Conference of
State Ministers & Secretaries
16 June 2010
Malnutrition
Ministry of Women and Child Development
Government of India
1
Nutrition: The Challenge
• Every fifth child in the world lives in India
• 22% babies are born with low birth weight
• 42.5% of children 0-5 years are underweight
• 53 out of 1000 live births do not complete their 1st year
• 79% children (6-35 months) are anaemic
• 69.5% children below 5 years are anaemic
• Inadequate focus on Early Childhood Care including IYCF
• 35.6 % women with low BMI
2
Nutrition: State-wise Status of Children
70
Children under age 5 years who are underweight (%)
60
60
56 57
50
43
41 42
40
40
40
38 38 39
37
37
36
40
45
47
49
33 33
30
30
20 20
22 23
25 25 25 26 26
20
MP
JH
BH
MG
CH
GJ
IN
UP
OR
RJ
TR
HR
WB
UT
KA
MH
HP
AS
AR
TN
DL
JK
NA
GA
PJ
KE
MN
MZ
SK
0
AP
10
NFHS 3 - % Anaemic Children 6-35 mths
100
90
80
70
60
50
40
30
20
10
BH
UP
KA
MP
HR
CG
PN
GJ
RJ
IND
AP
JH
AS
OR
TN
MH
WB
MG
JK
TR
AR
DL
UA
HP
SK
KE
MN
MZ
GO
0
BMI: State-wise Status of Women (15-49 yrs)
% Women with BMI (Below Normal)
50
45
40
35
30
25
20
15
10
5
0
Undernutrition – Causality Framework
Manifestations
Child Undernutrition
Inadequate
Dietary Intake
Lack of Household
Food Security
Disease/ Infections
Inadequate
Care for Women
Care for
Women
and and
Children
Children
Inadequate access to
Health Childcare Services &
Hygienic Environment
Immediate
determinants
Underlying
determinants
Lack of Information Education
Communication
Lack of Resources & Control
Human, Economic & Organisational
Political and Ideological Superstructure
Basic
determinants
Economic Structure
Potential resource base
Source: Adapted from UNICEF
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Cost of Malnutrition
– Malnutrition reduced India’s GDP by 3 – 9% in 1996
– Cost of treating malnutrition is 27 times more than the
investment required for its prevention
Cost of Malnutrition to the economy of a nation is
extremely high
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Source : ASCI, 1997
Nutrition and MDGs
Goal -1: Eradicate
extreme poverty
and hunger
Malnutrition erodes human capital through irreversible and
intergenerational effects on cognitive and physical
development
Goal -2: Achieve
universal primary
education
Malnutrition affects the chances that a child will go to
school, stay in school, and perform well
Goal -3: Promote
gender equality and
empower women
Anti female biases in access to food, health, and care
resources may result in malnutrition, possibly reducing
women’s access to assets. Addressing malnutrition
empowers women more than men.
Goal – 4: Reduce
child mortality
Malnutrition is directly or indirectly associated with most
child deaths, and it is the main contributor to the burden of
disease in the developing world.
Goal-5: Improve
maternal health
Maternal health is compromised by malnutrition, which is
associated with most major risk factors for maternal
mortality. Maternal stunting and iron and iodine deficiencies
particularly pose serious problems.
Goal -6: Combat
HIV/ AIDS, malaria,
and other diseases
Malnutrition may increase risk of HIV transmission,
compromise antiretroviral therapy, and hasten the onset of
full-blown AIDS and premature death. It increases the
chances of tuberculosis infection, resulting in disease, and
it also reduces malarial survival rates.
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Lancet : Maternal - Child Undernutrition
• Underlying cause of more than one-third of all child deaths < 5 yrs
• Largest Risk Factors to < 5 yrs death: Stunting, Severe Wasting & Intrauterine growth retardation
• Pregnancy to age 24 months: Critical window
PREVENTABLE THROUGH EFFECTIVE NUTRITION INTERVENTIONS
AT SCALE
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Lancet : Maternal - Child Undernutrition
• Effective interventions for maternal and child survival &
development :
– Breastfeeding & counseling,
– appropriate complementary feeding,
– vitamin A and zinc interventions (diarrohea ORS)
– Interventions to reduce iron and iodine deficiency
• 1.4 million deaths and 10 % of disease burden in <5 yrs :
due to inadequate and/ or non-exclusive breastfeeding
• 20 % of MMR: due to short stature and iron deficiency
anemia
10
National Nutrition Policy 1993 &
National Plan of Action on Nutrition 1995
• Key Areas:
(i) Food production; (ii) food supply; (iii) women and child development (iv)
health care; (v) rural development; (vi) people with special needs, (vii)
monitoring and surveillance; and (viii) information.
• Direct Nutrition Interventions:
– Ministry of Women and Child Development
• Awareness and advocacy on Nutrition (FNB)
• Integrated Child Development Services (ICDS)
• Scheme for Adolescent Girls- KSY, NPAG
– Ministry of Health and Family Welfare
• Iron and Folic Acid, Vit – A supplementation, IDD Control & deworming
– Department of Elementary Education and Literacy
• Mid-day Meal for school children
• Indirect Long -term Interventions: policy instruments leading to
institutional and structural changes
Indirect Interventions
Sector
Commitment towards Nutrition
Agriculture
Ensure National Level Food Security
Adequate Buffer Stocks
Nutritional Orientation of Agricultural Policy
Horticulture
Promote Nutrition oriented horticulture at
Community & House-hold level
Public
Distribution
of food
Ensure food & nutrition security at
household level
Education
Include Nutrition in curricula of all
educational systems – formal & non-formal
Health &
Family Welfare
Due emphasis to nutrition at all levels –
Medical Education, Training, Primary Health
Centre, Disease Surveillance
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Indirect Interventions
Sector
Rural Development
Commitment towards Nutrition
Ensure universal access to safe drinking
water and sanitation
Improve purchasing power through poverty
alleviation programs
Information &
Broadcasting
Create a climate of nutritional awareness
Launching a daily programme on “Nutrition &
Health” on Radio & TV
Women & Child
Development
Focus on eradication of malnutrition
Serve as the nodal department for
implementation of nutrition policy and
facilitating convergence of services
13
Existing Government Interventions: Life Cycle Approach
Beneficiaries
Schemes
Pregnant & Lactating
Women
ICDS, RCH-II, NRHM
Children 0-3 & 3-6 years
ICDS, RCH-II, NRHM, IMNCI
Rajiv Gandhi National Creche Scheme
Children 6-14 years
Mid Day Meals, Sarva Shiksha Abhiyan
Adolescent Girls 11-18
years
Nutrition Programme for Adolescent Girls
(NPAG), Kishori Shakti Yojana
Adults
NRHM,Food for Work, Aam Admi Bima
Yojana, NREGS, Skill Development
Mission,Women Welfare and Support
Programme, Adult Literacy Programme,
TPDS
Expanded but lagged by a decade: NRHM (2005-06), NHM (2005-06), NREGS
(2005-06), JSY (2006-07), TSC, MDM(2008-09), ICDS (2008-09), NRLM(2010-11)
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Focus on Continuum of Care in Nutrition
Approach
ICDS (PW+NM) /+ IGMSY
SABLA
MDM
ICDS
ICDS
Exclusive Breast
Feeding
0 - 6 mths
11 – 18 yrs Girls
6 – 14 yrs
3 – 6 yrs
Livelihoods + Income
IEC + BCC
6 mths – 3 yrs
Breast feeding & Complementary feeding
Flagship and Bharat Nirman Programmes
Food Security + Health Care + Water & Sanitation+ Environment
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FOUNDATION OF CHILD CARE AND DEVELOPMENT APPROACH
Core Interventions
1. Household food security and livelihood
2. Need for food supplementation programmes and Health
care
3. Strengthening & Restructuring of ICDS
4. Addressing the intergenerational cycle of adolescent,
maternal and child undernutrition
5. Policy, coordination and convergence of, nutrition
related sectors including health services and hygienic
interventions
6. Monitoring nutrition interventions
7. Capacity building
16
Focus on Key Results
•
Initiation of breastfeeding within one hour of birth
•
Exclusive breastfeeding of children upto 6 months
•
Introduction of complementary feeding upon completion of 6 months,
along with continued breastfeeding for 2 years
•
Appropriate Infant and Young Child Feeding (IYCF) practices
among children 6-24 months
•
Supplementary Nutrition through Anganwadi Centres
•
Access to care for the severely malnourished
NUTRITION STATUS OF UNDER 3s TO BE A LEAD INDICATOR FOR ALL
DEVELOPMENT PROGRAMMES
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Focus on Key Results
•
•
•
•
•
•
•
•
•
Iron supplements to children
Consumption of 100 IFA tablets by women & adolescent girls
Households with adequately iodised salt
Vitamin A supplementation every 6 months for children 9 - 59
months
Full immunization of children (BCG, Measles and three doses of
DPT and Polio)
Treatment of acute respiratory infection from health care facility
Oral rehydration therapy or increased fluids for diarrhoea treatment
Deworming of children every 6 months, if required
Safe disposal of stools
NUTRITION STATUS OF UNDER 3s TO BE A LEAD INDICATOR FOR ALL
DEVELOPMENT PROGRAMMES
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Key Actions
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Governance and Political Commitment
Implementation and Delivery
Multi Sectoral Programme Intervention
Correct Focusing
Convergence
Effective Monitoring
Community Mobilization and Participation
Communication, BCC, IEC and use of ICT
Development of a Cadre and Voluntary Action Groups of
Experts
19
Action by States
• Improving nutrition related governance of States/UTs:
– Constituting State Nutrition Council, chaired by Chief Minister
– Setting Up Interdepartmental Coordination Committee, chaired by
Chief Secretary
– District Coordination Committee, chaired by District Collector
– Establishing State Breastfeeding /Infant and Young Child Feeding
Committees, for implementing the IMS Act
• State/UT Nutrition Action Plans Mapping ‘high risk and vulnerable
districts’
– Developing Multisectoral State/ UT and District Nutrition Action
Plans (Project/ Block as a Unit)
– Creating thematic working groups on the above
– Specific Interventions for High Burden Districts
– Surveillance and Monitoring
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Action by States
• Establishing State Nutrition Resource Platform /Centres
• Behaviour Change Communication & Counselling
– State campaign
– Focus on national IYCF guidelines 2006
• Integrating and strengthening nutrition relevant actions in national/
state /district PIPs of related national flagship programmes
• Strengthening and restructuring of ICDS
• Implementation of ICDS with quality and flexibility
• Enhance community Participation through decentralisation
• Nutrition Audit of concerned sectors by third party & social audit
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THANK YOU
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