As part of POSHAN’s continuing analysis of nutrition outcomes in India, the team recently released a state-level analysis of the trends in nutrition outcomes, determinants, and interventions for the state of Gujarat. The analysis spans 2006-2016 and utilizes data from India’s National Family Health Surveys for 2005-2006 and 2015-2016 and the 2013-2015 Rapid Survey on Children, as well as a comprehensive review of national and state-level policies and programs aimed at improving women’s and children’s nutrition outcomes. The study also utilizes summary data reported in the NFHS-4 district-level fact sheets to examine inter-district variability.
The study focuses on a set of global nutrition targets for maternal, infant, and young child nutrition: stunting, wasting, low birth weight, exclusive breastfeeding, child overweight, and anemia status among women of reproductive age. Levels and changes in several immediate, underlying, and basic determinants of nutrition were also examined.
The report finds that while Gujarat often performs better than other states in terms of economy, infrastructure, industrialization, and governance, it still struggles to improve its overall performance in maternal and child nutrition.
Several of the studied targets in Gujarat have seen improvement over the past decade. Prevalence of child stunting, for example, has declined from 51.7 percent to 38.5 percent, while prevalence of low birth weight has declined from 22 percent to 19.5 percent. Exclusive breastfeeding has also seen some improvement, rising from 48 percent of children under the age of six months to 56 percent.
However, anemia among women of reproductive age remains a significant public health problem in Gujarat as a whole, with than half of the state’s women of reproductive age suffering from the condition. The prevalence of child wasting has also increased over the past decade, from 18.7 percent to 26.4 percent, with the level of severe wasting rising from 5.8 percent to 9.5 percent.
At the district level, results for these targets varied. Child stunting rates ranged from 23 percent to 51 percent, with Sabarkantha district being the highest. Forty percent of children under five years of age are stunted in almost half of Gujarat’s districts. Prevalence of child wasting ranges from 16 percent to 43 percent in the Dangs district. In terms of anemia among women of reproductive age, with the exception of Surat (40 percent), all other districts have over 50 percent anemia rates.
In terms of the determinants of poor nutrition, the study breaks down changes in immediate and underlying determinants, as well as changes in the coverage of nutrition-specific interventions in the state. Several indicators are identified as immediate determinants, including early initiation of breastfeeding, rates of diarrhea in children, and complementary child feeding practices. There are some positive signs. For example, low BMI among women was found to decrease over the past decade, from 36.3 percent to 27.8 percent. Similarly diarrhea rates in children declined from 13.1 percent to 8.4 percent. While progress was seen in early initiation of breast feeding (from 27.8 percent in 2006 to 50 percent in 2016), the report stresses that there remains room for further improvement. Similarly, complementary child feeding practices in Gujarat remains a significant concern. Timely introduction of nutritious complementary foods also declined over the past decade from 54 percent to 49 percent; the report also found that in 2016, only 5 percent of children between the ages of 6 and 23 months received an adequately nutritious diet.
Underlying determinants of poor nutrition are identified in the report as education (specifically literacy), early marriage, and infrastructure (specifically, access to electricity, safe drinking water, and improved sanitation facilities). Women’s literacy levels have increased over the past decade, from 64 percent to 73 percent; the number of women with more than 10 years of education has also increased, from 24 percent to 33 percent. However, there remains significant room for improvement, particularly in secondary education for women. Early marriage (defined as before the age of 18) has declined significantly over the past decade, dropping from 39 percent in 2006 to 25 percent in 2016.
Gujarat’s infrastructure has seen considerable improvement since 2006, according to the report. More than 90 percent of the state’s households had access to improved drinking water in 2016, while 96 percent of households had access to electricity. Access to improved sanitation facilities also increased, from 44 percent to 64 percent of households during this 10 year period.
The study examined a number of nutrition-specific interventions that have been established in Gujarat over the past decade. Coverage of food supplementation programs for pregnant women, lactating women, and children increased across the board (from 19 percent to 49 percent, from 12 percent to 49 percent, and from 40 percent to 70 percent, respectively). Pregnant women’s consumption of iron and folic acid rose from 25 percent to 37 percent, while children’s intake of vitamin A supplementation rose from 15 percent to 71 percent. The number of children who received full immunizations by the age of 23 months rose slightly from 45 percent to 50 percent, but there remains much room for improvement in this indicator.
The report’s authors provided several recommendations for further progress in women’s and children’s nutrition in Gujarat. Special emphasis should be placed on programs that provide health services for pregnant women and that provide education and support for proper infant and child feeding practices, particularly complementary feeding. The study also uncovered a rising trend of overweight and obesity in the state, with an accompanying rise in non-communicable diseases like high blood pressure and diabetes. Close to a quarter of adult women in Gujarat are either overweight or obese; that rate is one in five for adult men. This finding suggests that Gujarat needs to address both continued undernutrition and the emerging problem of overnutrition and nutrition-related diseases.