Prof. R.K.Panda* in Bhubaneswar, November 30, 2021: Malnutrition among children continues to be a major concern in India. As per the report of the National Family Health Survey (NFHS), 2015-16, the prevalence of child stunting, wasting and underweight under the age of five years comes to 39, 21.0 and 32.7 percent respectively.

The recent NFHS, 2019-20 data indicate that child malnutrition has not improved to the desired extent during the last five years and as such the country remains far behind the stipulation of the U.N –‘ending all forms of malnutrition for under five children by 2030’. Added to the key attribute of malnutrition -under-nutrition, predominantly seen in rural areas, in recent years the country has been witnessing rapid rise in the number of overweight and obese children.

The available data reveal that the number of obese children in the country has touched 14.4 million –second highest in number next to China in the world. Accordingly, the country is at present facing double burden of child malnutrition – co-existence of both under-nutrition and over-nutrition which has tremendous economic implications.

More so, what is more worrisome at present is the apprehension of the experts on the worsening of child malnutrition in the country over the last one and a half year due to Covid-19 pandemic. Their surveys show that there has been large-scale disruption in the on-going government schemes on child and maternal nutrition during the pandemic resulting in rapid rise in the number of malnourished children in the country.

These scholars contend that the children of the marginalized communities are found to be the biggest victims of such disruptions. On the backdrop of the prevailing status of child nutrition / malnutrition in the country, we here underline a few key issues those have all along remained neglected and need urgent attention.

No doubt the problem of child malnutrition is a multi-sectoral issue and as such requires a combined action involving a many stake-holders including institutional agencies. For improving child nutrition we see there are a number of policies and programmes direct and indirect operating in the country. ICDS serves as the most critical instrument in addressing the country’s child malnutrition challenges.

Besides we have a variety of health and livelihood promotion schemes such as Mid-Day Meal (MDM), Targeted Public Distribution System (TPDS), Special Nutrition Programme (SNP), Anaemic Mukta Bharat ( AMB) operating in the country to supplement in this efforts. Some new programmes such as POSHAN Abhyaan is added in recent years ( 2017) aiming at improving child and maternal nutrition and welfare.

On the working of these schemes there are mixed observations among the scholars. Yet, almost all the scholars working on different child nutrition schemes state the difficulty in evaluating the performance of such schemes individually due to their frequent clubbing with other schemes. Secondly, as they opine, most of these schemes are nutrition-specific and thus lack provisioning a broader set of child health and welfare. Added to this, these studies have reported lack of co-ordination between different layers of administration entrusted in implementing these schemes resulting in sub-optimal performance.

While discussing the working of different schemes on child malnutrition, a question is often raised about government policy all along in combating child and maternal malnutrition in the country. Since the Government Policy is better reflected in the way of budgetary allocations to this sector, in this context it is revealed that the annual budgetary allocations towards child and maternal nutrition is found abysmally low and counterintuitive over years. This year’s allocation to child nutrition is worked out to 0.57 percent of the total budget.

Compared to 2020-21 allocations this year’s allocations (2021-22) remain lower, particularly with regard to Anganwadi Services, National Nutrition Mission and MDM. Interestingly while allocations to total health sector has increased in 2021-22 budget, it has declined in case of child health nutrition. When the country is talking of Atmanirbhar Bharat, the meager budgetary allocation on child nutrition who constitute 40 percent of our population will certainly disrupt the process in achieving the goal.

Beside the above key issues, recent surveys conducted on child malnutrition at regional levels have explored a new nutrition reality. Contrary to the common belief that low-income states/ regions suffer from higher density of under-nourished children while high income states/ regions suffer from higher density of overweight/obese children, these recent surveys indicate that there is co-existence of under-nutrition and obesity irrespective of the level of development levels. While in developed regions there are pockets of high density under-nourished children, in relatively poorer regions there are also pockets of high density overweight/obese children. Thus both under-nutrition and obesity go hand in hand in a particular region.

Since child malnutrition takes into account both under-nourishment and over-nourishment in a large country like ours with regions and communities varying with malnutrition there is need for a sound policy which caters to both issues. Besides, as it is often complained that working of our nutritional schemes suffer from lack of reliable data at the Block level in identifying the malnourished children and monitoring the delivery services by Anganwadi Centres etc. The recent attempt to digitize data to track the status of malnourished children through Common Application Software( CAS) under POSHAN Abhiyaan has failed.

This suggests for developing software usable by the workers at the field level. Obesity is a product of higher economic growth. We find rise in the number of obese children in the country in the last two decades – the decades of higher economic growth. Since obesity is more prevalent among well-educated households, this suggests for educating mothers of these households about the shortcomings of child obesity. Since the meager budgetary allocations remains a big constraint in the successful working of various nutrition schemes in the country, there is need for doubling the present level of budgetary allocation. India has to strive for achieving the U.N’s stipulation – ‘ending all forms of malnutrition for under five children’ as a part S.D G by 2030.

*Formerly, Professor of Economics, Utkal University & Director,  Nabakrushna Choudhury Centre for Development Studies, Bhubaneswar