Lok Sabha Question No. 1192 (UNSTARRED), answered on 2024-02-09
Subject: Study on Malnutrition among Women and Children
Ministry: WOMEN AND CHILD DEVELOPMENT
Asked by: Sanjay Haribhau Jadhav

## GOVERNMENT OF INDIA MINISTRY OF WOMEN AND CHILD DEVELOPMENT

## LOK SABHA UNSTARRED QUESTION NO. 1192

TO BE ANSWERED ON 09.02.2024

## STUDY ON MALNUTRITION AMONG WOMEN AND CHILDREN

1192.   SHRI SANJAY JADHAV:

Will the Minister of Women and Child Development be pleased to state:

- (a) whether the Government has conducted any study or survey to find out the level of malnutrition among women and children across the country;
- (b) if so, the details and the outcome thereof;
- (c) the total number of malnourished children in the country and the number among them falling in the category of more severely malnourished;
- (d) if so, the details of malnourished children in the country, State/UT-wise;
- (e) the names of districts and States in which the number of malnourished children are maximum/minimum; and
- (f) the measures taken by the Government to deal with the problem of malnutrition among the children across the country?

## ANSWER

## MINISTER OF WOMEN AND CHILD DEVELOPMENT (SHRIMATI SMRITI ZUBIN IRANI)

(a)  to  (f)  The  data  on  malnutrition  among  women  and  children  is  released  under National Family Health Survey (NFHS), which is conducted by Ministry of Health & Family Welfare. The report of NFHS-5 is available on National Family Health Survey portal  (http://rchiips.org/nfhs/factsheet\_nfhs-5.shtml).  As  per  the  report  released  by the National Family Health Survey-5 (2019-21), 18.7% of Women of reproductive age group (15-49 years) have Body Mass Index (BMI) below normal (BMI <18.5 kg/ /m 2 ) and  57%  women  of  reproductive  age  group  (15-49  years)  are  anaemic.  The  key interventions of MoHFW to improve maternal and child health, inter alia , are placed at Annexure-I.

The  indicators  for  malnutrition  like  underweight,  stunting  and  wasting  have shown a steady improvement in National Family Health Survey (NFHS) conducted by Ministry of Health & Family Welfare. As per the recent report of NFHS-5 (2019-21), the nutrition indicators for children under 5 years have improved as compared with NFHS-4 (2015-16). Stunting has reduced from 38.4% to 35.5%, while Wasting has reduced from 21.0% to 19.3% and Underweight prevalence has reduced from 35.8% to 32.1%.

As per the data of Poshan Tracker for the month of December 2023, around 7.44 crore children under 6 years were measured, out of whom 36% were found to be stunted and 17% were found to be underweight and 6% children under 5 years were found to be wasted. The levels of underweight and wasting obtained from Poshan Tracker are much less than that projected by NFHS 5.

Government reviews the performance/impact of scheme on regular basis. In addition, a third-party evaluation of all Centrally Sponsored Schemes in Women and Child  Development  Sector  including  Anganwadi  services  was  conducted  by  NITI Aayog in 2020. The evaluation found the relevance of Anganwadi Services scheme satisfactory.

In the 15th Finance Commission, components of nutritional support for children below the age of 6 years, pregnant women and lactating mother, Adolescent Girls (14 - 18 years); Early Childhood Care and Education [3-6 years]; Anganwadi infrastructure including modern, upgraded Saksham Anganwadi, POSHAN Abhiyaan and Scheme for Adolescent Girls have been reorganized under Mission Saksham Anganwadi and Poshan 2.0 (Mission Poshan 2.0). Mission Poshan 2.0 focuses on Maternal Nutrition, Infant  and  Young  Child  Feeding  Norms,  Treatment  of  MAM/SAM  and  Wellness through AYUSH practices to reduce wasting and under-weight prevalence besides stunting and anemia.

Under Mission Poshan 2.0, Supplementary nutrition is provided to beneficiaries 300 days in a year through the network of 13.97 lakh AWC located across the country for bridging the gap in the intake as compared to the recommended dietary intake. Only fortified rice is being supplied to AWCs to meet the requirement of micronutrient and control anaemia among women and children. Greater emphasis is being given on the use of millets for preparation of Hot Cooked Meal and Take Home rations (THR not raw ration) at Anganwadi centers for Children below 6 years of age, Pregnant Women, Lactating Mothers.

The objectives of Poshan 2.0 are as follows:

- To contribute to human capital development of the country;
- Address challenges of malnutrition;
- Promote nutrition awareness and good eating habits for sustainable health and well-being; and
- Address nutrition related deficiencies through key strategies.

Steps have been taken to improve nutritional quality and testing in accredited labs, strengthen delivery and leverage technology under Poshan Tracker to improve governance. States/UTs have been advised to promote use of AYUSH systems for prevention of malnutrition and related diseases. A programme to support development of  Poshan  Vatikas  at  Anganwadi  Centers  to  meet  dietary  diversity  gap  leveraging traditional knowledge in nutritional practices has also been taken up.

Under  Poshan  2.0,  one  of  the  major  activities  undertaken  is  Community Mobilization and Awareness Advocacy leading to Jan Andolan to educate the people on nutritional aspects. IEC materials in the form of videos, pamphlets, flyers etc., in regional  languages  have  also  been  developed  around  critical  themes.  Social  & Behavioral  Changes  have  been  inculcated  through  conducting  Community  Based Events, Poshan Maah and Poshan Pakhwada in convergence with various Ministries/

Departments and other stakeholders. So far, more than 90 crore sensitization activities have  been  reported  by  States/  UTs  under  community  engagements  programmes through  11  Poshan  Maahs  and  Poshan  Pakhwadas  celebrated  in  the  months  of September  and  March-April  respectively.  Community  Based  Events  (CBEs)  have served as a significant strategy in changing nutrition practices. CBEs help to celebrate critical milestones in the life of pregnant women and children below two years of age and to disseminate critical information on inter alia, right time to ensure appropriate complementary  feeding  with  diet  diversity.  Close  to  3.70  crore  Community  Based Events have been held so far.

IT systems have been leveraged to strengthen and bring about transparency in nutrition delivery support systems at the Anganwadi centres. The 'Poshan Tracker' application was rolled out on 1st March, 2021 as an important governance tool. The Poshan  Tracker  facilitates  monitoring  and  tracking  of  all  AWCs,  AWWs  and beneficiaries  on  defined  indicators.  Technology  under  Poshan  Tracker  is  being leveraged  for  dynamic  identification  of  stunting,  wasting,  under-weight  prevalence among children.

Further, under Poshan 2.0, for the first time, a digital revolution was ushered in when  the  Anganwadi  Centres  were  equipped  with  mobile  devices.  The  mobile application has also facilitated digitization and automation of physical registers used by AWWs that helps in improving their quality of work. Poshan Tracker is available in 22  languages  including  Hindi  and  English.  It  has  facilitated  near  real  time  data collection for Anganwadi Services such as, daily attendance, ECCE, Provision of Hot Cooked Meal (HCM)/Take Home Ration (THR-not raw ration), Growth Measurement etc. The App also offers counselling videos on key behaviours and services which help disseminate messages on birth preparedness, delivery, post-natal care, breastfeeding and complementary feeding. States/UTs can see their progress on various indicators on the Poshan Tracker dashboard on monthly basis and can make course correction wherever required.

In addition, Ministry of Women & Child Development and Ministry of Health & Family Welfare jointly released the protocol  for  Community  Management  of Malnutrition (CMAM) to prevent and treat severe acute malnutrition children thereby reducing associated morbidity and mortality. The community-based approach involves timely  detection  and  screening  of  children  with  severe  acute  malnutrition  in  the community, management for those without medical complications with wholesome, local  nutritious  foods  at  home  and  supportive  medical  care.  Those  malnourished children who have medical complications are referred for facility-based care.

The  States/UTs  wise  detail  of  malnourished  children  in  the  country  is  at Annexure-II. The detail of States  with maximum and minimum malnourished children is at Annexure - III. The detail of districts with maximum and minimum malnourished children is at Annexure - IV.

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ANNEXURE REFERRED IN REPLY TO PART (f) of LOK SABHA UNSTARRED QUESTION NO. 1192 FOR 9.02.2024 REGARDING 'STUDY ON MALNUTRITION AMONG WOMEN AND CHILDREN' ASKED BY SHRI SANJAY JADHAV, M.P.

Interventions of  Nutrition  Division  of  MoHFW  to  improve maternal and child health including nutritional deficiencies and anemia are:

1. Mothers' Absolute Affection (MAA) to improve breastfeeding coverage which includes early initiation of breastfeeding and exclusive breastfeeding for first six months followed by age-appropriate complementary feeding practices through capacity building of frontline health workers and comprehensive IEC campaigns.
2. Community Based care of New-born and Young Children :  Under  Home Based  New-born  Care  (HBNC)  and  Home-Based  Care  of  Young  Children (HBYC) program, home visits are performed by ASHAs to improve child rearing practices and to identify sick new-born and young children in the community.
3. Nutrition Rehabilitation Centres (NRCs) are set up at public health facilities to provide in-patient medical and nutritional care to Severe Acute Malnourished (SAM)  children  under  5  years  of  age  with  medical  complications.  Under nutritional management of SAM children admitted in NRCs, therapeutic diet is provided during Stabilization phase and during rehabilitation phase. In addition to  curative  care,  special  focus  is  given  on  timely,  adequate  and  appropriate feeding for children, correction of micronutrient deficiencies, improving the skills for  mother  and  caregivers  on  complete  age-appropriate  caring  and  feeding practices and counselling support is provided to mothers for identifying nutrition and health problems in child.
4. Anemia  Mukt  Bharat  (AMB) strategy  aims  to  reduce  anemia  among  six beneficiaries  age  group  -  children  (6-59  months),  children  (5-9  years), adolescents (10-19 years),  pregnant  and  lactating  women  and  in women  of reproductive age group (15-49 years) in life cycle approach through implementation  of  six  interventions  via  robust  institutional  mechanism.  The interventions are Prophylactic Iron and Folic Acid Supplementation; Deworming; intensified year-round Behaviour Change Communication Campaign  for  improving  Iron  and  Folic  Acid  Supplementation  and  age appropriate infant and young child feeding practices; testing of anaemia using digital methods and point of care treatment; provision of Iron and Folic Acid fortified foods with focus on harnessing locally available resources; addressing non-nutritional causes of anaemia in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis.
5.  Under National Deworming Day (NDD) albendazole tablets are administered in a single fixed day approach via schools and Anganwadi centres in two rounds (February and August) to reduce the soil transmitted helminth (STH) infestation among all children and adolescents (1-19 years).

Annexure - II

ANNEXURE REFERRED IN REPLY TO PART (c) of LOK SABHA UNSTARRED QUESTION NO. 1192 FOR 9.02.2024 REGARDING 'STUDY ON MALNUTRITION AMONG WOMEN AND CHILDREN' ASKED BY SHRI SANJAY JADHAV, M.P.

The States/UTs wise detail of malnourished children in the country is as follows*:

| State                              |   Prevalence Stunting |   Prevalence Wasting |   of Prevalence Underweight | of   |
|------------------------------------|-----------------------|----------------------|-----------------------------|------|
| Andhra Pradesh                     |                 18.05 |                 4.72 |                        8.18 |      |
| Arunachal Pradesh                  |                 30.06 |                 4.39 |                        9.58 |      |
| Assam                              |                 40.29 |                 4.92 |                       16.43 |      |
| Bihar                              |                 41.43 |                10.15 |                       23.61 |      |
| Chhattisgarh                       |                 30.27 |                10.43 |                       14.82 |      |
| Goa                                |                 18.22 |                 2.03 |                        5.55 |      |
| Gujarat                            |                 44.65 |                 8.29 |                       20.69 |      |
| Haryana                            |                 26.29 |                 5.29 |                        8.41 |      |
| Himachal Pradesh                   |                 20.27 |                 1.96 |                        6.38 |      |
| Jharkhand                          |                 40.51 |                 7.91 |                       18.66 |      |
| Karnataka                          |                 39.81 |                 7.05 |                       17.13 |      |
| Kerala                             |                 31.82 |                 3.21 |                        9.52 |      |
| Madhya Pradesh                     |                 40.47 |                 6.95 |                       22.48 |      |
| Maharashtra                        |                 44.67 |                 5.35 |                       15.16 |      |
| Manipur                            |                 15.43 |                 1.29 |                        7.8  |      |
| Meghalaya                          |                 23.39 |                 1.36 |                        5.68 |      |
| Mizoram                            |                 23.86 |                 2.95 |                        5.05 |      |
| Nagaland                           |                 25.61 |                 4.43 |                        6.68 |      |
| Odisha                             |                 35.36 |                 3.43 |                       14.68 |      |
| Punjab                             |                 17.67 |                 4.41 |                        6.88 |      |
| Rajasthan                          |                 37.09 |                 7.42 |                       17.47 |      |
| Sikkim                             |                 12.7  |                 2.4  |                        2.4  |      |
| Tamil Nadu                         |                 14.89 |                 4.14 |                        7.42 |      |
| Telangana                          |                 29.9  |                 4.27 |                       12.79 |      |
| Tripura                            |                 37.95 |                 7.2  |                       15.61 |      |
| Uttar Pradesh                      |                 46.41 |                 5.32 |                       19.5  |      |
| Uttarakhand                        |                 34.47 |                 6.15 |                        8.61 |      |
| West Bengal                        |                 38.44 |                 8.31 |                       12.57 |      |
| Andaman & Nicobar Islands          |                 19.47 |                 4.78 |                        8.11 |      |
| Dadra & Nagar Haveli - Daman & Diu |                 47.15 |                11.05 |                       32.32 |      |
| Delhi                              |                 36.52 |                 2.89 |                       17.67 |      |
| J&K                                |                 16.57 |                 2.14 |                        4.71 |      |
| Ladakh                             |                 15.1  |                 1.02 |                        3.15 |      |
| Lakshadweep                        |                 41.26 |                13.04 |                       25.6  |      |
| Puducherry                         |                 29.7  |                 7.67 |                       11.41 |      |
| UT-Chandigarh                      |                 27.82 |                 0.45 |                        8.73 |      |

As per data available on Poshan Tracker (Dec 2023)

## Annexure-III

ANNEXURE REFERRED IN REPLY TO PART (e) of LOK SABHA UNSTARRED QUESTION NO. 1192 FOR 9.02.2024 REGARDING 'STUDY ON MALNUTRITION AMONG WOMEN AND CHILDREN' ASKED BY SHRI SANJAY JADHAV, M.P.

The detail of States  with maximum and minimum malnourished children is as follows*.

| State maximum stunted children   | with State with maximum wasted children   | State with maximum underweight children   | State with minimum stunted children   | State with minimum wasted children   | State with minimum underweight children   |
|----------------------------------|-------------------------------------------|-------------------------------------------|---------------------------------------|--------------------------------------|-------------------------------------------|
| Uttar Pradesh (46.41%)           | Chhattisgarh (10.43%)                     | Bihar (23.61%)                            | Sikkim (12.7%)                        | Manipur (1.29%)                      | Sikkim (2.4%)                             |

* The details have been taken from Poshan Tracker (Dec 2023)

Annexure - IV ANNEXURE REFERRED IN REPLY TO PART (e) of LOK SABHA UNSTARRED QUESTION NO. 1192 FOR 9.02.2024 REGARDING 'STUDY ON MALNUTRITION AMONG WOMEN AND CHILDREN' ASKED BY SHRI SANJAY JADHAV, M.P. The  detail  of  districts  with  maximum  and  minimum  malnourished  children  is  as follows*:

| District with maximum stunted children   | District with maximum wasted children   | District with maximum underweight children   | District minimum stunted children   | with District with minimum wasted children   | District with minimum underweight children   |
|------------------------------------------|-----------------------------------------|----------------------------------------------|-------------------------------------|----------------------------------------------|----------------------------------------------|
| Nandurbar (78%)                          | Banka (20%)                             | Tamenglong (62%)                             | Pathankot (2%)                      | South West Khasi Hills (1%)                  | Pathankot (1%)                               |

* The details have been taken from Poshan Tracker (Dec 2023)

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