WHAT LIES AT THE ROOT OF CHILD UNDERNUTRITION IN INDIA?
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On World Food Day, we are pleased to release a Data Note summarizing some of the major underlying determinants of maternal and child undernutrition. Efforts to address undernutrition must ensure they address these determinants through program and policies that tackle poverty, food insecurity, sanitation, and gender. Adequate food, good health and optimal care are the most proximal determinants of child nutrition. In India, two major government-run programs, the Integrated Child Development Services and the National Health Mission, deliver interventions that support these determinants. However, there is more to it than what meets the eye. In a recently produced Data Note, researchers at the International Food Policy Research Institute have pointed to some of the underlying and basic determinants of undernutrition at the household and community level, including parental education, women’s status, household food security, hygiene and socio-economic conditions.
This Data Note, “What lies at the root of child undernutrition in India? Understanding trends and patterns in underlying determinants between 2006 and 2016”, describes the key trends and patterns in some of these underlying determinants in India. It summarizes state and district data from the third and fourth rounds of India’s National Family Health Surveys (2006 & 2016). While this is pre-COVID-19 era data, it provides a snapshot of the trends and patterns of the underlying determinants and is indicative of the situation to expect during and beyond the pandemic.
Please download and explore this Data Note to look at the key findings related to the district-wise percentage of women (20-24 years old) married after the age of 18, women and men (15-49 years old) with at least 10 years schooling, households with electricity, an improved drinking water source, using improved sanitation facilities, and reporting no open defecation. It also shows trends in the status of these underlying determinants of child undernutrition in India, between 2006 and 2016.
The Note presents a set of recommendations for addressing the underlying causes to improve child undernutrition in India, particularly in the areas of education, age at marriage and household facilities in terms of water, hygiene and sanitation.
Education: It is a matter of grave concern that overall, the proportion of women and men in India with at least ten years of schooling was less than 50 percent in 2016. In the current context of COVID-19, when schools are being closed and education is moving toward digital platforms, there is a heightened risk that poorer children will be left behind. Hence, there is an urgent need to ensure that the solutions and adaptations are inclusive for all. It is imperative to ensure that the digital divide does not widen the education gap among different social and geographical strata.
Age at marriage: Despite the legal mandate for minimum age at marriage, even in 2016 almost 1 in 4 women were married before the age of 18. Interventions are needed to support delayed marriage and first childbirth to ensure improved maternal and child nutrition. There is a need for:
- Interventions to support education for girls and livelihoods for women, including unconditional cash transfers, cash transfers conditional on school enrolment or attendance, school vouchers, life-skills curriculum and livelihood training.
- Interventions to address other reasons for early marriage, including addressing safety and security for girls and young women, implementing existing legal acts related to dowry and early marriage and mobilizing a wide range of stakeholders, including the youth.
While it is not known how the girls’ age at marriage will be affected in the context of COVID-19 pandemic, it is important not to lose focus on it, given its crucial link to undernutrition.
Water, hygiene and sanitation: As per the National Annual Rural Sanitation Survey 2017-18, 77 percent of households in India were found to have access to toilets. In 2019, 95 percent of districts (709 out of 739 districts) in India were declared Open Defecation Free (Department of Drinking Water & Sanitation, 2019). While it is important to ensure that households are using an improved sanitation facility across all states, the following considerations are essential:
- Construction of improved sanitation facilities must be accompanied with behavior change communication to ensure their usage.
- Provision of sanitation facilities should be coupled with ensuring adequate water resources for maintaining the hygiene and sanitation of such facilities.
The social movements related to hygiene in the context of COVID-19 could be leveraged on to further behavior change for improved sanitation to support nutrition and other health outcomes.
The nutrition community in India has expressed its commitment to accelerate efforts during the current COVID-19 crisis to address food security and safeguard access to primary health care, safe drinking water, environment, household sanitation and address gender issues pertaining to women’s education and delaying age of conception. Evidence from successful nutrition cases outside and within India highlights that these underlying determinants are essential for driving successful declines in undernutrition. Hence it is essential not to lose sight of what lies at the root of child undernutrition and stay focused on addressing the underlying determinants so that the present generation of children, and those born into a post-COVID-19 world, are protected from malnutrition. Read more about it in the Data Note on "What lies at the root of child undernutrition in India? Understanding trends and patterns in underlying determinants between 2006 and 2016”.
