Lok Sabha Question No. 999 (UNSTARRED), answered on 2020-09-18
Subject: Malnutrition
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Rajyavardhan Singh Rathore

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 999 TO BE ANSWERED ON 18 TH SEPTEMBER, 2020

## MALNUTRITION

## 999. COL. RAJYAVARDH AN RATHORE:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) the details of initiatives taken to address the malnutrition rate in the country, pursuant to the implementation of National Health Policy and National Nutrition Strategy;
- (b)  whether  the  Government  proposes  t o  eradicate/ reduce  all  forms  of  malnutrition  by  2030 under  National Health  Policy  and  National  Nutrition  Strategy,  if  so,  the strategy  in  place  to achieve this goal;
- (c) the details of progress made and targets achieved in t e implementation of such init iatives State/UT - wisealong with the district - wise details for the State of Rajasthan;
- (d)  whether  the  Government  has  issued/framed  any specific  local  guidelines  regarding  the nutritional value of v arious food items, based on the variation in the food being consumed by different  communities  within  the country,  if  so,  the  details  thereof,  State/UT - wise  including Rajasthan; and
- (e)  the  details  of  initiatives  introduced  since  the COVID - 19  pandemic  to  address  the  unique challenges posed by the pandemic?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

(a) & (b). The National Nutrition Strategy (NNS) released by NITI Aayog in September, 2 focuses  on  preventing  and  reducing  under - nutrition  across  the life  cycle.  Most  of  the recommendations presented in the strategy document have been subsumed within the design POSHAN (Prime Minister Overarching Scheme for Holistic Nourishment) Abhiyaan launched by Government of India in 2018.

The targets  of  POSHAN  Abhiyaan  are  to  reduce  stunting,  underweight  and  low  birth weight by 2% per annum and the reduction of Anemia by 3% per annum.

National Health Policy, 2017 envisages 40% reduction in prevalence of stunting in un -five children by 20 25 as a cross sectoral goal.

POSHAN Abhiyaan provides an overarching framework to improve overall malnutrtion level  by  leverging  funds,  functionaries,  technical  resources  and  IEC  activities  from programme  and  schemes  such  as  Integrated  Child  Deve lopment  Services  (ICDS),  Pradhan Mantri  Matru  Vandana  Yojana  (PMMVY),  National  Health  Mission  (NHM),  Swacch  Bharat Mission (SBM), National Rural Livelihood Mission (NRLM), Mahatma Gandhi National Rural Employment  Gurantee  Assurance  (MNREGA)  and  Public  Dist ribution  System.  In  addition, various  welfare  schemes  are  being  implemented  which  help  in  improving  the  nutritio indicators  of  vulnerable  population  such  as:  Annapurna  Scheme  for  the  seniour  citize Emergency  Feeding  Programmes. Awareness  generation activities  such  as  'Eat  Right  India' campaign and nutrition counselling through various plateforms are als being promoted.

(c).  As  per  the  report  of  Comprehensive  National  Nutrition  Survey  (CNNS)  condcuted  in States  during  2016 - 18,  prevalence  of  stu nting  and  underweight  among  under - five  children  is 34.7% and 33.4% respectively, which is an improvement and reduction from the levels repo in National Family Health Survey - 4, which were 38.4% and 35.7% respectively. For the State of Rajasthan the decl ine in stunting and underweight in under -five children are 39.1% to 36.8% and 36.7% to 31.5% respectively. TheState - wise details are annexed. The district wise detailsare not available in CNNS report.

(d). National Institute of Nutrition, Indian Council of Medical Research (ICMR) has published Indian Food Composition Tables in 2017. These tables provides nutritional information on discrete  food  components  for  528  key  foods  with  widest  possible  coverage  of  nutrient bioactive components of key foods representing all major food groups. The sampling design was geographically well dispersed and statistically representative with respect to region and Overall, 107 districts out of the total 630 districts representing 17% of the country a ed for the collection of key foods for analysis. The national sampling plan addresses the k identified in the Indian food supply but does not include food specific to the sub - population of the country. Hence, the details regarding variation in food consumed by various communities is not available.

(e). During the COVID -19 pandemic, there have also been challenges in service delivery of I supplementation  in  school  going  children  and  distribution  of  IFA  tablets  to  out  of adolescent  girls,  pre gnant  and  lactating  mothers  at  VHSNDs.  Similarly,  service  delivery  i campaign approach for different activities such as National Deworming Day (NDD), Intensi Diarrhoea Control Fortnight (IDCF) and Vitamin A Supplementation programmes were also got aff ected.

In order to address these challenges, the MoHFW has issued guidance notes to all States and UTs regarding ' Enabling Delivery of Essential Health Services during the COVID 19 Outbreak '  on  14 th April,  2020  and  'Provision  of  Reproductive,  Maternal ,  Newborn,  Child, Adolescent Health plus Nutrition services during and post COVID -19 pandemic' on 24 th May, 2020 for continuation of service delivery amid COVID - 19 pandemic.

As  per  these  guidance  notes,  the  States  and  UTs  have  been  advised  to  ensure  ho distribution of Iron Folic Acid supplementation to the target age groups i.e. Pre - school Children

6- 59 months, Children 5 - 9 years, adolescents 10 -19 years, Pregnant and lactat ing Women in the containment zones.

In  non - containment  zones,  it  has  been  advised  to  undertake  distribution  of  I supplements through the VHSNDs to be held in the staggered manner while ensuring all personal  protective  measures  and  physical  distancin g  norms  by  the  frontline  workers  i.e. ASHAs/ANMs/AWWs.

Similarly, to ensure continuous nutritional support to Anganwadi beneficiar Anganwadi  Workers  and  Helpers  have  been  distributing  supplementary  Nutrition  at  th doorsteps  of  the  beneficiaries.  Furth er,  Ministry  of  Women  Child  Development  has  issued necessary directions to the States/UTs to ensure distribution of food items and nutritio by Anganwadi workers, once in 15 days, at the doorstep of beneficiaries.

……

State/UT wise percentage of stunting, w asting and underweight in under - five children  as  per  Nation al  Family  Health  Survey  (NFHS -4,  2015 - 16)  and Comprehensive national Nutrition Survey (CNNS, 2016 - 18)

| S.No   | State/UT          | Stunting   | Stunting   | Underweight   | Underweight   |
|--------|-------------------|------------|------------|---------------|---------------|
| S.No   | State/UT          | NFHS - 4   | CNNS       | NFHS - 4      | CNNS          |
|        | India             | 38.4       | 34.7       | 35.7          | 33.4          |
| 1      | Delhi             | 31.9       | 28.8       | 27.0          | 28.1          |
| 2      | Haryana           | 34.0       | 34.9       | 29.4          | 28.8          |
| 3      | Himachal Pradesh  | 26.3       | 28.4       | 21.2          | 22.6          |
| 4      | Jammu & Kashmir   | 27.4       | 15.5       | 16.6          | 13.1          |
| 5      | Punjab            | 25.7       | 24.3       | 21.6          | 19.7          |
| 6      | Rajasthan         | 39.1       | 36.8       | 36.7          | 31.5          |
| 7      | Uttarakhand       | 33.5       | 29.9       | 26.6          | 18.7          |
| 8      | Chhattisgarh      | 37.6       | 35.4       | 37.7          | 40.0          |
| 9      | Madhya Pradesh    | 42.0       | 39.5       | 42.8          | 38.7          |
| 10     | Uttar Pradesh     | 46.2       | 38.8       | 39.5          | 36.8          |
| 11     | Bihar             | 48.3       | 42.0       | 43.9          | 38.7          |
| 12     | Jharkhand         | 45.3       | 36.2       | 47.8          | 42.9          |
| 13     | Odisha            | 34.1       | 29.1       | 34.4          | 29.2          |
| 14     | West Bengal       | 32.5       | 25.3       | 31.5          | 30.9          |
| 15     | Arunachal Pradesh | 29.3       | 28.0       | 19.4          | 15.5          |
| 16     | Assam             | 36.4       | 32.4       | 29.8          | 29.4          |
| 17     | Manipur           | 28.9       | 28.9       | 13.8          | 13.0          |
| 18     | Meghalaya         | 43.8       | 40.4       | 28.9          | 29.6          |
| 19     | Mizoram           | 28.1       | 27.4       | 12            | 11.3          |
| 20     | Nagaland          | 28.6       | 26.2       | 16.7          | 16.3          |
| 21     | Sikkim            | 29.6       | 21.8       | 14.2          | 10.9          |
| 22     | Tripura           | 24.3       | 31.9       | 24.1          | 23.8          |
| 23     | Goa               | 20.1       | 19.6       | 23.8          | 20.3          |
| 24     | Gujarat           | 38.5       | 39.1       | 39.3          | 34.3          |
| 25     | Maharashtra       | 34.4       | 34.1       | 36            | 30.9          |
| 26     | Andhra Pradesh    | 31.4       | 31.5       | 31.9          | 33.5          |
| 27     | Karnataka         | 36.2       | 32.5       | 35.2          | 32.4          |
| 28     | Kerala            | 19.7       | 20.5       | 16.1          | 18.7          |
| 29     | Tamil Nadu        | 27.1       | 19.7       | 23.8          | 23.5          |
| 30     | Telangana         | 28.0       | 29.3       | 28.3          | 30.8          |