Improving nutrition outcomes in Jammu and Kashmir between 2006-2020

Improving nutrition in Jammu and Kashmir
Trends in outcomes, determinants and interventions
between 2006 and 2020
VERSION: September 10, 2021
This slide deck is an evolving work in progress, with updates being made frequently. If you want to use or
cite this, please email us at IFPRI-POSHAN@cgiar.org to receive the most updated version

Nutrition on India’s policy agenda
• The Prime Minister's Overarching Scheme for Holistic Nutrition or POSHAN Abhiyaan or National Nutrition Mission, is
Government of India's flagship effort to improve maternal and child nutrition outcomes by 2022.
• India launched POSHAN Abhiyaan on 8th March 2018. The contours of the Mission are being updated in 2021.
Background
Nutrition
outcomes
Determinants
Intervention
coverage
2014 (6 mo): New
administration
established);
Nutrition community
develops LAA 2014
2015: NITI Aayog
established; Policy
priorities: Digital
India, Aadhar,
Sanitation Mission;
nutrition still a
“learning agenda”.
Other social welfare
programs reviewed
(e.g., NREGA)
2016: Stated policy
priorities
implemented.
Nutrition mission
inputs received from
multiple groups; July
finance ministry
meeting on nutrition
2017: Final nutrition
strategy unveiled by
NITI Aayog in
September;
acknowledges
underlying issues
(poverty, etc.) but
actions still focused
on ICDS-health
programs
2018: Nutrition
Mission launched in
March – strong ICDS-
Health-Sanitation
link. Poverty/food
insecurity still not
central to agenda
2019: Election year.
Nutrition Mission
strongly visible and
implemented (focus
on BCC, awareness);
poverty alleviation
not part of nutrition
agenda
2021: Mission
POSHAN 2.0
launched in Union
Budget 2021 to
improve nutritional
outcomes.

Data and analysis
Note: NFHS-5 data source: Factsheets for 22 states/UTs
Background
Nutrition
outcomes
Determinants
Intervention
coverage
• Data sources for trends analysis: National Family Health Survey (NFHS-3 (2005-06), NFHS-4 (2015-16)
and NFHS-5 (2019-20))
– Child nutrition outcomes: all child data
– Adult nutrition outcomes: man or woman data
– Immediate and underlying determinants: last-child data
– Intervention coverage: last-child data
• Data sources for head count analysis: Census 2011 data to project district-level population of
children under 5 year, women aged 15-49, men aged 15-54 for the year 2019
– Number of pregnant and lactating women at district-level are estimated using HMIS data for the year 2019 and
prevalence from NFHS-5 factsheet
• All the indicators are mapped to the POSHAN Abhiyaan monitoring framework
• Descriptive statistics were estimated, and trend analysis was conducted to examine changes in
outcomes, determinants, and coverage of interventions across the three time periods (2005-06,
2015-16 and 2019-20)
• District level headcount of undernutrition outcomes was computed using undernutrition prevalence
and projected population data for 2019

MORTALITY & NUTRITION OUTCOMES

Infant & child mortality rates in Jammu and Kashmir, per
1,000 live births (2005-06, 2015-16 & 2019-20)
Background
Nutrition
outcomes
Determinants
Intervention
coverage
30 23 10 45 32 16 51 38 19
0
20
40
60
80
100
2005-06 2015-16 2019-20 2005-06 2015-16 2019-20 2005-06 2015-16 2019-20
Neonatal mortality rate Infant mortality rate Under-five mortality rate
Mortality
rate
(per
1000)
Jammu and Kashmir 2005-06 Jammu and Kashmir 2015-16 Jammu and Kashmir 2019-20 India average
Source: NFHS-3 (2005-06), NFHS-4 (2015-16) & NFHS-5 state factsheets (2019-20)

Trends in undernutrition outcomes in Jammu and Kashmir
(2005-06, 2015-16 & 2019-20)
Undernutrition among children <5y Undernutrition among women (15-49y)
1NA refers to the unavailability of data for a particular indicator in the NFHS-5 state and district factsheets (2019-20)
2In NFHS-3, 84.7% of data was missing, while 32.7% of data was missing in NFHS-4.
Background
Nutrition
outcomes
Determinants
Intervention
coverage
219 214 1NA 35 28* 27 15 14 19 5 7 10 27 19* 21 59 54 73 24 12* 5 52 49 67 56 47 44
0
20
40
60
80
100
Low birth weight Stunting Wasting Severe wasting Underweight Anemia Underweight Anemia
(non-pregnant)
Anemia
(pregnant)
%
*p<0.05, difference between 2006 and 2016 at the state level

Inter-district variability in undernutrition outcomes
in Jammu and Kashmir (2019-20)
Source: NFHS-5 state & district factsheets (2019-20)
Undernutrition among children
<5y
Undernutrition among women
(15-49y)
District average 2019-20
State average 2019-20
Background
Nutrition
outcomes
Determinants
Intervention
coverage
27 19 10 21 73 5 67 44
0
20
40
60
80
100
Stunting Wasting Severe wasting Underweight Anemia Underweight Anemia
(non pregnant)
Anemia
(pregnant)
%

Trends in overweight/obesity & non-communicable diseases
in Jammu and Kashmir (2005-06, 2015-16 & 2019-20)
Note 1: Data on blood pressure and sugar levels not available in NFHS-3 (2005-06).
Note 2: 1NA refers to the unavailability of data for a particular indicator in the specified NFHS round.
Background
Nutrition
outcomes
Determinants
Intervention
coverage
3 7*
10 17 29* 29 7 22* 32 1NA 14 15 1NA 17 15 1NA 6 4 1NA 7 4
0
20
40
60
80
100
Overweight/ obesity
child
Overweight/ obesity
women
Overweight/ obesity
men
High blood pressure
women
High blood pressure
men
High sugar level
women
High sugar level
men
%
*p<0.05, difference between 2006 and 2016 at the state level

Inter-district variability in overweight/obesity & non-
communicable diseases in Jammu and Kashmir (2019-20)
Note: Data on prevalence of overweight among men not available at district level in NFHS-5 (2019-20). District level information not available in NFHS 3 (2005-06).
Source: NFHS-5 state & district factsheets (2019-20)
Background
Nutrition
outcomes
Determinants
Intervention
coverage
10 29 32 15 15 4 4
0
20
40
60
80
100
Overweight/
obesity
child
Overweight/
obesity
women
Overweight/
obesity
men
High blood
pressure
women
High blood
pressure
men
High sugar level
women
High sugar level
men
%

Stunting among children <5 years in Jammu and Kashmir
(2015-16 & 2019-20)
Source: NFHS-4 (2015-16) & NFHS-5 district & state factsheets (2019-20)
Note: Stunting prevalence ≥30% is considered to be very high for public health significance. Source: de Onis et al. (2018).
Top 10 districts with highest change in
prevalence between 2015-16 & 2019-20
District Change (pp)
1 Baramulla -9.8
2 Reasi -9.4
3 Kathua -8.7
4 Kupwara -6.8
5 Ramban -6.8
6 Rajouri -5.9
7 Doda -5.0
8 Udhampur -4.5
9 Ganderbal -3.6
10 Kargil -2.1
Background
Nutrition
outcomes
Determinants
Intervention
coverage

Number of stunted children <5 years in Jammu and Kashmir
(2019-20)
Source: IFPRI estimates - The headcount was calculated as the product of the undernutrition prevalence and the total eligible projected population for each
district in 2019. Prevalence estimates were obtained from NFHS 5 (2019-20) and projected population for 2019 was estimated using Census 2011.
Note: The total number of children <5 years is 937,413, pregnant women 15-49 years is 374,141, and non-pregnant women 15-49 years is 3,452,875.
Background
Nutrition
outcomes
Determinants
Intervention
coverage
District Stunted children
(number)
District Stunted children
(number)
1 Anantnag 27,578 11 Poonch 10,124
2 Srinagar 24,680 12 Kulgam 9,608
3 Kupwara 21,982 13 Kathua 8,363
4 Jammu 20,718 14 Bandipore 7,080
5 Badgam 19,025 15 Ramban 6,550
6 Baramulla 17,722 16 Kishtwar 4,923
7 Rajouri 14,999 17 Reasi 4,565
8 Udhampur 14,537 18 Samba 4,392
9 Pulwama 10,717 19 Ganderbal 4,283
10 Doda 10,713 20 Shupiyan 4,267

Wasting among children <5 years in Jammu and Kashmir
(2015-16 & 2019-20)
Note: Wasting prevalence ≥15% is considered to be very high for public health significance. Source: de Onis et al. (2018).
Background
Nutrition
outcomes
Determinants
Intervention
coverage
Districts with highest change in
1 Srinagar -9.9
2 Doda -8.0
3 Reasi -4.1
4 Ramban -3.0
5 Poonch -3.0

Number of wasted children <5 years in Jammu and Kashmir
(2019-20)
Source: IFPRI estimates - The headcount was calculated as the product of the undernutrition prevalence and the total eligible projected
population for each district in 2019. Prevalence estimates were obtained from NFHS 5 (2019-20) and projected population for 2019 was
estimated using Census 2011.
Background
Nutrition
outcomes
Determinants
Intervention
coverage
District Wasted children
(number)
District Wasted children
(number)
1 Anantnag 24,350 11 Shupiyan 6,362
2 Kupwara 22,158 12 Poonch 6,098
3 Srinagar 13,911 13 Ganderbal 5,996
4 Baramulla 13,902 14 Kishtwar 4,081
5 Jammu 13,812 15 Ramban 3,976
6 Badgam 13,417 16 Bandipore 3,934
7 Rajouri 11,138 17 Kulgam 3,823
8 Kathua 8,631 18 Samba 3,657
9 Udhampur 7,717 19 Reasi 3,353
10 Pulwama 7,320 20 Doda 3,112

Severe wasting among children <5 years in Jammu and
Kashmir (2015-16 & 2019-20)
Background
Nutrition
outcomes
Determinants
Intervention
coverage
1 Srinagar -10.4
2 Doda -4.9
3 Ramban -3.8
4 Poonch -2.9
5 Reasi -2.0
Districts with highest change in prevalence
between 2015-16 & 2019-20

Number of severely wasted children <5 years in Jammu and
Kashmir (2019-20)
Source: IFPRI estimates - The headcount was calculated as the product of the undernutrition prevalence and the total eligible projected population for each
district in 2019. Prevalence estimates were obtained from NFHS 5 (2019-20) and projected population for 2019 was estimated using Census 2011.
Background
Nutrition
outcomes
Determinants
Intervention
coverage
District
Severely wasted
children (number) District
Severely wasted
children (number)
1 Anantnag 13,691 11 Ganderbal 3,079
2 Kupwara 12,977 12 Pulwama 3,062
3 Jammu 7,980 13 Kishtwar 2,739
4 Baramulla 6,722 14 Poonch 2,580
5 Badgam 6,460 15 Doda 1,966
6 Rajouri 5,940 16 Samba 1,757
7 Srinagar 5,684 17 Ramban 1,682
8 Kathua 5,025 18 Kulgam 1,624
9 Udhampur 3,741 19 Reasi 1,367
10 Shupiyan 3,375 20 Bandipore 1,292

Underweight children <5 years in Jammu and Kashmir
(2015-16 & 2019-20)
Note: Underweight prevalence ≥30% is considered to be very high for public health significance (used similar cut-off as stunting). Source: de Onis et al. (2018).
Background
Nutrition
outcomes
Determinants
Intervention
coverage
1 Reasi -13.0
2 Srinagar -12.4
3 Doda -8.8
4 Poonch -3.6
5 Kishtwar -3.0
6 Jammu -1.8

Number of underweight children <5 years in Jammu and
Kashmir (2019-20)
Background
Nutrition
outcomes
Determinants
Intervention
coverage
District Underweight
children (number)
District Underweight
children (number)
1 Anantnag 27,675 11 Poonch 7,349
2 Kupwara 22,512 12 Shupiyan 6,498
3 Rajouri 16,039 13 Ramban 5,403
4 Badgam 14,623 14 Kulgam 5,176
5 Jammu 13,505 15 Doda 4,980
6 Baramulla 13,215 16 Bandipore 4,720
7 Udhampur 12,432 17 Ganderbal 4,653
8 Srinagar 11,816 18 Kishtwar 3,168
9 Kathua 9,935 19 Reasi 3,017
10 Pulwama 9,664 20 Samba 2,778

Anemia among children <5 years in Jammu and Kashmir
(2015-16 & 2019-20)
Note: : Anemia prevalence ≥40% is considered to be a severe public health problem. Source: WHO (2011).
Background
Nutrition
outcomes
Determinants
Intervention
coverage
Shupiyan -3.1
District with highest change in prevalence
between 2015-16 & 2019-20

Number of anemic children <5 years in Jammu and Kashmir
(2019-20)
population for each district in 2019-20. Prevalence estimates were obtained from NFHS 5 (2019-20) and projected population for 2019 was
Background
Nutrition
outcomes
Determinants
Intervention
coverage
District Anemic children
(number)
District Anemic children
(number)
1 Anantnag 69,576 11 Kulgam 23,613
2 Kupwara 62,491 12 Kathua 23,088
3 Badgam 54,203 13 Poonch 19,067
4 Srinagar 51,730 14 Bandipore 18,955
5 Baramulla 48,307 15 Ganderbal 18,675
6 Jammu 47,148 16 Reasi 16,148
7 Rajouri 33,974 17 Kishtwar 14,231
8 Pulwama 28,966 18 Ramban 14,194
9 Udhampur 24,647 19 Samba 11,110
10 Doda 23,749 20 Shupiyan 9,949

Underweight women, 15-49 years in Jammu and Kashmir
(2015-16 & 2019-20)
Note: Underweight prevalence ≥40% is considered as very high prevalence. Source: WHO (1995)
Background
Nutrition
outcomes
Determinants
Intervention
coverage
1 Udhampur -15.1
2 Samba -12.9
3 Rajouri -12.7
4 Kupwara -10.7
5 Kathua -10.5
6 Jammu -9.9
7 Doda -9.7
8 Reasi -9.2
9 Kishtwar -7.7
10 Poonch -7.5
2015-16 2019-20
Jammu and Kashmir 12.1 5.2
Udhampur 19.1 4.0
Samba 16.5 3.6
Rajouri 17.5 4.8
Kupwara 15.8 5.1
Kathua 15.8 5.3
Jammu 14.1 4.2
Doda 14.7 5.0
Reasi 13.5 4.3
Kishtwar 12.8 5.1
Poonch 14.3 6.8
Shupiyan 9.3 2.0
Ramban 14.6 7.6
Badgam 10.9 4.7
Pulwama 9.1 2.9
Kulgam 7.8 2.1
Anantnag 8.7 4.1
Baramulla 14.3 10.6
Ganderbal 8.9 7.7
Srinagar 4.3 3.5
Bandipore 9.5 10.4

Underweight women, 15-49 years in Jammu and Kashmir
(2019-20)
Background
Nutrition
outcomes
Determinants
Intervention
coverage
District Underweight women
(number)
District Underweight women
(number)
1 Baramulla 32,372 11 Udhampur 6,796
2 Jammu 21,545 12 Ganderbal 6,748
3 Srinagar 14,648 13 Ramban 6,107
4 Anantnag 13,044 14 Doda 6,084
5 Bandipore 12,389 15 Pulwama 5,134
6 Kupwara 11,065 16 Reasi 3,897
7 Kathua 10,384 17 Samba 3,826
8 Badgam 9,896 18 Kishtwar 3,467
9 Poonch 9,402 19 Kulgam 2,843
10 Rajouri 8,965 20 Shupiyan 1,728

Anemia among non-pregnant women, 15-49 years in Jammu and
Kashmir (2015-16 & 2019-20)
Source: NFHS-4 (2015-16) & NFHS-5 district and state factsheets (2019-20)
Note: Anemia prevalence ≥40% is considered to be a severe public health problem. Source: WHO (2011).
Background
Nutrition
outcomes
Determinants
Intervention
coverage
1 Srinagar -8.2
2 Udhampur -1.1

Number of non-pregnant anemic women, 15-49 years
Background
Nutrition
outcomes
Determinants
Intervention
coverage
District Non-pregnant anemic
women (number)
District Non-pregnant anemic
women (number)
1 Jammu 3,49,848 11 Udhampur 97,353
2 Anantnag 2,40,841 12 Bandipore 88,511
3 Baramulla 2,23,242 13 Doda 82,619
4 Srinagar 2,19,726 14 Poonch 77,839
5 Kupwara 1,64,023 15 Ganderbal 68,266
6 Badgam 1,57,911 16 Samba 67,596
7 Pulwama 1,32,251 17 Reasi 58,993
8 Rajouri 1,15,795 18 Kishtwar 58,604
9 Kathua 1,08,153 19 Shupiyan 56,606
10 Kulgam 1,04,925 20 Ramban 49,576

Anemia among pregnant women, 15-49 years
(2015-16 & 2019-20)
Note: : Anemia prevalence ≥40% is considered to be a severe public health problem. Source: WHO (2011).
Background
Nutrition
outcomes
Determinants
Intervention
coverage
1 Kupwara -38.4
2 Shupiyan -15.6
3 Ramban -13.2
4 Pulwama -11.7
5 Udhampur -11.6
6 Kathua -9.7
7 Srinagar -5.7
8 Badgam -4.3
9 Poonch -3.5
10 Rajouri -3.2

Number of pregnant anemic women, 15-49 years
Background
Nutrition
outcomes
Determinants
Intervention
coverage
District Pregnant anemic women
(number)
District Pregnant anemic women
(number)
1 Srinagar 37,940 11 Doda 3,871
2 Jammu 30,289 12 Pulwama 3,573
3 Baramulla 13,105 13 Kathua 3,427
4 Anantnag 12,408 14 Ganderbal 3,288
5 Udhampur 7,306 15 Poonch 3,135
6 Kupwara 7,145 16 Reasi 2,932
7 Badgam 7,015 17 Kishtwar 2,841
8 Kulgam 6,379 18 Ramban 2,678
9 Rajouri 6,177 19 Samba 2,088
10 Bandipore 3,919 20 Shupiyan 1,669

Prevalence of low BMI among women declined rapidly between 2006 and 2020. There was a sharp increase in proportion of women consuming IFA during
pregnancy between 2006 and 2016 but stagnated between 2016 and 2020. Mixed picture on infant feeding; Early initiation of breastfeeding steadily
improved between 2006 and 2020. Exclusive breast feeding improved remarkably between 2006 and 2016 but declined by 2020. Proportion of children
receiving semi-solid and solid food steadily declined from 58 to 42% between 2006 and 2020. Proportion of children receiving age-appropriate diverse foods
and for adequate number of times in a day improved between 2006 and 2016 but declined to 14% by 2020. Morbidity among children remained below
10%.
Trends in immediate determinants in Jammu and Kashmir
(2005-06, 2015-16 & 2019-20)
Background
Nutrition
outcomes
Determinants
Intervention
coverage
(%)
Source: NFHS-3 (2005-06), NFHS-4 (2015-16) & NFHS-5 state factsheet (2019-20). Note: Data on continued breastfeeding at 2 years, egg and/or flesh foods consumption, sweet beverage consumption, and bottle feeding of
infants not available in NFHS-5 factsheets (2019-20)/state report. 0Indicator comparable between NFHS-3 and NFHS-4 but differs slightly with NFHS-5

Inter-district variability in immediate determinants
Background
Nutrition
outcomes
Determinants
Intervention
coverage
Source: NFHS-5 district & state factsheets (2019-20)
1NA refers to the unavailability of data for a particular indicator in the specified NFHS round
56 62 42 14 5 30 6 4
0
20
40
60
80
100
Early initiation
of
breastfeeding
Exclusive
breastfeeding
Timely
introduction of
complementary
foods
Continued
breastfeeding
at 2 years
Adequate diet Egg and/or
flesh food
consumption,
6–23m
Sweet
beverage
consumption,
6–23 m
Bottle feeding
of infants, 0–23
m
Women with
body mass
index <18.5
kg/m2
Consumed IFA
100+ days
Diarrhea in the
last two weeks
ARI in the last
two weeks
%
1NA 1NA 1NA 1NA

Trends in underlying determinants in Jammu and Kashmir
(2005-06, 2015-16 & 2019-20)
All underlying determinants improved steadily between 2006 and 2020. Large improvements in households using improved sanitation facility.
Remarkable improvements observed in women's education and age at marriage.
Background
Nutrition
outcomes
Determinants
Intervention
coverage
(%)
Source: NFHS-3 (2005-06), NFHS-4 (2015-16) & NFHS-5 state factsheets and state reports (2019-20)
Note 1: Safe disposal of feces not available in NFHS-5 factsheets (2019-20)/state report and data on HHs with hand washing facility not available in NFHS-3 (2005-06) and NFHS-5 factsheets (2019-20)/state report. Data on open defecation and HHs
with BPL card for 2019-2020 are taken from NFHS-5 state reports.
Note 2: Several of these determinants are applicable for maternal undernutrition as well
0Indicator comparable between NFHS-3 and NFHS-4 but differs slightly with NFHS-5

Inter-district variability in underlying determinants in Jammu
and Kashmir (2019-20)
District average (2019-20)
State average (2019-20)
Background
Nutrition
outcomes
Determinants
Intervention
coverage
Source: NFHS-5 district and state factsheets (2019-20)
Note 1: Several of these determinants are applicable for maternal undernutrition as well.
77 51 5 92 76 99
0
20
40
60
80
100
Women who
are literate
Women with
≥10 years
education
Girls
married
before age
of 18 years
Women 15-
19 years
with child or
pregnant
HHs with
improved
drinking
water
source
HHs with
improved
sanitation
facility
HHs with
hand
washing
facility
Open
defecation
Safe disposal
of feces
HHs with
BPL card
HHs with
electricity
(%)
1NA
1NA refers to the unavailability of data for a particular indicator in the specified NFHS round.
1NA 1NA 1NA

COVERAGE OF NUTRITION INTERVENTIONS

Background
Nutrition
outcomes
Determinants
Intervention
coverage
Trends in interventions across
the first 1000 days
2005-06, 2015-16, 2019-20
(%)
Pregnancy: Large improvements in received MCP card (69pp) from 2006
to 2020, with 97% coverage in 2020. Modest improvements in food
supplementation, and health and nutrition education from 2006 to 2020
(25-32pp), however, coverage remained <40% in 2020.
Delivery and Postnatal: Large improvements in institutional birth, skilled
birth attendant and postnatal care for mothers and babies from 2006 to
2020 (36-82pp). Despite considerable improvements in provision of food
supplementation, and health and nutrition education from 2006 to 2020
(23-30pp), coverage remained <35% in 2020.
Early Childhood: Considerable improvement in provision of full
immunization, Vitamin A supplementation and ORS during diarrhea from
2006 to 2020 (19-40pp), with coverage >80% in 2020. Coverage of most
services remained low, despite large improvements from 2006 to 2020;
provision of Zinc during diarrhea and child weighing provision was <50%
in 2020.
Source: NFHS-3 (2005-06), NFHS-4 (2015-16) & NFHS-5 state factsheets and state reports (2019-20).
Note: Interventions’ coverage is based on the last child data.
0Indicator comparable between NFHS-3 and NFHS-4 but differs slightly from NFHS-5.
Note 1: Data missing for 2019-20 is not available in the NFHS-5 factsheets (2019-20). Information on use of bed nets during
pregnancy not available in NFHS-3 data (2005-06).
Note 2: Data on food supplementation and health and nutrition education during pregnancy and post-natal care, and
weight measurement during childhood and counselling on child growth for 2019-20 are taken from NFHS-5 State Reports.
Note 3: Refer to district dashboard for the inter-district variability in the coverage of interventions.

Coverage of nutrition related interventions in Jammu and
Kashmir : district dashboard (2019-20)
Background
Nutrition
outcomes
Determinants
Intervention
coverage
Note 1: Data missing for 2019-20 is not available in the NFHS-5 factsheets and state reports (2019-20).
Source: NFHS-5 district factsheets and state reports (2019-2020)
District name Demand
for
FP
satisfied
Iodized
salt
Any
ANC
visits
ANC
first
trimester
≥4
ANC
Received
MCP
card
Received
IFA
tab/syrup
Tetanus
injection
Deworming
Weighing
Birth
preparedness
counselling
Breastfeeding
counselling
Counselling
on
keeping
baby
warm
Cord
care
counselling
Food
supplementation
Health
&
nutrition
education
Malaria
prevention-
use
of
bed
nets
Institutional
birth
Financial
assistance
(JSY)
Skilled
birth
attendant
Postnatal
care
for
mothers
Postnatal
care
for
babies
Food
supplementation
Health
&
nutrition
education
Full
immunization
Vitamin
A
Paediatric
IFA
Deworming
Care
seeking
for
ARI
ORS
during
diarrhea
Zinc
during
diarrhea
Food
supplementation
(6-35
months)
Weighing
Counselling
on
child
growth
JAMMU AND KASHMIR 98.1 86.6 80.9 97.3 72.5 91.9 8.8 92.4 56.4 95.1 84.2 81.5 86.2 82.3 62.3 80.8 50.5
Anantnag 98.3 82.0 80.9 97.8 68.5 97.8 18.0 90.5 67.9 98.1 85.1 81.3 83.3 88.3 82.3
Badgam 98.9 83.3 66.5 93.4 79.6 97.5 14.0 96.5 69.0 98.5 88.7 86.3 92.5 93.5 62.1
Bandipore 98.5 82.9 82.6 97.5 73.9 91.1 8.9 92.8 35.3 93.7 82.6 81.9 90.3 84.5 66.1
Baramula 99.1 84.0 75.2 96.0 76.2 88.2 9.0 96.2 48.5 97.0 80.1 76.0 73.7 83.4 70.3 57.0 42.2
Doda 97.7 86.3 74.3 98.3 59.6 79.5 0.9 73.5 43.2 75.6 71.6 71.6 61.7 55.4
Ganderbal 97.7 86.9 80.4 95.5 72.7 88.8 3.2 98.0 58.1 98.6 88.4 87.0 81.2 83.6 62.3
Jammu 98.9 93.2 95.4 99.0 82.0 92.0 3.4 96.5 56.6 97.0 92.2 86.0 84.1 85.6
Kathua 98.0 83.2 31.6 98.1 76.1 89.4 44.1 97.1 31.3 98.5 81.2 77.1 100.0 88.3
Kishtwar 94.7 80.3 76.4 95.8 80.5 89.3 15.3 91.6 36.7 94.1 75.7 75.4 91.6 67.0 77.0
Kulgam 97.8 95.5 92.2 97.7 65.9 93.1 0.8 98.9 63.3 99.6 91.5 92.6 98.1 92.6
Kupwara 98.5 83.7 89.2 99.3 79.3 96.8 6.2 97.1 64.6 99.0 90.5 89.6 93.2 89.0 62.3 95.9 61.0
Pulwama 98.6 96.6 96.2 98.9 71.9 90.7 6.3 97.8 57.6 98.1 95.0 93.7 88.8 85.2
Punch 98.9 80.5 86.4 98.0 78.0 94.4 11.6 86.0 65.3 93.8 81.7 78.9 91.2 81.0 79.5
Rajouri 96.0 82.5 71.9 95.4 63.4 94.3 9.0 88.8 66.6 94.4 78.7 75.8 95.0 81.0 38.0 76.7 47.4
Ramban 98.6 84.6 79.2 95.9 70.6 92.9 8.9 80.4 63.1 91.7 71.3 70.1 78.9 70.7 47.0
Reasi 92.3 83.4 75.9 92.9 58.2 86.5 6.4 69.3 43.9 73.3 64.7 63.6 79.1 73.5
Samba 98.7 86.6 96.2 100.0 78.5 84.5 6.1 97.9 47.9 99.0 92.3 87.6 90.9 73.5 69.8
Shupiyan 98.5 80.8 86.8 96.9 78.5 92.3 10.7 98.3 58.2 97.5 84.5 83.0 92.2 69.7
Srinagar 99.0 95.2 85.1 97.8 62.2 92.4 0.5 99.2 53.2 99.2 90.9 88.8 90.9 85.2
Udhampur 96.1 80.1 69.8 97.3 67.1 93.7 8.1 87.2 67.3 91.1 71.2 69.1 85.8 80.1 56.4 86.2 44.3
Pre-
pregnancy
Pregnancy Delivery & postnatal Early childhood

0
20
40
60
80
100
Overweight/
obesity
child
Overweight/
obesity
women
Overweight/
obesity
men
High blood
pressure
women
High blood
pressure
men
High sugar
level
women
High sugar
level
men
(%)
2005-06 2015-16 2019-20
1NA 1NA 1NA 1NA
0
20
40
60
80
100
Stunting Wasting Severe
wasting
Underweight
child
Anemia
child
Underweight
women
Anemia
Non pregnant
women
Anemia
Pregnant
women
(%)
2019-20 2015-16 2005-06
Children: Stunting and wasting prevalence declined by 7 percentage points (pp)
and 1pp respectively, between 2006 and 2016; stunting continued to decline by
1pp while wasting increased by 5pp between 2016 and 2020. Underweight
declined by 8pp between 2006 and 2016 and continued to decline by 3pp
between 2016 and 2020. Anemia declined by 5pp between 2006 and 2016 but
increased by 19pp between 2016 and 2020.
Women: Underweight declined by 12pp between 2006 and 2016 and continued
to decline by 7pp between 2016 and 2020. Anemia decreased by 3pp and 9pp
among non-pregnant and pregnant women respectively, between 2006 and
2016; but increased by 18pp among non-pregnant women and decreased by
3pp among pregnant women between 2016 and 2020. Overweight/obesity
increased by 12pp between 2006 and 2016 and remained constant at 29
percent between 2016 and 2020
Men: Overweight/obesity increased by 16pp between 2006 and 2016 and
further increased by 10pp between 2016 and 2020.
Attention is needed to improve (%s in 2020):
• Outcomes: Anemia in children (73%) non-pregnant women (67%) and
pregnant women (44%).
• Immediate determinants: Timely introduction of complementary foods
(42%) adequate diet (14%); 100+ IFA (30%).
• Underlying determinants: Women with ≥ 10 years education (51%).
• Coverage of interventions: Food supplementation for women (34-38%);
health and nutrition education for women (36-39%); postnatal care for
mothers and children (25-28%); growth monitoring of children (41%).
Trends in nutrition outcomes, determinants and coverage of interventions in Jammu and Kashmir (2005-06, 2015-16 & 2019-20)
Source: NFHS-3 (2005-06), NFHS-4 (2015-16) & NFHS-5 state factsheets and state reports
(2019-20)⁰Indicator comparable between NFHS-3 and NFHS-4 but differs slightly with
NFHS-5
1NA refers to the unavailability of data for a particular indicator in the NFHS-5 state and
district factsheets (2019-20)
Undernutrition outcomes Overweight/obesity and non communicable diseases
Immediate determinants Key takeaways
Underlying determinants
(%) (%)
(%)

Annex: Methodological notes
• Nutrition outcomes, their immediate and underlying determinants, and nutrition related interventions were identified following the Poshan Abhiyaan
monitoring framework.
• The selected indicators were harmonized across the National Family Health Survey (NFHS) 3 (2005-06) and 4 (2015-16) data and NFHS 5 factsheets (2019-
20). For those indicators that were not comparable, details were specified in a footnote.
• The method of women sampling across the three NFHS rounds was compared:
• Descriptive statistics were estimated, and trend analysis was conducted to examine changes in outcomes, determinants, and coverage of interventions
across the three time periods. Further, top 10 districts with the highest change in prevalence between 2016 & 2020 were identified. Statistical software Stata
16.0 and R were used to perform the analyses.
• District level headcount of undernutrition outcomes was computed using undernutrition prevalence and projected population data for the year 2019.
o The prevalence P was calculated as children/women with nutritional deficit (q) divided by the eligible sample of children/women (n) in the district (j) and expressed in percentage as: Pj= (qj/nj)
×100
o The headcount was calculated as the product of P and the total eligible population N for each district: Hj= Pj×Nj
• Findings were visualized using spatial maps, bar graphs and line plots. The maps and other graphs were prepared on R and Excel, respectively.
• Cut-off values for public health significance were based on WHO guidelines on all indicators
https://apps.who.int/iris/bitstream/handle/10665/332223/9789241516952-eng.pdf?ua=1 except severe wasting (based on agreement with UNICEFF)
NFHS – 3 (2005-2006) NFHS-4 (2015-2016) NFHS-5 (2019-2020)
• Target sample size in NFHS-3 was fixed
in terms of ever married women age
15-49 years
• All eligible women age 15-49 i.e. all
women age 15-49 who are usual
members of the selected households
or who spent the night before the
survey in the selected households
were eligible to be interviewed in the
survey.
• Information on sampling strategy not
available yet

Annex: Indicator definitions
Mortality and nutrition outcomes
Neonatal mortality rate Neonatal mortality rate per 1000 live births
Infant mortality rate Infant mortality rate per 1000 live births
Under-five mortality rate Under-five mortality rate (U5MR) per 1000 live births
Low birth weight Percentage of live births in the five years preceding the survey with a reported birth weight less than 2.5 kg, based on either a written record or the mother's recall
Stunting among children Percentage of children age 0-59 months who are stunted i.e. height-for-age z score < -2SD
Wasting among children Percentage of children age 0-59 months who are wasted i.e. weight-for-height z score < -2SD
Severe wasting among children Percentage of children age 0-59 months who are wasted i.e. weight-for-height z score < -3SD
Underweight children Percentage of children age 0-59 months who are underweight i.e. weight-for-age z score < -2SD
Anemia among children Percentage of children age 6-59 months who are anemic i.e. (Hb <11.0 g/dl)
Underweight women Percentage of women age 15-49 whose Body Mass Index (BMI) is below normal (BMI <18.5 kg/m2)
Anemia among non-pregnant women Percentage of non-pregnant women age 15-49 who are anemic (<12.0 g/dl)
Anemia among pregnant women Percentage of pregnant women age 15-49 who are anemic (<11.0 g/dl)
Overweight/obesity - children Percentage of children age 0-59 months who are overweight i.e. weight-for-height z score > 2SD
Overweight/obesity - women Percentage of men age 15-54 who are overweight or obese (BMI ≥25.0 kg/m2)
Overweight/obesity - men Percentage of men age 15-54 who are overweight or obese (BMI ≥25.0 kg/m2)
High blood pressure among women^ Percentage of women age 15-49 with elevated blood pressure (Systolic >140 mm Hg or diastolic >90 mm Hg)
High blood pressure among men^ Percentage of men age 15-54 with elevated blood pressure (Systolic >140 mm Hg or diastolic >90 mm Hg)
High sugar level among women^ Percentage of women age 15-49 with elevated blood pressure (Systolic >140 mm Hg or diastolic >90 mm Hg)
High sugar level among men^ Percentage of men age 15-54 with high blood sugar levels (141-160 mg/dl)
^ Indicator not available in NFHS-3; $ Indicator not available in NFHS-5 factsheets/state reports; 0 Indicator comparable between NFHS-3 and NFHS-4 but differs slightly with NFHS-5
1 Definition per NFHS-3/NFHS-4 ; 2 Definition as per NFHS-5 factsheet

Immediate determinants
Early initiation of breastfeeding Percentage of children under age 3 years breastfed within one hour of birth for the last child born in the 3 years before the survey
Exclusive breastfeeding Percentage of youngest children under age 6 months living with mother who were exclusively breastfed
Timely introduction of
complementary foods0
1Percentage of youngest children age 6-8 months living with mother who received solid or semi-solid food; 2Percentage of youngest children age 6-8 months
living with mother who received solid or semi-solid food and breastmilk
Continued breastfeeding at 2 years$ Percentage of youngest children 12–23 months of age who were fed breast milk during the previous day
Adequate diet0 Percentage of youngest children 6–23 months of age who consumed a minimum acceptable diet during the previous day
Eggs and/or flesh foods
consumption$
Percentage of youngest children 6–23 months of age who consumed egg and/or flesh food during the previous day
Sweet beverage$ Percentage of youngest children 6–23 months of age who consumed a sweet beverage during the previous day
Bottle feeding for infants$ Percentage of youngest children 0–23 months of age who were fed from a bottle with a nipple during the previous day
Women with body mass index <18.5
kg/m2 0
1Percentage of women age 15-49 with a youngest child < 5 years who have BMI below normal (BMI <18.5 kg/m2) ; 2Percentage of women age 15-49 whose BMI
is below normal (BMI <18.5 kg/m2)
Consumed IFA 100+ days Percentage of mothers age 15-49 who consumed iron folic acid for 100 days or more during the last pregnancy in last five years preceding the survey
Diarrhea in the last two weeks0 1Percentage of youngest children under age five who had diarrhoea in the two weeks preceding the survey; 2Percentage of children under age 5 who had
diarrhoea in the 2 weeks preceding the survey
ARI in the last two weeks0 1Percentage of youngest children under age five who had symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey; 2Percentage of
children under age five who had symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey

^ Indicator not available in NFHS-3; $ Indicator not available in NFHS-5 factsheets/state reports; @Indicator not available in NFHS-5 factsheets but available in NFHS-5 states reports; 0 Indicator comparable between NFHS-3 and NFHS-4 but differs slightly with NFHS-5
Women who are literate0 1Percentage of women age 15-49 with a birth in five years preceding the survey who are literate i.e. those who completed standard 6 or higher and can read a
whole sentence; 2Percentage of women age 15-49 who are literate i.e. those who completed standard 9 or higher and can read a whole sentence or part of a
sentence.
Women with ≥10 years education0 1Percentage of women age 15-49 with a birth in five years preceding the survey with 10 or more years of schooling; 2Percentage of women age 15-49 with 10 or
more years of schooling
Girls 20-24 years married before age
of 18 years0
1Percentage of women aged 20-24 years with a birth in five years preceding the survey who were married before age 18 years; 2Percentage of women aged 20-24
years who were married before age 18 years
Women 15-19 years with child or
pregnant
Percentage of currently married women aged 15-49 who had their first birth before age 20 years and in the five years preceding the survey
HHs with improved drinking water
source0
1Percentage of youngest children under age 5 living in household that use an improved source of drinking water; 2Population living in households that use an
improved sanitation facility
HHs with improved sanitation facility0 1Percentage of youngest children under age 5 living in household that uses improved toilet facility; 2Population living in households that use an improved sanitation
facility
HHs with hand washing facility^$ Percentage of youngest children under age 5 living in household that had soap and water for washing hands
Open defecation@ Percentage of youngest children under age 5 living in household that has no toilet facility/defecates in open
Safe disposal of feces$ Percentage of youngest children living with mother whose stools were disposed of safely
HHs with BPL card@ Percentage of youngest children under age 5 living in households with BPL card
HHs with electricity0 1Percentage of youngest children under age 5 living in household that has electricity; 2Population living in households with electricity

1 Definition per NFHS-3/NFHS-4 ; 2 Definition as per NFHS-5 factsheet; @Indicator not available in NFHS-5 factsheets but available in NFHS-5 state reports
Interventions
Demand for FP satisfied@ Percentage of currently married women age 15-49 with demand for family planning satisfied by modern methods
Iodized salt0 1Percentage of women age 15-49 living in HHs that use iodized salt; 2Percentage of households using iodized salt
Any ANC visits$ Percentage of women age 15-49 with a live birth in the five years who received at least one ANC for the last birth
ANC first trimester Percentage of women (15-49 years of age) attended by any provider during the first trimester of pregnancy that led to the birth of the youngest child in the last 2
years
≥ 4ANC Percentage of mothers age 15-49 who had at least 4 antenatal care visits for last birth in the 5 years before the survey
Received MCP card Percentage of mothers who registered last pregnancy in the 5 years preceding the survey for which she received a Mother and Child Protection (MCP) card
Received IFA tab/syrup@ Percentage of women who received IFA (given or purchased) tablets during the pregnancy for their most recent live birth in the 5 years preceding the survey
Tetanus injection Percentage of women whose last birth was protected against neonatal tetanus (for last birth in the five years preceding the survey )
Deworming- pregnancy@ Percentage of women who took an intestinal parasite drug during the pregnancy for their most recent live birth in the 5 years preceding the survey
Weighing- pregnancy@ Percentage of women age 15-49 with a live birth in the five years preceding the survey who were weighed during ANC for the last birth
Birth preparedness counselling$ Percentage of women who had at least one contact with a health worker in the three months preceding the survey and were counselled on birth preparedness;
calculated among women age 15-49 who gave birth in the five years preceding the survey
Breastfeeding counselling@ Percentage of women who met with a community health worker in the last three months of pregnancy and received advice on breastfeeding (for the last
pregnancy in the five years preceding the survey)
Counselling on keeping baby warm@ Percentage of women who met with a community health worker in the last three months of pregnancy and received advice on keeping the baby warm for their
most recent live birth in the five years preceding the survey
Cord care counselling^@ Percentage of women who met with a community health worker in the last three months of pregnancy and received advice on cord care for their most recent live
birth in the five years preceding the survey
Food supplementation - pregnancy@ Percentage of youngest children under age 5 whose mother received supplementary food from AWC during pregnancy
Health & nutrition education –
pregnancy@
Percentage of mothers who received health and nutrition education from an Anganwadi Centre (AWC) during last pregnancy in the five years preceding the survey
Malaria prevention- use of bed nets^$ Percentage of women who used mosquito net during the pregnancy for their most recent live birth in the 5 years preceding the survey

1 Definition per NFHS-3/NFHS-4 ; 2 Definition as per NFHS-5 factsheet; @Indicator not available in NFHS-5 factsheets but available in NFHS-5 state reports
Interventions
Institutional birth0 1Percentage of women age 15-49 who gave birth in health/institutional facility for their most recent live birth in the 5 years preceding the survey;
2Percentage of live births to women age 15-49 in the five years preceding the survey that took place in a health/institutional facility
Financial assistance (JSY)@ Percentage of women who received financial assistance under JSY for their most recent live birth that took place in institutional facility in the 5 years
preceding the survey
Skilled birth attendant0 1Percentage of women whose last delivery was attended by a skilled health personnel for their most recent live birth in the 5 years preceding the survey;
2Percentage of births attended by skilled health personnel for births in the 5 years before the survey
Postnatal care for mothers Percentage of mothers who received postnatal care from a doctor/nurse/LHV/ANM/midwife/other health personnel within 2 days of delivery for their
most recent live birth in the five years preceding the survey
Postnatal care for babies Percentage of children who received postnatal care from a doctor /nurse /LHV /ANM /midwife /other health personnel within 2 days of delivery for last
birth in the 5 years before the survey
Food supplementation – postnatal@ Percentage of youngest children under age 5 whose mother received supplementary food from AWC while breastfeeding
Health & nutrition education – postnatal@ Percentage of youngest children under age 5 whose mother received health check-ups from AWC while breastfeeding
Full immunization0 1Percentage of youngest living children age 12-23 months fully vaccinated based on information from either vaccination card or mother's recall;
2Percentage of children age 12-23 months fully vaccinated based on information from either vaccination card or mother's recall
Vitamin A – early childhood0 1Percentage of youngest children age 6-59 months who received Vitamin A supplementation in the last 6 months preceding the survey; 2 Percentage of
children age 9-35 months who received a vitamin A dose in the last 6 months
Pediatric IFA0@ Percentage of youngest children age 6-59 months who received iron supplements in the past 7 days preceding the survey
Deworming – early childhood0@ Percentage of youngest children age 6-59 months who received deworming tablets in the last 6 months preceding the survey
Care seeking for ARI0 1Percentage of youngest children under age 5 years with fever or symptoms of ARI in the 2 weeks preceding the survey taken to a health facility or health
provider; 2Percentage of children under age 5 years with fever or symptoms of ARI in the 2 weeks preceding the survey taken to a health facility or health
provider
ORS during diarrhea0 1Percentage of youngest children under age 5 years with diarrhoea in the 2 weeks preceding the survey who received oral rehydration salts (ORS);
2Percentage of children under age 5 years with diarrhoea in the 2 weeks preceding the survey who ORS
Zinc during diarrhea0 1Percentage of youngest children under age 5 years with diarrhoea in the 2 weeks preceding the survey who received zinc; 2Percentage of children
under age 5 years with diarrhoea in the 2 weeks preceding the survey who received zinc
Food supplementation (children 6-35
months)$
Percentage of youngest children age 6-35 months who received food supplements from AWC in the 12 months preceding the survey
Weighing – early childhood@ Percentage of youngest children under age 5 who were weighed at AWC in the 12 months preceding the survey
Counselling on child growth@ Percentage of youngest children under age 5 whose mother received counselling from an AWC after child was weighed in the 12 months preceding the
survey

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