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Child malnutrition: Is India backsliding?

children. School children having mid-day meal in school, Radhu Khandu Village, Sikkim, India. Image credit: Keith Levit / 123rf. Cap: Schoolchildren eat a midday meal in the village of Radhu Khandu in Sikkim. Children are acutely affected by hunger and malnutrition in India. Worryingly, the country's progress in fighting child malnutrition shows signs of reversal. Image credit: Keith Levit / 123rf
Schoolchildren eat a midday meal in the village of Radhu Khandu in Sikkim. Children are acutely affected by hunger and malnutrition in India. Worryingly, the country’s progress in fighting child malnutrition shows signs of reversal. Image credit: Keith Levit / 123rf

The latest National Family Health Survey (NFHS) data indicates that child malnutrition remains a major social crisis in India, with the advances made in tackling child malnutrition over the course of recent years coming undone. 

Results from NFHS-5 paint what aptly describes as “a disconcerting picture.” Multiple states, reports, have seen hard-won gains in combating child malnutrition reflected in past NFHS results “reversed in several states. With the pandemic and the economic crisis, nutritional indicators are likely to worsen further.” In Gujarat, Himachal Pradesh, Kerala, Maharashtra, Telangana and West Bengal, six of India’s ten large states, indicators related to nutrition such as the rates of stunting (where one’s height is too low for their age), wasting (where one’s weight is too low compared to their height), and underweight (where they weigh too little for someone their age) worsened. In seven of those ten states, the indicators worsened or were unchanged. 

Livemint’s summary notes that the statistics show that, during the 2019-20 period, “a majority of the 22 states and union territories covered in the first phase saw the proportion of stunted children…wasted children…and underweight children…rise compared to the previous round conducted in 2015-16.” Such findings are indeed disturbing and reflect a trend of backsliding that portends to undo decades of progress.

An IndiaSpend analysis published earlier this month highlighted that “India has the largest number of stunted children in the world, and among the highest share of stunted children of any country outside sub-Saharan Africa. However, between 2005-06 and 2015-16, two previous rounds of the NFHS, India made substantial progress, lowering the share of stunted children by nearly ten percentage points.

“However the latest fifth round of NFHS indicates that the last five years could have reversed many of these gains. The share of stunted, wasted and underweight children has grown in the majority of states for which data have been made available. Rates of stunting have risen in rich states such as Kerala, Gujarat, Maharashtra, Goa and Himachal Pradesh, all of which had lowered their rates of stunting in the previous decade. If the all-India rates of child stunting were to rise, as the Phase-I data indicate, this would represent the first increase in child stunting since 1998-99.”

Malnutrition measurements in Madhya Pradesh. Image credit: DFID – UK Department for International Development [CC BY 2.0 (]
Indeed, against the backdrop of COVID-19, hunger has become a poignant crisis. Many fear starvation more than the novel coronavirus, as reflected in the harrowing words of one migrant labourer forced to participate in a mass exodus from the cities where they worked to the villages they hail from. He warned “hunger will kill us before any disease does.” Even when lockdown measures considered to be a contributory factor in India’s hunger crisis were relaxed, hunger remained a problem. Marginalised groups are particularly susceptible.

Even in the months before the onset of the pandemic in India, hunger presented a widespread and, in a number of respects, worsening public health crisis. This is despite government efforts to tackle vaccine-preventable diseases, poor sanitation, and up the ante on inadequate nutrition standards that facilitate a crisis of undernutrition through campaigns such as Eat Right India. 

On the rankings of the International Food Policy Research’s Global Hunger Index (GHI) last year, India slipped. It placed 102nd out of 117 countries with a score of 30.3 out of 100 – worse than the score of the south Asia region as a whole and many of its neighbour states. Children are especially vulnerable to hunger in India, with the GHI finding that “just 9.6 percent of all children between 6 and 23 months of age are fed a minimum acceptable diet.” Additionally, last year, a report by the India State-Level Disease Burden Initiative found that, of the lives of more than 1.04 million children under five lost in 2017, malnutrition accounted for seven lakh – almost seventy percent. 

assorted fast food,junk food. Image credit: margouillat / 123rf
Unhealthy diets are fuelling higher numbers of overweight and obese children in India, adding to a triple burden of child malnutrition in the country. Image credit: margouillat / 123rf

India’s child malnutrition crisis is not a battle to be fought solely in terms of children affected by stunting, wasting, or who are underweight. NFHS-5 also reflected an increase in the number of overweight and obese children between the 2015-16 and 2019-20 periods, feeding into what is termed a triple burden of malnutrition: overnutrition, undernutriton, and micronutrient deficiencies.

The causes of India’s child malnutrition crisis are manifold. As the report outlines, “the factors that determine how much nutrition children get include the disease environment, the education, health and nutrition of women, parental education, access to public services and household amenities, and the use of sanitation facilities.” As noted above, government-led efforts are underway and have been for some time to address these issues. The pandemic offers extra challenges: the NFHS-5 data is an assessment of the pre-COVID era, so in tackling child malnutrition, it must be taken into account going forward. 

In tackling child malnutrition, facilitating economic growth is not enough. As Livemint highlights in its analysis, “a comparison of the NFHS data and official economic data shows that richer states did have lower rates of child stunting, but increases in per capita income over the last five years were not necessarily correlated with reductions in child stunting.” One means of fighting child malnutrition, notes, is fortifying the public distribution system which excludes millions. 

India is no stranger to hunger or to excess. Beset by inequities between its states and union territories, what the NFHS data reflects is the universalism of malnutrition – especially among children – as a human tragedy and why the response to it must be multisectoral and multi-faceted. Economic growth has taken India to be one of the world’s largest economies, but it remains the grim fact that it is also one of the world’s hungriest nation states. To change that is the need of the hour.

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