Relying solely on food supplements and fortification may not be sufficient to effectively tackle malnutrition caused by micronutrient deficiencies
Inadequate dietary diversity and meal frequency can leave infants and young children vulnerable to malnutrition, particularly stunting and micronutrient deficiencies. Photo: Vikas Choudhary / CSE. It is imperative to ensure that children aged 6-23 months have a minimum dietary diversity (MDD) to achieve healthy diets and nutrition. MDD for children aged 6-23 should include foods and beverages from at least five of the eight defined food groups during the previous day or within 24 hours, according to World Health Organization (WHO).
WHO has developed guidelines for Infant and Young Child Feeding (IYCF) practices, with MDD being one of the core indicators. The global health body has provided clear guiding principles for feeding breastfed and non-breastfed children and recommends that children aged 6-23 months be fed a variety of foods to ensure that their nutrient needs are met.
In addition, food group diversity is associated with improved linear growth in young children. A diet lacking in diversity can increase the risk of micronutrient deficiencies, which can harm children’s physical and cognitive development.
Also read: India’s child wasting rate 18.7% as per latest UN inter-agency estimates
The eight food groups used for tabulation of this indicator are breast milk, grains, roots, tubers, plantains, pulses (beans, peas, lentils), nuts, seeds, dairy products (milk, infant formula, yoghurt, cheese), flesh foods (meat, fish, poultry, organ meats), eggs, vitamin-A rich fruits and vegetables and other fruits and vegetables.
Breast milk alone may no longer be sufficient to meet an infant’s nutritional requirements, particularly after the age of 6-8 months. Therefore complementary foods such as solid, semisolid or soft foods are necessary to meet their nutritional needs.
Infants, children, adolescents and women are particularly susceptible to malnutrition. Therefore, optimising nutrient-rich diets early in life, particularly during the 1,000 days from conception to a child’s second birthday, is crucial to ensure the best possible start in life and achieve long-term benefits.
Inadequate dietary diversity and meal frequency can leave infants and young children vulnerable to malnutrition, particularly stunting and micronutrient deficiencies, leading to increased morbidity and mortality among children. India has high child malnutrition, with 36 per cent of children stunted, 19 per cent wasted and 32 per cent underweight.
Poor-quality diets are one of the most significant barriers to children’s survival, growth, development and learning today. The risks are highest during the first two years of life when inadequate nutrient intake can irrevocably impair a child’s quickly expanding body and brain.
Also read: Multiple exclusions push Odisha’s children into malnutrition death
India has a significantly low proportion of children (15 per cent) who meet MDD, followed by Nepal (34 per cent), which suggests that South Asian countries are trailing behind in terms of MDD, according to data (Senarath et al., 2012).
A study published in journals like Child Indicators Research and BMC Nutrition revealed that children from the richest wealth quintile had a greater chance of receiving MDD (Bhati, et al., 2022) than those from the poorest quintile.
Also, the mother’s educational status was found to have significantly contributed — about 43.8 per cent — to MDD inequality in 2005-06, which decreased to 35.5 per cent in 2015-16 (Tripathy et al., 2023). India has been low and sluggish in Dietary Diversity Scores and lagging in terms of the government’s attention to it.
We analysed data from two rounds of the National Family Health Surveys (NFHS) — NFHS-4 (2015-2016) and NFHS-5 (2019-2021) — to understand the dietary diversity among children aged 6-23 months receiving solid, semisolid and breastmilk; receiving adequate diets as MDD aged 6-23 months; and breastfed and non-breastfed children aged 6-23 months receiving adequate diets across the country.
A figure showing regional disparity across states/UTs.
The figure above highlights that at the national level, nearly 46 per cent of infants aged 6-8 months received solid, semisolid and breastmilk in 2019-2021 — an increase from 43 per cent in 2015-2016. While states such as Manipur, Kerala, Himachal Pradesh, West Bengal and Odisha were at the top of the list, Uttar Pradesh, Rajasthan, Jharkhand, Madhya Pradesh and Chhattisgarh lagged behind.
However, many states experienced increments in providing solid, semisolid and breastmilk to infants 6-8 months from 2015-2016 to 2019-2021. However, Uttar Pradesh, Jharkhand, Chhattisgarh, Jammu and Kashmir, Karnataka, Andhra Pradesh, Telangana and Tamil Nadu states witnessed negative results.
A figure showing the percentage of children aged 6-23 months receiving adequate diet.
At the national level, only 11.3 per cent of children aged 6-23 months received an adequate diet in 2019-21 — an increase from 9.6 per cent in 2015-16, way below the WHO recommendations. In states like Meghalaya, Sikkim, Kerala and West Bengal, more than 20 per cent of children aged 6-23 months were provided with adequate diets.
On the other hand, states like Gujarat, Uttar Pradesh, Assam, Bihar, Rajasthan, Maharashtra, Madhya Pradesh, Telangana and Andhra Pradesh were at the lowest rung in terms of providing adequate diets to children. States like Tamil Nadu, Chhattisgarh, Assam, Jammu & Kashmir, Nagaland, Puducherry and Mizoram showed a declining MDD among children.
A notable difference was found in rural and urban areas in 2019-21. The difference between rural and urban India is 11 per cent and 12.3 per cent, respectively. The figure above clearly shows that except for a few states, like Himachal Pradesh, Odisha, Kerala, Karnataka, Haryana, Bihar and Telangana, children residing in rural areas received lower MDD than in urban areas.
However, Andhra Pradesh, Mizoram, Tamil Nadu and Madhya Pradesh saw a high concentration of MDD in urban areas.
A figure showing the percentage of breastfed children aged 6-23 months receiving an adequate diet.
At the national level, 11 per cent of breastfed children aged 6-23 months received an adequate diet in 2019-21 — an increase from 8.7 per cent in 2015-2016. Further, the state-wise figure shows that between 2015-2016 and 2019-2021, there was an increase in the adequate diet for breastfed children.
However, a few states — Assam, Telangana, Chhattisgarh, Tamil Nadu, Mizoram, Jammu and Kashmir, Laddakh, Sikkim and Nagaland — showed a declining trend.
A figure showing the percentage of non-breastfed children receiving an adequate diet.
The figure above shows that at the national level, non-breastfed children receiving an adequate diet declined to 12.7 per cent in 2019-2021 from 14.3 per cent in 2015-2016. The data shows that more than 13 states are below the national average.
Moreover, huge variations exist across the states / Union Territories (UT). It ranges from 2.5 per cent in Chhattisgarh to 32.5 per cent in Meghalaya. Furthermore — Assam (5.4 per cent), Dadra and Nagar Haveli and Daman Diu (4 per cent), Gujarat (6 per cent) and Uttar Pradesh (7 per cent) — were the states at the lowest rung.
States such as Kerala, Tamil Nadu, Himachal Pradesh, Jammu and Kashmir and Odisha have provided adequate diets for non-breastfed children compared to other states / UTs.
NFHS survey highlighted that despite improvements in the proportion of children receiving solid, semisolid and breastmilk, the proportion of children receiving adequate diets as per MDD remains low in India, with huge variations across different states and rural-urban areas.
The data also emphasises the need to improve the dietary diversity of breastfed children, who are more vulnerable to malnutrition. However, India has initiated several programs to improve micronutrient intake among children. POSHAN Abhiyaan, or National Nutrition Mission, is the Government of India’s flagship program to improve nutritional outcomes for children, pregnant women and lactating mothers. However, still, India has to go a long way to stamp out child malnutrition.
The disparities in MDD across different regions and socioeconomic groups highlight the need for targeted interventions to improve child nutrition. Previous studies suggest that socioeconomic status, particularly the mother’s educational status, significantly determines MDD inequalities among children aged 6-23 months.
Additionally, efforts to increase awareness and knowledge about the importance of MDD could also help promote better dietary practices among caregivers. Therefore, promoting a diverse diet that includes foods from multiple food groups can be crucial in preventing malnutrition and improving the health and development of children.
Efforts to address malnutrition through MDD must include a multi-sectoral approach that addresses the underlying causes of malnutrition, such as poverty, food insecurity, and inadequate access to health care, education, and safe water and sanitation.
Implementing a food-based minimum dietary diversification approach can be a sustainable and long-term strategy to address the issue of micronutrient deficiency among children aged 6-23 months in India. Relying solely on food supplements and fortification may not be sufficient to effectively tackle malnutrition caused by micronutrient deficiencies among children.
Therefore, promoting dietary diversity through the consumption of a variety of foods from different food groups can be a more effective and sustainable approach to addressing this issue. This approach can not only provide the required micronutrients but also offer other essential nutrients that can contribute to the overall health and well-being of the children.
Views expressed are the authors’ own and don’t necessarily reflect those of Down To Earth
Prem Shankar Mishra is a Postdoctoral Research Associate at the Indian Institute of Management, Bangalore, and Abhipsa Tripathy is a Research Scholar at the Indian Institute of Technology, Dhanbad.
We are a voice to you; you have been a support to us. Together we build journalism that is independent, credible and fearless. You can further help us by making a donation. This will mean a lot for our ability to bring you news, perspectives and analysis from the ground so that we can make change together.
.png)
Comments are moderated and will be published only after the site moderator’s approval. Please use a genuine email ID and provide your name. Selected comments may also be used in the ‘Letters’ section of the Down To Earth print edition.