WHA TARGETS ON NUTRITION: WHERE DOES INDIA STAND?
In 2012, the World Health Assembly unanimously endorsed a set of six global nutrition targets to be achieved by 2025 in order to improve maternal, infant and young child nutrition across the world (see left). These targets were further endorsed as part of the Sustainable Development Goals in 2015.
This week, as India marks National Nutrition Week, it is important to take stock of the country’s progress on the six global nutrition targets. Despite known data challenges that we have highlighted previously, it is essential to assess whether India’s efforts on improving nutrition are leading to change.
With caveats about potential data comparability, we compile and compare data from multiple data sources (National Family Health Survey rounds 3 (NFHS3, 2006) and 4 (NFHS 4, 2015) and the Rapid Survey on Children (RSOC, 2014). Our aim is to highlight and strengthen awareness about these indicators and the targets set for change.
What are the global targets?
The global targets (see above) are ambitious and intended to spur the urgent action necessary to prevent the unnecessary loss of human potential due to poor nutrition. Depending on the current status of these indicators, countries must set the same ambitious targets for themselves – at the national and subnational level.
Where does India stand on these target indicators?
Prevalence levels of the six WHA indicators for maternal and child nutritionare still high in India. India’s investments in actions to reduce these forms of malnutrition are especially important to achieve the global targets that India and other countries are now signatory to (see below).
How have these target indicators changed over time? And what does that mean for change in the future?
During the eight year period between NFHS3 and RSoC, under-5 stunting reduced by 9 percentage points, low birth weight by 3 percentage points, exclusive breastfeeding improved by 19 percentage points, and child wasting reduced by five percentage points. This is definitely a mix of good news, and not-so-good news. The stunting reductions are impressive, and as our work with collaborators at the Public Health Foundation of India on the India Health Report and with others on the Global Nutrition Report has shown, the reductions in some states in India parallel or exceed those seen in some of the leading countries for stunting declines. Breastfeeding gains are also impressive. Childhood wasting and low birth weight, however, remain areas of challenge, where declines have been less impressive. Little is known about where India currently stands on overweight or anemia at the national level because data are not available yet on these indicators.
What do the latest data from the National Family Health Survey-4 say about states across India?
The NFHS4 was carried out between 2014 and 2015, just two years after the WHA targets were announced. Although NFHS4 fact sheets are now available for 18 states, these fact sheets do not provide data on low birth weight and childhood overweight. Thus, our ability to review state-level progress on all WHA indicators remains limited until more detailed factsheets or reports are available.
Nevertheless, a review of the available fact sheets for these 18 states shows that although all states have witnessed a reduction in stunting rates between 2006 and 2015, levels remain high in several states – e.g., Bihar has the highest rate of under-5 stunting (48.3 percent). Goa, at the other end, has 20.1 percent.
Anemia in women of reproductive age has declined in most states; however, it has increased in Haryana, Meghalaya and Tamil Nadu between 2006 and 2015. Again, as with stunting, despite the declining prevalence of anemia in most states, prevalence levels remain very high in most states.
The story is more cheerful for exclusively breastfeeding. Fifteen of 18 states for which NFHS4 data is available have already achieved the WHA target of at least 50% exclusive breastfeeding. Meghalaya, Puducherry and Tamil Nadu are three states which are yet to reach the 50 per cent target, though. Still, there is no rest for the weary - Karnataka and West Bengal, which have already achieved the target, saw declines in breastfeeding between 2006 and 2015.
On wasting, there is little good news from the NFHS4; many states in India seem to have seen an increase in stunting rather than a decrease. Manipur with a prevalence of 6.8 percent, is the only state which is close to the target, with the prevalence in all other states being more than 14 percent.
What do findings on these targets mean for action?
To end hunger, achieve food security and improve nutrition by 2030 (United Nations, 2015), India needs to set a national target for all indicators, and engage productively with all states to support state-level target-setting and prioritization of critical policy actions for all WHA targets. State level target-setting, leadership to steer policy and strategy formulation, adequate financing for nutrition, and strong implementation with an equity lens are all crucial given the stark differences in the performance of different states. In this context, we cannot help but call out the limited availability of data on all WHA indicators at the national- and state-level. These data gaps are a fundamental challenge to benchmark and accelerate progress on all WHA target indicators. As national and statel-level nutrition strategies are developed and implementation unfolds, adequate, high-quality comparable data should be a non-negotiable accompanying investment.
Wondering how YOUR state is performing? Look no further! Click the image below.
