On 12 December 2020, the Ministry of Health and Family Welfare under the Government of India launched the report of the first phase of National Family Health Survey 2019-20 (NFHS-5) for the 22 states and Union territories. Researchers, policymakers and other stakeholders, including the parents of millions of children, were expecting to hear the great news that India had made massive progress toward eliminating the problem of child malnutrition.
Unfortunately, the first-phase report gives startling revelations of no progress toward reducing child undernutrition in the last five years since 2015-16 (NFHS-4). The estimates from the report indicate that instead of making progress, states are reversing the headway made in the last decades. Out of 22 states and UTs, 18 have more than 25% stunted children and 16 have greater than 25% underweight ones. Meghalaya, with an increase of 2.7%, has the most (46.5%) stunted children while Bihar (42.9%) is at the second place with a 5.4% reduction during this period.
In the last five years, the Indian government has taken up some steps including the launch of the POSHAN Abhiyan, national nutrition policy and mission, new health policy and NITI Aayog’s aspirational district scheme to end hunger and malnutrition. We analysed the trend over time in child malnutrition from the NFHS-5 report based on WHO’s child growth reference standard of 2006. Only three states (Sikkim, Bihar and Manipur) showed just above 5% reduction in stunting. In the same period, stunting increased by more than 4% in seven states, which surprisingly includes Kerala and Goa, two of the states where the prevalence was lowest in NFHS-4.
Similarly, childhood underweight also increased in a majority of the states. Bihar (41%) with a reduction of 2.9% and Gujarat (39.7%) with an increase of 0.4% have the highest percentage of underweight children followed by Maharashtra (36.1%), Karnataka (32.9%) and Assam (32.8%). Only Andhra Pradesh showed a more than 5% decrease while in Nagaland, the prevalence of underweight kids increased by 10%, followed by Jammu and Kashmir (4.4%), Himachal Pradesh (4.3%) and Kerala (3.6%). Low weight and compromised immune systems result in new episodes of wasting, which is a mix of acute and chronic undernutrition.
This is considered as the worst form of child malnutrition. Economically better-off states like Maharashtra and Gujarat have more than a quarter of under-five wasted children. West Bengal and Maharashtra showed no improvement while in 12 other states, the cases of wasting increased between a range of 1.4% to 8.2%. A more distressing point is that the percentage of overweight children is on the rise, with a significant increase between NFHS-4 and NFHS-5. Except Kerala and Goa, the proportion of overweight children is increasing in other states even with very high prevalence of child undernutrition. The simultaneous increase in both undernutrition as well as overnutrition is very disturbing because till now the major challenge was to tackle the former.
Hence, India is off the track in fulfilling the target of Sustainable Development Goals (SDGs) related to child undernutrition because the progress on infant mortality and anaemia is also quite slow and not promising. It is extremely worrying that with the persistent child undernutrition, child and adult overweight is increasing. Covid-19 is also a huge catastrophe on human life, including the economic state, health and well-being of the people. The crisis upended life rapidly in a way that was never seen in past epidemics. India’s food insecurity was in a dire situation well before Covid-19. The Global Hunger Index (GHI-2020) put India in the serious food insecurity category and ranked it 94 out of 117 countries, below its neighbouring nations Pakistan, Bangladesh, Nepal and Sri Lanka.
The loss of livelihood of millions of people during the pandemic has aggravated this problem. Further, the currently released report does not cover the larger states where prevalence of child malnutrition was very high in 2015-16 as per NFHS-4 data (i.e. Uttar Pradesh, Madhya Pradesh, Rajasthan, Jharkhand and Odisha) and where massive reverse migration took place during Covid-19. The economic slowdown and shocks experienced in the last five years might have been partially, if not fully, responsible for such an undesirable progress on child malnutrition.
The virus has halted the functioning of ICDS, child immunisation and mid-day meal scheme in schools, which would have adverse impacts on child and maternal health as well as nutritional outcomes.
The figures are based on the survey conducted well before the outbreak of the health crisis. What is worrying is that the Covid-induced lockdown has worsened the existing economic distress, inequality, and food and nutrition insecurity.
All this signals the need for an urgent commitment to address the issue. Therefore, a large-scale survey representing the diverse population must be implemented by the government. Only after that can researchers, policymakers and different stakeholders analyse the impact of the virus on education, employment, health, nutrition and food security. India needs to intensify its nutrition-related action (i.e. both supplementary nutrition and nutrition-sensitive interventions) with a more inclusive approach considering both undernutrition and overnutrition .
Mukesh Kumar
Research Scholar, Dept of Humanities and Social Sciences, IIT Roorkee
Pratap C Mohanty
Assistant Professor of Economics, IIT Roorkee
(Views are based on our analysis of the recently released NFHS-5 data and are personal)
(pratap.mohanty@hs.iitr.ac.in)