Lok Sabha Question No. 228 (STARRED), answered on 2020-03-06
Subject: Malnutrition and Stunting among Children
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Suresh Kodikunnil

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

## LOK SABHA STARRED QUESTION NO. 228 TO BE ANSWERED ON THE 6 TH MARCH, 2020 MALNUTRITION AND STU NTING AMONG CHILDREN

## *228. SHRI KODIKUNNIL SURESH:

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

- (a) whether as per the National Family H ealth Survey (NFHS) IV around 38.4 percent of children under 5 years of age are stunted in th e country and there has been anincrease in childhood wastin g in 10 years, from 19.8 per cent to 21 per cent with a cute malnutrition rising in the country, if so, the details thereof and the reasons therefor;
- (b) the details of interventions undertaken by the Government to address this issue;
- (c)  whether  the  Gove rnment  is  further  seized  of  the fac that  Micronutrient deficiencies or 'hidden hunger' remains high in the country;
- (d)  if  so,  whe ther  the  Government  proposes  to conduct  a  study  on  th e prevalence  of  such  conditions n  the  country  by  const ituting  a  high  level committee; and
- (e) if so, the details thereof?

## THE MINISTER OF HEALTH AND FAMILY WELFARE

## ANSWER (DR. HARSH VARDHAN)

- (a)to (e) A Statement is laid on the Table of the House.

## STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION NO. 228* FOR 6 TH MARCH , 2020

(a)  to (c ) Yes. As per the National Family Health Survey (NFHS - 4) 2015 - 16, 38.4%  of  under - five  children  are  stunted  and  21%  are  wasted.  Stunting  ha reduced  from  48%  in  NFHS - 3  to  38.4%  in  NFHS - 4,  however,  wasting  has increased from 19.8% in NFHS - 3  to  21%  in  NFHS - 4.  Oneof t he  reason  for slight increase is wasting while other indicator of malnutrition which has come down in NFHS 4 has been identified as seasonality.

The Government of India has initiated various interventions to add the  issues  of  under - nutrition  in  the  country. POSHAN  (Prime  Minister 's Overarching Scheme for Holistic Nourishment) Abhiyaan as been launched to address  malnutrition  challenges  in  Indi a  by  engaging  all the  important stakeholders  through  convergence .  The  goals  of  POSHAN  Abhiyaan  is  to prevent  and  reduce  stunting,  underweight  and  low  birth  weight  by  2%  p annum and the reduction of anaemia by 3% per annum.

The Government of India has als o launched several schemes under the aegis  of  Ministry  of  Women  and  Child  Development  (MWCD)  to  tackle  the malnutrition  in  the  country  including  Aanganwadi  Services,  Schemes  f Adolescent Girls (SAG) and Pradhan Mantri Matru Vandana Yojna (PMMVY) to impro ve the nutritional and health status of children in the age group - 6 yrs.  The  Anganwadi  services  scheme  provide  a  package  of  six  servic including Supplementary Nutrition, Pre School Non Formal Education, Nutrition and Health Education, Immunization, Health Checkups and Referral Services.

In addition to aforementioned interventions, Reproductive, Maternal, Newb Child, Adolescent Health and Nutrition (RMNCAH+N) under National Health Mission  (NHM)  is  also  implemented  to  reduce  malnutrition  across  th e  life cycle. The details of various health and nutrition interventions under National Health Mission (NHM) are as follows:

- Early  initiation,  Exclusive  breastfeeding  for first  six  months  and Complementary Feeding are important for the prevention of malnut rition in  under  five  children.    The  Mothers'  Absolute  Affection  (MAA) program is being implemented to promote age appropriate IYCF practice while  capacitating  health  care  providers  at  the  facility  and  commu level as well as awareness generation of the mothers and care providers through mother's meeting,
- Home Based Care for Young Children (HBYC) has been initiated 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  counselling  and  breastfeeding  promotion  till month of life.
- Sick children with Severe Acute Malnutrition (SAM) are being treat and  managed  for  medical  complications  at  special  units  called Nutrition Rehabilitation Centres (N RCs), set up at public health facilities.
- Universal Immunization Programme (UIP) is being supported to provide vaccination to children against life threatening diseases suc Tuberculosis, Diphtheria, Pertusis, Polio, Tetanus, Hepatitis B, Mea Rubella, Pneumonia and Meningitis caused by Haemophilus Influenzae B. The Rotavirus vaccination has also been rolled out in the countr prevention  of  Rotaviral  diarrhoea.  Mission  Indradhanush  is  targete immunize  children  who  are  either  unvaccinated  or partially  vaccinated i.e.  those  that  have  not  been  covered  during  the  rounds  of  rou immunization for various reasons.
- Biannual Vitamin A supplementation (VAS) roundsare being conducted for children from 9 months to 5 yr. of age group.
- National De - worming Day is being implemented as a fixed day strategy to administer Albendazole tablets to all the children in the age grou -19 years through the platform of AWCs and schools for good nutrition outcomes and prevention of anaemia.
- Prevention of childhood illness such as diarrheal diseases which in tu prevents childhood malnutrition. Control of childhood diarrhoea is b carried out by conducting annual Intensified Diarrhoea Control Fortn (IDCF) and Defeat Diarrhoea Initiative.
- 'Anemia  Mukt  Bharat  (AMB)' for  supplementation  and  treatment  of anaemia  in  children,  adolescents,  pregnant  and  lactating  women,  a women of reproductive age group in programme mode through life cycle approach. This involves bi - weekly IFA syrup supplementation to c hildren 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 fo provision of maternal a nd child health services and creating awareness on maternal  and  child  care  in  convergence  with  Ministry  of  Women  and Child  Development.  Health  and  nutrition  education  through  mass  an

social  media  is  also  promoted  to  improve  healthy  practices  and genera te demand for service uptake.

- Mother and Child Protection Card is the joint initiative of the Ministry Health  &  Family  welfare  and  the  Ministry  of  Woman  and  Child Development  to  addresses  the  nutrition  concerns  in  children,  pregn women and lactating mothers.
- Under 'Rastriya Bal Swasthya Karyakaram' (RBSK) children of 0 - 18 years  of  age  are  screened  for  selected  health  conditions  classifie 4Ds -Diseases, Deficiencies, Defects and Developmental delays including  screening  for  Severe  Acute  Mal - nut rition  and  provides  free referral and treatment facilities for identified children.
- The  Government  is  also  promoting  the  use  of  fortified  wheat  flo fortified  rice,  fortified  oil  and  double  fortified  salt  in  publi supplementary nutrition programm es.

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

(d) &(e) TheMinistry of Health and Family Welfare (MoHFW), Government of India with support from UNICEF has already conducted the Comprehensive National Nutrition Survey (CNNS), during 2016 - 18 in 30 States, covering the age group of 0 - 19 yrs. The objective of the CNNS was to assess the levels of under - nutrition, micronutrient level and Non Communicable Diseases (NCDs) related risk factors in the children and adolescents.

The CNNS result indicate improvement in stunting from 38.4% to 34.7%, wasting from 21.0% to 17.3% and underweight from 35.7% to 33.4% among children below five years of age in comparison to NFHS IV. The deficiency various micronutrients namely Vitamin A , Vitamin D, B12, Zinc, Iron and folic acid was also noted and this ranged from 13.8% to 31.8% in under five chil

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