Nutrition Strategy of India

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The first consultation to evolve a Nutrition Strategy of India was held in NITI Aayog on 28th October 2015 and was chaired by Ms. Sindhushree Khullar, CEO, NITI Aayog.

Mandated to analyse the emerging data on undernutrition and formulate a specific strategy for poorly performing states and districts, in consultation with the Ministries of Women and Child Development and Health and Family Welfare, NITI Aayog anchored this milestone meeting.

This was the first in a series of consultations, designed to include states, sectoral ministries and other stakeholders including experts, professional bodies, international agencies, voluntary agencies and community based organizations.

Nutrition is crucial for the fulfi llment of human rights – especially those of the most vulnerable children, girls and women, locked in an intergenerational cycle of multiple deprivation. It constitutes the foundation for human development, by reducing susceptibility to infections, reducing related morbidity, disability and mortality, enhancing cumulative lifelong learning capacities, and adult productivity.

It is critical to prevent undernutrition, as early as possible, across the life cycle, to avert irreversible cumulative growth and development defi cits that compromise maternal and child health and survival, achievement of optimal learning outcomes in education and gender equality.

current affairs bank poMr. V. Somasundaran, Secretary Women and Child Development; Mr. C.K. Mishra, Additional Secretary Health and Family Welfare and other senior officials from the NITI Aayog, Ministries of WCD, Health and Family Welfare, Statistics and Programme Implementation and Additional Registrar General of India shared valuable insights on the key priorities and design of the Nutrition Strategy of India, as well as Nutrition data.

Ongoing initiatives under the Integrated Child Development Services, National Health Mission and other programmes were highlighted. Representatives of international agencies such as World Bank, UNDP, UN Women, UNICEF and WHO also shared their views at this forum.

NITI Aayog has been tasked with preparing the draft Nutrition Strategy pf India by the end of December 2015, in consultation with both the concerned ministries, sectoral experts, States and other relevant stakeholders.

It was decided that an Inter-Ministerial Group on Health and Nutrition Data will also be constituted, to identify the focus districts and finalize recommendations for monitoring and tracking progress of the Nutrition Strategy of India.

Need of Nutrition Strategy in India

Over the past 15 years India’s economic growth rate has been unprecedented. The International Monetary Fund reports an average growth in real gross domestic product (GDP) of nearly 6% in the 1990s and of 8% in 2000-10.

The economic growth has not, however, been associated with corresponding reductions in the rates of childhood undernutrition.

The National Family Health Survey, which provides India’s most authoritative statistics on nutrition status, showed that 43% of children under 5 years old were underweight for age in 1998-9; by 2005-6 the percentage had only dropped to 40%.

At that rate of progress India will not reach its millennium development goal target (to halve the proportion of underweight children by 2015) until 2043. By contrast, China has already met its goal and Brazil is expected to do so by 2015.

Undernutrition is responsible for 35% of deaths among children under 5 and 11% of the total global disease burden. It also reduces schooling attainment: an improvement in height for age z scores of 1 is a predictor of an extra half a year of schooling and substantially increases the likelihood of being poorer later in life since less schooling is a predictor of lower wages (46% in a longitudinal study from Guatemala) and lower lifetime incomes.

During 1981-2005 India’s poverty rate fell from 60% to 42%. This decline is similar to China’s more lauded poverty reduction (a fall from 40% to 29%) over the same period. Yet unlike China, India is not reducing undernutrition. Given the importance of childhood nutrition it is important to ask why high levels of undernutrition are so persistent in India.

World Bank Report on Nurition Strategy in India

Halving the prevalence of underweight children by 2015 is one of the key indicators of progress towards the Millennium Development Goal 1(MDG 1) for eradicating undernutrition, hunger and poverty. Economic growth alone is not enough to reduce undernutrition and meet the nutrition MDG goal and direct investments and efforts to address the malnutrition are urgently required.

Nearly 47% of India‟s children are underweight, a third of India‟s children are born with low birth weights condemning them to a lower growth trajectory for life, nearly 45 percent are stunted (short height for their age), 75 percent are anemic, and 57 percent are Vitamin A deficient. And, progress in reducing undernutrition has been much slower in India than in many other countries with comparable socio-economic indicators.

Much of this undernutrition happens in the first two years of life of a child, and the damage to brain development and future productivity is essentially irreversible. Undernourished children have higher rates of mortality, lower cognitive performance, and are more likely to drop out of school. Thus, not only is India lagging behind in progress towards the achievement of MDG 1, the high levels of malnutrition has implications for human development, especially among the poor and vulnerable sections of the population.

There exist significant inequalities across states and socio-economic groups. Even as political leaders and policymakers have acknowledged undernutrition as a serious problem, there is need for more concrete actions as well as a good understanding of the determinants of malnutrition, the challenges in addressing the complex problem and of evidence-based approaches that have been shown to improve malnutrition in varying contexts. An entire range of causes and existing structures of poverty, health, education, gender among others, are contributing to undernutrition.

The dimensions of undernutrition, complex in their characteristics, vary along the axes of geographic location, gender, caste, and economy.There is heightened political awareness of the problem of undernutrition and the need for urgent action. India has over the past three decades made considerable investments to improve the nutritional status of its women and children. India‟s primary program response to nutrition, the ICDS has been expanded several folds, yet reduction in undernutrition has been insignificant.

The most recent National Family Health Survey showing the lack of improvement in undernutrition has drawn the attention of the highest levels in the government, including the Prime Minister and the Planning Commission, yet an understanding of the critical issues and the right focus and a commitment to action in the right direction is needed.Undernutrition is often mistakenly perceived as a “food alone‟ issue. It is not widely understood that while food security is a necessary condition to improve nutrition, in of itself, it is not a sufficient condition to eradicate undernutrition.

Feeding, caring and health practices together are important for good nutrition.Recognized as a “silent emergency”, there is an urgent need to highlight the problem of nutrition, raise the level of public and political discourse around the issue, and finally reposition it as a critical issue that is central to India’s development agenda at all levels – national, state, district, local government and the community level.

At the same time there is a need to engage a variety of stakeholders in the process – the executive, the legislature, the media, civil society and the community. Prioritizing Nutrition – A strategy for commitment building and Advocacy seeking to reposition nutrition in public and political discourse, the “Prioritizing Nutrition – A Strategy for Commitment Building and Advocacy” initiative, supported by the World Bank, was a pilot effort to demonstrate a set of strategic activities to build commitment for nutrition, raise the level of public discourse about nutrition, build a better understanding of the critical gaps and issues to be addressed and advocate for policy and program directions to address these to enhance the commitment for nutrition.

The “Prioritizing Nutrition‟ initiative was constructed around a structured framework that attempted to create awareness about the social, economic, cultural/ political conditions sustaining undernutrition.

Adopting a bottoms-up approach, one of the key strategies in the initiative was to sensitize stakeholders – from the grassroots to the national government – to strengthen social and political commitment at the state and national levels towards preventing and eradicating malnutrition.

The initiative worked using a framework with five strategic directions: i) to strengthen political and executive commitment to reduce undernutrition; ii) to align policy and planning with the drivers of undernutrition; iii) to strengthen institutions and systems to be more responsive and accountable; iv) to strengthen communities‟ and individuals‟ understanding of undernutrition build communities‟ capacities to demand their rights; v) and to increase the visibility of the issue of nutrition in the mainstream public discourse, encouraging public participation and intervention.

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