While it is heartening to see some improvements in some of the child health and nutrition indicators in India, as revealed by the recent National Family Health Survey findings (NFHS-5), a closer look at the numbers suggests that it’s still a long way to go in reaching the Poshan Abhiyan targets and the Sustainable Development Goals (SDG) within the stipulated time of 2022 and 2030 respectively.
The second phase of the latest NFHS data (5th round) included information on key indicators and trends of child health and nutriution for 14 states and UTs in India, namely Arunachal Pradesh, Chandigarh, Chhattisgarh, Haryana, Jharkhand, Madhya Pradesh, NCT of Delhi, Odisha, Puducherry, Punjab, Rajasthan, Tamil Nadu, Uttar Pradesh and Uttarakhand, while the data related to rest 22 states and UTs were published in 2020.
During the fifth round of NFHS, data were collected in two phases – the former from 17 June 2019 to 30 January 2020 and the latter from 2 January 2020 to 30 April 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 as well.
Puja Marwaha, the CEO at CRY – Child Rights and You said, “While according to the recent NFHS numbers India has made good progress in child immunisation indicators (76.4 per cent of children within the age-group of 12-23 months are reported to be vaccinated with BCG/Measles and three doses each of Polio and DPT in 2020, as compared to 62 per cent in 2015 – thus showing a growth of 23.23 per cent in the last lustrum), the point to be noted 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 childmortality rates, but at the same time the progress falls short of achieving SDG targets – thus providing an early warning sign of delay in fulfilling commitments in ensuring long term gains in child nutrition. While there is some improvement in the status of birth weight, wasting and stunting, there is only a marginal increase in the percentage of children age below 3 years who have been breastfed within one hour of the birth (NFHS-5 – 41.8% and NFHS-4 – 41.6%, a change of only 0.48 percentage points),” she said.
Highlighting the worrying trends in children’s nutrition status, Puja said, “Though the percentage of wasted children below 5 years has decreased over the last 5 years (NFHS-5 – 19.3% and NFHS-4 – 21%), the percentage of under-5 children who were severely wasted has actually increased (NFHS-5 – 7.7% and NFHS-4 – 7.5%)
But the biggest worry, according to Puja, is the indicators showing rising trends of anaemia.“A close look at the numbers reveal that anaemia among children has increased considerably 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, GoI) was a reduction in prevalence of anemia in children (6-59 months) from 58.4 to 19.7 by the year 2022.
Percentage of anaemic women aged 15-19 years has also increased from the last round (NFHS-5 – 59.1 per centand NFHS-4 – 54.1 per cent; which means a growth of 9.24 per cent).
The target set in the National Nutrition Strategy (NITI Aayog, GoI) was a reduction in prevalence of anaemia in women and girls (15-49 years) from 53.1 to 17.7 by the year 2022.
“Therefore, reducing the prevelance of anaemia in women and children is important as it is also often associated with chronic malnutrition, spontaneous abortions, low birth weight, neonatal and infant mortality),” Puja commented.
However, there is one interesting point (or, apparent contradiction?) that is to be noted here – while maternal aneamia is on the rise, intake of Iron-Folic supplements by expecting mothers during their first and second trimester has shown some improvement too – NFHS-5 shows that 44.1 per cent of mothers consumed IFA supplements for 100 days or more during pregnancy, while the figure was 30.3 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,” Puja stated.
She further said, “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 suffer from multiple forms of malnutrition and hunger, and given the fact that much of our progress 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,” Puja concluded.