Photo: AFP
Photo: AFP

Advances in nutrition: myth or reality?

Systems that frequently generate data on a consistent set of indicators across the country will enable greater insights on how to eliminate malnutrition

Since 2005-06, the date of the last nationwide government survey of nutrition, the story has been one of a curse, a national shame and a disconnect. This is because despite rapid economic growth in the past 15 years, nutrition indicators for children under five have barely moved.

Can we now change that story? If the new data from the government of India-United Nations Children’s Fund Rapid Survey of Children (RSOC), as reported in the Global Nutrition Report 2014, and partial findings from some of the states where the District Level Household Survey (DLHS-4) is to believed, then the answer is yes. The new data from RSOC indicate that the nationwide percentage of children under five who are too short for their age (i.e. stunted) has dropped from 48% to 38% in seven years. That is rapid, by any country’s standards. Thirty eight percent is still very high, but the direction and speed of travel represents a step change. To put it in context, the change represents 10 million fewer stunted children. That is 10 million more children who will stand a better chance of seeing their fifth birthday, learning more in school, and earning more for themselves, their families, community and nation.

Why should we believe the headlines from RSOC? Because the story of substantial reduction in stunting rates is consistent with a state-wide survey from Maharashtra that is in the public domain. That survey, conducted by the International Institute for Population Studies in Mumbai, finds similar levels of stunting declines during the same period. The DLHS-4 results from Maharashtra support findings on stunting reduction.

The DLHS-4 presents a mixed picture on the rate of reductions in stunting across different states, but overall, they also suggest that the news on improvements is quite positive. Of the states for which DLHS fact sheets are available, four have shown substantial reductions in stunting: Maharashtra, Haryana, Andhra Pradesh and Karnataka. What drove these declines? Did the combination of factors that led to declines in Maharashtra have anything in common with those in these other states? What insights do these offer for policy directions that the central and state governments must take to ensure a better future for children? Without the data at hand, knowledge about the best strategy mix for undernutrition reduction remains elusive.

A bigger data issue at present is that little to no nutrition data is available for those states which have had the highest burden of undernutrition in the country. DLHS-4 did not cover the high burden states of Uttar Pradesh, Rajasthan, Madhya Pradesh, Odisha and Chhattisgarh; these states are to be covered under the Annual Health Survey 2013-14, which includes an anthropometry component. These two surveys cannot, however, be combined to derive national trend statistics that are comparable to National Family Health Survey-3 (NFHS-3). NFHS-4 has had its ups and downs, but appears to be back on the agenda; yet, data from this survey will not be available in time for a review of where India stands on millennium development goal-1 (eradicating extreme poverty and hunger) progress, nor in time to craft a realistic nutrition strategy or to set targets for new global goals.

State-level trend data is essential to build data-driven nutrition strategies for individual states. Several strategy development processes are nevertheless moving ahead even in the absence of data—a case in point is the new Nutrition Mission in Uttar Pradesh. Without data that provides baselines and estimates of pre-mission rates of reduction, however, it is near impossible to set realistic and meaningful goals. Later on, it will make it difficult to assess whether rates of reduction were indeed accelerated by the renewed momentum and action for nutrition that missions bring.

Overall, we believe good news exists, and that progress against undernutrition in India is not a myth. Nonetheless, having systems that reliably and frequently generate data on a consistent set of indicators across the country will enable greater insights on how to lift the curse of malnutrition.

Purnima Menon and Lawrence Haddad are senior research fellows at the International Food Policy Research Institute.

Comments are welcome at otherviews@livemint.com

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