In India, every second child is affected by some form of malnutrition.

• The UNICEF report on child nutrition found that one in three children under the age of five years — around 200 million children worldwide — are either undernourished or overweight. 

What is malnutrition?

• Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients. 
• The term malnutrition covers 2 broad groups of conditions. 

1. One is ‘undernutrition’—which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals). 
2. The other is overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes, and cancer).

The malnutrition data:

• • The report said 35% of Indian children suffer from stunting due to lack of nutrition, 17% suffer from wasting, 33% are underweight and 2% are overweight. 
  • According to government figures, stunting and wasting among children in the country have reduced by 3.7 percent and the number of underweight children has reduced by 2.3 percent from 2016 to 2018.
  • As per the National Family Health Survey (NFHS)-4 (2015-16), 35.7 percent of children below five years are underweight, 38.4 percent are stunted and 21 percent are wasted in the country.
  • Among countries in South Asia, India fares the worst (54%) on the prevalence of children under five who are either stunted, wasted or overweight. 

• India also has the highest burden of deaths among children under five per year, with over 8 lakh deaths in 2018. 

Comprehensive National Nutrition Survey

• The CNNS, the first-ever nationally representative nutrition survey of children and adolescents in India, has also found that 35 percent of children under five were stunted, 22 percent of school-age children were stunted while 24 percent of adolescents were thin for their age.
• The Ministry of Health conducted the survey to collect a comprehensive set of data on the nutritional status of Indian children from 0-19 years of age. 
• Also, the survey used gold standard methods to assess anemia, micronutrient deficiencies and biomarkers of NCDs for the first time in India.

• As per the World Bank Report titled ‘Nutrition in India’, India loses over 12 billion U.S. Dollars in Gross Domestic Product due to direct productivity losses and indirect losses due to poor mental development and schooling, and increased costs of healthcare.

Malnutrition due to poor diet

• The report pointed to poor calorie share of fruits and vegetables, and a substantial lack of diet based on milk and milk products, as the country’s diet continues to be cereal-based.

• One in five children under age 5 has vitamin A deficiency, which is a severe health problem in 20 states. Every second woman in the country is anemic, as are 40.5% of children. 
• One in ten children is pre-diabetic.

Reasons behind poor diet of children:

• Poverty, urbanization as well as climate change.

• • Due to urbanization, India moved away from seasonal food as well as traditional food one hand and consumption of processed food has increased on the other. 
  • Obesity is spiraling out of control. Increasing income shows correspondingly high increments in the fat intake but not protein intake. 
  • Access to diverse, micronutrient-rich foods such as fresh fruits, vegetables, legumes, pulses, and nuts has not improved equally for everyone. 

Initiatives are taken to Reduce Malnutrition

• Under the multi-sectoral approach for accelerated action on the determinants of malnutrition in targeting nutrition in schemes/programs of all the sectors.
  • The Integrated Child Development Services (ICDS) provides a package of six services namely supplementary nutrition, pre-school non-formal education, nutrition & health education, immunization, health check-up, and referral services.
  • National Nutrition Mission, National Health Mission (NHM), Mid-Day Meal Scheme, Rajiv Gandhi Schemes for Empowerment of Adolescent Girls (RGSEAG) namely SABLA,  Indira Gandhi Matritva Sahyog Yojna (IGMSY) as direct targeted interventions. 

Indirect Multi-sectoral interventions include 

• • Targeted Public Distribution System (TPDS), National Horticulture Mission, National Food Security Mission, Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS), Swachh Bharat Abhiyan, National Rural Drinking Water Programme, etc.  All these schemes address one or other aspects of nutrition.

Issues and challenges:

A trap of poverty, malnutrition

• Mothers who are hungry and malnourished produce children who are stunted, underweight and unlikely to develop to achieve their full human potential.

Ambitious targets:

• The government’s National Nutrition Mission (renamed as Poshan Abhiyaan) aims to reduce stunting by 2% a year, bringing down the proportion of stunted children in the population to 25% by 2022.

Poor disbursal of funds:

• With respect to centrally supported schemes such as ICDS, data show that the budgetary allocations have decreased over time. 
• State and Union Territory governments have only used 16% of the funds of Poshan Abhiyan allocated to them. 
• Fortified rice and milk were to be introduced in one district per state by March 2019. But this had not been done, and officials in charge of public distribution had not yet got their act together. 

Low recruitment of Anganwadi workers:

• • Anganwadis are key to the distribution of services to mothers and children. 

• But many States, including Bihar and Odisha, which have large vulnerable populations, are struggling to set up functioning anganwadis, and recruit staff.

• Many workers are unable to play an effective role in attending to the problem of malnutrition because of low wages and inadequate training.

Difficult access to food:

• Global Hunger Index 2019 Report: India ranked 102 out of 117 countries in the Global Hunger Index (GHI) 2019 that is placed at much below to its South Asian neighbors such as Nepal, Bangladesh, and Pakistan.
• Malnutrition is a reflection of age-old patterns of social and economic exclusion. Over 40% of children from Scheduled Tribes and Scheduled Castes are stunted. Close to 40% of children from the Other Backward Classes are stunted.

Poor sanitation:

• Poor sanitary conditions caused by open-defecation and other issues, in turn, lead to the incidence of diarrhoeal diseases; these diseases make children susceptible to stunting.

Way forward:

Food fortification:

• To improve nutritional content in food products, steps are being taken towards universal food fortification. 
• A proposed policy would provide for adding essential vitamins and minerals (iron, folic acid, vitamin, iodine) to food items (rice, wheat flour, salt, edible oil, milk) sold in markets.

State’s responsibility:

• Article 47 of the Indian Constitution provides that it is the “duty of the State to raise the level of nutrition and the standard of living and to improve public health”. 
• The agencies of State governments have to adopt a comprehensive and coordinated multi-sectoral approach which is formulated by taking into account the varied nature of local-level challenges. 

Modernise Anganwadis through the use of corporate social responsibility funds

Improve nutrition awareness of communities

Operationalization of a national nutrition surveillance system: Thus, there exists a need to collect and maintain real-time data on various nutrition indicators using ICT and GIS like a database of pregnant mothers.

Improving sanitation: The implementation and maintenance of the Swachh Bharat Mission should be strengthened.

Judicial and civil society activism: For example, the Right to Food Campaign (launched in March 2014), which is an informal network of individuals and organizations, is the result of public interest litigation. The United Nations General Assembly has adopted a resolution proclaiming the UN Decade of Action on Nutrition from 2016 to 2025.