Opinion: POSHAN Abhiyaan & Beating Malnutrition — Battling The Challenge Of Stunting & Other Nutrition Issues 

India has implemented several nutrition programmes over the last 40 years, including the Integrated Child Development Services (ICDS) and the midday meal scheme. However, nutrition issues and stunting  persist, and are roadblocks to the country’s development. The return on investment in reducing stunting and wasting is manifold, $18 on every $1 invested. According to the World Bank, “A 1% loss in adult height thanks to childhood stunting is related to a 1.4% loss in economic productivity.” The high rate of anaemia among women (57% in 2019-21) poses a negative impact on their future pregnancies. The situation worsens when these infants also receive inadequate diets. 

India is ranked 111 among 125 countries assessed in the 2023 Global Hunger Index, and 116 out of 180 countries in the Human Capital Index. India also has the world’s largest number of stunted (32 million) and wasted children (20.1 million). Also, 6.7 million children reportedly have ‘Zero Food’ (haven’t eaten in the last 24 hours), according to a 2023 study in Lancet Discovery Science. Almost 19% of women and 16% of men aged 15-49 in India are underweight, and almost an identical proportion are overweight or obese (24% of women and 23% of men). The 2019 Food and Nutrition Analysis indicates a high level of stunting among children under five years (one in three children), and a double burden of malnutrition with 23% of women with low BMI (<18.5) and 21% overweight/obese (BMI>25). 

According to a study, 4.6 million cases of stunted children under five years can be prevented by scaling up several interventions. The model predicted that supplementary food provision during childhood, coupled with access to improved sanitation and water, could prevent 86.5% of stunting cases. 

While India has taken strides in reducing malnutrition, much still remains to be done before the country can achieve the global targets. The ICDS, India’s primary nutritional and child development scheme, employs a multipronged approach to children’s wellbeing by integrating health, educational, and nutritional interventions through a community network of anganwadi centres (AWCs). A study mapping the extent and equity of ICDS coverage between 2006 and 2016 indicated a substantial rise in the proportion of pregnant and lactating women and their children under five years using the programme services. 

A Worrying Cycle

Malnutrition can cause a GDP loss of 4% for India. Inadequate dietary intake is typically the cause for the poor nutritional status of girls.  Only half of all women consume a wholesome diet, with only 47% having a daily intake of green leafy vegetables, 46% consuming fruits once every week, and 45% eating pulses daily. Undernourished women will likely become undernourished mothers, with a greater chance of birthing low-birth-weight babies who are more liable to infections and growth failure. This perpetuates an intergenerational cycle of malnutrition, which is heightened by poverty, social exclusion, and gender discrimination, resulting in irreversible effects on cognitive and physical development. Evidence suggests that continued investment in areas with a high rate of early marriage and childbearing, and the subsequent eradication of adolescent pregnancy, will result in a reduced burden of undernutrition in India.

The POSHAN Abhiyaan/National Nutrition Mission, a confluence of multiple schemes and programmes launched in 2018, aimed at improving the nutritional status of children from 0-6 years, adolescent girls, pregnant women, and lactating mothers. The programme has catered to 10 crore beneficiaries through over 100 crore nutrition sensitisation activities. A better proportion of these activities are focused on overall nutrition, anaemia, hygiene (water and sanitation), breastfeeding, growth monitoring, and immunisation. These activities aim to raise awareness on good nutrition and hygiene by providing accurate information and supplements to manage undernutrition.

Covid-19 has further exacerbated the challenge of good nutrition with an extensive loss of lives and livelihood, and service disruptions due to lockdowns and other curbs. For instance, over 120 million children missed out on the midday meal and about 70 million on the supplementary food at the anganwadi centres in 2020-21. Since the launch of POSHAN Abhiyaan, many initiatives have been started — IMPAct4Nutrition: Engaging with the private sector to support POSHAN Abhiyaan in improving the nutritional status of children under five, adolescent girls, and lactating mothers. 

‘Ayush4Anganwadi’: A Memorandum of Understanding between the Ministry of AYUSH and the Ministry of Women and Child Development. Under this POSHAN Vatika programme, nutri-gardens and medicinal gardens will be developed in anganwadis. Workers at the centre, called ‘DHATRI (dedicated health activist to replenish the innutrition)’, will promote Ayurveda nutrition at grassroots level. 

Mission POSHAN 2.0: Announced in the 2021 Union Budget, it is an intensified strategy to strengthen nutritional content, delivery, outreach, and outcome across 112 aspirational districts. 

POSHAN Tracker: A mobile-based app launched by the Ministry of Women and Child Development in March 2021, POSHAN Tracker is a beneficiary-centric service delivery portal that promotes real-time data analytics. As a governance tool, it assists anganwadi workers in identifying the prevalence of stunting, wasting, and low weight among children, and also helps them track the delivery of nutrition services.

POSHAN Gyan: A national digital repository of online resources and communication material developed by government agencies and other organisations for knowledge awareness and behaviour change associated with nutrition. 

Reaching The Target

Although malnutrition has gained policy priority, the successful implementation of programmes to tackle it require the effective use of funds. As of March 2022, only 66% of funds allocated (approx. Rs 37 billion of Rs 54 billion allocated) for POSHAN Abhiyaan have been spent. The utilisation of funds by the State shows stark differences among the various states and Union territories, 100% in Sikkim and Meghalaya, and 0% in Punjab and West Bengal. 

Food security is key to India’s overall development agenda. Proactive measures are needed to deal with the longstanding problems of malnutrition and food insecurity. Convergence of programmes across sectors  must be strengthened to achieve better nutrition and health outcomes. A national commitment to action was made to attain nutrition security in an exceedingly coordinated and effective manner even amid the Covid-19 pandemic. This must be accompanied by sustained leadership and a multisectoral approach to ensure  POSHAN Abhiyaan achieves the target of food and nutrition security. The imperative is to plot structured, time-bound and location-specific strategies with due consideration to socioeconomic factors, such as the impact of the pandemic. It is also crucial to adopt a comprehensive approach that addresses the various sectors and dimensions of nutrition to achieve a malnutrition-free India.

The author is Senior Fellow, Health Initiative, Observer Research Foundation, New Delhi.

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