Need for a holistic approach to reduce stunting: NFHS 5 shows concerning scenario

Stunting in early life -- particularly in the first 1000 days from conception until the age of two - has adverse functional consequences on the child.

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Need for holistic approach to reduce stunting: NFHS 5 shows concerning scenario

Overview

Malnutrition manifests in four broad forms: wasting, stunting, underweight, and micronutrient deficiencies. Stunting is defined as low height-for-age. It is the result of chronic or recurrent malnutrition, usually associated with poverty, poor maternal health, and nutrition, frequent illness, and/or inappropriate feeding and care in early life.

Stunting in early life — particularly in the first 1000 days from conception until the age of two – has adverse functional consequences on the child. Some of those consequences include poor cognition and educational performance, low adult wages, lost productivity, and, when accompanied by excessive weight gain later in childhood, an increased risk of nutrition-related chronic diseases in adult life such as diabetes, cardiovascular diseases, etc.

Also Read: NFHS-5 Report shows more than half of India’s children and women are anemic

Global Perspective

Childhood stunting is one of the most significant impediments to human development. In 2020, globally, 149.2 million (22%) children under the age of 5 years of age were stunted. Almost two-thirds of these children live in low- and middle-income countries. Stunting and other forms of under-nutrition are thought to be responsible for nearly half of all child deaths globally.

Indian Context

As per CNNS, in India, 35 percent of children younger than five years of age are stunted, a manifestation of chronic undernutrition. According to a World Bank 2019 report, India has the second-highest number of stunted children in South Asia (38%), after Afghanistan (41%).

Despite rapid macro-economic growth, more than one-third of the global burden of childhood stunting is contributed by India. The Global Hunger Index (2021) has placed India at the 101stspot among 116 countries, based on the total undernourishment of the population. Several studies reveal that India loses up to 4 percent of its gross domestic product (GDP) and up to 8 percent of its productivity due to child malnutrition.

Findings from recent NFHS 5 surveys

The results of the stunting in children are based on the National Family Health Survey Report (2019-21). It was observed that the place of residence shows a high variation in the stunted children. The survey findings reveal that at an overall level, the proportion of stunted children in rural areas is reported to be substantially high (37.3%) as compared to the urban areas (30%).

In rural areas of Meghalaya, the proportion of stunted children was reported to be at 48.2% which was highest amongst the states of India. The Indian states wherein the proportion of stunted children in rural areas is reported to be higher than 40 percent are- Meghalaya (48.2%), Dadra & Nagar Haveli and Daman & Diu (45.7%), Bihar (43.9%), Jharkhand (42.3%), Uttar Pradesh (41.3%). The lowest proportion was reported in Puducherry with 15.6%

In Urban areas, the highest proportion of stunted children aged under 5 years was recorded in Bihar which was reported to be at 36.8%.

The Indian states wherein the proportion of stunted children in urban areas are reported to be higher than 30 percent are- Bihar (36.8%), Meghalaya (35.1%), Maharashtra (34.9%), Dadra & Nagar Haveli, and Daman & Diu (32.9%), Gujarat (32.4%), Karnataka (32.2%), West Bengal (32.1%), Lakshadweep (30.7%) and Madhya Pradesh& Jammu &Kashmir (30.1% each).

NFHS-5 vs NFHS-4

The level of stunting in NFHS-5 (2019-21) has either deteriorated or improved only marginally in most states and union territories, as compared to NFHS-4 (2015-16). Out of the total states surveyed, the levels of stunting worsened in 12 states while others recorded a marginal improvement. The rates of stunting went up substantially in the states of Tripura (8%), Goa (5.7%), Lakshadweep (5.2%), Telangana (5.1%), Nagaland (4.1%), Kerala (3.7%), Meghalaya (2.7%), Dadra & Nagar Haveli and Daman & Diu (2.2%), West Bengal (1.3%), Maharashtra & Mizoram (0.8% each) and Gujarat (0.5%).

Tripura emerged as the worst-performing state on the indicator, with a rise from 24.3% to 32.3% in the last four years. The states wherein the rate of stunting went down by more than 5 percent points are- Bihar (5.4%), Himachal Pradesh & Manipur (5.5% each), Jharkhand (5.7%), Madhya Pradesh (6.3%), Uttarakhand & Haryana (6.5% each), Uttar Pradesh (6.6%) and Sikkim & Rajasthan (7.3% each).

Conclusion: SDG target 2.2 envisages the end of all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age.

In a study published in Lancet in 2013, researchers found that scaling up proven nutritional interventions to 90% coverage could reduce global stunting by 20% and under-5 child mortality by 15%. The key health and nutrition interventions that are already a part of Government of India programs include ante-natal care (ANC) coverage, iron, and folic acid supplementation, institutional delivery, early and exclusive breastfeeding, timely and age-appropriate complementary feeding, complete immunization, growth monitoring with special focus on severe and acute malnutrition (SAM) and moderate acute malnutrition (MAM) identification and referral. Tackling stunting requires a holistic approach and not just focusing on medical-based interventions. It is in time with our government’s approach of Poshan Abhiyan, an overarching scheme, to collaborate all nutrition-specific interventions that are being offered in the country currently, in a focused approach. But to curb the problem of stunting focus also needs to be brought on maternal education, birth spacing, provision of safe water and sanitation facilities, etc.

While interventions on the supply side are critical in realizing progressive nutrition outcomes, it is important to realize that the success of all these initiatives rests with the mother and the family, as they influence the demand and offtake of these suggested interventions.


  • Dhruvi Bagaria

    Indian Institute of Public Health Gandhinagar

  • Gaurav Suresh Gunnal
    MSc in Biostatistics and Demography, International Institute for Population Sciences
  • Kaleem Ahmad Khan
    School of Community Health-Oriented Operation Links (School)


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Need for a holistic approach to reduce stunting: NFHS 5 shows concerning scenario
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Stunting in early life -- particularly in the first 1000 days from conception until the age of two - has adverse functional consequences on the child.
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THE POLICY TIMES
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