Malnutrition Among Indian Children

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 (contd.)

• 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