The level of child undernutrition remains unacceptable throughout the world, with 90 per cent of the developing world’s chronically undernourished (stunted) children living in Asia and Africa.
Detrimental and often undetected until severe, undernutrition undermines the survival, growth and development of children and women, and diminishes the strength and capacity of nations.
With persistently high levels of undernutrition in the developing world, vital opportunities to save millions of lives are being lost, and many more millions of children are not growing and developing to their full potential.
Nutrition is a core pillar of human development and concrete, large-scale programming not only can reduce the burden of undernutrition and deprivation in countries but also can advance the progress of nations.
In India 20 per cent of children under five years of age suffer from wasting due to acute undernutrition. More than one third of the world’s children who are wasted live in India.
Forty three per cent of Indian children under five years are underweight and 48 per cent (i.e. 61 million children) are stunted due to chronic undernutrition, India accounts for more than 3 out of every 10 stunted children in the world.
Undernutrition is substantially higher in rural than in urban areas. Short birth intervals are associated with higher levels of undernutrition.
The per centage of children who are severely underweight is almost five times higher among children whose mothers have no education than among children whose mothers have 12 or more years of schooling.
Undernutrition is more common for children of mothers who are undernourished themselves (i.e. body mass index below 18.5) than for children whose mothers are not undernourished.
Children from scheduled tribes have the poorest nutritional status on almost every measure and the high prevalence of wasting in this group (28 per cent) is of particular concern.
• India has the highest number of low birth weight babies per year at an estimated 7.4 million.
• Only 25 per cent of newborns were put to the breast within one hour of birth.
• Less than half of children (46 per cent) under six months of age are exclusively breastfed.
• Only 20 per cent children age 6-23 months are fed appropriately according to all three recommended practices for infant and young child feeding.
• 70 per cent children age 6- 59 months are anaemic. Children of mothers who are severely anaemic are seven times as likely to be severely anaemic as children of mothers who are not anaemic.
• Only half (51 per cent) of households use adequately iodized salt.
• Only one third (33 per cent) Indian children receive any service from an anganwadi centre; less than 25per cent receive supplementary foods through ICDS; and only 18 per cent have their weights measured in an AWC.
(Source NFHS 3, 2005-2006)
Undernutrition jeopardizes children’s survival, health, growth and development, and it slows national progress towards development goals. Undernutrition is often an invisible problem.
There is a critical window of opportunity to prevent undernutrition by taking care of the nutrition of children in the first two years of life, girls during adolescence, and mothers during pregnancy and lactation – when proven nutrition interventions offer children the best chance to survive and reach optimal growth and development.
Optimal infant and young child feeding entails the initiation of breastfeeding within one hour of birth; exclusive breastfeeding for the first six months of the child’s life; and continued breastfeeding for two years or more, together with safe, age-appropriate and hygienically prepared complementary foods starting at 6 months of age.
There is growing evidence of the benefits to mother and child of early initiation of breastfeeding, preferably within the first hour after birth. Early initiation of breastfeeding contributes to reducing neonatal mortality.
It ensures early skin-to-skin contact, which is important in preventing hypothermia and establishing the bond between the mother and her child. Early initiation of breastfeeding also reduces a mother’s risk of post-partum haemorrhage, one of the leading causes of maternal mortality.
Colostrum, the milk produced by the mother just after delivery during the first post-partum days, provides protective antibodies and essential nutrients, acting as a first “natural” immunization for newborns, strengthening their immune system and reducing the chances of death in the neonatal period.
Optimal complementary feeding is the most effective intervention that can significantly reduce stunting during the first two years of life.
A comprehensive programme approach to improving complementary feeding practices includes timely introduction of age-appropriate and hygienically prepared complementary foods, counseling for caregivers on feeding and care practices and on the optimal use of locally available foods, improving access to quality foods for poor families through social protection schemes and safety nets, and the provision of fortified foods and micronutrient supplements when needed.
Vitamin and mineral deficiencies are highly prevalent throughout the developing world.
Anaemia in young children is a serious concern, because it can result in increased morbidity from infectious diseases and impaired cognitive performance, behavioral and motor development, coordination, language development, and school achievement. Vitamin A is essential for a well-functioning immune system; its deficiency increases the risk of mortality significantly.
Vitamin A supplementation twice yearly reduces the risk of blindness, infection, undernutrition and death associated with vitamin A deficiency, particularly among the most vulnerable children.
Iodized salt consumed as table salt and/or as food-grade salt (used in food processing) improves brain development; prevents motor and hearing deficits. Zinc given as part of Oral Rehydration Therapy for the treatments for diarrhoea reduces duration and severity of diarrhoea and subsequent episodes
Hand washing with soap by caregivers’ and children prior to food preparation and eating, serving foods immediately after preparation, using clean utensils and avoiding feeding bottles helps reduce diarrhoea and associated undernutrition in the child.
Every adolescent girl must be protected against undernutrition and nutritional deficiencies like anaemia through dietary counseling, weekly iron and folic acid supplementation, twice yearly de-worming prophylaxis. In addition developing life-skills to avoid early marriage and early pregnancy is also vital.
Every pregnant woman must have access to sufficient quality and quantity food including during pregnancy and lactation. Every pregnant woman and breastfeeding mother must take iron folic acid supplements daily to reduce maternal anaemia and improve pregnancy and lactation outcomes.
Regular consumption of salt with adequate levels of iodine is required by all pregnant women in order to prevent foetal brain damage associated with iodine deficiency.
Significant disparity in nutritional status also exists in terms of mothers’ education and literacy. A number of studies and analyses have found a significant association between low maternal literacy and poor nutrition status of young children.
In many developing countries, the low status of women is considered to be one of the primary determinants of undernutrition across the life cycle.
Women’s low status can result in their own health outcomes being compromised, which in turn can lead to lower infant birth weight and may affect the quality of infant care and nutrition.
A study in India showed that women with higher autonomy (indicated by access to money and freedom to choose to go to the market) were significantly less likely to have a stunted child when compared with their peers who had less autonomy.
Children who are undernourished, not optimally breastfed or suffering from micronutrient deficiencies have substantially lower chances of survival than children who are well nourished.
They are much more likely to suffer from a serious infection and die from common childhood illnesses such as diarrhoea, measles, pneumonia and malaria, as well as HIV and AIDS.
According to the most recent estimates, child undernutrition contributes to more than one third of child deaths. Undernourished children who survive may enter the vicious cycle of recurring illness and faltering growth, with irreversible damage to their growth, cognitive development, school performance, and future productivity as adults.
UNICEF supports the Government in its objectives to reduce and prevent malnutrition, and to improve the development of children under three-years-old, especially those in marginalized groups.
UNICEF is assisting the government to further expand and enhance the quality of ICDS in various ways: by improving the training of anganwadi workers; by developing innovative communication approaches with mothers; helping to improve monitoring and reporting systems; providing essential supplies; by developing community based early childcare interventions.
UNICEF supports iron supplementation for adolescent girls and Vitamin A supplementation for children. It encourages the universal use of adequately iodised salt by educating the general population and collaborating with the salt industry.
UNICEF’s program contributes to reducing hunger and malnutrition rates, especially among the three most vulnerable groups of children (0-35 months old), children of economically disadvantaged populations and children of socially excluded groups.
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Caroline den Dulk
Chief of Communication
Communication Officer (Media)