National Nutrition Strategy 2017

National Nutrition Strategy (NNS) has been published by NITI Aayog in 2017.

Nutritional Situation Analysis

High levels of maternal and child undernutrition in India have persisted, despite strong Constitutional, legislative policy, plan and programme commitments.

Child undernutrition :

India is home to the largest number of children in the world. Nearly every fifth young child in the world lives in India. Children and women together constitute around 70% of India’s people - representing not just the present human resource base - but also the future. This resource base is eroded by undernutrition - which undermines their survival, health, cumulative learning capacities and adult productivity and must be urgently addressed.

Nearly every third child in India is undernourished – underweight (35.7%) or stunted (38.4%) and 21% of children under five years are wasted as per NFHS 4 2015-16. Moreover, the NFHS-4 data indicates that every second child is anemic (58.4%).

Recent data, especially for challenging states is promising, suggestive of acceleration. However, the pace of reduction remains low and calls for focused interventions in the area for optimal results.

Undernutrition in women and girls

As per NFHS 3, every third woman in India was undernourished (35.5 % with low Body Mass Index) and every second woman (15-49 years) was anemic (55.3%). About 15.8 % were moderately to severely thin, with BMI less than 17. Bihar (45%), Chhattisgarh (43%), Madhya Pradesh (42%) and Odisha (41%) were the states with the highest proportion of undernourished women.

The findings from NFHS 4 (2015-16) highlight that nutritional status of women and girls (in the age group 15-49 years) has improved for all States.

Maternal care

NFHS-4 findings reveal that there is better care for women during pregnancy and childbirth - contributing to reduction of maternal deaths and improved child survival. Almost all mothers have received antenatal care for their most recent pregnancy and increasing numbers of women are receiving the recommended four or more visits by the service providers.

Overall, the Total Fertility Rate (TFR) or the average number of children per woman has also gone down from 2.7 in NFHS-3 to 2.2 in NFHS-4. However, in terms of absolute values, institutional births continues to remain extremely low in Nagaland (32.8%), Meghalaya (51.4%), Arunachal Pradesh (52.3%), Jharkhand (61.9%) and Bihar (63.8%), which are the bottom five states with respect to institutional births.

NFHS 4 findings reveal that around 26.8 per cent of currently married women in the age-group 20-24 years were married before attaining the age of 18 years.

Micronutrient deficiencies

Deficiencies of key vitamins and minerals such as Vitamin A, Iron, Iodine and Zinc continue to coexist and interact with protein and energy deficits and need to be addressed synergistically, through a multipronged approach.

Infant and Young child feeding practices

There has been improvement in the early initiation of breastfeeding rate, from 23.4% in NFHS-3 to 41.6% in NFHS-4. Similarly, there has been an overall improvement over NFHS 3 levels in children under six months who were exclusively breastfed, from 46.3% to 54.9%. Children aged between 6-8 months receiving solid or semi-solid food and breastmilk has gone down from 52.6% to 42.7%.

Prevention and management of common neonatal and childhood illness

The prevention and management of common neonatal and childhood illnesses is critical for breaking the vicious cycle of malnutrition and infection, wherein infections such as diarrhea, acute respiratory infections and measles adversely impacting nutrition status and undernutrition increases susceptibility to infections, perpetuating this cycle. Effectively managing the onset of infections such as diarrhea and acute respiratory infections, adequate care and referral of severely undernourished and sick children remains a challenge.

Safe drinking water, sanitation and hygiene

NFHS 4 (2015-16) shows that families are now more inclined to use improved water and sanitation facilities. Over two-thirds of households in every State/UT (except Manipur) have access to an improved source of drinking water, and more than 90% of households have access to an improved source of drinking water in 19 States/Union Territories. More than 50% of households have access to improved sanitation facilities in 26 States/Union Territories. Similarly, in 20 States/ UTs, more than 50% households use clean cooking fuel, which reduces the risk of respiratory illness and pollution.

Vision

VISION 2022 - "Kuposhan Mukt Bharat" - Free from malnutrition, across the life cycle.

The National Nutrition Strategy is committed to ensuring that every child, adolescent girl and woman attains optimal nutritional status- especially those from the most vulnerable communities. The focus is on preventing and reducing undernutrition across the life cycle- as early as possible, especially in the first three years of life. This commitment also builds on the recognition that the first few years of life are forever - the foundation for ensuring optimum physical growth, development, cognition and cumulative lifelong learning.

Monitorable outcomes

The National Nutrition Strategy will contribute to key national development goals for more inclusive growth, such as the reduction of maternal, infant and young child mortality, through its focus on the following monitorable targets

1. To prevent and reduce undernutrition (underweight prevalence) in children (0- 3 years) by 3 percentage points per annum from NFHS 4 levels by 2022.
2. To reduce the prevalence of anemia among young children, adolescent girls and women in the reproductive age group (15- 49 years) by one third of NFHS 4 levels by 2022.

Guiding principles

The implementation of the National Nutrition Strategy will be guided by the following key principles of action.

1. A life cycle approach - A life cycle approach will be adopted, with a focus on critical periods of nutritional vulnerability and opportunity for enhancing human development potential.
2. Early preventive action - emphasis on preventing under nutrition, as early as possible, across the life cycle.
3. Inclusive and gender sensitive : It will be rooted in a rights based framework that seeks to promote the rights of women and children to survival, development, protection and participation - without discrimination.
4. Community empowerment and ownership : Families and communities will be enabled for improved care behaviors and nutrition of children and women, to demand quality services, to contribute to increased service utilization and to participate in community based monitoring.
5. Valuing, recognising and enhancing contribution of Anganwadi workers, helpers and ASHAs
6. Decentralisation and flexibility : Contextually relevant, decentralized approaches will be promoted, with greater flexibility at State, district and local levels for greater and sustained programme effectiveness and impact, in harmony with the approach of cooperative federalism.
7. Ownership of Panchayati Raj institutions and urban local bodies
8. Foster innovation
9. Informed by science and evidence
10. Ensure that there is no conflict of interest

Nutrition Interventions

1. Infant and Young Child Care and Nutrition - These interventions will focus on children under 3 years, through the promotion of
• Universal early initiation (within 1 hour of birth) and exclusive breastfeeding for the first six months of life.
• Universal timely and appropriate complementary feeding after six months, along with continued breastfeeding for two years or beyond.
• Universal growth monitoring and promotion of young children-using WHO CGS with counseling of mothers/families using the Mother Child Protection Card.
• Universal access to infant and young child care (including ICDS, crèches, linkages with MGNREGA), with improved supplementary nutritional support/THR through ICDS.
• Enhanced care, improved feeding during and after illness, nutritional support, referrals and management of severely and acutely undernourished and/or sick children.
2. Infant and Young Child Health
• Improved new born care and care of low birth weight babies.
• Bi annual vitamin A supplementation for children 9-59 months
• Universal, timely and complete immunization of infants against vaccine preventable diseases (and subsequent booster doses) with quality assurance.
• Ensuring that young children receive micronutrient supplementation and bi annual deworming as per MHFW guidelines. This includes- IFA supplementation for children 6-59 months and Bi annual deworming for children Over 1 year-59 months (linked to bi annual VAS rounds).
• Prevention and management of common neonatal and childhood illnesses such as diarrhoea (with ORS and zinc supplementation) and Acute Respiratory Infections (ARI) and severe acute malnutrition, at community and facility level.
3. Maternal Care, Nutrition and Health
• Improved supplementary nutritional support during pregnancy and lactation (ICDS).
• Improved antenatal care - including health and nutrition counseling (also family support for extra diet and rest to ensure adequate weight gain), IFA supplementation, consumption of adequately iodized salt and screening /management of severe anemia.
• Enhanced maternity protection (through the effective implementation of PMMVY)
• Institutional deliveries, lactation management, improved post-natal and new born care.
• Promoting marriage at the right age, first pregnancy at the right age, inter pregnancy recoupment/ birth spacing and shared care/ parenting responsibilities.
• Promoting Women’s Literacy and Empowerment
4. Adolescent Care, Nutrition and Health
• Equal care of the girl child at different stages of the life cycle- linked to the Beti Bachao Beti Padhao initiative.
• Improved access to health care, counseling support through school health programmes, ARSH and deworming as per MHFW National Deworming Initiative.
• Improved access to nutritional support through Mid-Day Meals in schools (MHRD) and through SABLA for out of school girls.
• Universal access of girls in school and girls out of school to IFA supplementation.
• Girls’ education, skill development and female literacy.
• Changing gender constructs -Gender sensitization and life skills for adolescents.
• No Child Marriage- Marriage of young women after the age of 18 years.
5. Addressing Micronutrient Deficiencies - including Anemia
6. Community Nutrition (Interventions addressing the community)
• Ensuring universal access to safe drinking water, sanitation and hygiene, in an open defecation free environment, through Swachh Bharat.
• Prevention and treatment for malaria through the Use of bed-nets and/or intermittent preventive therapy for malaria (as per MHFW protocols) in malaria-endemic areas; Facilitating mosquito control measures; Other relevant health /disease control measures specific for the state/district, relevant for improving nutrition at community levels - such as JE, kala azar etc.
• Ensuring access to household food security, social protection systems and safety nets.
• Nutrition Education to ensure that optimal feeding and caring practices, dietary diversity nutritious foods; sanitation and hygiene and healthy lifestyles are promoted-addressing undernutrition and also the dual burden of malnutrition. (This includes Nutrition Education in the school curriculum and in colleges).
• Focused Interventions to reaching the most nutritionally vulnerable community groups (such as SC, STs, minorities, others) and address multiple nutritional vulnerabilities such as those related to seasonal distress, disease outbreaks, natural disasters (such as floods, drought, earthquakes) and other situations.
• Flexible responses to other State/district specific needs for improving nutrition at community levels.

To access the complete National Nutrition Strategy document, click here.

Source : NITI Aayog