This document summarizes national trends in nutrition outcomes, determinants, and interventions in India between 2005-2006 and 2015-2016 based on data from major health surveys. Key findings include: - Stunting declined significantly from 48% to 38.4% but state levels varied widely. Other outcomes like wasting, anemia, and exclusive breastfeeding saw limited improvement. - Immediate determinants like early initiation of breastfeeding, timely introduction of foods, and child feeding practices showed limited progress. - Coverage of nutrition interventions increased overall but remained variable across states and along the continuum of care from pregnancy to early childhood. - Underlying social and economic determinants like women's education and access to

1. National-­‐Level
Trends
in
Outcomes,
Determinants
and
Interventions
Rasmi
Avula
with
Purnima
Menon,
Sneha
Mani,
Neha
Kohli,
Phuong
Nguyen
International
Food
Policy
Research
Institute
New
Delhi|
May
3,
2017

2. Nutrition
in
the
global
agenda
2.2 BY 2030 END ALL FORMS OF MALNUTRITION, INCLUDING
ACHIEVING BY 2025 THE INTERNATIONALLY AGREED TARGETS ON
STUNTING AND WASTING IN CHILDREN UNDER FIVE YEARS OF
AGE, AND ADDRESS THE NUTRITIONAL NEEDS OF ADOLESCENT
GIRLS, PREGNANT AND LACTATING WOMEN, AND OLDER
PERSONS

3. Tracking
progress:
Health
and
nutrition
surveys
in
India,
1990-­‐2015*
1990 1995 2000 2005 2010 2015
NFHS-­‐1 NFHS-­‐2 NFHS-­‐3 NFHS-­‐4
DLHS-­‐1 DLHS-­‐2 DLHS-­‐3
AHS AHS AHS
RSOC
Survey
types
CNNS
*only
includes
surveys
representative
at
the
district
level
or
higher
NFHS:
National
Family
Health
Survey;
DLHS:
District
Level
Household
Survey
AHS:
Annual
Health
Survey;
RSOC:
Rapid
Survey
on
Children
CNNS:
Comprehensive
National
Nutrition
Survey

4. POSHAN
Report:
Trends
in
nutrition
outcomes,
determinants,
and
interventions
• Description
of
national
and
state
trends
– WHA
targets
– Multiple
determinants
– Nutrition-­‐specific
interventions
• Generate
a
dialogue
to
support
policy
decisions
for
improving
nutrition
in
multiple
states

5. Methods
• Data
sources:
– National
Family
Health
Survey-­‐4
(NFHS-­‐4,
2015–16)
factsheets
– National
Family
Health
Survey-­‐3
(2005–06)
factsheets/report
– Rapid
Survey
on
Children
(RSoC,
2013–2014)
for
indicators
that
are
currently
not
available
in
NFHS-­‐4
fact
sheets.
• Analysis
– trends
and
levels
– Outcome
indicators
– Immediate
and
underlying
determinants
– Coverage
of
nutrition-­‐specific
interventions

6. Indicators
based
on
UNICEF’s
conceptual
framework
and
Indian
policy
framework
Outcomes
(WHA
targets+)
• Stunting
• Wasting
• Low
birthweight
• Exclusive
breastfeeding
• Underweight
• Anemia
(women
of
reproductive
age,
pregnant
women,
children)
Immediate
determinants
• Low
body
mass
index
(BMI)
• Early
initiation
of
breastfeeding
• Timely
introduction
of
foods
• Adequate
diet
• Prevalence
of
acute
respiratory
infection
(ARI)
• Prevalence
of
diarrhea
Underlying
determinants
• Women
who
are
literate
• Women
with
at
least
10
years
of
education
• Access
to
electricity
• Married
before
18
• Improved
sanitation
• Improved
drinking
water
Nutrition
interventions
• Early
initiation
of
breastfeeding
• Timely
introduction
of
foods
• Adequate
diet
• Prevalence
of
acute
respiratory
infection
(ARI)
• Prevalence
of
diarrhea
• ANC
(first
trimester)
• ANC
4
or
more
visits)
• ANC-­‐neonatal
tetanus
injections
• Consumption
of
IFA
supplements
• Food
supplementation
(pregnancy)
• Janani
Suraksha
Yojana (JSY)
• Skilled
attendant
at
birth
• Delivery
in
a
health
facility
• Birth
registration
• Food
supplementation
(lactation)
• Full
immunization
• Vitamin
A
supplementation
Menon
et
al.
2017.
Trends
in
Nutrition
Outcomes,
Determinants,
and
Interventions
in
India.
Page
15

7. Trends
in
key
global
nutrition
targets
and
nutrition
outcomes
in
India,
2005-­‐06
to
2015-­‐16
48
19.8
55
46.4
21.5
42.5
59
69.4
38.4
21
53
54.9
18.6
37.5
50
58.4
0
10
20
30
40
50
60
70
Stunting Wasting Anemia
among
women
Exclusive
breastfeeding
Low
birthweight
Underweight
Anemia
among
pregnant
women
Anemia
among
children
2005-­‐06 2015-­‐16
32.8
5
61.1
13.7
Source:
NFHS-­‐3;
NFHS-­‐4
and
RSOC
for
low
birth
weight
World
Health
Assembly
Nutrition
Target
Level
27.9

8. Stunting
declined
– broad
improvements,
tremendous
state-­‐level
variability
in
extent
of
improvement
2005-­‐06
Source:
NFHS-­‐3;
NFHS-­‐4
2015-­‐16

9. Changes
in
immediate
determinants
of
nutrition:
Limited progress
on
IYCF
and
child
health
35.5
22.923.4
41.6
52.6
42.7
9 9.2
5.8
2.7
0
10
20
30
40
50
60
70
2006 2016
%
Women
with
body
mass
index
<18.5
Early
initiation
of
breastfeeding
Timely
introduction
of
foods
Diarrhea
in
the
last
two
weeks
ARI
in
the
last
two
weeks

10. Uttar
Pradesh
Uttarakhand
Rajasthan
NCT
of
Delhi
Punjab
Jharkhand
Chandigarh
Madhya
Pradesh
Bihar
Telangana
Andhra
Pradesh_New
Himachal
Pradesh
India
Andaman
&
Nicobar
Island
Haryana
Tripura
Jammu
&
Kashmir
Chattisgarh
West
Bengal
Dadra
and
nagar
haveli
Gujarat
Nagaland
Lakshadweep
Tamil
Nadu
Daman
&
Diu
Karnataka
Maharashtra
Arunachal
Pradesh
Meghalaya
Kerala
Assam
Puducherry
Manipur
Sikkim
Odisha
Mizoram
Goa
Andhra
Pradesh
0 20 40 60 80 100
%
2006 2016
Tripura
Rajasthan
Bihar
Uttar
Pradesh
Haryana
Madhya
Pradesh
Punjab
India
Maharashtra
NCT
of
Delhi
Andaman
&
Nicobar
Island
Karnataka
Uttarakhand
Jharkhand
Gujarat
Assam
Jammu
&
Kashmir
West
Bengal
Himachal
Pradesh
Arunachal
Pradesh
Chattisgarh
Odisha
Andhra
Pradesh_New
Telangana
Sikkim
Kerala
Meghalaya
Tamil
Nadu
Mizoram
Nagaland
Puducherry
Manipur
Andhra
Pradesh
Chandigarh
Dadra
and
nagar
haveli
Daman
&
Diu
Goa
Lakshadweep
0 20 40 60 80 100
%
2006 2016
Early
initiation
of
breastfeeding Timely
introduction
of
complementary
foods

11. Coverage
of
all nutrition-­‐specific
interventions
increased;
variable
coverage
0
10
20
30
40
50
60
70
80
90
100
2006 2016
%
ANC
visit
during
first
trimester
4+
ANC
visits
for
last
birth
Consumed
IFA
during
pregnancy
Food
supplementation
during
pregnancy
Delivery
in
health
facility
Births
assisted
by
a
health
professional
Birth
registration
Food
supplementation
during
lactation
Fully
immunization
Received
vitamin
A
in
the
last
6
months
Food
supplementation
for
children
ORS
during
diarrhea

12. 0
10
20
30
40
50
60
70
80
90
100
%Coverage
of
interventions
varies
across
continuum
of
care,
among
states
in
2016
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.

13. Women’s
education,
age
at
marriage
and
infrastructure
improved;
sanitation
improved
but
still
remains
a
big
challenge
0
10
20
30
40
50
60
70
80
90
100
2006 2016
%
Women
who
are
literate
Women
with
≥10
years
education
Girls
married
before
age
of
18
Households
with
access
to
improved
drinking
water
Households
with
access
to
improved
sanitation
facility
Households
with
electricity

14. Emerging
health
problems:
Non-­‐
communicable
diseases
13.4
18.6
7.98.8
20.7
5.8
0
10
20
30
40
50
60
70
Hig
blood
pressure Overweight/Obesity High
sugar
level
%
Men Women

15. Summary
• Progress
on
several
maternal
and
child
nutrition
outcomes in
the
last
decade
– Anemia
still
a
public
health
concern
in
India
– Stunting
still
a
public
health
concern
in
some
states
• Modest
and
mixed
improvements
in
the
immediate
determinants of
nutrition
– Disease
burden
unchanged
• Intervention
coverage
shows
positive
trends
over
time
for
most
interventions
• Substantial
progress
on
underlying
determinants
– Sanitation
lags
behind
• Interstate
variability
is
masked
in
national
averages
– Unpack,
investigate,
set
goals,
develop
strategies