals - iron, vitamin A, zinc and iodine.

3. Breastfeeding practices 

WHO has identified poor infant feeding as a risk factor for the survival of the child contributing Neonatal death. Lack of improvement in infant and young child feeding practices.

4. Poor sanitation.

About half of Indians defecate outside without using toilets and from here children  pick up parasites and chronic infections that impair the ability of the intestines to absorb nutrition. UNICEF reports death of almost 117,000 Indian children per year from diarrhea.

5. Tribal Issues.

Open Defecation, lack of clean drinking water, illiteracy, lack of health education, Infrastructure and health professionals.

India is epicenter of global malnutrition. India ignores the problem of under nutrition and its impact on child development at its peril and risks large economic, health and social consequences for future generations. The condition of women and girls is a depressing reality across the whole India. More than half of the women are anaemic. Level of attained education are low for most Indian women, with only few states have more than 50% of their women with 10 years of schooling. Early marriage is a clear predictor for poor nutritional outcomes.

This repots paints several pictures about India, a data poor country. The diverse picture about the life condition of Indian children. Good improvement from states like Kerala, Goa, Manipur and Tamil Nadu but dismal ones in Bihar, Jharkhand and Uttar Pradesh.

The importance of this report which guides our effort towards the “Zero Hunger”. Malnutrition at such an early stages reduces intelligence, affects the formation of cognitive and non-cognitive skills which further affect the long term wellbeing. This is not only limited to the physical growth but education and economic productivity as well. Therefore, much prevalence of ‘hidden hunger’ in the country with increased likelihood of infection, disease and health.

The cost of malnutrition is high both for individuals and nations implying high budgetary expenditures over health services and diminished productive potential of the workforce. 

Worldwide undernutrition is responsible for 45 per cent child deaths, directly or diseases made more severe because of it. This makes huge impacts on health, Economic and social implications.

What India is doing in improving the status of nutrition?

Government Initiatives 

1. Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) – Bringing focus on all the life stages with nutrition as a cross cutting issue especially for adolescents. Improving adolescent girls’ nutrition and delaying first pregnancy is one of key intervention.

2. Rashtriya Kishor Swasthya Karyakram (RKSK) – Improving adolescent girls’ nutrition and to break the intergenerational cycle of malnutrition.

3. Janani Suraksha Yojana (JSY) & Janani Shishu Suraksha Karyakram (JSSK) – Contributing towards rapid increase in coverage of essential interventions for child and pregnant women.

4. Nutrition Rehabilitation Centres – Established at district and sub district level providing health facilities for management of children with sickness and severe acute malnutrition.

5. National Iron Plus Initiative  and Vitamin A supplements – To control anemia covering all life stages  and Vitamin A supplementation strategy in children for reduction in pneumonia and diarrhea related mortality, reduced incidence of measles and diarrhea.

6. Guidelines on Infant and Young Child Feeding – Recommending exclusive breastfeeding for the first six months to new born.

7. Child Development Scheme Mission – Focusing early childcare, promoting Infant and Young Child Feeding practices through intense home visits, use of relevant IEC, improving knowledge and skill base of nutrition counsellors, supervisors and frontline workers.

8. Anganwadi worker and ASHAs Worker - on imparting essential training to Anganwadi workers and further reiterated the need for more coordination between Anganwadi workers and ASHAs and also between various ministries. 

Further Needs to be focused on:

1. Social protection mechanism:

Insurances in weather, social, life and medical will reduce extra cost for post remedial expenditure. Digitisation of schemes like ICDS, NRHM, MNREGA and reforms in PDS and use of Information Communication Technology for timely monitoring and delivery of services. 

2. In Tribal and Rural Areas:

Road, Rail and school infrastructure developments with provision of safe drinking water and toilets at all houses. Traditional healers and youth can be trained to administer drugs and help ASHA workers.

3. Policy Design:

Redesigning nutrition and health policy on the basis of science and technology. More focused should be made on girl’s and women’s education, health and nutrition training of anganwadi workers.

4. Bio-Fortification:

This is new process by which the nutritional quality of food crops is improved through agronomic practices, conventional plant breeding or modern biotechnology.

5. Support of corporate leaders and philanthropists:

Indian corporate world have great opportunities to work in this untapped area by bringing together businesses, citizens and NGOs to resolve basic issues and devise pragmatic solution.

This PHFI report shows that India’s national Successes mask massive inter-state variability, gender inequalities are possibly having an impact on children’s nutritional outcomes. India must build on its human development successes with better redistributive justice. Policies that promote income redistribution and reduce inequality can have a positive impact on undernutrition. Investment in nutrition and child development is central to achieving better health and better economic and social wellbeing for any nation. India is no exception where undernutrition is a serious threat to child development. Accelerating action at the state level is essential for changing the future course of Indian children.