The persistent problem of malnutrition in India

Abstract

India contributes to about a third of the total number of the under-nourished in the world. Generally, under-nutrition is assessed as under-weight or stunting and/or wasting. The Periodic surveys by the National Nutrition Monitoring Bureau (NNMB) and the National Family Health Survey (NFHS) reveal unacceptably high prevalence of under-weight and stunting among Indian children of 0-59 months of age. About 19% Indian children are born with low birth weight (<2500 g) due to chronic maternal under-nutrition. About a third of the rural adults also have chronic energy deficiency (BMI <18.5). Anaemia, as assessed by low haemoglobin, is widespread among the vulnerable segments of population. Calorie inadequacy, with or without protein inadequacy, is the predominant dietary problem and a large majority of individuals consume less than 70% of the recommended dietary allowance of micronutrients. Though the periodic surveys by NNMB and/or NFHS indicate gradual reduction in under-nutrition over time, its prevalence is unacceptably high. However, all the nutrient intakes show a decline over the last four decades. Even if India achieves the WHO Assembly's first of the six global nutrition targets of 40% reduction by 2025 in the extent of stunted in under-5 children, unacceptably high proportion of one in four children might still be stunted. Nutritional anaemia and sub-clinical vitamin A deficiency are widespread. Deficiencies of other micronutrients like riboflavin, folic acid, vitamin B12 and vitamin D are also rampant. Among the adults, while there is a gradual reduction in chronic energy deficiency over the four decade follow-up period, there is also a gradual increase in overweight and obesity. Substantial increases in economic growth experienced over the past two decades did not translate into a similar substantial reduction in under-nutrition, perhaps due to unequal economic growth excluding the poor. Nutrition-sensitive interventions and programmes in agriculture, social safety nets, early child development, education, women's empowerment and access to safe drinking water and sanitation have enormous potential to scale-up and enhance the effectiveness of nutrition-specific interventions.