REPORTS

× India comprises one-sixth of the world’s population and one-third of the global burden of undernutrition. Between 2006 and 2016, India made progress in reducing stunting among children below five years; the progress, however, was not uniform across all its states (Menon et al. 2018). There are interstate differences in stunting reduction despite a common national policy framework for nutrition-specific and nutrition-sensitive programs. Given the paucity of insights on what factors drive successful change in nutritional outcomes such as stunting at the state level in India, we conducted studies in the four states of Chhattisgarh, Gujarat, Odisha, and Tamil Nadu. In this report, we present an analysis of the change in stunting among children less than five years of age over a 24-year period in the state of Gujarat in India. We chose to study Gujarat—along with the states of Odisha (Kohli et al. 2017) and Chhattisgarh (Kohli et al. 2020)— because between 2006 and 2016, declines in stunting in these states, in absolute terms, were higher than the national average.

× A notable approach to addressing maternal undernutrition during pregnancy in India in recent years has been the integration of hot-cooked meals (HCM) for pregnant and lactating women together with the provision of other health/nutrition services. Called the One Full Meal (OFM) program, these efforts aim to improve maternal nutrition and health across India by bundling center-based HCM with other nutrition services and behavior change communication implemented through the Integrated Child Development Services (ICDS) scheme. The program is offered at anganwadi centers (AWCs) and has been implemented in eight states in India, including Andhra Pradesh, Chhattisgarh, Gujarat, Karnataka, Maharashtra, Telangana, Madhya Pradesh, and Uttar Pradesh. Although the OFM program has been implemented since 2013, there is limited consolidated insight on its effectiveness or on broader lessons for implementation. The objectives of this evidence review of the OFM program are, therefore, to (1) compare the different state OFM program models on their objectives, implementation elements, cost norms and monitoring mechanisms; (2) develop program impact pathways on the potential ways in which the program could influence intended outcomes; and (3) examine the availability of evidence underpinning the program’s intended pathways to impact.

× India comprises one-sixth of the world’s population and one-third of the global burden of undernutrition. Between 2006 and 2016, India made progress in reducing stunting among children below five years; the progress, however, has not been uniform across all its states (Menon et al. 2018). There are interstate differences in stunting reduction despite a common national policy framework for nutrition-specific and nutrition-sensitive programs. Given the paucity of insights on what factors drive successful change in nutritional outcomes such as stunting at the state level in India, we conducted studies in the four states of Chhattisgarh, Gujarat, Odisha, and Tamil Nadu. In this report, we document the story of change in Tamil Nadu, which is one of the exemplary states in India. With a long history of nutrition and health reforms, it stands out as a leader in social development. We aimed to update prior work on Tamil Nadu to assess more recent changes in nutritional outcomes, determinants, and coverage of interventions. Our key goals were to: 1) examine changes in child stunting, known determinants of stunting and key health and nutrition interventions between 1992 and 2016; 2) assess the contribution of diverse determinants and intervention coverage changes to the changes in stunting between 2006 and 2016; and (3) interpret the changes in the context of policies, programs, and other changes in the state.

× This report explores the state of nutrition in Odisha, assesses how nutrition outcomes changed in the state, and more importantly, and examines the road that lies ahead of Odisha on the journey to support better nutrition for the state. Nutrition progress in Odisha: Odisha has made more rapid progress in reducing child undernutrition than many other richer states. Particularly between 2006 and 2016, nutrition and health outcomes improved significantly in the state. The prevalence of stunting declined from 45 percent to 34.1 percent, although there was a marginal increase in wasting from 19.6 to 20.4 percent and in severe wasting from 5.2 to 6.4 percent. In 2018, a further decline was noted in the prevalence of stunting (28.9 percent) and wasting (12.9 percent). Although anemia among women of reproductive age declined by 10 percentage points between 2006 and 2016, it is still high, with over half the women in the state suffering from anemia. Exclusive breastfeeding for children under 6 months of age is an area of progress, improving from 50.8 percent in 2006 to 65.6 percent in 2016; the prevalence of low birth weight, however, remained nearly unchanged during this period (Kohli et al. 2017). Emerging nutritional challenges, such as noncommunicable diseases, are likely to create new challenges in coming years.

× Data systems and their usage are of great significance in the process of tracking malnutrition and improving programs. The key elements of a data system for nutrition include (1) data sources such as survey and administrative data and implementation research, (2) systems and processes for data use, and (3) data stewardship across a data value chain. The nutrition data value chain includes the prioritization of indicators, data collection, curation, analysis, and translation to policy and program recommendations and evidence based decisions. Finding the right fit for nutrition information systems is important and must include neither too little nor too much data; finding the data system that is the right fit for multiple decision makers is a big challenge.
Developed together with NITI Aayog, this document covers issues that need to be considered in the strengthening of efforts to improve the availability and use of data generated through the work of POSHAN Abhiyaan, India’s National Nutrition Mission. The paper provides guidance for national-, state-, and district-level government officials and stakeholders regarding the use of data to track progress on nutrition interventions, immediate and underlying determinants, and outcomes. It examines the availability of data across a range of interventions in the POSHAN Abhiyaan framework, including population-based surveys and administrative data systems; it then makes recommendations for the improvement of data availability and use.
To improve monitoring and data use, this document focuses on three questions: what types of indicators should be used; what types of data sources can be used; and with what frequency should progress on different indicator domains be assessed.

× This report aims to provide a general overview of national trends and of state-level variability in nutrition outcomes, determinants, and intervention coverage, thus helping to identify areas of progress and areas where more investment is critical to accelerate progress. Using data available at the time of analysis and writing, the goal of this report is to bring together data to support policy decisions for nutrition at the national level and across multiple states.

× This report presents findings of a study conducted in three districts of Odisha to examine the state of delivery and use of ten select essential nutrition interventions (ENIs) and the role of intersectoral coordination in their delivery.

× In India, policies are in place to address the set of nutrition-specific interventions that will accelerate progress in nutrition, if implemented at scale. These interventions include iron and folic acid supplementation during pregnancy, breastfeeding counseling, complementary feeding counseling, vitamin A supplementation, and food supplementation for pregnant and lactating women and young children. However, systematic data on the coverage of these interventions are limited, as are insights into how best they may be designed and delivered to reach full coverage. This report presents findings of a study conducted in three districts of Madhya Pradesh to examine the state of delivery and use of ten select essential nutrition interventions (ENIs) and the role of intersectoral coordination in their delivery.

× Undernutrition imposes a staggering cost worldwide in terms of lives lost, forgone productivity, healthcare spending, and reduced lifetime earnings (Horton et al. 2010). In India, nutrition policies recognize the multifaceted nature of interventions necessary to accelerate progress in nutrition. These interventions include a set of broadly agreed upon nutrition-specific interventions such as iron and folic acid supplementation during pregnancy, breastfeeding promotion, complementary feeding education, vitamin-A supplementation in early childhood, food supplementation (Avula et al. 2013) that are to be delivered at scale to improve maternal and child nutrition. Two national programs in India—Integrated Child Development Services (ICDS) and National Rural Health Mission (NRHM)—together are designed to cover all of these nutrition-specific interventions (Avula et al. 2013).

× This paper analyzes the current nutrition situation in Uttar Pradesh and examines nutrition-related services, programs, and policies with the goal of informing strategic directions for nutrition-related policy in Uttar Pradesh. This paper uses an assessment framework that explicitly considers the biological, programmatic, and sociopolitical aspects of nutrition in Uttar Pradesh.

× The silent scourge of undernutrition and major nutritional deficiencies of public health importance persists across India despite decades of planned programmes and interventions. The maternal and child undernutrition scenario in India represents a complex set of determinants, including poverty, lack of knowledge, and access. Other factors that confound this dangerous interplay of barriers are erosion of conventional food consumption patterns exacerbated by poor hygienic practices, diseases such as malaria and diarrhoea, and lack of access to safe water and sanitation.

× This nutrition stakeholder analysis is based on data gathered through a participatory interview technique called Net-Map. Net-Map identifies key stakeholders who are relevant to an issue, maps the links among these stakeholders, and describes their power over the specific issue. It has been used widely in policy and stakeholder analyses. The Net-Map interview in Odisha was facilitated by the International Food Policy Research Institute (IFPRI), New Delhi, with support from the Department of Women and Child Development, Odisha.

× The first part of this review provides an overview of the current nutrition knowledge landscape in India based on the secondary research conducted on the existing knowledge systems and networks catering to nutrition-based information needs of policymaking audiences in India. The second section of the report shares the outcomes of face-to-face interviews conducted with the conveners of these knowledge networks. It also shares the findings from the interviews with decisionmakers and program implementers and impressions of these networks from a user perspective.

× This report summarizes all the findings of the review that was conducted over a 6-month period in 2012, placing it in the context of the macro-policy environment in India in which decisions have been, and are being, made to tackle undernutrition. An effort has been made to present the findings in such a way that the review and policy assessments can help strengthen the overall enabling environment that is required to fast-track action in India on undernutrition.

× Poshan Samvad (hereinafter referred to as “the Knowledge Forum”) is a forum of and for frontline workers who are engaged in the domain of nutrition for public health. The Knowledge Forum is aimed at enabling these workers to come together to freely share and discuss among their peer and counterpart groups their ideas, perceptions, reflections, problems, prospects, issues, and concerns pertaining to the realities of combating malnutrition. The Forum is envisaged to go a long way toward responding to their questions and concerns. The consultations at the Forum will enhance and sustain the effectiveness of service providers by providing knowledgeable, articulated insights into the immediate and perturbing challenges they often confront toward achieving an informed resolution.