Presented at 'Strengthening National, State and District-level Actions for Nutrition: Insights from the National Family Health Survey Data' on 13th December, 2017 at IIC, New Delhi. Visit the POSHAN website for more: www.poshan.ifpri.info

1. Delivering interventions during the first 1000
days: Implications for achieving India’s nutrition
goals
Rasmi Avula, Phuong Nguyen, Sneha Mani, Neha Kohli, Purnima Menon
International Food Policy Research Institute
December 13, 2017

2. Trends in key global nutrition targets and nutrition
outcomes in India, 2005-06 to 2015-16
48
19.8
55
46.4
21.5
38.4
21
53
54.9
18.6
0
10
20
30
40
50
60
70
Stunting Wasting Anemia among
women
Exclusive
breastfeeding
Low birthweight
2005-06 2015-16
Source: NFHS-3; NFHS-4 and RSOC for low birth weight
World Health Assembly Nutrition Target Level

3. Conceptual framework for child nutrition

4. Interventions across continuum of care in the Indian policy
and programmatic framework
PRECONCEPTION
- IFA
- Deworming
- Fortification (Iodized
salt)
PREGNANCY
- IFA, Calcium
- Food supplements
- Counseling
- Weighing
- Malaria prevention
- Deworming
- Maternity benefits
DELIVERY &
POSTNATAL
- Conditional cash
transfer
- Delay cord clamping
- New-born care
counseling
- IFA, Calcium
- Food supplements
EARLY
CHILDHOOD
Counseling on IYCF
Immunization
IFA, Vitamin A
supplements
Food supplements
Growth monitoring
Double ration
SAM management
ORS & Zinc
Deworming
90% coverage  20% reduction in stunting (Bhutta et al. 2008)

5. Variable coverage of interventions across continuum of
care, and among the states in 2016
84.1
58.6
51.2
89
30.3
27.8
78.9 79.7
81.4
24.3
51.0
36.4
20.3
62
60.2
13.4
27.6
49.2 50.6
20.3
0
10
20
30
40
50
60
70
80
90
100
Percentage%
Sources: NFHS-4. RSoC data was used for indicators on pregnancy registration, food supplementation during pregnancy, lactating and for children, visits by health worker,
pediatric IFA and deworming for children. Note: Bars are the national average and the dots are the state averages
PREGNANCY DELIVERY & POSTNATAL EARLY CHILDHOOD

6. Pregnancy registration Received at least 4 ANC check-ups
593 districts: > 75% pregnancy registration Only in 158 of 640 districts > 75% received at least 4 ANC visits
Bringing the focus to the action centers: Districts

7. IFA consumption New-born checkup
618 districts: <50 percent of children had a
newborn checkup
<25 percent coverage in 290 districts

8. Vitamin A supplementation Immunization
>75% coverage only in 129 districts >75% coverage only in 150 districts

9. 63.2
45.1
83.3
32.5
79.8
17
40.1
37.4
32.4
28.3
80.4
13.5
25.5
31.7 29.3
25.8
62.2
66.7
40.7
35
60.6
21.9
44.4
37.7 40.1
27.4
91
0
10
20
30
40
50
60
70
80
90
100
%
Points of investment and encouragement to improve
delivery of interventions: An example of Haryana
PREGNANCY DELIVERY & POSTNATAL EARLY CHILDHOOD
Health
Health
Health
ICDS
ICDS
ICDS
Source: NFHS-4 Haryana State ReportIndicate service delivery platformsNote:
Implement
Review
Plan

10. Closing thoughts
▪ Targets are set for improving nutrition outcomes
▪ Policies and programs exist for improving the determinants
▪ India’s nutrition strategy and the mission rightly focus on the
districts
oHuge potential for improving delivery of interventions
▪ Focus on achieving coverage
oExamine reasons for gaps in coverage - Plan
oIdentify, test, and scale solutions – Implement
oRevisit and reflect - Review