Key Findings from the National Family Health Survey-5 (NFHS-5)
The National Family Health Survey-5 (NFHS-5), covering the period 2019-2021, is the most recent large-scale national health data available and serves as a crucial benchmark for evaluating India's nutritional progress. The report reveals a complex situation, with notable reductions in stunting and underweight but a more concerning stagnation and, in some cases, increase in child wasting. The data offers a pre-COVID-19 pandemic baseline, against which future impacts will be measured.
Child Malnutrition Indicators
- Stunting (low height-for-age): The prevalence of stunting among children under five years of age decreased from 38.4% in NFHS-4 (2015-16) to 35.5% in NFHS-5. While this signifies a positive trend, the number remains high, with India still home to a third of the world's stunted children.
- Wasting (low weight-for-height): The national average for child wasting saw a slight decrease from 21.0% to 19.3% between NFHS-4 and NFHS-5. However, the Global Hunger Index 2023 highlights India's child wasting rate (at 18.7%) as the highest in the world, indicating a severe issue that remains a major public health emergency.
- Underweight (low weight-for-age): Overall underweight prevalence among children under five years dropped from 35.7% to 32.1%.
- Severe Acute Malnutrition (SAM): The prevalence of SAM among preschool children remains an alarming 7.7% and has worsened in several districts, including identified malnutrition hotspots. Some districts, particularly in Bihar, Gujarat, Maharashtra, and Uttar Pradesh, have shown a critical increase in SAM prevalence.
Adult Nutrition and Anemia
The NFHS-5 data also revealed significant nutritional issues among adults, particularly women. The prevalence of anemia is a major concern, affecting a staggering 57.0% of women aged 15-49 years and 67.1% of children aged 6-59 months. This reflects the intergenerational cycle of malnutrition, where undernourished girls become anemic women who then give birth to undernourished children.
Comparison of NFHS-4 (2015-16) vs. NFHS-5 (2019-21)
| Indicator | NFHS-4 (2015-16) | NFHS-5 (2019-21) | Percentage Change |
|---|---|---|---|
| Stunting (Children Under 5) | 38.4% | 35.5% | -2.9% |
| Wasting (Children Under 5) | 21.0% | 19.3% | -1.7% |
| Underweight (Children Under 5) | 35.7% | 32.1% | -3.6% |
| Severe Acute Malnutrition (Children Under 5) | 7.5% | 7.7% | +0.2% |
| Anemia (Women 15-49) | 53.1% | 57.0% | +3.9% |
| Overweight/Obesity (Women 15-49) | 20.6% | 24.0% | +3.4% |
Major Drivers of Malnutrition in India
Reports consistently identify a number of interconnected factors contributing to India's persistent malnutrition problem. These are often rooted in broader socioeconomic and systemic issues.
- Socioeconomic Inequality and Poverty: Access to nutritious food is significantly impacted by economic status, with the poorest households suffering from higher rates of malnutrition. The Multidimensional Poverty Index 2023 noted that 13.5 crore people in India are still under the poverty line.
- Inadequate Sanitation and Hygiene: Poor sanitation practices, including open defecation, and limited access to clean water increase the risk of infectious diseases like diarrhea, which directly contribute to undernutrition by impairing nutrient absorption.
- Gender Discrimination: Socio-cultural factors often lead to discriminatory feeding practices where girls and women receive less nutrition. This perpetuates an intergenerational cycle, as undernourished girls grow into undernourished women who are more likely to have malnourished children.
- Dietary Shifts: While food production has increased, there is a lack of dietary diversity, with a heavy focus on staple grains over nutrient-rich foods. The shift towards processed and high-sugar foods also contributes to the 'double burden' of malnutrition, where undernutrition coexists with overweight and obesity.
Government Efforts and Programmatic Gaps
In response to these challenges, the Government of India has launched and strengthened several initiatives aimed at improving nutritional outcomes. However, reports highlight ongoing implementation hurdles.
POSHAN Abhiyaan (National Nutrition Mission): This flagship program utilizes an ICT-based monitoring system and aims to improve nutrition for women, mothers, and children. However, reports have pointed out significant challenges, including under-reporting of malnutrition cases by frontline workers due to pressure and inadequate capacity-building. Only 37% of allocated funds were spent in the initial phase (2017-2019).
Integrated Child Development Services (ICDS): Anganwadi centres are the cornerstone of the ICDS program, providing supplementary nutrition and health services. Yet, effectiveness is hampered by issues such as insufficient infrastructure, governance failures, and the limited reach to marginalized communities.
Community-Based Management of Acute Malnutrition (CMAM): While CMAM has shown effectiveness in treating uncomplicated SAM, coverage remains low, with recent data suggesting only 20% of children needing treatment are covered. Strengthening this community-level approach is crucial for wider impact.
The Way Forward
While India has made commendable progress in some areas of malnutrition reduction, the latest reports highlight that the pace of improvement is too slow and uneven. The persistence of child wasting, the stagnation of Severe Acute Malnutrition rates, and the continuing high prevalence of anemia underscore the urgent need for comprehensive and robust action. A holistic approach that addresses the multi-faceted determinants—from socioeconomic factors and sanitation to gender inequality and programmatic implementation gaps—is essential. Strengthening frontline workers, improving real-time monitoring, ensuring equitable resource allocation, and focusing on community-based interventions are critical next steps to accelerate progress towards India's nutrition targets.
For more detailed information, the NITI Aayog's official reports on child nutrition provide in-depth analysis and policy recommendations.
