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Insights into Editorial: Thousand days of nutrition, and a billion dreams




How far India goes in realising its billion plus dreams over the next decade or two will be determined by how well it nourishes the physical well-being and mental potential of its people, particularly its children.

If one has to pick the single gravest threat that blocks the promise of this young nation at the foundational level, it has to be arguably malnutrition.

Malnourished children tend to fall short of their real potential physically as well as mentally.

That is because malnutrition leaves their bodies weaker and more susceptible to illnesses.

In 2017, a staggering 68% of 1.04 million deaths of children under five years in India was attributable to malnutrition, reckoned a Lancet study in 2019.

Recent Findings:

  1. Malnutrition was the predominant risk factor for death in children younger than 5 years of age in every state of India in 2017, accounting for 68·2% of the total under-5 deaths, and the leading risk factor for health loss for all ages, responsible for 17·3% (16·3–18·2) of the total disability-adjusted life years (DALYs).
  2. The malnutrition DALY rate was much higher in the low SDI than in the middle SDI and high SDI state groups.
  3. This rate varied 6·8 times between the states in 2017, and was highest in the states of Uttar Pradesh, Bihar, Assam, and Rajasthan.
  4. The prevalence of low birthweight in India in 2017 was 21·4% (20·8–21·9), child stunting 39·3%, child wasting 15·7%, child underweight 32·7%, anaemia in children 59·7%, anaemia in women 15–49 years of age 54·4%, exclusive breastfeeding 53·3%, and child overweight 11·5%.
  5. If the trends estimated up to 2017 for the indicators in the NNM 2022 continue in India, there would be 8·9% excess prevalence for low birthweight, 9·6% for stunting, 4·8% for underweight, 11·7% for anaemia in children, and 13·8% for anaemia in women relative to the 2022 targets.
  6. For the additional indicators in the WHO and UNICEF 2030 targets, the trends up to 2017 would lead to 10·4% excess prevalence for wasting, 14·5% excess prevalence for overweight, and 10·7% less exclusive breastfeeding in 2030.
  7. The prevalence of malnutrition indicators, their rates of improvement, and the gaps between projected prevalence and targets vary substantially between the states.

Post-COVID challenges in proving Nutrition:

As the flagship programme (POSHAN Abhiyaan) completes 1,000 days this week, it is time to renew our commitment to nutrition for two reasons.

First, because it conveys the deeply symbolic value of the first 1,000 days from conception of a child till the child turns two years old, marking the most crucial period for nutrition interventions in a lifecycle, which once missed could result in irreversible damage to the child’s physical and mental well-being.

Second, focus on nutrition is critical as COVID-19 threatens to derail the gains India has made in nutrition in more than one way.

For one, COVID-19 is pushing millions into poverty, reducing incomes of many more and disproportionately affecting the economically disadvantaged, who are also most vulnerable to malnutrition and food insecurities.

Second, pandemic-prompted lockdowns disrupted essential services — such as supplementary feeding under anganwadi centres, mid-day meals, immunisation, and micro-nutrient supplementation which can exacerbate malnutrition.

Heavy burden will face in the long-run:

  1. Children who survive malnutrition do not do as well as they could. Without necessary nutrients, their brains do not develop to the fullest.
  2. No wonder then, they end up performing poorly at school than they otherwise would.
  3. Malnutrition places a burden heavy enough for India, to make it a top national priority.
  4. About half of all children under five years in the country were found to be stunted (too short) or wasted (too thin) for their height, estimated the Comprehensive National Nutrition Survey, carried out by the Ministry of Health and Family Welfare with support of UNICEF three years ago.
  5. The country has been making progress on nutrition for the last two decades, but it was after the Prime Minister launched the Prime Minister’s Overarching Scheme for Holistic Nutrition (POSHAN) Abhiyaan in 2018, that a holistic approach to tackle malnutrition started gathering momentum.
  6. Under it, the government strengthened the delivery of essential nutrition interventions so that more children have the right start in life for optimum growth, health, development and a prosperous future.

Financial commitments:

To ensure this, the country needs to retain its financial commitments for the nutrition schemes it already runs and earmark additional funds to preserve nutritional security in vulnerable communities, particularly women and children in slum areas, migrants, the population in tribal areas and districts with malnutrition rates.

Pandemic spurred challenges have also negatively hit other proven underlying drivers of malnutrition.

For instance, economic insecurities often force girls into early marriage, early motherhood, discontinue their schooling, and reduce institutional deliveries, cut access to micronutrient supplements, and nutritious food which largely tend to be perishable, all of which may worsen malnutrition.

Accelerating efforts to address these will be needed to stop the regression into the deeper recesses of malnutrition.

Way Ahead to solve the problem of Nutrition:

  1. It is in this challenging backdrop, leaders from academia, civil society, development partners, community advocates and the private sector have come together as part of ‘commitment to action’ to seek and support the government in a six-pronged action that can save and build on the advances India has made in nutrition.
  2. These clear action points include commitments around sustained leadership, dedicated finances, multi-sectoral approach and increased uninterrupted coverage of a vulnerable population under programmes enhancing nutrition.
  3. One reason POSHAN Abhiyaan succeeded in galvanising action so fast was because it was led by the Prime Minister himself.
  4. That example must be sustained so that leadership of food and nutrition security rests with the Prime Minister at the national level, a Chief Minister at the State level, a district magistrate at the district and panchayat at the village level.
  5. This was already imperative for POSHAN Abhiyaan to succeed, but it has now become critical as COVID-19 compounds an already complex challenge.
  6. In terms of policies, vision, strategies, India already has some of the world’s biggest early childhood public intervention schemes such as the Integrated Child Development Scheme, the mid-day meal programme, and Public Distribution System.
  7. India needs to ensure coverage of every single child and mother, along with 12 months of Poshan Maah (Nutrition Month), 52 weeks of breastfeeding weeks and 365 days of take-home ration.


To truly grasp the depth and breadth of the COVID-19-caused nutrition crisis, the country must track nutrition indices through data systems.

Evidence generated through data will also serve well to track the positive impact of POSHAN Abhiyaan, and course correct on the long journey to a well-nourished India.

It takes time for nutrition interventions to yield dividends, but once those accrue, they can bring transformative generational shifts.

Filling in the nutrition gaps will guarantee a level-playing field for all children and strengthen the foundations for the making of a future super-power.