In the recent
past, there has been a renewed discussion around nutrition in India. A
few months ago, the Ministry of Health and Family Welfare had released
the National Health Policy, 2017. It highlighted the negative impact of
malnutrition on the population’s productivity, and its contribution to
mortality rates in the country. In light of the long term effects of
malnutrition, across generations, the NITI Aayog released the National
Nutrition Strategy this week. This post presents the current status of
malnutrition in India and measures proposed by this Strategy.
What is malnutrition?
Malnutrition indicates that children are
either too short for their age or too thin. Children whose height is
below the average for their age are considered to be stunted.
Similarly, children whose weight is below the average for their age are
considered thin for their height or wasted. Together, the stunted and
wasted children are considered to be underweight – indicating a lack of
proper nutritional intake and inadequate care post childbirth.
What is the extent of malnutrition in India?
India’s performance on key malnutrition
indicators is poor according to national and international studies.
According to UNICEF, India was at the 10th spot among countries with the
highest number of underweight children, and at the 17th spot for the
highest number of stunted children in the world.
Malnutrition affects chances of survival
for children, increases their susceptibility to illness, reduces their
ability to learn, and makes them less productive in later life. It
is estimated that malnutrition is a contributing factor in about
one-third of all deaths of children under the age of 5. Figure 1
looks at the key statistics on malnutrition for children in India.
Figure 1: Malnutrition in children under 5 years (2005-06 and 2015-16)
NFHS Survey. Sources: National Family Health Survey 3 & 4; PRS.
Over the decade between 2005 and 2015,
there has been an overall reduction in the proportion of underweight
children in India, mainly on account of an improvement in stunting.
While the percentage of stunted children under 5 reduced from 48% in
2005-06 to 38.4% in 2015-16, there has been a rise in the percentage of
children who are wasted from 19.8% to 21% during this period. A high
increase in the incidence of wasting was noted in Punjab, Goa,
Maharashtra, Karnataka, and Sikkim.
The prevalence of underweight children
was found to be higher in rural areas (38%) than urban areas (29%).
According to WHO, infants weighing less than 2.5 Kg are 20 times more
likely to die than heavier babies.2 In India, the national average
weight at birth is less than 2.5 Kg for 19% of the children. The
incidence of low birth-weight babies varied across different states,
with Madhya Pradesh, Rajasthan and Uttar Pradesh witnessing the highest
number of underweight childbirths at 23%.
Further, more than half of India’s
children are anaemic (58%), indicating an inadequate amount of
haemoglobin in the blood. This is caused by a nutritional deficiency of
iron and other essential minerals, and vitamins in the body.
Is malnutrition witnessed only among children?
No. Among adults, 23% of women and 20%
of men are considered undernourished in India. On the other hand, 21%
of women and 19% of men are overweight or obese. The simultaneous
occurrence of over nutrition and under-nutrition indicates that adults
in India are suffering from a dual burden of malnutrition (abnormal
thinness and obesity). This implies that about 56% of women and 61% of
men are at normal weight for their height.
What does the National Nutrition Strategy propose?
Various government initiatives have been
launched over the years which seek to improve the nutrition status in
the country. These include the Integrated Child Development Services
(ICDS), the National Health Mission, the Janani Suraksha Yojana, the
Matritva Sahyog Yojana, the Mid-Day Meal Scheme, and the National Food
Security Mission, among others. However, concerns regarding
malnutrition have persisted despite improvements over the years. It is
in this context that the National Nutrition Strategy has been released.
Key features of the Strategy include:
- The Strategy aims to reduce all forms of malnutrition
by 2030, with a focus on the most vulnerable and critical age groups.
The Strategy also aims to assist in achieving the targets identified as
part of the Sustainable Development Goals related to nutrition and
- The Strategy aims to launch a National Nutrition Mission,
similar to the National Health Mission. This is to enable integration
of nutrition-related interventions cutting across sectors like women and
child development, health, food and public distribution, sanitation,
drinking water, and rural development.
- A decentralised approach
will be promoted with greater flexibility and decision making at the
state, district and local levels. Further, the Strategy aims to
strengthen the ownership of Panchayati Raj institutions and urban local
bodies over nutrition initiatives. This is to enable decentralised
planning and local innovation along with accountability for nutrition
- The Strategy proposes to launch interventions with a focus on improving healthcare and nutrition
among children. These interventions will include: (i) promotion of
breastfeeding for the first six months after birth, (ii) universal
access to infant and young child care (including ICDS and crèches),
(iii) enhanced care, referrals and management of severely undernourished
and sick children, (iv) bi-annual vitamin A supplements for children in
the age group of 9 months to 5 years, and (v) micro-nutrient
supplements and bi-annual de-worming for children.
- Measures to improve maternal care
and nutrition include: (i) supplementary nutritional support during
pregnancy and lactation, (ii) health and nutrition counselling, (iii)
adequate consumption of iodised salt and screening of severe anaemia,
and (iv) institutional childbirth, lactation management and improved
- Governance reforms
envisaged in the Strategy include: (i) convergence of state and district
implementation plans for ICDS, NHM and Swachh Bharat, (ii) focus on the
most vulnerable communities in districts with the highest levels of
child malnutrition, and (iii) service delivery models based on evidence
 National Health Policy, 2017, Ministry of Health and Family Welfare, March 16, 2017
 Nutrition in India, Ministry of Health and Family Welfare, 2005-06
 Unstarred Question No. 2759, Lok Sabha, Answered on March 17, 2017
 Helping India Combat Persistently High Rates of Malnutrition, The World Bank, May 13, 2013
 Unstarred Question No. 4902, Lok Sabha, Answered on December 16, 2016
 National Family Health Survey – 3, 2005-6, Ministry of Health and Family Welfare
 National Family Health Survey – 4 , 2015-16, Ministry of Health and Family Welfare
 National Nutrition Strategy, 2017, NITI Aayog, September 2017
 Rapid Survey On Children, Ministry of Women and Child Development, 2013-14