Malnutrition indicators in India remain among the highest in the world, despite a declining trend since the early 1990s. The recent figures from NFHS 4 are encouraging, showing further improvement on most indicators.

Key Nutrition Metrics:

• Key Centrally Sponsored Schemes (CSSs) with a focus on health have seen budgetary cuts over the last two years. Central allocations to the ICDS have declined almost by 10%.
• A complimentary public intervention is the Mid-Day Meal programme. Field studies highlight the link between the provision of school meals and improved cognition.

Existing Policy Framework:

The most prominent government nutrition interventions include the ICDS programme led by the Ministry of Women and Child Development (MWCD), and the NHRM led by the Ministry of Health and Family Welfare (MHFW). Both CSSs prioritise the role of community level organisations – AWCs and AWWs under ICDS and Accredited Social Health Activists (ASHAs) under the NHRM – for delivery of nutrition interventions to the target groups of pregnant and lactating mothers and infants.

These programmes are supplemented by the PDS, which is used to provide subsidised food grains to large sections of the country’s poor. In addition, more than six states, including Maharashtra, Madhya Pradesh, Uttar Pradesh, Odisha, Gujarat, Karnataka and most recently Jharkhand have also established state nutrition missions.

Policy Recommendations:

1)Strengthen and restructure ICDS and leverage PDS:

ICDS needs to be in mission mode. Last – mile delivery of ICDS interventions needs to standardise the nutritional component of supplementary food, prioritise educational outreach to pregnant and lactating mothers, improve programme targeting and streamline operations of AWCs through better infrastructure provision and training for AWWs.

2)Extend coverage of food fortification of staples:

Currently fortification of staples is limited to the mandatory iodisation of salt. Additional proposals under consideration include making the double fortification of salt (with iodine and iron), and the fortification of edible oils mandatory. The standards of hot cooked meal should also be changed to using only fortified inputs.

3)Target multiple contributing factors, for example, WASH

Swachh Bharat Abhiyan has increased access to toilets throughout the country.  However, the push for toilet construction must be combined with a strategy for behavioural change.

4)Align agricultural policy with national nutritional objectives:

Agriculture policy must be brought in tune with nutrition policy, with incentives provided for encouraging the production of nutrient rich and local crops for self-consumption. Efforts should be made to discourage the cultivation of resource rich cash crops with no nutrient value such as sugar cane and cotton.

5)Boost private sector engagement in nutrition intervention:

Private sector collaboration in the form of public-private partnerships (PPPs) has the potential to leverage the appropriate technology for scaling-up food fortification interventions and to develop and distribute nutrient-rich foods to improve maternal and infant nutrition. The PPPs can leverage technological solutions for scaling up food fortification initiatives and complement the government’s outreach efforts through mass awareness.