Improved nutrition has become increasingly recognized as a key component in attaining the Sustainable Development Goal (SDG) target of ending hunger in all its forms by 2030. While many countries have made progress in reducing malnutrition, however, child undernutrition remains high in developing regions, and improving infant and young child feeding practices (IYCF) remains a significant challenge.
In a new paper published in Maternal & Child Nutrition, researchers examine India’s progress and capabilities in establishing and scaling up programs to support IYCF practices. Appropriate IYCF practices include initiation of breastfeeding within an hour after birth, exclusive breastfeeding for the first six months of life, and age-appropriate complementary feeding practices after six months. The research team utilized multiple information sources to analyze India’s ability to deliver IYCF interventions at scale. The authors reviewed (a) India's national nutrition policies and platforms, (b) program implementation experiences based on published literature and program documents, and (c) literature on the impact of interventions to improve IYCF in the country between 2000-2014.
The report finds that despite a supportive policy environment and the existence of multiple operational platforms to deliver IYCF programs, India’s progress on widely establishing appropriate IYCF practices has been mixed. Current levels of early initiation of breastfeeding remain at around 44 percent. While current exclusive breastfeeding rates are higher at 65 percent, only one out of two Indian children received complementary foods between six and eight months of age. This represents a decline from complementary feeding rates of 56 percent seen a decade ago. In addition, only one in five Indian children consumed at least four food groups between six and eight months of age. The report also finds that India’s Integrated Child Development Services (ICDS), a national program that provides food supplements to infants and young children, only reaches 50 percent of eligible children nationwide.
India’s national nutrition policies and action plans, established and implemented through the Ministry of Health and Family Welfare (MHFW) and the Ministry of Women and Child Development (MWCD), have long recognized the importance of IYCF practices. The finds that India’s IYCF policies have generally aligned and evolved with global nutrition recommendations, such as those put forth by the World Health Organization (WHO); specifically India appears to have a supportive environment and vision for scaling up two important interventions: nutrition counseling and provision of complementary food supplements (CFS). For example, the report finds that all states in India include CFS in their nutrition programming.
However, several challenges remain to effectively scaling up and implementing nutrition policies. Strengthening the capacity of frontline health workers to provide effective nutrition counseling is one such challenge. The report finds that there are often gaps in supervision of health workers in many states and that guidelines, training materials, and training programs are often not harmonized in terms of content. The need to improve the capacity of counseling programs has been recognized, however, and many programs have started to incorporate strategies to do so, including recruiting new paid staff or volunteers, providing training and materials (such as checklists and flip charts) to assist in service delivery, and improving monitoring and supervision mechanisms. The report highlights that large-scale government nutrition platforms need to make more effort to integrate and scale up these types of activities.
The study also found that counseling services tend to focus on exclusive breastfeeding and the initiation of complementary feeding at the age of six months, with a dearth of attention paid to appropriate complementary feeding practices as a child ages. The content of counseling services thus needs to be expanded to include this more long-term thinking, particularly focusing on the dietary diversity needed by older infants and children.
The quality and reach of CFS interventions also needs to be strengthened, the report says. The Supreme Court of India has made steps to limit the role of contractors in the production of CFS products, as this role has been found to be associated with corruption and lower quality products in some states; however, there remain different production and distribution modalities in different states, highlighting the need for better monitoring and enforcement of quality standards and delivery, the report says. One study mentioned in the report finds that only 50 percent of children under three years of age receive CFS products.
In addition, the report argues that the nutritional content of CFS products themselves needs to be reviewed to bring the products up to speed with more modern knowledge regarding infants’ nutritional needs. The current guidelines for CFS in India highlight caloric intake rather than nutrient intake or dietary diversity; the use of these high-calorie products could run the risk of displacing the use of breast milk and contributing to poorer quality diets.
Finally, financing also provides a challenge to both DFS and nutrition counseling programs. The study found that financing gaps still exist for both types of interventions, limiting their reach and preventing many states from reaching the full coverage goals set forth by national and state policies.
By: Sara Gustafson