Rise in teenage pregnancies, poor maternal health hurdle to breaking intergenerational cycle of undernutrition

Significant incidences of early marriage and childbearing are among the important causes of undernutrition

By Shoba Suri
Published: Wednesday 03 February 2021
NFHS-5 highlights the challenges in breaking the intergenerational cycle of undernutrition

Breaking the intergenerational cycle of undernutrition is one of the key pillars towards eliminating malnutrition in India. The process, however, has seen a history of neglect.

Intergenerational influences are defined as “conditions, exposures and environments experienced by one generation relate to the health, growth and development of the next generation.”

Significant incidences of early marriage and childbearing are among the important causes of undernutrition, due to the adverse intergenerational bearing on health, education and employment.

India has seen impressive gains in the past decades in reducing marriages among children below 18. While early marriage figures in the 22 states and Union territories covered in the latest National Family Health Surey (NFHS-5) has not increased since the last report published five years ago, teenage pregnancies have increased.

This raises risks of complications at birth, low birth weight and higher maternal and child mortality rates.

 Trends in early marriage (below 18 years) and teenage pregnancies in 22 states/UTs


Of concern is Tripura, showing a steep incline in both child marriage and teenage pregnancies. Assam and Manipur also show a rise in child marriage. Andhra Pradesh, Himachal Pradesh, Manipur, Sikkim and Lakshadweep witnessed a rise in teenage pregnancies.

Malnutrition trends are alarming, with 11 states show a rise in stunting in children under five years of age, the highest being reported from Meghalaya (46.5 per cent) and Bihar (42.9 per cent). NFHS-5 shows a sharp rise in stunting for Kerala, Goa and Tripura, which is a cause for concern.

Wasting remains stagnant or shows a rise in most of the states/UTs. Underweight population is on the rise in 11 states.

The threat of double burden of malnutrition (coexistence of undernutrition along with overweight and obesity) is evident from the increase in overweight prevalence in children under five.  A steep rise in overweight children under five has been observed in Himachal Pradesh and Mizoram and the Union territories of Ladakh and Lakshadweep.

Data on nutritional status of women indicates a decline in percentage of women who are thin (body mass index less than 18.5) and a sharp rise in women who are obese/overweight in 16 of the 22 states/UTs.

Evidence indicates that children born to adolescent mothers have a 10 per cent higher prevalence for stunting. Case studies from across India show how adolescents and young girls get consumed into the intergenerational cycle of malnutrition.

The cycle is heightened by poverty, social exclusion and gender discrimination, leading to irreversible effects on cognitive and physical development. It can be combatted through robust interventions for both mother (pre- and post-pregnancy) and child, thereby, addressing the high burden of stunting.

Anaemia in children under five has increased in 16 states/UTs since NHFS-4, with a very significant rise in Assam (32.7 percentage points), Mizoram (27.1 percentage points), Manipur (18.9 percentage points) and Jammu & Kashmir (18.9 percentage points), to name a few.

Anaemia in women of reproductive age (15-49 years) shows an increase in 16 states/UTs. Assam (19 percentage points), Jammu & Kashmir (17 percentage points) and Ladakh (14.4 percentage points) show the highest rise in anaemia levels.

Anaemia in adolescent girls (15-19 years) also rose 16 states/UTs. A sharp rise can be observed in Jammu & Kashmir (26.3 percentage points), Assam (24.3 percentage points), Tripura (15.7 percentage points) and Ladakh (15.3 percentage points).

Anaemia in adolescent mothers has a lasting impact, posing the risk of maternal mortality, low birth weight and higher risk of anaemia in the newborn.

Assam seems to be performing poorly on all nutrition-specific interventions, which is a cause for concern. About 40 per cent adolescent girls suffered from anaemia in the state, according to the 2016-18 Comprehensive National Nutrition Survey. A quarter of adolescent girls are deprived of the four school-based services including mid-day meal, bi-annual health checkup and deworming and weekly iron and folic acid supplementation.

NFHS-5 data indicates a wide variation in the consumption of iron and folic acid supplementation by pregnant women, with Kerala at 67 per cent and Nagaland at 4.1 per cent. Various factors, including level of education of mother and birth order influence the consumption of IFA among pregnant women.

Exclusive breastfeeding has improved across states but early initiation of breastfeeding and complementary feeding has declined in many.

The nutrition-sensitive indicators on water and sanitation, however, showed marked improvement with increased coverage across states/UTs. Ante-natal care coverage has also has improved in 11 state/UTs, with Goa having the highest coverage at 93 per cent, and Bihar and Manipur recording significant improvement.

Antenatal care can help in reducing adverse health outcomes during pregnancy and childbirth. An analysis from NFHS-4  indicates lower maternal education, poor wealth quintile and teenage pregnancies as some of the reasons for lower utilisation of ante-natal care services in India.

Investment in maternal and child health, and adolescent well-being, yields a high benefit-cost ratio, with a triple dividend in both low and upper-middle income countries.

Benefit-Cost Ratio: Return on every dollar invested

(Source: Lancet)

Successful stories of change across India suggest investment in girls and women and heightened delivery of health and nutrition interventions bring down malnutrition. A review on the approach to break the intergenerational cycle of malnutrition suggests investing in nutrition over a life span as it has an impact over generations.

The National Nutrition Strategy calls for a life cycle approach, with focus on nutrition interventions during critical periods for improved growth and development.

Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth

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