Despite continued high levels of poverty and social inequality, Odisha has made significant progress in improving women’s and children’s nutrition and health outcomes over the past 25 years, according to a new article (1) published in Global Food Security. Stunting among children under 5 declined from 45 percent to 38 percent between 2006 and 2014, while stunting among children under 3 declined from 49 percent to 44 percent between 1998-1999 and 2005-2006. Infant mortality has also declined, from 112 deaths per 1000 live births in 1992-1993 to 56 deaths per 1000 live births in 2013-2014.
To determine what factors have driven this progress and how future nutrition challenges can continue to be successfully addressed in the state, the paper examines changes in nutrition outcomes, determinants, and programs from 1990 to 2015. The authors use a variety of sources to construct a timeline of changes in nutrition outcomes, determinants, and policies; these sources include public nutrition data, policy and program documentation, published literature, and interviews with decision-makers, development partners, civil society actors, and community members.
The study finds that there were improvements in several important determinants of health and nutrition over the past 25 years in Odisha, including exclusive breastfeeding, the availability of oral rehydration salts to treat diarrhea, cereal productivity, and increased access to safe drinking water. The authors cite increased investments in and coverage by several important health and nutrition programs – including Integrated Child Development Services (ICDS) and the Public Distribution System (PDS) programs – as driving factors behind these improvements.
According to the paper, in the 1990s, Odisha ranked low on the IMR, which was the human rights commission that monitored starvation deaths in districts with a high population of scheduled tribes. That low ranking, combined with intense media attention, led policymakers in the state to put strong emphasis on scaling up of health and nutrition interventions and reducing mortality rates. Well-qualified bureaucrats were appointed in the state to direct and maintain health and nutrition interventions, and electoral stability ensured that these programs continued to receive political support. In addition, state- and national-level financing increased in the mid-2000s, helping to roll out and strengthen support for these programs. This positive enabling environment has played a key role in the state’s progress in nutrition and health outcomes.
The involvement of several important development partners has also played a role in improving nutrition in Odisha. Funding and technical assistance was given to a variety of state- and national-level programs by UNICEF, DFID, UNOPS, CARE, and the World Bank.
Several challenges remain in Odisha, however. Progress has been slow in terms of complementary child feeding, screening for severe malnutrition, and important pre-natal care (such as providing iron folate supplements to pregnant women). Scheduled tribes in Odisha also face decreased access to land and ability to grow important traditional crops; marginalized groups were also found to have decreased uptake of nutrition interventions, making closing these equity gaps an important factor to be addressed to further improve the state’s health and nutrition outcomes. A lack of improved sanitation facilities is also prevalent across the state, and Odisha’s economic growth is lower than India’s average as a whole. Continued funding and political commitment will be needed to address these challenges and to continue Odisha’s impressive health and nutrition progress.
(1) "What Will It Take to Accelerate Improvements in Nutrition Outcomes in Odisha?" Co-authored by Neha Kohli, Rasmi Avula, Mara van den Bold, and Purnima Menon of IFPRI, Elisabeth Becker of Yale University, Nicholas Nisbett of the University of Sussex, and Lawrence Haddad of the Global Alliance for Improved Nutrition.