Lok Sabha Question No. 4006 (UNSTARRED), answered on 2021-03-19
Subject: Stunting/Malnutrition/Mortality among Children
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Vishnu Dutt Sharma, M. K. Raghavan

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

## LOK SABHA UNSTARRED QUESTI ON NO. 4006 TO BE ANSWERED ON 19 TH MARCH, 2021

## STUNTING/MALNUTRITIO N/MORTALITY AMONG CH ILDREN

## 4006. SHRI VISHNU DATT SHA RMA: SHRI M.K. RAGHAVAN:

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

(a) whether the National Family Health Survey 2019 - 20  shows  that  situation in several states including Kerala has worsened in child stunting rate, child wasting, malnutrition and mortality among children below 5 years;

- (b) if so, the details thereof;
- (c) the parameters adopted to accept the status and the statistics related to these cases during th last five years, State/UT -wise, district - wise;
- (d)  the  details  of the  long  term  adverse  effects  of hese  issues  and  the  efforts/proposals augmented to overcome this situation;
- (e) the reasons for a reversal of statistics from NFHS - 3 and NFHS- 4 in the NFHS - 5; and
- (f) the corrective measures taken by the Government in this regard?

## ANSWER

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

(a)  to (c): As per dataon nutritional indicators  under theNational  Family  Health  Surveys (NFHS), the situation of malnutrition (Stunting, wasting, underweight and mortality) among children underfive, hasimprovedinmany States. Keralahasshown adecline inunder - five child mortality rate asperNFHS - 5 (2019 - 20)in comparison toprevious roundi.e, NFHS - 4 (2015 - 16). The  State/UT - wise percentage  of  children  under  five  years  classified  as  stunted,  wast underweight and under - five mortality rates according toNFHS - 3 (2005 - 06), NFHS - 4 (2015 - 16) and NFHS - 5 (2019 - 20)aregivenatAnnexure- I& II .

(d)to(f): Government hasengaged with State Governments ona sustained basis toensure that targets are achieved. Jan Andolan and community -based events under Poshan Abhiyaan have contributed tobehavioural change on nutrition - related aspects. Besides, with a focuson health. wellness and immu nity, steps have been takentoensurenutritional quality, strengthen delivery mechanisms, introduce transparency and leverage technology for improving governance. Th

Go vernmentofIndia hasinitiated various interventions toaddress theissues ofunder - nutrition in the  country.  POSHAN  (Prime  Minister's  Overarching  Scheme  for  Holistic Nourishment) Abhiyaan has been launchedto addressmalnutrition challenges in Indiaby engagingallthe important stakeholders through convergence. The goalsofPOS HAN Abhiyan istoprevent and reducestunting. underw eightand low birth weight by 2% per annum and  the  reduction  of anaemiaby 3% perannum.

In addition toaforementioned interventions, Reproductive, Maternal, Newborn.  Child, Adolescent Health and Nutrition (RMNCAH+N) under National Health Mission (NHM) isalso implemented  to reducemalnutrition  across  the life cycle. The details of variousHealthand nutrition interventions under National Health Mission (NHM) are asfollow s:

- Ear1y initiation, Exclusive breastfeeding for first sixmonths and Complementary Feeding are  important forthe  prevention of malnutrition in  tinder  fixe  children. The Mothers' Absolute  Affection  (MAA)  program  is  being  implemented to promote  age  appropriate IYCF practices while capacitating health care providers atthe facility and community level as well as awareness  generation  of the mothers and care  providers  through  mother's meeting.
- Home Based Care for Young Children (HBYC)hasbeen initiated asan extension ofHome Based Newborn Care(HBNC) toprovidecommunity basedcareby ASHA  workers with focuson improvement in child rearing practices, nutrition counselling and breastfeed promotion till 15' h month oflife.
- Sick children withSevere Acute Malnutrition (SAM) are being treated and managed for medical complications at special units called asNutrition Rehabilitation Centres (NRCs), set up atpublic health facilities.
- BiannualVitaminA supplementation (VAS) roundsarebeingconductedforchildren from9 months to5 yr. of age group.
- National  De - worming  Day isbeing  implemented  as a  fixed  day strategy to administer Albendazole tablets toall thechildren inthe age group of1 -19 years through theplatform ofAWCs and schools forgood nutritional outcomes and prevention ofanaemia.
- Prevention ofchildhood illness such asdiarrheal diseases which inturnprevents childhood malnutrition. Control of childhood diarrhoea isbeing  carried out by  conducting  annual Intensified Diarrhoea Control Fortnight (IDCF) and Defeat Diarrhoea Initiative.
- 'Anemia MuktBharat(AMB) ' for supplementation and treatment of anaemia inchildren, adolescents,  pregnant  and  lactating  women,  and  women  of  reproductive  age  group  i programme mode through life cycle approach.
- Under 'Rastriya Bal Swasthya Karyakaram' (RBSK) children of 0 18 yearsofage are screened  for  selected  health  conditions  classified  into  4Ds - D seases,  Deficiencies, Defects and Developmental delays including screeni ng for Severe Acute Mat - nutrition and provides free r ferral and treatment facilities for identified children.
- The Government is also promoting the use of fortified wheat flour, foi4ified rice. fo oi1 and double  fortified salt in publicfunded supplementary  nutrition  programmes.  All these programs address one orother aspects related to stunting·, wastingand nutrition.

## Annexure -I

Statewise Percentageof Children  under fiveyears classified as stunted,  wa sted  and underweight for22 Phase - IStates/UTs -NFHS - 5 (2019 - 20), NFHS -4 (2015 - 16)and NFHS -3 (2005 - 06)

|                          | Children under 5 years who arestunted (height - for - age)(%)   | Children under 5 years who arestunted (height - for - age)(%)   | Children under 5 years who arestunted (height - for - age)(%)   | Children under5 years who arewasted (weight - for - height) (%)   | Children under5 years who arewasted (weight - for - height) (%)   | Children under5 years who arewasted (weight - for - height) (%)   | Children under 5 years who areunderweight (weight -for - age)(%)   | Children under 5 years who areunderweight (weight -for - age)(%)   | Children under 5 years who areunderweight (weight -for - age)(%)   |
|--------------------------|-----------------------------------------------------------------|-----------------------------------------------------------------|-----------------------------------------------------------------|-------------------------------------------------------------------|-------------------------------------------------------------------|-------------------------------------------------------------------|--------------------------------------------------------------------|--------------------------------------------------------------------|--------------------------------------------------------------------|
| State/ Union             | NFHS - (2019- 20)                                               | NFHS 2015- 16)                                                  | - NFHS - 3(2005- 06)                                            | NFHS - 5 (2019- 20)                                               | NFHS - 4 (2015- 16)                                               | NFHS - 3(2005- 06)                                                | NFHS - 5 (2019 -20)                                                | NFHS - 4 (2015- 16)                                                | NFHS - 3(2005-06)                                                  |
| Territory Andhra Pradesh | 31.2                                                            | 31.4                                                            | NA                                                              | 16.1                                                              | 17.2                                                              | NA                                                                | 29.6                                                               | 31.9                                                               | NA                                                                 |
| Assam                    | 35.3                                                            | 36.4                                                            | 46.5                                                            | 21. 7                                                             | 17                                                                | 13.7                                                              | 32.8                                                               | 29.8                                                               | 36.4                                                               |
| Bihar                    | 42.9                                                            | 48.3                                                            | 55.6                                                            | 22.9                                                              | 20.8                                                              | 27.1                                                              | 41                                                                 | 43.9                                                               | 55.9                                                               |
| Goa                      | 25.8                                                            | 20.1                                                            | 25.6                                                            | 19.1                                                              | 21.9                                                              | 14.1                                                              | 24                                                                 | 23.8                                                               | 25                                                                 |
| Gujarat                  | 39                                                              | 38.5                                                            | 5l.7                                                            | 25.1                                                              | 26.4                                                              | 18.7                                                              | 39.7                                                               | 39.3                                                               | 44.6                                                               |
| HimachalPradesh          | 30.8                                                            | 26. 3                                                           | 38.6                                                            | 17.4                                                              | 13.7                                                              | 19.3                                                              | 25.5                                                               | 21.2                                                               | 36.5                                                               |
| Karnataka                | 35.4                                                            | 36.2                                                            | 43.7                                                            | 19.5                                                              | 26.1                                                              | 1 7.6                                                             | 32.9                                                               | 35.2                                                               | 37.6                                                               |
| Kerala                   | 23.4                                                            | 19.7                                                            | 24.5                                                            | 15.8                                                              | 15.7                                                              | 15.9                                                              | 19.7                                                               | 16.1                                                               | 22.9                                                               |
| Maharashtra              | 35.2                                                            | 34.4                                                            | 46.3                                                            | 25.6                                                              | 25.6                                                              | 16.5                                                              | 36.1                                                               | 36                                                                 | 37                                                                 |
| Man i pur                | 23.4                                                            | 28.9                                                            | 35.6                                                            | 9.9                                                               | 6.8                                                               | 9                                                                 | 13.3                                                               | I3.8                                                               | 22. 1                                                              |
| Meghala5 a               | 46.5                                                            | 43.8                                                            | 55.1                                                            | 12. 1                                                             | 15.3                                                              | 30.7                                                              | 26.6                                                               | 28.9                                                               | 48.8                                                               |
| Mizoram                  | 28.9                                                            | 28.1                                                            | 39.8                                                            | 9.8                                                               | 6.1                                                               | 9                                                                 | 12.7                                                               | 12                                                                 | 19.9                                                               |
| Nagaland                 | 32.7                                                            | 28.6                                                            | 38.8                                                            | 19. 1                                                             | 11.3                                                              | 13.3                                                              | 26.9                                                               | 16.7                                                               | 25.2                                                               |
| Sikkim                   | 22.3                                                            | 29.6                                                            | 38.3                                                            | 13.7                                                              | l4.2                                                              | 9.7                                                               | 13. 1                                                              | 14.2                                                               | 19.7                                                               |
| Telangana                | 33.1                                                            | 28                                                              | NA                                                              | 21. 7                                                             | 18                                                                | NA                                                                | 31.8                                                               | 28.3                                                               | NA                                                                 |
| Tripura                  | 32.3                                                            | 24.3                                                            | 35.7                                                            | 18.2                                                              | 16.8                                                              | 24.6                                                              | 25.6                                                               | 24.1                                                               | 39.6                                                               |
| West Bengal              | 33.8                                                            | 32.5                                                            | 44.6                                                            | 20.3                                                              | 20.3                                                              | 16.9                                                              | 32.2                                                               | 31.5                                                               | 38.7                                                               |
| A&N Islands              | 22.5                                                            | 23.3                                                            | NA                                                              | 16                                                                | 18.9                                                              | NA                                                                | 23.7                                                               | 21.5                                                               | NA                                                                 |
| DNH & DD                 | 39.4                                                            | 37.2                                                            | NA                                                              | 21.1                                                              | 26.7                                                              | NA                                                                | 38.7                                                               | 35.8                                                               | NA                                                                 |
| Ja mm u & Kashmir        | 26.9                                                            | 27.4                                                            | NA                                                              | 19                                                                | 12.2                                                              | NA                                                                | 21                                                                 | 16.6                                                               | NA                                                                 |
| Ladakh                   | 30.5                                                            | 30.9                                                            | NA                                                              | 17.5                                                              | 9.3                                                               | NA                                                                | 20.4                                                               | 18.7                                                               | NA                                                                 |
| Lakshadweep              | 3.2                                                             | 26.8                                                            | NA                                                              | 1 7.4                                                             | 13.7                                                              | NA                                                                | 25.8                                                               | 23.6                                                               | NA                                                                 |

Note:  For  Dadra  &  Nagar  Haveli  and  Daman  &  Diu  (DNH&DD),  Jammu  and Kashmir and Ladakh whose administrative bound aries have been modified recently, the estimates have been taken from the state/ UT factsheets of NFHS - 5. NA: Not Available.

## Annexure - II

## State wiseUnder- five mortality rates for 22 Phase - IStates/UTs -NFHS - 5 (2019 - 20), NFHS - 4 (2015- 16)and NFHS - 3 (2005 - 06)

| S.No.   | States/UTs                          | NFHS - 5 (2019-20)   | NFHS - 4 (2015-16)   | NFHS - 3 (2005-06)   |
|---------|-------------------------------------|----------------------|----------------------|----------------------|
| 1       | Andaman & NicobarIslands            | (24.5)               | 13.0                 | NA                   |
| 2       | Andhra Pradesh                      | 35.2                 | 40.8                 | 63.2                 |
| 3       | Assam                               | 39.1                 | 56.5                 | 85                   |
| 4       | Bihar                               | 56.4                 | 58.1                 | 84.8                 |
| S       | Dadra & Nagar Haveliand Daman & Diu | 37                   | 39.9                 | NA                   |
| 6       | Goa                                 | (10.6)               | (12.9)               | 20.3                 |
| 7       | Gujarat                             | 37.6                 | 43.5                 | 60.9                 |
| 8       | Himachal Pradesh                    | 28.9                 | 37.6                 | 41.5                 |
| 9       | Jammu & Kashmir                     | 18.5                 | 37.6                 | NA                   |
| 10      | Karnataka                           | 29.5                 | 31.5                 | 54.7                 |
| 11      | Kerala                              | 5.2                  | 7.1                  | 16.3                 |
| 12      | Ladakh                              | 29.5                 | 40.6                 | NA                   |
| 13      | Lakshadweep                         | (0.0)                | (30.2)               | NA                   |
| 14      | Maharashtra                         | 28                   | 28.7                 | 46.7                 |
| 15      | Manipur                             | 30                   | 25.9                 | 41.3                 |
| 16      | Meghalaya                           | 40                   | 39.6                 | 70.5                 |
| 17      | Mizoram                             | 24                   | 46                   | 52.9                 |
| 18      | Nagaland                            | 33                   | 37.5                 | 64.7                 |
| 19      | Sikkim                              | 11.2                 | 32.2                 | 40.1                 |
| 20      | Telangana                           | 29.4                 | 31.7                 | NA                   |
| 21      | Tripura                             | 43.3                 | 32.7                 | 59.2                 |
| 22      | West Bengal                         | 25.4                 | 31.8                 | 59.6                 |

NA: Not Available