Malnutrition refers to a condition that arises due to the lack of proper nutrients or an imbalance of nutrients in the body. It can occur due to inadequate intake or absorption of essential nutrients such as vitamins, minerals, protein, and carbohydrates. Malnutrition can result in stunted growth, weakened immune system, anemia, and other health problems, and can be particularly harmful to young children and pregnant women. 

According to the Global Nutrition Report 2020, nearly one in three people worldwide is either malnourished or overweight. The report also highlights that while progress has been made in some areas, such as reducing stunting in children under five, the world is not on track to achieve most of the 2025 global nutrition targets. 

In India, malnutrition remains a significant public health challenge. The National Family Health Survey (NFHS) 5 data from 2019-20 highlights that 34.7% of children under five are stunted, 17.3% are wasted, and 33.4% are underweight. The data also shows that malnutrition is higher in rural areas and among disadvantaged communities, such as Scheduled Castes and Scheduled Tribes. 

The NFHS-5 data also highlights the need to address micronutrient deficiencies, such as anemia, which affects a significant proportion of the population. The data shows that 59.7% of children aged 6-59 months and 53.1% of women aged 15-49 years are anemic. 

Efforts are being made to address malnutrition in India through various interventions, including social protection schemes, such as the Integrated Child Development Scheme (ICDS), Mid-Day Meal Scheme, and the Public Distribution System (PDS). The government has also launched initiatives to promote the production and consumption of nutrient-rich foods, such as the National Nutrition Mission (Poshan Abhiyaan) and the National Food Fortification Program. However, sustained efforts are needed to address the complex and multi-faceted challenge of malnutrition in India. 

Multi-dimensional determinants of Malnutrition 

Malnutrition is a complex issue that has multidimensional determinants. Some of the key determinants of malnutrition are: 

Mother's Health: Maternal health plays a crucial role in ensuring the nutritional status of children. Poor maternal health, such as anemia or undernutrition, can lead to adverse birth outcomes and affect the growth and development of children. 

Social Inequality: Malnutrition is often associated with social inequality and poverty. Marginalized groups such as Scheduled Castes, Scheduled Tribes, and other vulnerable communities are more likely to suffer from malnutrition due to limited access to food, healthcare, and other resources. 

Sanitation: Access to clean water and sanitation is critical for maintaining good health and preventing diseases. Poor sanitation can increase the risk of diarrheal diseases, which can lead to malnutrition due to nutrient loss. 

Lack of Diversified Food: Limited access to diverse and nutritious food can lead to nutrient deficiencies and malnutrition. This is particularly true for households with limited income, as they may not be able to afford a diverse diet. 

Food Insecurity: Food insecurity, which refers to the lack of access to sufficient, safe, and nutritious food, is a significant determinant of malnutrition. Food insecurity can lead to undernutrition, overnutrition, or both, depending on the availability and affordability of food. 

Failure of Government Approaches: The government has launched various schemes, such as the Integrated Child Development Scheme (ICDS), to address malnutrition. However, the success of these schemes has been limited due to factors such as inadequate funding, poor implementation, and lack of community participation. 

COVID-19 and Children: The COVID-19 pandemic has exacerbated the problem of malnutrition among children, particularly in low- and middle-income countries. School closures and disruptions in food supply chains have led to a decrease in access to food and nutrition services, which can have long-term effects on children's health and development. 

Addressing the multi-dimensional determinants of malnutrition requires a comprehensive and integrated approach that involves various sectors such as health, education, agriculture, and social welfare. It also requires a focus on community participation and empowerment to ensure that interventions are tailored to the specific needs of different communities. 

National Family Health Survey-5 and Malnutrition 

The National Family Health Survey (NFHS) is a large-scale survey conducted in India to collect data on population, health, and nutrition indicators. The latest survey, NFHS-5, was conducted in 2019-2020 and provides important insights into the state of malnutrition in India. 

According to the NFHS-5 data, malnutrition remains a significant public health challenge in India. The survey found that 34.7% of children under the age of five are stunted, which means they are too short for their age due to chronic malnutrition. Stunting is a long-term consequence of malnutrition and can lead to poor cognitive development, lower educational attainment, and reduced economic productivity in adulthood. 

The survey also found that 17.3% of children under five are wasted, which means they are too thin for their height due to acute malnutrition. Wasting is a severe form of malnutrition that can lead to increased morbidity and mortality. 

The NFHS-5 data also highlights the need to address micronutrient deficiencies, such as anemia, which affects a significant proportion of the population. The survey found that 59.7% of children aged 6-59 months and 53.1% of women aged 15-49 years are anemic. Anemia can lead to fatigue, decreased physical performance, and increased susceptibility to infections. 

The data also shows that malnutrition is higher in rural areas and among disadvantaged communities, such as Scheduled Castes and Scheduled Tribes. This highlights the need to address social inequalities and improve access to healthcare, sanitation, and nutritious food for marginalized communities. 

Efforts are being made to address malnutrition in India through various interventions, including social protection schemes, such as the Integrated Child Development Scheme (ICDS), Mid-Day Meal Scheme, and the Public Distribution System (PDS). The government has also launched initiatives to promote the production and consumption of nutrient-rich foods, such as the National Nutrition Mission (Poshan Abhiyaan) and the National Food Fortification Program. However, sustained efforts are needed to address the complex and multi-faceted challenge of malnutrition in India. 

International Agencies and Malnutrition 

Government Initiatives 

ICDS 

The ICDS scheme is an important initiative of the Government of India to improve the health and nutrition status of children and pregnant and lactating women. It provides a range of services, including supplementary nutrition, immunization, health check-ups, referral services, and nutrition and health education. The scheme is implemented by trained service providers, including Anganwadi Workers, Anganwadi Helpers, Lady Supervisors, and Medical Officers. 

PM Matru Vandana Yojana 

The Pradhan Mantri Matru Vandana Yojana (PMMVY) is a maternity benefit scheme introduced by the Government of India to provide financial assistance to pregnant and lactating women for their first live birth. The scheme provides a total benefit amount of Rs. 5,000 in three installments, which are transferred directly to the beneficiary's bank account. The scheme is applicable to all pregnant and lactating women who are aged 19 years or above and have completed at least six months of pregnancy. The scheme is monitored by the Ministry of Women and Child Development at the central, state, and district levels. 

Mid-day Meals 

The Mid-Day Meal scheme is a government initiative that provides free nutritious meals to school-going children. The objective of the scheme is to increase enrollment, retention, and attendance in schools. The scheme is applicable to all children studying in government and government-aided schools across the country. The meal provided under the scheme includes carbohydrates, proteins, vitamins, and minerals, and is served during lunchtime in the school premises. The scheme is implemented by the Ministry of Education in partnership with the State Governments and UT administrations. The meal is prepared by local NGOs or self-help groups. The scheme is monitored by the Ministry of Education at the central level, and the implementation of the scheme is also monitored at the district and state levels. 

POSHAN Abhiyan 

The National Nutrition Mission (Poshan Abhiyaan) is a government initiative aimed at improving the nutritional status of children, pregnant women, and lactating mothers. The objective of the scheme is to achieve specific nutrition-related goals through the provision of nutrition-specific and nutrition-sensitive interventions such as the provision of iron and folic acid tablets, Vitamin A, deworming tablets, and nutritional counselling. Behavioural change and awareness generation activities are also carried out for mothers and caregivers. The scheme is implemented by the Ministry of Women and Child Development in partnership with the State Governments and UT administrations through the Integrated Child Development Services (ICDS) platform. The scheme covers all pregnant women, lactating mothers, and children under six years of age across the country. The scheme is monitored at the national, state, and district levels through various indicators such as stunting, wasting, and underweight. An online dashboard has been set up for real-time monitoring of the scheme's progress. 

Janani Suraksha Yojana 

The Janani Suraksha Yojana (JSY) is a government initiative aimed at promoting institutional deliveries among pregnant women and reducing maternal and neonatal mortality. The objective of the scheme is to provide cash assistance to pregnant women who deliver in government health facilities or accredited private health facilities, as well as incentives to Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs) for promoting institutional deliveries. The scheme is implemented by the Ministry of Health and Family Welfare in partnership with the State Governments and UT administrations through the National Health Mission (NHM) platform. The scheme covers all pregnant women from BPL families across the country. The scheme is monitored at the national, state, and district levels through various indicators such as institutional deliveries, maternal mortality, and neonatal mortality.