Malnutrition is a major problem in India, with over 1/3 of the world's malnourished children living in India. The document outlines the scope and causes of malnutrition in India. Major causes include poverty, food prices, dietary practices, lack of breastfeeding, and gender inequality. It then proposes multi-sector solutions that address the issue across the entire lifecycle through both direct interventions like supplements and feeding practices, and indirect interventions like access to water/sanitation, education, and socio-cultural factors. The solutions framework is based on principles of addressing the nutrient deficit, breaking intergenerational cycles, and coordinated multi-sector actions. Mega coordination across ministries and sectors is needed to effectively implement the solutions

1. A Manthan of reducing “Malnutrition in India”

2. Problem Statement
Malnutrition refers to the
situation where there is an
unbalanced diet in which some
nutrients are in excess, lacking or
wrong proportion.

3. Scope of Broad Problems
What is the Problem?
The World Bank estimates that India is
one of the highest ranking countries in
the world for the number of children
suffering from malnutrition. The
prevalence of underweight children in
India is among the highest in the world,
and is nearly double that of Sub-
Saharan Africa with dire consequences
for mobility, mortality, productivity and
economic growth.
The 2011 Global Hunger Index (GHI)
Report ranked India 15th, amongst
leading countries with hunger
situation. It also places India amongst
the three countries where the GHI
between 1996 and 2011 went up from
22.9 to 23.7
Why it is a Problem?
Despite India's 50% increase in GDP
since 1991, more than one third of the
world's malnourished children live in
India. Among these, half of them under
3 are underweight and a third of
wealthiest children are over-nutriented.
One of the major causes for
malnutrition in India is gender
inequality. Due to the low social status
of Indian women, their diet often lacks
in both quality and quantity. Women
who suffer malnutrition are less likely
to have healthy babies. In India,
mothers generally lack proper
knowledge in feeding children.
Consequently, new born infants are
unable to get adequate amount of
nutrition from their mothers.

4. Causes of Problems
Major causes of malnutrition include poverty and food prices, dietary practices and
agricultural productivity, with many individual cases being a mixture of several factors.
•Diseases and infections: Malnutrition can be a consequence of health issues such
as gastroenteritis or chronic illness, especially the HIV/AIDS pandemic Diarrhea and other
infections can cause malnutrition through decreased nutrient absorption, decreased intake
of food, increased metabolic requirements, and direct nutrient loss. Parasite infections can
also lead to malnutrition.
•Dietary practices A lack of adequate breastfeeding leads to malnutrition in infants and
children, associated with the deaths of an estimated one million children annually. Illegal
advertising of breast milk substitutes continues three decades after its 1981 prohibition
under the WHO International Code of Marketing Breast Milk Substitutes.

5. Causes of Problems
From 2010 to 2011
•No major Policy Change or Strategy Shift
•ICDS Restructuring still in process
•New Scheme for Adolescent Girls -Sabla, introduced in 200 Districts
•New Responsibilities, but no additional worker
•Karnataka Nutrition Mission implementation begins

6. Reasons for Selecting a Specific Cause
Future threats:
There are a number of potential disruptions to global food supply that could cause
widespread malnutrition.
Climate change is of great importance to food security, with 95 percent of all
malnourished peoples living in the relatively stable climate region of the sub-tropics and
tropics. According to the latest IPCC reports, temperature increases in these regions are
"very likely“. Even small changes in temperatures can lead to increased frequency of
extreme weather conditions. Many of these have great impact on agricultural production
and hence nutrition. An increase in extreme weather such as drought in regions such as
Sub-Saharan Africa would have even greater consequences in terms of malnutrition. Even
without an increase of extreme weather events, a simple increase in temperature reduces
the productivity of many crop species, also decreasing food security in these regions.
Colony collapse disorder is a phenomenon where bees are dying in large
numbers. Since many agricultural crops worldwide are pollinated by bees, this represents a
serious threat to the supply of food.
An epidemic of wheat stem rust caused by race Ug99 is currently spreading across Africa
and into Asia and, it is feared, could wipe out more than 80 percent of the world’s wheat
crops.

7. Reasons for Selecting a Specific Cause

8. Reasons for Selecting a Specific Cause

9. Fighting malnutrition, mostly through fortifying foods with micronutrients (vitamins and
minerals), improves lives at a lower cost and shorter time than other forms of aid, according to
the World Bank.
Tablets of the therapeutic Spirulina dietary supplement. Micronutrients can be obtained
through fortifying foods. Fortifying foods such as peanut butter sachets (see Plumpy'Nut
and Spirulina) have revolutionized emergency feeding in humanitarian emergencies because
they can be eaten directly from the packet, do not require refrigeration or mixing with scarce
clean water, can be stored for years and, vitally, can be absorbed by extremely ill
children. The United Nations World Food Conference of 1974 declared Spirulina as 'the best
food for the future' and its ready harvest every 24 hours makes it a potent tool to eradicate
malnutrition.
Proposed Solution

10. Proposed Solution
Multi-SectoralSolutions
 •Nosingleinterventioncaneradicatemalnutrition
 •Thepackageofinterventionsmustbewidelyinter-
sectoralsoastoaddressatleastamajorityofthecauses
 •Theymustbesimultaneoussothatthebenefitofoneinter
ventionisnotlostonaccountoftheabsenceofanother
 •Theymustcovertheentirelifecycleofwomenandchildre
ntocreateandimmediateimpactwithinonegenerationo
nthenutritionalstatusofthethreeciticallinksofmalnutr
ition,namely,children,adolescentgirls,andwomen
 •Only then can the benefits be sustainable enough to
break the inter-generational cycle, and be passed on
the next generation.

11. Proposed Solution
Fundamental causes of Malnutrition in India not yet
addressed programmatically
 Malnutrition in India is deeply rooted in the intergenerational cycle of
low birth weight babies, underweight children, malnourished, anemic
adolescent girls and pregnant women. However, current policies and
programs do not address the issue inter-generationally.
 More than 30% population of India suffers from a Calorie-Protein, Micro
nutrient Deficit, (CMPD). This factor not yet acknowledged or addressed
specifically in any program, (except in general through the TPDS, whose
out reach to the lowest percentile of poverty is poor.) Besides, TPDS even
if working efficiently only provides for cereals,(and in some cases pulses
and sugar,) a subsistence diet for the poor.
Until the above two root causes are substantively addressed, existing
scattered interventions will have negligible impact on reducing
malnutrition.

12. Essential Interventions to Combat
Malnutrition
(A)Direct interventions–
Related to the consumption and absorption of adequate protein calorie/micro-nutrient rich
foods essential to combat malnutrition, namely:
 Weighment of child within 6 hours of birth and thereafter at monthly intervals.
 Timely initiation of breastfeeding within one hour of birth, and feeding of
colostrums to the infant.
 Exclusive breastfeeding during the first six months of life.
 Timely introduction of complementary foods at six months and adequate intake
of the same, in terms of quantity, quality and frequency for children between 6-24
months.
 Dietary supplements of all children between 6 months –72 months through
energy dense foods made by SHGs from locally available food material to bridge
the protein calorie gap.
 Safe handling of complementary foods and hygienic complementary feeding
practices.
 Complete immunization and Vit. A supplementation.
 De-worming of all family members bi-annually.
Implementation of Solutions

13. Essential Interventions to Combat
Malnutrition
 Frequent, appropriate, and active feeding for children during and after
illness, including oral rehydration with Zinc supplementation during
diarrhea.
 Timely and quality therapeutic feeding and care for all children with
severe and acute malnutrition.
 Dietary supplements of iron –rich, energy dense foods made from
locally available food material prepared by women SHGs for adolescent
girls and women, especially during growth periods and pregnancy to fill
the protein calorie gap and ensure optimal weight gain during
pregnancy.
 Anaemia screening for children, adolescent girls and women.
 Weight monitoring of all adolescent girls and pregnant women.
 Prevention and management of Micro-Nutrient deficiencies, especially
through IFA supplementation to prevent anaemiain adolescent girls and
women.
 Making available low cost energy foods for the general population.
 Fortification of common foods.
Implementation of Solutions

14. Essential Interventions to Combat
Malnutrition
(B)Indirect Interventions–
Related to issues of health, safe drinking water, hygienic sanitation and socio-
cultural factors such as early marriage and pregnancy of girls, female literacy
and poverty reduction, to eradicate malnutrition on a long term, sustainable
basis.
 Access to safe drinking water (treatment, storage, handling and
transport), sanitation and hygiene.
 Increased female education and completion of secondary schooling for
the girl child, delayed age of marriage and pregnancy.
 Increased access to basic health services by women.
 Expanded and improved nutrition education and involvement at
Panchayat and community level to create demand.
 Increased gender equity.
 Linking Agriculture/Horticulture and Nutrition.
Implementation of Solutions

15. The Mission strategy is based on the following
over-arching principles:
 Bridge the protein-calorie-micronutrient deficit which affects at least 50% of the population.
 Cover the entire life-cycle of women and children so as to break the inter-generational cycle
of malnutrition within the shortest possible time.
 Formulate a tightly integrated multi-sectoral strategy to address all or majority of direct and
indirect causes of malnutrition simultaneously, many of which existing on going programs.
 Interventions include Direct interventions, based on adequate food and micro-nutrients,
and Indirect interventions, addressing issues of health, education, water, sanitation and
socio-cultural, factors that are critical to eradicate malnutrition on a long term, sustainable
basis.
 Initiate a sustained general public awareness campaign, through the multi-media and
interpersonal communication mode to reach the general public, especially at the grass-roots,
regarding proper nutritional practices.
 Establish vigorous monitoring mechanisms at the administrative and community levels,
using participatory mechanisms and cast responsibility upon the respective functionaries for
achieving results. Build accountability through intensive monitoring of nutritional
indicators in the Mission Blocks by the Mission Secretariat, Community Monitoring, and by
third-party evaluations.
Impact of Solutions

16. MEGACOORDINATION
Challenges & Mitigation Factors
No single Ministry can effect such Mega Coordination.
Effective coordination between the Ministries that have
substantive primary mandates of their own, requires a Mission
Mode, under the leadership of the Prime Minister or Deputy
Chairman Planning Commission.

17. Thank you
A Presentation by
Aditya Chaturvedi, Ayushi Jain, Ishu Mishra, Asmita Madan, Portia Pachauri