Nutritional agenda

Context: The fifth round of the National Family Health Survey (NFHS 2019-20) factsheets on the burden of child under nutrition is not encouraging.

How is under nutrition measured?

• Relied on the measure of a child’s anthropometry: Children are defined as stunted, underweight or wasted if their standardised height-for-age, weight-for-age or weight-for-height is more than two standard deviations below the (WHO) Child Growth Standards median.
  • However, under nutrition can also be measured by observing the adequacy and sufficiency of food or dietary intake among children.

What is the status of under nutrition in the fifth round of NFHS report?

• NFHS-4 (2015-16): The percentage of children (aged 6-23 months) who do not meet the minimum dietary adequacy as defined under the Infant and Young Child Feeding (IYCF) practices by WHO is 83.9%; a decline of just over 2 percentage points.
  • Thus, eight out of 10 children appear to be experiencing a dietary shortfall.
  • Analysis based on NFHS-4 has shown that consumption of protein-rich food as well as fruit and vegetables were substantially low.
• Dietary adequacy: Goa experienced the largest percentage point decline (11.1%), and Jammu and Kashmir observed the highest increase in its percentage of children not meeting dietary adequacy over the last three years (76.5% to 86.4%).
  • While there are some variations, in every State more than 75% of the children do not receive the minimum adequate diet.
• Anaemia prevalence: Anaemia prevalence among children increased by about eight percentage points from 51.8% to 60.2%. The prevalence of anaemia in childhood increased in 18 of the 22 States/Union Territories.
  • In the majority of the States, two out of three children have possible iron-deficiency. The State-wise trends for adults are mixed, although it is clear that women are substantially at a far greater risk for anaemia than men.

What are the steps to be taken?

• Initiatives: (POSHAN) Abhiyaan and the Anemia Mukt Bharat or AMB Strategy was launched in 2018 with efforts to improve Iron and Folic Acid (IFA) supplementation.
  • Behaviour change and anaemia-related care and treatment across six target groups including pregnant women, lactating mothers, and children, and the provisional verdict is mixed for women and concerning for children.
• Typology: A classification of nutritional status using a combined typology based on children who experience dietary failure and anthropometric failure is crucial.
  • A recent NFHS-4 based study using this typology found that 36.3% of children who experienced a dietary failure do not show anthropometric failure.
• Nutrition agenda: Dietary factors can clearly be a major determinant of stagnancy in the nutritional status of Indian children. Therefore the nutrition agenda needs to be considered from “food as a right” perspective.
• Quality data: Data available in a timely manner and in public domain, is empowering, as the NFHS has demonstrated over the last 25-plus years. But systematic and quality data on what Indians eat remains largely unknown.
  • A modern data initiative leveraging and combining aspects of the NFHS, the National Nutrition Monitoring Bureau and the National Sample Surveys that collected data on detailed household-level consumption and expenditure on various food items should be considered.

Way forward

• Decluttering our current approach to reducing the burden of child under nutrition and keeping it simple with a policy goal to providing affordable (economic and physical) access to quality food items, particularly for lower socioeconomic populations groups, should be prioritised.