This is despite the gains the country has made on access to sanitation and clean drinking water, a factor that is closely tied to child malnutrition.
The latest child malnutrition numbers, as reported by the first phase of the National Family Health Survey (NFHS) 2019-20, should prove distressing for policy. A report in The Indian Express (IE), based on the NFHS data, says that several states have reversed course on key malnutrition indicators and have recorded worsening levels over NFHS 2015-16. And, this is despite the gains the country has made on access to sanitation and clean drinking water, a factor that is closely tied to child malnutrition.
As per the first phase of NFHS 2019-20, which covers 17 states and five Union Territories including J&K, several states like Telangana, Kerala, Bihar and Assam as well as the UT of J&K saw an increase in the number of child wasting—this reflects acute/short-period malnutrition, with afflicted children having low weight for their height. Child wasting in India has always been at higher levels than comparable economies, but the fact that the downward trend in prevalence has reversed is deeply worrying.
The proportion of underweight children in several big states such as Gujarat, Maharashtra, West Bengal, Telangana, Assam and Kerala has risen. Child stunting—low height for age, a sign of chronic undernutrition—has increased in Telangana, Gujarat, Kerala, Maharashtra, and West Bengal. Stunting is of particular concern since it is an early indicator of undernutrition’s lasting, often lifelong, imprint on the development of a person, including cognitive development.
Given this data is from the survey before Covid struck, and that data for key states such as Madhya Pradesh and Uttar Pradesh are still to come, chances are the overall picture will be darker—Covid disruptions, in terms of the impact of shutdowns, restrictions and lost income/livelihoods, are likely to have affected nutritional security of households quite adversely, more so in the poorer states.
The fact that the infant- and under-5 mortality rates appear to have stagnated—under-5 mortality rates have fallen in low single-digits or remained the same in key states, while NFHS 2015-16 had reported a sharp 33% decline over NFHS 2005-06—is indicative of child malnutrition being central to mortality. Also, the previous two NFHS bracket a high-growth period; given the effect of wealth on nutrition levels—as discussed in a recently released study by Shyma Jose, Ashok Gulati and Kriti Khurana—it is clear that to fix nutrition, especially against the background of the pandemic, the country will need to focus on meaningful economic revival.
The Jose-Gulati-Khurana study also underscores the importance of a multi-dimensional approach to tackling nutrition challenges—with factors such as mother’s education, age of child-bearing, etc, having a significant bearing on a child’s nutrition security. Also, given micronutrient deficiency exacts a heavy toll on children’s development—the Comprehensive National Nutrition Survey reports concerning levels of deficiency of iron and certain vitamins among pre-school and school-going age children, leading to anaemia, low bone-density, reduced immunity, etc—there is a need to mount efforts on biofortification of crops, especially those procured for the PDS; bear in mind, Save the Children pegs the economic cost of micronutrient deficiency at $15-46 billion.
The government needs to step up efforts under its flagship nutritional security programme, the Poshan Abhiyan under the Integrated Child Development Services umbrella (which also houses other nutritional security interventions); targeted interventions under Poshan Abhiyan have seen only around 50% coverage. Without more intensive, widespread and multipronged efforts, the concern is the post-Covid era could look worse for India’s nutritional security for children.