The India Health Report on Nutrition 2015, produced by the IFPRI-led consortium ‘Transform Nutrition,’ investigates maternal and child undernutrition in India across Indian states and demographic groups. The report’s goal is to deepen the policy dialogue in India, raise awareness about the challenges of undernutrition and highlight areas for action, especially at the state-level to accelerate improvement in the nutritional status and development of India’s children. The authors note that at present, there is no data available that provides a comprehensive view of nutrition and its determinants that would support evidence-based policy making on a state level and the report aims to fill this gap.
The report is based around 18 core global nutrition indicators that are used to provide an overview of nutrition in India and in each state. These indicators were compiled from multiple sources, including: nationally representative surveys, databases and reports. These data sources were complemented by perspective papers written by leading experts. From the 18 indicators used there are a number that are particularly significant and effective at depicting the child and maternal undernutrition context of India, including that 38.7 percent of children under 5 years are stunted and 15.1 percent are wasted, 55.3 percent of women aged between 15-49 years old are anemic, 69.5 percent of children aged 6-59 months are anemic and that 44.7 percent of adolescent girls have low a BMI. These indicators vary significantly depending on geographical location. For example, Uttar Pradesh’s stunting rate is 50.4 percent while Kerala’s is 19.4 percent. Similarly 60 percent of adolescent girls have a low BMI in Rajasthan while this figure is 10 percent in Sikkim.
Based on these indicators, the report conducts an analysis on the state of maternal and child undernutrition in India, specifically highlighting the socio-economic causes and determinants of undernitrition. The key finding of the report is that stunting, wasting and under-nutrition rates of India’s children have declined since 1990, especially during the last decade, but India still has over 40 million stunted children and 17 million wasted children under five. Proportionately India’s undernutrition rates still exceed levels observed in countries with similar income and development indicators. For instance, India has around the same GDP per capita (PPP) as Ghana yet it has a under 5 stunting rate of around 40 percent compared to Ghana’s rate of 25 percent.
These rates of improvement in nutritional status have not kept pace with significant gains in economic prosperity and agricultural productivity in India during recent decades. There is a global trend that stunting and undernutrition rates decline with economic progress, but economic growth does not automatically reduce undernutrition. The report highlights that gains in economic and agricultural performance have not directly translated into improved nutrition because of other challenging factors such as: inappropriate feeding and care practices, disease burdens, biases against girl children and cultural practices. Based on this analysis, the report suggests that improvements in healthcare services, women’s empowerment, social protection and water and sanitation infrastructure alongside economic growth are needed to improve nutrition in India.
The report finds that the maternal and child nutrition situation varies significantly across India’s states. All Indian states have recorded consistent reductions in undernutrition over the past decade with states in northeastern India recording rapid reductions while others such as Uttar Pradesh and Bihar are achieving slower reductions. This report indicates that state-specific approaches are necessary to achieve further gains in reducing stunting, wasting and undernutrition.
As noted above, the underlying reasons for India’s high rates of stunting and variability in progress are complex and interrelated. The report argues that some of the most important underlying drivers of poor nutrition in India are: breastfeeding and complementary feeding patterns, income inequality, food insecurity and poor diet quality, social inequality, poor sanitation and hygiene conditions and gender inequalities. Although these drivers vary substantially by state, the report argues that policies need to focus on improving access to health services and to improve the social factors that create enabling conditions for better child growth. This can be done by reducing income inequality, improving the health and social status of women, scaling up water and sanitation services and addressing food insecurity.
In conclusion, this analysis illustrates that India needs to tackle child and maternal undernutrition and that doing so is a necessary precondition for future development. The key policy recommendation is for state-level action, with leadership, financial and policy support from the national and state government. The policy framework for nutrition action already exists but increased political commitment, financing and accountability are needed. Furthermore the report highlights that public programs need to be expanded and that the nutrition, health and social agendas need to be further aligned. India’s disappointing results and continuing high rates of child and maternal undernutrition risks large economic, health and social consequences for future generations as a well-nourished and healthy workforce is necessary for achieving broad based development. The report highlights that policies that promote income redistribution and reduce inequality can have a positive impact on undernutrition. Investments in nutrition and child development are central to achieving better health and better economic and social wellbeing for India.
The full report, a synopsis, an all-India factsheet, and state specific dashboards can be accessed here. The dashboards present statistical information in the form of tables and graphs on the nutrition situation in each State in India (over 500 pages) it is hoped that these can support the development of evidence based policies.
By Bas Paris, IFPRI