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State of nutrition: A reality check for India’s worst-performing states

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Toxins within unripened lychees are thought to have played a role in the child deaths due to suspected encephalitis in Muzaffarpur, Bihar earlier this year – and malnutrition has been identified as a root cause.

As India observes Poshan Maah – National Nutrition Month – Health Issues India focuses on two Indian states with the worst state of nutrition deficiency in the country.

Recently, a journalist was booked by the Uttar Pradesh government for “maligning the image of the state government” after he uncovering uncovered the state government’s ostensible apathy regarding health of its children. He had brought to light how children were being fed salt and roti as part of the mid-day meal scheme in school. Even though the journalist was accused of maligning the state government, he was only exposing the state of nutrition among its children.

The state spends over Rs 1137 crore on midday meal scheme, but it only covers 59 percent of the state’s children at primary level and 53 percent at upper primary level. A reality check on the state’s nutrition value is needed and it’s this: it’s the second-worst in the country.

Uttar Pradesh has the second-highest rate of stunting of children below the age of five, as per the Annual Health Survey released in 2014. Stunting or low height for age is caused by not having nutritious food over a long period of time and by frequent infections. The effects, which include delayed motor development and impaired cognitive function, are largely irreversible and have manifold effects on socio-economic development later in life.

Compared to other Indian states, more children in Uttar Pradesh are underweight, with low weight for age, a risk associated with child mortality. According to a report in, the Integrated Child Development Services (ICDS) programme is barely operational and lacks basic infrastructure. The state officials blame reduction in central government funds but, compared to other states, Uttar Pradesh has failed to increase allocations at the state level. 

The news from Uttar Pradesh comes a couple of months after 162 children became a victim of acute encephalitis syndrome (AES) after consuming lychees (litchis) on an empty stomach in Bihar. The fruit was not the culprit – it was malnourishment. 

Responding to a question over the deaths, Minister of State for Health Ashwini Choubey, in his written reply in Rajya Sabha, said consumption of lychees is safe for healthy individuals, but in “malnourished children, it triggers hypoglycaemia and leads to seizures or AES”.

Bihar is ahead of Uttar Pradesh in the dismal state of nutrition in children. As per the National Family Health Survey-4 (NFHS-4), 43.9 percent of under-five children in Bihar are underweight, 15.2 percent severely underweight and 20.8 percent experiencing wasting.

Though, ironically, funds spent in micronutrient supplementation programmes, infant and young child feeding (IYCF) practices, nutrition rehabilitation centres (NRCs) and diarrhoea control activities in Bihar have seen a continuous decline since the 2013-14 fiscal year, except for two consecutive years of growth in 2017 and 2018. NFHS-4 further states that Bihar, Madhya Pradesh, Meghalaya, Jharkhand, Uttar Pradesh and Dadra & Nagar Haveli, have more than 40 percent of their children stunted.

Undernutrition is both a consequence as well as a cause of poverty and the effects of development not being relinquished by the Indian population in an inclusive manner. This cycle of undernutrition, visible as low birth weight, is compounded by gender discrimination and social exclusion. IndiaSpend’s analysis shows that to achieve zero hunger by 2030, India will have to lift 48,370 people out of hunger every day. This is only possible with better collaboration between states and centre and it can be only possible with a more immeasurable political will. If malnutrition can been curtailed in Kerala and Tamil Nadu, then why not Uttar Pradesh and Bihar? This is a question that India needs to ponder over.

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