Unpalatable numbers

It is indeed heartening to see improvements in some child health and nutrition indicators in India, as revealed by the fifth round of the National Family Health Survey (NFHS-5). But a closer look at the trends suggests it's a long way to go in meeting Poshan Abhiyan targets and the United Nations-mandated Sustainable Development Goals (SDG) within the 2022 and 2030 deadlines respectively.

The second phase of the latest NFHS data included information on key indicators and trends of child health and nutrition for 14 states and Union Territories (UTs):

• Arunachal Pradesh

• Chandigarh

• Chhattisgarh

• Haryana

• Jharkhand

• Madhya Pradesh

• Delhi

• Odisha

• Pondicherry

• Punjab

• Rajasthan

• Tamil Nadu

• Uttar Pradesh

• Uttarakhand

Data related to the other 22 states and UTs were published in 2020.

During the fifth round of NFHS, data were collected in two phases — first, from June 17, 2019 to January 30, 2020 and second, from January 2, 2020 to April 30, 2021.

As the first phase of data were collected before the COVID pandemic struck, it is difficult to assess the scale and quantum of the impact caused by the pandemic on the status of child immunisation and many other child health and nutrition parameters.

According to the recent NFHS numbers, India has made good progress in child immunisation indicators: 76.4 per cent of those in the 12-23 months age-group were reportedly vaccinated with BCG / measles and three doses each of polio and DPT in 2020, up from 62 per cent in 2015 — a growth of 23.23 per cent in the last lustrum.

The point to be noted, however, is that child immunisation programmes clearly fall short of reaching the last-mile child.

One can also see some positive trends when it comes to child nutrition, feeding practices and mortality rates. At the same time, the progress falls much short of achieving SDG targets — thus providing an early warning sign of delay in fulfilling commitments in securing long-term gains in child nutrition.

There is some improvement in the status of birth weight, wasting and stunting. But there is only a marginal increase in the percentage of children below three who have been breastfed within one hour of birth: 41.8 per cent in NFHS-5, up only 0.48 percentage points from 41.6 per cent in NFHS-4.

Though the percentage of wasted children below five decreased in five years — to 19.3 per cent (NFHS-5) from 21 per cent NFHS-4), the percentage of those under five and severely wasted actually increased (NFHS-5: 7.7per cent; NFHS-4: 7.5per cent).

The biggest worry is the rising trend of anaemia. A close look at the numbers reveal that anaemia has increased considerably among children from the previous round. In NFHS-4, 58.6 per cent children within the age-group of 6-59 months had been reported to be anaemic, while in NFHS-5 it is 67.1 per cent, showing an alarming growth of 14.51 per cent.

The target set in the National Nutrition Strategy (NITI Aayog) was a reduction in prevalence of anaemia in children (6-59 months) from 58.4 to 19.7 by the year 2022.

Percentage of anaemic women aged 15-19 years also increased from the last round (NFHS-5: 59.1 per cent; NFHS-4: 54.1 per cent — a growth of 9.24 per cent). Again, the target was a reduction from 53.1 per cent to 17.7 per cent by 2022.

Reducing the prevalence of anaemia in women and children, therefore, is important. It is also often associated with chronic malnutrition, spontaneous abortions, low birth weight, neonatal and infant mortality.

There is one interesting point to be noted though: While maternal anaemia is on the rise, intake of Iron Folic Acid (IFA) supplements by expecting mothers during their first and second trimester has shown some improvement too.

NFHS-5 showed that 44.1per cent of mothers consumed IFA supplements for 100 days or more during pregnancy, while the figure was 30.3 per cent in NFHS-4.

Overall, one cannot disagree with the fact that improvement in maternal health outcomes has the potential to not only improve the health of women but also impact the health and nutrition outcomes of their children, especially in the initial years of growth.

Therefore, increasing focus on improving gender equity in health and nutrition has the potential to break the intergenerational cycle of malnutrition.

While findings of the latest round of NFHS conveys some good news when it comes to securing gains in child health and nutrition, it needs more efforts across many indicators to achieve Poshan Abhiyaan and globally agreed upon SDG targets which India is a signatory of.

Let us not forget that a majority of our child population still suffers from multiple forms of malnutrition and hunger. And given the fact that much of the progress made in the recent years might have been undone by the deadly COVID pandemic, it is critical that we do not allow it to derail the gains we have made thus far and use this opportunity to build back better and equal.

This calls for considerable increase in public provisioning on child health and nutrition. Only a transformative increase in budget allocation to address child malnutrition and hunger, coupled with a strengthened health delivery system and a robust monitoring mechanism in reaching out to the last mile children, can make us ensure healthier childhoods. DTE

Views expressed are personal.