Conference of State Ministers & Secretaries 16 June 2010 Malnutrition

1. Conference ofState Ministers & Secretaries16 June 2010Malnutrition Ministry of Women and Child Development Government of India

2. Nutrition: The Challenge • Every fifth child in the world lives in India • 22% babies are born with low birth weight • 42.5% of children 0-5 years are underweight • 53 out of 1000 live births do not complete their 1st year • 79% children (6-35 months) are anaemic • 69.5% children below 5 years are anaemic • Inadequate focus on Early Childhood Care including IYCF • 35.6 % women with low BMI

3. Nutrition: State-wise Status of Children

4. NFHS 3 - % Anaemic Children 6-35 mths

5. BMI: State-wise Status of Women (15-49 yrs)

6. Undernutrition – Causality Framework Child Undernutrition Manifestations Inadequate Dietary Intake Disease/ Infections Immediate determinants Inadequate access to Health Childcare Services & Hygienic Environment Lack of Household Food Security Inadequate Care for Women and Children Care for Women and Children Underlying determinants Lack of Information Education Communication Lack of Resources & Control Human, Economic & Organisational Basic determinants Political and Ideological Superstructure Economic Structure Potential resource base Source: Adapted from UNICEF

7. Cost of Malnutrition • Malnutrition reduced India’s GDP by 3 – 9% in 1996 • Cost of treating malnutrition is 27 times more than the investment required for its prevention • Cost of Malnutrition to the economy of a nation is extremely high Source : ASCI, 1997

8. Nutrition and MDGs

9. Lancet : Maternal - Child Undernutrition • Underlying cause of more than one-third of all child deaths < 5 yrs • Largest Risk Factors to < 5 yrs death: Stunting, Severe Wasting & Intra-uterine growth retardation • Pregnancy to age 24 months: Critical window PREVENTABLE THROUGH EFFECTIVE NUTRITION INTERVENTIONS AT SCALE

10. Lancet : Maternal - Child Undernutrition • Effective interventions for maternal and child survival & development : • Breastfeeding & counseling, • appropriate complementary feeding, • vitamin A and zinc interventions (diarrohea ORS) • Interventions to reduce iron and iodine deficiency • 1.4 million deaths and 10 % of disease burden in <5 yrs : due to inadequate and/ or non-exclusive breastfeeding • 20 % of MMR: due to short stature and iron deficiency anemia

11. National Nutrition Policy 1993 &National Plan of Action on Nutrition 1995 • Key Areas: (i) Food production; (ii) food supply; (iii) women and child development (iv) health care; (v) rural development; (vi) people with special needs, (vii) monitoring and surveillance; and (viii) information. • Direct Nutrition Interventions: • Ministry of Women and Child Development • Awareness and advocacy on Nutrition (FNB) • Integrated Child Development Services (ICDS) • Scheme for Adolescent Girls- KSY, NPAG • Ministry of Health and Family Welfare • Iron and Folic Acid, Vit – A supplementation, IDD Control & deworming • Department of Elementary Education and Literacy • Mid-day Meal for school children • Indirect Long -term Interventions: policy instruments leading to institutional and structural changes

12. Indirect Interventions Sector Commitment towards Nutrition Agriculture Ensure National Level Food SecurityAdequate Buffer StocksNutritional Orientation of Agricultural Policy Horticulture Promote Nutrition oriented horticulture at Community & House-hold level Public Distribution Ensure food & nutrition security at of food household level Education Include Nutrition in curricula of all educational systems – formal & non-formal Health & Family Welfare Due emphasis to nutrition at all levels –Medical Education, Training, Primary Health Centre, Disease Surveillance

13. Indirect Interventions Sector Commitment towards Nutrition Rural Development Ensure universal access to safe drinking water and sanitation Improve purchasing power through poverty alleviation programs Information & Create a climate of nutritional awareness Broadcasting Launching a daily programme on “Nutrition & Health” on Radio & TV Women & Child Focus on eradication of malnutrition Development Serve as the nodal department for implementation of nutrition policy and facilitating convergence of services

14. Existing Government Interventions: Life Cycle Approach Expanded but lagged by a decade:NRHM (2005-06), NHM (2005-06), NREGS (2005-06), JSY (2006-07), TSC, MDM(2008-09), ICDS (2008-09), NRLM(2010-11)

15. Focus on Continuum of Care in Nutrition Approach ICDS (PW+NM) /+ IGMSY SABLA 11 – 18 yrs Girls MDM ICDS Livelihoods + Income IEC + BCC 6 – 14 yrs 3 – 6 yrs ICDS Exclusive Breast Feeding 6 mths – 3 yrs Breast feeding & Complementary feeding 0 - 6 mths Flagship and Bharat Nirman Programmes Food Security + Health Care + Water & Sanitation+ Environment FOUNDATION OF CHILD CARE AND DEVELOPMENT APPROACH

16. Core Interventions • Household food security and livelihood • Need for food supplementation programmes and Health care • Strengthening & Restructuring of ICDS • Addressing the intergenerational cycle of adolescent, maternal and child undernutrition • Policy, coordination and convergence of, nutrition related sectors including health services and hygienic interventions • Monitoring nutrition interventions • Capacity building

17. Focus on Key Results • Initiation of breastfeeding within one hour of birth • Exclusive breastfeeding of children upto 6 months • Introduction of complementary feeding upon completion of 6 months, along with continued breastfeeding for 2 years • Appropriate Infant and Young Child Feeding (IYCF) practices among children 6-24 months • Supplementary Nutrition through Anganwadi Centres • Access to care for the severely malnourished NUTRITION STATUS OF UNDER 3s TO BE A LEAD INDICATOR FOR ALL DEVELOPMENT PROGRAMMES

18. Focus on Key Results • Iron supplements to children • Consumption of 100 IFA tablets by women & adolescent girls • Households with adequately iodised salt • Vitamin A supplementation every 6 months for children 9 - 59 months • Full immunization of children (BCG, Measles and three doses of DPT and Polio) • Treatment of acute respiratory infection from health care facility • Oral rehydration therapy or increased fluids for diarrhoea treatment • Deworming of children every 6 months, if required • Safe disposal of stools NUTRITION STATUS OF UNDER 3s TO BE A LEAD INDICATOR FOR ALL DEVELOPMENT PROGRAMMES

19. Key Actions • Governance and Political Commitment • Implementation and Delivery • Multi Sectoral Programme Intervention • Correct Focusing • Convergence • Effective Monitoring • Community Mobilization and Participation • Communication, BCC, IEC and use of ICT • Development of a Cadre and Voluntary Action Groups of Experts

20. Improving nutrition related governance of States/UTs: Constituting State Nutrition Council, chaired by Chief Minister Setting Up Interdepartmental Coordination Committee, chaired by Chief Secretary District Coordination Committee, chaired by District Collector Establishing State Breastfeeding /Infant and Young Child Feeding Committees, for implementing the IMS Act State/UT Nutrition Action Plans Mapping ‘high risk and vulnerable districts’ Developing Multisectoral State/ UT and District Nutrition Action Plans (Project/ Block as a Unit) Creating thematic working groups on the above Specific Interventions for High Burden Districts Surveillance and Monitoring Action by States

21. Establishing State Nutrition Resource Platform /Centres Behaviour Change Communication & Counselling State campaign Focus on national IYCF guidelines 2006 Integrating and strengthening nutrition relevant actions in national/ state /district PIPs of related national flagship programmes Strengthening and restructuring of ICDS Implementation of ICDS with quality and flexibility Enhance community Participation through decentralisation Nutrition Audit of concerned sectors by third party & social audit Action by States

22. THANK YOU