Distribution by demographics or socio-economic factors
- Rural (50%) vs. urban (38%)
- Girls (48.9%) vs. boys (45.5%)
- SC/ST (53-56%) vs. others (44%)
- 60% in lowest wealth quartile. Interestingly, spread among all quartiles.
- These differences widened in 1990s
Distribution by demographics or socio-economic factors (
- It is concentrated in pockets
- One in 2 children underwieght in: Maharashtra, Orissa, Bihar, Madhya Pradesh, UP and Rajasthan. Last 4 account for 43% of underweight children.
- 10% of villages account for 28% of underweight children
Micronutrient deficiencies
- Preschool children: 75% (iron) 57% (Vit.A)
- 87% of pregnant women have anemia
- Distribution across demographic and socio-economic factors similar to underweight
Has there been improvement?
- Reduction not good enough
- 11% between 92-93 and 98-99, but not comparable to countries with similar socio-economic factors
ICDS (Integrated Child Development Services)
- World's largest early child development
program - Multi-sectoral approach.
- Anganwadi centers
- Supplementary feeding, immunization, health checkups, health and nutrition education to adult women, micronutrient supplements, pre-school education, growth monitoring
- By 2004 6lakhs AWC workers, 33M children and 6M women
Impact of ICDS
- No statisticaly significant relationship
between presence of anganwdi center and nutritional status! - Covers 90% of administrative blocks
- Does not cover states where underweight is most prevalent (or is it other way around?) Growth rate higher in poorer villages
- Poorer states have lower coverage of ICDS
- A whole bunch of studies, some say it has helped, some say not.
- Another paper said it helped younger kids more than 4-6 kids.
Bright spots of ICDS
- Doing well in a bunch of states
- Synergizing with RCH (Reproductive and Child Health program)
- Different states adopt different flavors of the ICDS program
- Promoting community participation: Mothers committees, self help groups etc. are working together with the anganwadi workers in many places. Having more volunteers (change agents)
ICDS Problems
- Food and supplements delivery not proper - leakage
to non-targeted individuals, irregularity, mis-communication with parents - More focus on expanding coverage than distributing food; instead, should be on nutritional and family-based feeding/caring and educating people.
- Does not target kids nder 3, or preferentially target girls/lower income groups
- Not in proportion to magnitude of problem
- Operational challenges: workers overburdened in providing primary education also to kids aged 4-6
Determinants of nutritional status
- Food security
- Access to health resources
- Appropriate child care behavior
How to overcome these problems
- Refocus objectives: either pre-school education
or malnutrition - Emphasis on educating to improve feeding pratices, better overall health and sanitation, how to cook nutritious food in a low budget
- Work with health sector more
- Redirected to vulnerable groups (kids <>
- Mini anganwadi centres;split work into 2 roles - one for health and one for preschool education
- Improve food procurement; make it decentralized or contract
- More community based; tailored to local needs
