Lok Sabha Question No. 955 (UNSTARRED), answered on 2020-02-07
Subject: Dual Problem of Malnutrition and Obesity
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Sanjay Sadashivrao Mandlik, Sudheer Gupta, Gajanan Chandrakant Kirtikar, Bidyut Baran Mahato, Shrirang Appa Barne

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

## LOK SABHA UNSTARRED QUESTION NO. 955 TO BE ANSWERED ON 07 TH FEBRUARY, 20 20

## DUAL PROBLEM OF MALN UTRITION AND OBESITY

## 955. SHRI SANJAY SADASHIV RAO MANDLIK:

SHRI SUDHEER GUPTA:

SHRI GAJANAN KIRTIKAR:

SHRI BIDYUT BARAN MAHATO:

SHRI SHRIRANG APPA BARNE:

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

- (a) whether as per a recent report of Lancet Journal the dual problem of malnutrition and o has increased remarkably in the Indian household during the last two decades;
- (b)  if  so,  the  details  thereof  and  the  reasons  for  the  same  along  with  the  respons e Government thereto;
- (c) whether bone infection is increasing among the malnourished children due to which chi are becoming vulnerable to disability and if so, the details thereof;
- (d) whether the Government has prepared any plan to bring out the Indian household particularly poor ones from this double burden of malnutrition and obesity, if so, the details thereof;
- (e) the funds spent during the last decade for the schemes being run by the Ministry to malnutrition and obesity, State/UT - wise; and
- (f) the further measures taken by the Government to make the country free from malnutriti obesity?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

(SHRI ASHWINI KUMAR CHOUBEY)

(a)& (b): As per the burden of child and maternal malnutrition and trends in its indicato states  of  India:  the  Global  Burden  of  Disease  Study  1990 - 2017  by India  state - Level  Disease Burden Initiative Malnutrition Collaborators, published in The lancet in December, 2019, the prevalence of stunting in children upto 5 years of age is 39.3%, wasting 15.7%, underwei 32.7%. and the prevalence of overweight in children aged 2 - 4  years is 11.5% suggesting dual burden of malnutrition.

The major reason of t he dual burden of malnutrition are  inappropriate child feeding practi worm infestation intake of junk food and drinks, lack of physical activities, high fat die

The Government of India has launched POSHAN (Prime Minister Overarching Scheme for  Holistic  Nourishment)  Abhiyaan,  to  address  malnutrition  in  India  through  converge behaviour  change,  IEC  advocacy,  training  and  capacity  building,  innovations  and  dema generation.  POSHAN  Abhiyaan  focuses  on  educating  families  on  the  need  for  nutrition  a motivating  them  on  adopting  these  into  their  behaviour.  The  promotion  of  locally  ava nutritious food through various community based events (CBEs), exhibitions, r allies, workshops and  meetings  is  one  of  the  strategy  under  the  POSHAN  Abhiyaan. Anaemia  Mukt  Bharat (AMB)  strategy,  Defeat  Diarrhea  (D - 2)  initiative  and  Home  Based  Care  of  Young  Children (HBYC) are the important components of the POSHAN Abhiyaan implement ed by the MoHFW.

(c): Although malnourished children are more vulnerable than normal children to any infec including bone infection due to lower immunity, there is no data to substantiate increase infection  among  malnourished  children  due  to  w hich  children  are  becoming  vulnerable  to disability.

(d):  The  Government  of  India  has  already  launched  POSHAN  (Prime  Minister  Overarching Scheme for Holistic Nourishment) Abhiyaan to improve nutritional status in the country.

Ministry of Health and fa mily Welfare has also initiated various advocacy and awareness campaigns including the 'Eat Right India' Campaign, which is built on the two broad pillars of 'Eat Healthy' and 'Eat Safe'. This aims to engage, excite and enable citizens to impr health and wellbeing.

Village  Health  Sanitation  and  Nutrition  Day  (VHSND)  platform  is  being  used  fo creating community awareness on importance of balanced and healthy diet, and bringing des changes in the dietary practices through group counselling ses sions.

The Government is also promoting use of fortified wheat flour, fortified rice, fort and double fortified salt in public funded supplementary nutrition programmes.

In order to prevent and control major Non Communicable Diseases (NCDs) the National Programme for Prevention of Control of Cancer, Diabetes, Cardiovascular Diseases and Str is being implemented in all the States/UTs. Under NPCDCS, NCD cell have been established National, State and District levels for programme management, a nd NCD clinics are being set up at District and block levels, to provide services for early diagnosis, treatment and fol - up for common NCDs. Health promotion through behavior change with involvement of community, civil society, community based organizat ion, schools and media etc is an important activity. The role of physical activities in health promotion and prevention of NCDs is also being ado key strategy.

Reproductive, Maternal, Newborn, Child Adolescent health and Nutrition (RMNCAH+N) under National Health Mission (NHM) is also implemented to reduce malnutrition across the cycle. The detail of various health and nutrition interventions under National Health Missio (NHM) is as follows:

- Promotion  of  Institutional  deliveries  through cash  incentive  under  Janani  Suraksha Yojana  (JSY)  and  Janani  Shishu  Suraksha  Karyakaram  (JSSK)  which  entitles  all pregnant  women  delivering  in  public  health  institutions  to  absolutely  free  de including Caesarean section, post - natal care and treatment of sick infants till one year of age.  Pradhan  Mantri  Matru  Vandana  Yojana  (PMMVY)  is  another  maternity  benefit programme under which cash incentive of Rs. 5000 is provided to pregnant women and lactating mothers.
- Early initiation and exclusive breastfeedi ng for first six months and appropriate Infant and  Young  Child  Feeding  (IYCF)  practices  are  promoted  under  Mothers'  Absolute Affection (MAA) in convergence with Ministry of Women and Child Development.
- Home  Based  Care  for  Young  Children  (HBYC)  has  been  in itiated  as  an  extension  of Home  Based  Newborn  Care  (HBNC)  to  provide  community  based  care  by  ASHA workers with focus on improvement in child rearing practices, nutrition counsellin breastfeeding promotion till 15th month of life.
- Treatment of sick ch ildren with Severe Acute Malnutrition (SAM) at special units calle the Nutrition Rehabilitation Centres (NRCs), set up at public health facilities.
- Universal Immunization Programme (UIP) is being supported to provide vaccination t children  against  life thr atening  diseases  such  as  Tuberculosis,  Diphtheria,  Pertusi Polio,  Tetanus,  Hepatitis  B,  Measles,  Rubella,  Pneumonia  and  Meningitis  caused Haemophilus  Influenzae  B.  The  Rotavirus  vaccination  has  also  been  rolled  out  in country  for  prevention  of Rotaviral  diarrhoea.  Mission  Indradhanush  is  targeted  to immunize children who are either unvaccinated or partially vaccinated i.e. those th not been covered during the rounds of routine immunization for various reasons.
- Vitamin A supplementation ( VAS) for children till the age of 5 years.
- National De -worming Day as a fixed day strategy to administer Albendazole tablets to the children in the age group of 1 - 19 years through the platform of AWCs and schools for good nutritional outcomes and preve ntion of anaemia.
- Prevention  of  childhood  illness  such  as  diarrheal  diseases  which  in  turn  pre childhood malnutrition. Control of childhood diarrhoea is being carried out by condu annual Intensified Diarrhoea Control Fortnight (IDCF) and Defeat Diarrhoea Initiative.
- 'Anemia Mukt Bharat (AMB)' for supplementation and treatment of anaemia in children, adolescents,  pregnant  and  lactating  women,  and  women  of  reproductive  age  group  i programme  mode  through  life  cycle  approach.  This  involves,  bi - weekly  IFA  syrup supplementation  to  children  6 -59  months,  weekly  IFA  tablet  supplementation  to children 5 -10 years and adolescents 10 -19 years, and IFA tablets to pregnant and lactating women.
- Village Health Sanitation and Nutrition Days (VHSNDs) are observed for provision of maternal and child health services and creating awareness on maternal and child ca convergence  with  Ministry  of  Women  and  Child  Development.  Health  and  nutrition education through mass and social media is also promoted to imp rove healthy practices and to generate demand for service uptake.
- Mother  and  Child  Protection  Card is  the  joint  initiative  of  the  Ministry  of  Health Family welfare and the Ministry of Woman and Child Development which addresses the nutrition concerns in ch ldren, pregnant women and lactating mothers.
- Under 'Rastriya Bal Swasthya Karyakaram' (RBSK) children of 0 -18 years of age are screened  for  selected  health  conditions  classified  into  4Ds -Diseases,  Deficiencies, Defects and Developmental delays incl uding screening for Severe Acute Mal - nutrition and provides free referral and treatment facilities for identified children.
- The Government is also promoting use of fortified wheat flour, fortified rice, fort and double fortified salt in public fun ded supplementary nutrition programmes.

All these programs address one or other aspects related to nutrition and have the potential to improve nutritional outcomes in the country.

(e): The fund spent in the schemes which have direct bearing in reductio n of malnutrition like Micronutrient  Supplementation  Programme  (MSP),  Infant  and  Young  Child  Feeding  (IYCF) practices, Nutrition Rehabilitation Centres (NRCs) and Diarrhoea Control activities dur last decade by the Ministry is annexed.

(f): The Government is undertaking various measures and POSHAN Abhiyaan is implemented as  a  convergent  mission.  The  goals  of  POSHAN  Abhiyaan  are  to  achieve  improvement  in nutritional status of Children from 0 - 6 years, Adolescent Girls, Pregnant Women and Lactating Mothers in a time bound manner.

The target of POSHAN Abhiyaan are as under:

|   S.No | Objective                                                                                        | Target          |
|--------|--------------------------------------------------------------------------------------------------|-----------------|
|      1 | Prevent and reduce Stunting in children (0-6 years)                                              | @ 2% p.a.       |
|      2 | Prevent and reduce under - nutrition (underweight prevalence) in children (0 - 6 years)          | @ 2% p.a.       |
|      3 | Reduce the prevalence of anaemia among Children(6 - 59 months)                                   | young @ 3% p.a. |
|      4 | Reduce the prevalence of anaemia among Women Adolescent Girls in the age group of 15 - 49 years. | and @ 3% p.a.   |
|      5 | Reduce Low Birth Weight (LBW).                                                                   | @ 2% p.a        |

## Annexure

## State/UT- wise Funds spent (In lakhs) in Micronutrient Supplementation Programmes, Infant and Young Child Feeding (IYCF) practices, Nutrition Rehabilitation Centres (NRCs) and Diarrhoea Control activities in the last decade (2009 - 10 to 2018- 19)

| S.No.                     | Name of the State/UTs     | 2009- 10                  | 2010- 11                  | 2011- 12                  | 2012- 13                  | 2013- 14                  | 2014- 15                  | 2015- 16                  | 2016- 17                  | 2017- 18                  | 2018- 19                  |
|---------------------------|---------------------------|---------------------------|---------------------------|---------------------------|---------------------------|---------------------------|---------------------------|---------------------------|---------------------------|---------------------------|---------------------------|
| A. High Focus States      | A. High Focus States      | A. High Focus States      | A. High Focus States      | A. High Focus States      | A. High Focus States      | A. High Focus States      | A. High Focus States      | A. High Focus States      | A. High Focus States      | A. High Focus States      | A. High Focus States      |
| 1                         | Bihar                     | 34.79                     | 41.45                     | 469.52                    | 1009.30                   | 2049.37                   | 675.15                    | 437.29                    | 540.98                    | 1007.20                   | 515.55                    |
| 2                         | Chhattisgarh              | 44.37                     | 159.74                    | 174.92                    | 217.87                    | 362.34                    | 298.99                    | 393.30                    | 451.02                    | 534.06                    | 544.97                    |
| 3                         | Himachal Pradesh          | 0.90                      | 0.00                      | 0.00                      | 25.00                     | 0.00                      | 0.07                      | 20.64                     | 34.83                     | 14.10                     | 7.81                      |
| 4                         | Jammu & Kashmir           | 0.26                      | 20.95                     | 55.53                     | 6.35                      | 29.21                     | 12.54                     | 27.32                     | 24.57                     | 71.98                     | 30.45                     |
| 5                         | Jharkhand                 | 28.18                     | 115.35                    | 201.68                    | 207.33                    | 399.34                    | 484.83                    | 565.24                    | 436.14                    | 419.70                    | 685.61                    |
| 6                         | Madhya Pradesh            | 1572.43                   | 1939.24                   | 1667.88                   | 1745.90                   | 2637.80                   | 1815.16                   | 1907.71                   | 2854.19                   | 2657.04                   | 2668.95                   |
| 7                         | Orissa                    | 354.54                    | 365.47                    | 107.49                    | 315.34                    | 124.28                    | 281.24                    | 194.58                    | 247.63                    | 306.46                    | 1040.53                   |
| 8                         | Rajasthan                 | 6.09                      | 168.08                    | 172.95                    | 256.89                    | 111.20                    | 205.92                    | 390.16                    | 437.15                    | 302.23                    | 460.25                    |
| 9                         | Uttar Pradesh             | 211.20                    | 154.58                    | 19.85                     | 76.15                     | 129.42                    | 189.39                    | 570.83                    | 1004.69                   | 980.34                    | 714.33                    |
| 10                        | Uttarakhand               | 0.00                      | 0.00                      | 0.00                      | 23.17                     | 0.00                      | 9.63                      | 19.39                     | 59.36                     | 30.55                     | 157.03                    |
|                           | Sub Total                 | 2252.76                   | 2964.86                   | 2869.82                   | 3883.30                   | 5842.96                   | 3972.92                   | 4526.46                   | 6090.55                   | 6323.66                   | 6825.50                   |
| B. NE State s             | B. NE State s             | B. NE State s             | B. NE State s             | B. NE State s             | B. NE State s             | B. NE State s             | B. NE State s             | B. NE State s             | B. NE State s             | B. NE State s             | B. NE State s             |
| 11                        | Arunachal Pradesh         | 0.00                      | 2.07                      | 0.12                      | 2.00                      | 13.03                     | 20.08                     | 29.42                     | 118.62                    | 49.08                     | 15.45                     |
| 12                        | Assam                     | 52.53                     | 35.20                     | 65.65                     | 50.59                     | 92.33                     | 75.49                     | 270.20                    | 246.69                    | 183.83                    | 209.25                    |
| 13                        | Manipur                   | 3.00                      | 9.03                      | 15.24                     | 1.18                      | 8.93                      | 110.72                    | 24.05                     | 163.63                    | 10.29                     | 99.77                     |
| 14                        | Meghalaya                 | 1.85                      | 3.17                      | 7.98                      | 8.62                      | 3.01                      | 20.44                     | 13.75                     | 68.76                     | 11.38                     | 85.13                     |
| 15                        | Mizoram                   | 0.13                      | 0.00                      | 0.91                      | 0.00                      | 47.25                     | 14.06                     | 112.42                    | 71.60                     | 4.20                      | 6.75                      |
| 16                        | Nagaland                  | 0.00                      | 0.00                      | 12.96                     | 19.76                     | 8.09                      | 4.32                      | 77.41                     | 110.79                    | 4.10                      | 87.86                     |
| 17                        | Sikkim                    | 0.54                      | 0.38                      | 0.00                      | 3.01                      | 0.00                      | 2.56                      | 8.34                      | 10.66                     | 1.83                      | 1.70                      |
| 18                        | Tripura                   | 47.67                     | 0.34                      | 18.40                     | 9.90                      | 50.52                     | 8.75                      | 52.59                     | 14.18                     | 21.31                     | 7.14                      |
|                           | Sub Total                 | 105.72                    | 50.19                     | 121.26                    | 95.05                     | 223.16                    | 256.43                    | 588.19                    | 804.92                    | 286.02                    | 513.05                    |
| C. Non- High Focus States | C. Non- High Focus States | C. Non- High Focus States | C. Non- High Focus States | C. Non- High Focus States | C. Non- High Focus States | C. Non- High Focus States | C. Non- High Focus States | C. Non- High Focus States | C. Non- High Focus States | C. Non- High Focus States | C. Non- High Focus States |
| 19                        | Andhra Pradesh            | 0.00                      | 0.00                      | 0.00                      | 80.62                     | 21.58                     | 29.20                     | 316.43                    | 279.09                    | 122.57                    | 380.00                    |
| 20                        | Goa                       | 1.30                      | 2.46                      | 107.76                    | 8.01                      | 10.25                     | 8.47                      | 0.97                      | 15.12                     | 8.24                      | 1.11                      |
| 21                        | Gujarat                   | 41.38                     | 587.13                    | 565.30                    | 750.53                    | 655.75                    | 988.83                    | 1231.48                   | 1043.31                   | 913.46                    | 926.01                    |
| 22                        | Haryana                   | 45.94                     | 2.59                      | 7.46                      | 4.34                      | 103.88                    | 130.51                    | 9.51                      | 18.31                     | 37.41                     | 512.61                    |
| 23                        | Karnataka                 | 0.00                      | 117.04                    | 23.91                     | 281.98                    | 69.77                     | 48.93                     | 73.54                     | 72.50                     | 79.56                     | 106.47                    |
| 24                        | Kerala                    | 172.22                    | 102.70                    | 18.97                     | 58.99                     | 1.91                      | 10.72                     | 3.69                      | 38.65                     | 50.29                     | 118.09                    |
| 25                        | Maharashtra               | 328.53                    | 1105.73                   | 2539.46                   | 1799.34                   | 1521.83                   | 768.28                    | 162.55                    | 201.21                    | 225.05                    | 188.34                    |
| 26                        | Punjab                    | 0.00                      | 104.62                    | 4.03                      | 92.96                     | 11.44                     | 58.76                     | 18.76                     | 49.35                     | 72.03                     | 0.69                      |
| 27                        | Tamil Nadu                | 0.00                      | 0.00                      | 0.00                      | 2.45                      | 89.73                     | 353.57                    | 53.18                     | 199.53                    | 242.32                    | 194.97                    |

| 28                  | Telangana                 | --                  | --                  | --                  | --                  | --                  | 4.38                | 45.61               | 39.85               | 123.97              | 55.67               |
|---------------------|---------------------------|---------------------|---------------------|---------------------|---------------------|---------------------|---------------------|---------------------|---------------------|---------------------|---------------------|
| 29                  | West Bengal               | 49.19               | 340.50              | 148.66              | 548.14              | 389.70              | 248.55              | 1478.36             | 893.42              | 933.68              | 1125.91             |
|                     | Sub Total                 | 638.56              | 2362.77             | 3415.55             | 3627.36             | 2875.83             | 2650.21             | 3394.07             | 2850.33             | 2808.58             | 3609.87             |
| D. Small States/UTs | D. Small States/UTs       | D. Small States/UTs | D. Small States/UTs | D. Small States/UTs | D. Small States/UTs | D. Small States/UTs | D. Small States/UTs | D. Small States/UTs | D. Small States/UTs | D. Small States/UTs | D. Small States/UTs |
| 30                  | Andaman & Nicobar Islands | 0.00                | 0.00                | 0.00                | 0.00                | 0.00                | 0.72                | 0.00                | 2.18                | 0.06                | 0.00                |
| 31                  | Chandigarh                | 9.98                | 0.00                | 0.00                | 0.01                | 0.05                | 0.21                | 0.00                | 0.00                | 0.88                | 0.21                |
| 32                  | Dadra & Nagar Haveli      | 0.00                | 0.00                | 0.00                | 2.66                | 1.74                | 1.33                | 59.20               | 0.93                | 0.26                | 0.11                |
| 33                  | Daman & Diu               | 1.24                | 0.60                | 0.00                | 0.33                | 0.00                | 0.00                | 0.00                | 0.08                | 0.00                | 1.13                |
| 34                  | Delhi                     | 11.19               | 9.69                | 3.05                | 24.40               | 2.81                | 3.51                | 4.91                | 3.78                | 4.78                | 16.42               |
| 35                  | Lakshadweep               | 0.00                | 0.00                | 0.00                | 0.00                | 0.00                | 0.00                | 0.66                | 0.97                | 1.24                | 0.00                |
| 36                  | Puducherry                | 1.38                | 1.00                | 9.29                | 3.50                | 0.80                | 0.00                | 15.00               | 24.98               | 1.40                | 13.63               |
|                     | Sub Total                 | 23.79               | 11.29               | 12.34               | 30.90               | 5.39                | 5.77                | 79.77               | 32.92               | 8.62                | 31.50               |
|                     | Grand Total               | 3020.83             | 5389.11             | 6418.98             | 7636.62             | 8947.35             | 6885.33             | 8588.49             | 9778.73             | 9426.88             | 10979.91            |

## Note:

- Expenditure includes expenditure against Central Release, State share & unspent balan the beginning of the year. It is updated upto 31 - 03- 2019, hence provisional.
- The Above Figures are as per FMR reported by State/UTs.