Assessing progress on the coverage of interventions in the first 1000 days in India: Role of national programs

Abstract

Background High coverage of nutrition-specific interventions is critical to meet global nutrition targets, and it is imperative to understand how to attain it. We examined trends and inequalities in the coverage of interventions in India and the role of the National Nutrition Mission (NNM) in achieving improvements. Methods We conducted trends and equity analysis of 30 interventions using two rounds of National Family Health Survey data (2015-2016, n=1 78 874, and 2019-2021, n=1 70 697). We also compared coverage between states that received incentives and monitoring under NNM and those that did not. We reviewed programme documents and grey literature to construct a policy timeline to trace pathways to coverage improvement and consulted with stakeholders to confirm interpretation of findings. Findings Between 2016 and 2021, coverage improved significantly for nearly all interventions (∼1-22 percentage points (pp) during pregnancy, ∼7-20 pp during delivery/postpartum and∼5-17 pp during early childhood). Improvements in coverage were higher among the poor and in rural areas compared with the rich and in urban areas, respectively; wealth and residence gaps narrowed for most interventions. These improvements could be traced to community mobilisation, technology and monitoring under NNM. Improvements in coverage of growth monitoring and counselling were higher in states that received additional incentives and monitoring under NNM. Stakeholders concurred that the improvements in coverage were likely driven by NNM. Interpretation Focused policy attention and programmatic efforts improved coverage and reduced inequities indicating an inclusive approach. Persistent coverage gaps for certain interventions require further inquiry.