27-Jul-2022: Measures to Address Malnutrition 

Government has accorded high priority to the issue of malnutrition and is making serious efforts to address this issue. POSHAN Abhiyaan, a flagship scheme of the Government was launched in 2018 to address the malaise of malnutrition by adopting a synergised and result oriented approach. Further, to address various policy and systemic needs, the Integrated Child Development Scheme and Anganwadi Services schemes were re-evaluated in respect of programme design, implementation process, outcome and impact and for re-assessing the relevance of the programme in achieving its aims and goals. The efforts under the Supplementary Nutrition Programme under Anganwadi Services, Scheme for Adolescent Girls and POSHAN Abhiyaan have been re-aligned as ‘Saksham Anganwadi and POSHAN 2.0’ for maximizing nutritional outcomes. It seeks to address the challenges of malnutrition in children, adolescent girls, pregnant women and lactating mothers through a strategic shift in nutrition content and delivery and by creation of a convergent eco-system to develop and promote practices that nurture health, wellness and immunity.

POSHAN Abhiyaan aims to reduce malnutrition in the country by adopting a synergised and result oriented approach. The targets laid down under the Abhiyaan are as under:

Sl.No	Objective	Target
1.	Prevent and reduce Stunting in children (0- 6 years)	@ 2% p.a.
2.	Prevent and reduce under-nutrition (underweight prevalence) in children (0-6 years)	@ 2% p.a.
3.	Reduce the prevalence of anaemia among young Children(6-59 months)	@ 3% p.a.
4.	Reduce the prevalence of anaemia among Women and Adolescent Girls in the age group of 15-49 years.	@ 3% p.a.
5.	Reduce Low Birth Weight (LBW).	@ 2% p.a.

The estimated number of underweight, malnourished and severely malnourished children under 5 years of age is obtained under National Family Health Survey (NFHS) conducted by the Ministry of Health & Family Welfare. As per the recent report of NFHS-5 (2019-21), the nutrition indicators for children under 5 years have improved as compared with NFHS-4 (2015-16). Stunting has reduced from 38.4% to 35.5%, Wasting has reduced from 21.0% to 19.3% and Underweight prevalence has reduced from 35.8% to 32.1%. Further percentage of women (15-49 years) whose BMI is below normal has reduced from 22.9 in NFHS-4 to 18.7 in NFHS-5.

The efforts under the Supplementary Nutrition Programme under Anganwadi Services and POSHAN Abhiyaan have been rejuvenated and converged as ‘Saksham Anganwadi and POSHAN 2.0’ (Mission Poshan 2.0). It seeks to address the challenges of malnutrition in children, adolescent girls, pregnant women and lactating mothers through a strategic shift in nutrition content and delivery and by creation of a convergent eco-system to develop and promote practices that nurture health, wellness and immunity.

Poshan 2.0 shall focus on Maternal Nutrition, Infant and Young Child Feeding Norms, Treatment of MAM/SAM and Wellness through AYUSH. It will rest on the pillars of Convergence, Governance, and Capacity-building. Poshan Abhiyan will be the key pillar for Outreach and will cover innovations related to nutritional support, ICT interventions, Media Advocacy and Research, Community Outreach and Jan Andolan.

Under Poshan 2.0, focus is on diet diversity, food fortification, leveraging traditional systems of knowledge and popularizing use of millets. Nutrition awareness strategies under Poshan 2.0 aim to develop sustainable health and well-being through regional meal plans to bridge dietary gaps. Strategy of Jan Andolan, was developed to strengthen convergent actions across multiple stakeholders with focus on exclusive breast-feeding, complimentary feeding, growth monitoring, prevention of diarrhoea, hygiene, water and sanitation, anemia prevention, importance of Poshan Vatikas for cultivation of local vegetables, medicinal plants/herbs and fruits at the community level, etc. Poshan Abhiyaan has provided a strong platform for targeted home visits, community-based events (CBEs) and growth monitoring with greater emphasis placed on home visits to promote maternal, infant and young child nutrition practices. More than 40 crore activities have been carried out under Poshan Maah and Poshan Pakhwada and 3.70 lakh CBEs have been conducted since the launch of the Abhiyaan. Best practices have been disseminated through zonal work-shops to address the challenges of malnutrition.

6-Apr-2022: Malnutrition Free India

Government has accorded high priority to the issue of malnutrition and is making serious efforts to address this issue. Government implements Anganwadi Services Scheme, POSHAN Abhiyaan, Pradhan Mantri Matru Vandana Yojana and Scheme for Adolescent Girls under the Umbrella Integrated Child Development Services Scheme (ICDS) as targeted interventions for Children under 6 years, Pregnant Women and Lactating Mothers and Adolescent Girls, throughout the country. POSHAN Abhiyaan aims to reduce malnutrition in a phased manner, through a synergised and result oriented approach. Further, Mission Poshan 2.0, an integrated nutrition support programme has been announced in budget 2021-22 for all States/UTs. It seeks to strengthen nutritional content, delivery, outreach and outcomes with focus on developing practices that nurture health, wellness and immunity to disease and malnutrition. All these schemes address in one or other aspects related to nutrition and have the potential to improve nutritional outcomes in the country.

Global Hunger Index (GHI) is published by ‘Concern Worldwide & Welthungerhilfe. The GHI scores are based on the values of four component indicators, viz., Undernourishment among population, Child Wasting, Child Stunting and Child Mortality. GHI is a tool for measuring and tracking hunger at global, regional, and country levels. Global Hunger Index (GHI) does not reflect India’s true picture as it is a flawed measure of 'Hunger'. It should not be taken at face value as it is neither appropriate nor representative of hunger prevalent in a country. Out of its four indicators, only one indicator, i.e., undernourishment, is directly related to hunger. The indicator "undernourishment among population" in GHI is obtained through a gallup survey, which has completely disregarded Government’s economic response to Covid-19 of providing free food grains to 80 crore National Food Security Act beneficiaries under Pradhan Mantri Garib Kalyan Anna Yojna.

The data on nutritional indicators in the country on the other hand, is captured under the National Family Health Surveys conducted periodically by the Ministry of Health and Family Welfare. Under the Survey, the level of malnutrition among children is assessed using the WHO standards and for adults the Body Mass Index cut-offs recommended by WHO are used to assess the prevalence of under and over nutrition. Further, NFHS also provides comprehensive information on other determinants of malnutrition, viz., prevalence of micronutrient deficiencies like anaemia, food intake and infant and young child feeding and care practices including data on immunization, maternal health and nutrition, etc. The data provided by the national level survey is used to guide policies and programmes to address the nutritional challenges faced by the country.

25-Mar-2022: Initiatives To Reduce Mortalities Due To Malnutrition

There are 1080 Nutrition Rehabilitation Centres (NRCs) operational across the country. These NRCs provide medical and nutritional care of the admitted sick children with Severe Acute Malnutrition (SAM), including the tribal sick SAM children.

Government of India is taking some initiatives to reduce the mortalities due to malnutrition. Some of the key measures are as under:

1. Nutritional Rehabilitation Centre: As per Operational Guidelines on Facility Based Management of Children with Severe Acute Malnutrition released in 2011, Nutrition Rehabilitation Centre (NRC) is a unit in a health facility where children with Severe Acute Malnutrition (SAM) are admitted and managed. The unit should be a distinct area within the health facility and should be in proximity to the pediatric ward/inpatient facility.
2. Integrated Child Development Schemes (ICDS): Launched on 2nd October, 1975, the Integrated Child Development Services (ICDS) Scheme is one of the flagship programmes of the Government of India, implemented by Ministry of Women and Child Development. It is the foremost symbol of country’s commitment to its children and nursing mothers, as a response to the challenge of providing pre-school non-formal education on one hand and breaking the vicious cycle of malnutrition, morbidity, reduced learning capacity and mortality on the other. The beneficiaries under the Scheme are children in the age group of 0-6 years, pregnant women and lactating mothers.

The ICDS Scheme offers a package of six services, viz. (a) Supplementary Nutrition (b) Pre-school non-formal education (c) Nutrition & health education (d) Immunization (e) Health check-up and (f) Referral services. The last three services are majorly related to health and are financially and technically supported by Ministry/Department of Health and Family Welfare implemented through the State.

3. Poshan Abhiyan is a multi-ministerial convergence mission with the vision to ensure attainment of malnutrition free India by 2022. The objective of POSHAN Abhiyaan to reduce stunting in identified Districts of India with the highest malnutrition burden by improving utilization of key Anganwadi Services and improving the quality of Anganwadi Services delivery.

The Ministry of Women and Child Development (MWCD) is implementing POSHAN Abhiyaan in phased manner. There are a number of schemes directly/indirectly affecting the nutritional status of children (0-6 year's age) and pregnant women and lactating mothers.

4. Infant and young child feeding practices: GOI has released a guideline on Infant and young child feeding practices to improve the cognitive development, enhance weight gain and to prevent malnutrition among children. As per the guidelines for enhancing optimal infant and young child feeding practices 2013 which includes practices of initiating breast feeding within one hour of birth, exclusive breast feeding for the first 6 months of life, initiation of appropriate complementary feeding from the age of 6 months, continued breast feeding for 2 years and beyond.

Outpatient services are also provided, outpatient services of public health facilities comprising of:

• Antenatal clinic
• IYFC counselling centre
• Sick child consultation in outpatient department

5. Kangaroo Mother Care (KMC) and optimal feeding of low-birth-weight infants: Public health facilities encourage for Kangaroo Mother care and optimal feeding of low-birth-weight infants- As per Operational guidelines on Kangaroo Mother care and optimal feeding of low-birth-weight infants 2014, KMC is associated with reduced incidence of severe illness including pneumonia during infancy. In most of the studies KMC has been found to be more effective than incubator care for stable newborns in providing adequate thermal care, reducing nosocomial infections, improving exclusive breastfeeding and weight gain, and fostering greater maternal and family involvement in care.

16-Mar-2022: Malnutrition among Children

The estimated number of underweight, malnourished and severely malnourished children under 5 years of age is obtained under National Family Health Survey (NFHS) conducted by the Ministry of Health & Family Welfare. As per the recent report of NFHS-5 (2019-21), the nutrition indicators for children under 5 years have improved as compared with NFHS-4 (2015-16). Stunting has reduced from 38.4% to 35.5%, Wasting has reduced from 21.0% to 19.3% and Underweight prevalence has reduced from 35.8% to 32.1%.

Government has accorded high priority to the issue of malnutrition and is implementing several schemes like Anganwadi Services, Scheme for Adolescent Girls and Pradhan Mantri Matru Vandana Yojana (PMMVY) under the Umbrella Integrated Child Development Services (ICDS) Scheme as direct targeted interventions to address the problem of malnutrition in the country. Children with Severe Acute Malnutrition are treated at the Nutrition Rehabilitation Centres established by the Ministry of Health and Family Welfare.

Further, POSHAN Abhiyaan launched on 8th March 2018, aims to reduce malnutrition in the country by adopting a synergised and result oriented approach.

Mission Poshan 2.0, an integrated nutrition support programme has been announced in budget 2021-2022 for all States/UTs. It seeks to strengthen nutritional content, delivery, outreach and outcomes with focus on developing practices that nurture health, wellness and immunity to disease and malnutrition. Steps have been taken to improve nutritional quality and testing in accredited labs, strengthen delivery and leverage technology under Poshan Tracker to improve governance. States/UTs have been advised to promote use of AYUSH systems for prevention of malnutrition and related diseases. A programme to support development of Poshan Vatikas at Anganwadi Centres to meet dietary diversity gap leveraging traditional knowledge in nutritional practices has also been taken up. Guidelines were issued for transparency and accountability in delivery of supplementary nutrition and to track nutritional outcomes on 13.01.2021.

Top 10 and Bottom 10 Districts in Stunting

Top 10 and Bottom 10 Districts in Wasting

Top 10 and Bottom 10 Districts in Underweight

State/UT wise prevalence of Stunting, Wasting and Underweight among children under 5 years as per NFHS 5 survey

15-Dec-2021: Malnutrition-Free India

Malnourishment in children (stunting, wasting and underweight) under 5 years has reduced as per NHFS-5 (2019-21) from 38.4% to 35.5%, 21.0% to 19.3% and 35.8% to 32.1% respectively as compared to NHFS-4 (2015-16).Malnutrition among women aged 15-49 years has also reduced from 22.9% to 18.7%.

Details of funds released and utilised under POSHAN Abhiyaan & ICDS scheme from FY 2018-19 to 2020-21 are as follows:

Amount in ₹ lakhs

Government has accorded high priority to the issue of malnutrition and is implementing several schemes like Anganwadi Services, Scheme for Adolescent Girls and Pradhan Mantri Matru Vandana Yojana (PMMVY) under the Umbrella Integrated Child Development Services (ICDS) Scheme as direct targeted interventions to address the problem of malnutrition in the country.

Anganwadi Services Scheme aims to improve the nutritional and health status of pregnant women & lactating mothers and reduce the incidence of mortality, morbidity and malnutrition. Under the Scheme, pregnant women and lactating mothers are provided supplementary nutrition, nutrition and health education, immunization, health check-up and referral services.

Further, POSHAN Abhiyaan launched on 8th March 2018, aims to achieve improvement in nutritional status of Adolescent Girls, Pregnant Women and Lactating Mothers in a time bound manner by adopting a synergised and result oriented approach.

Mission Poshan 2.0, an integrated nutrition support programme has been announced in budget 2021-2022 for all States/UTs. It seeks to strengthen nutritional content, delivery, outreach and outcomes with focus on developing practices that nurture health, wellness and immunity to disease and malnutrition. Steps have been taken to improve nutritional quality and testing in accredited labs, strengthen delivery and leverage technology under Poshan Tracker to improve governance. States/UTs have been advised to promote use of AYUSH systems for prevention of malnutrition and related diseases. A programme to support development of Poshan Vatikas at Anganwadi Centres to meet dietary diversity gap leveraging traditional knowledge in nutritional practices has also been taken up. Guidelines were issued for transparency and accountability in delivery of supplementary nutrition and to track nutritional outcomes on 13.01.2021.

29-Jul-2021: Efforts to reduce Malnutrition among Women and Children

As per the report released by the National Family Health Survey-4 (2015-16), conducted by Ministry of Health & Family Welfare, prevalence of undernutrition among women is 22.9% as compared to male (20.2%), which is an improvement from the levels of 35.5% and 34.2% respectively reported in National Family Health Survey-3 conducted in 2005-06.

Women are at greater risk of malnutrition due to the increased nutritional needs associated with menstruation, pregnancy, and lactation. Women are also more exposed to risk factors for malnutrition such as HIV/AIDS, food insecurity and poverty. The nutritional status of women has major implications on the well-being and nutrition of all family members. The determinants of malnutrition are often intrinsically related to gender dynamics in households and communities. Improving gender dynamics is thus a necessity to prevent malnutrition.

The data on nutritional indicators is captured under the National Family Health Surveys conducted periodically by the Ministry of Health & Family Welfare, with International Institute for Population Sciences (IIPS) being the nodal agency for conducting the surveys using a standardized methodology.

To ensure consistent and accurate recording and reporting of the critical programme data, the Ministry has initiated efforts towards quality data collection, analysis for differential planning and supervision for improved action at community level as part of strengthening and systems quality improvement via ICT based application, Poshan Tracker. The Poshan Tracker is built on latest technology for ensuring real-time monitoring and providing real-time information relating to various parameters of service delivery and malnutrition under Mission Poshan 2.0.

Government implements Anganwadi Services Scheme, POSHAN Abhiyaan, Pradhan Mantri Matru Vandana Yojana and Scheme for Adolescent Girls under the Umbrella Integrated Child Development Services Scheme (ICDS) as targeted interventions for children upto the age of 6 years, Pregnant Women and Lactating Mothers and Adolescent Girls, throughout the country. POSHAN Abhiyaan aims to reduce malnutrition in a phased manner, through a life cycle approach, by adopting a synergised and result oriented approach. Target is to bring down stunting of children under 6 years from 38.4% to 25% by the year 2022. All these schemes address in one or other aspects related to nutrition and have the potential to improve nutritional outcomes in the country.

For alleviation of malnutrition, Government has announced Mission Poshan 2.0 to strengthen nutritional content, delivery, outreach and outcomes with focus on developing practices that nurture health, wellness and immunity to disease and malnutrition.

For greater transparency, accountability and quality in nutrition support programme and service delivery, streamlined guidelines dated 13.1.2021 have been issued to States/UTs. These guidelines emphasize on ensuring the quality of supplementary nutrition, highlights roles and responsibilities of duty holders, IT enabled data management and monitoring, leveraging of traditional knowledge through AYUSH, procurement and convergence for achieving good nutritional outcomes.