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Mapping Nutrition

© UNICEF India
Children being served a nutritious meal.

At first sight, it is a bit incongruous. What is a chart of cartoon figures doing at a nutrition counselling and childcare session for malnourished children in a village in South 24 Parganas in West Bengal?

And why are some of the caricatures ‘incomplete’, with a hand or a leg missing?

There is a method behind the seeming madness. Each stroke of the cartoon depicts how many times the mother has brought her child to the feeding centre, with the ideal being 12 times a month.

“Nobody wants to see their child being depicted as incomplete in the cartoon chart, with a limb or a nose missing. This is one of the ways in which our centre provides these non-literate women an incentive to ensure they don’t miss a feeding session,” says an officer of a local voluntary group.

This unique strategy is part of what is known as the Positive Deviance (PD) project, which covers 500 villages in state districts of Murshidabad, South 24 Parganas, Purulia and Dakhin Dinajpur.  The statistics are alarming. There is high prevalence of malnutrition, particularly amongst children under three years old: every second child in the state is underweight, three out of four are anaemic and four out of 10 newborns are at risk of being iodine deficient.

The project is aimed at the state’s malnourished children and identifies local solutions and available resources to rectify the situation. It is called Positive Deviance because it looks at the positive side of an otherwise very grim picture. Even in the most backward, poor communities, some children will be healthy and well nourished. The project looks at what makes that young child healthy, nourished and well developed, and it focuses on those aspects.

With the help of key partners – the Department of Social Welfare and WCD, Health, Panchayati Raj Institute and NGOs – Rupali Haldar, the anganwadi (childcare) worker in the village of Mala in South 24 Parganas, has detailed the nutrition status of all the children in a series of maps. By using colour coding, wherein the colour red indicates severe malnutrition, yellow the moderately malnourished and green normal, the maps show exactly how many children are in each household, and details their nutrition status. Plotted with the help of panchayat (village local governing body) members, the maps also show the location of the feeding centres in the village.

“Whenever we see that there are 10 to 12 children in the area, we open a PD centre for women to come and feed their children 12 times a month,” says Rupali. Under the project, the most malnourished children up to three years old are chosen for a PD centre.

© UNICEF India
Mother breast feeding and talking with her child.

'Positive deviance'

The basic food, consisting of rice and pulses, is provided by ICDS.However, mothers contribute all the vegetables and eggs that are then cooked collectively. “Our idea is to teach them how to cook a nourishing meal with available food stuff. They can then continue the same feeding practice in their homes,” says a field level facilitator.

The centre, a small house in the village, is buzzing with activity at lunchtime. Groups of mothers are feeding khichdi (a nourishing gruel made with rice, lentils and vegetables) to their babies. The khichdi made with contributions from all the mothers is nourishing, hot and the children are clearly enjoying their meal.

Kashmira Bibi, whose 14-month-old son was in the third grade of malnutrition is now in the first grade. She is quite sure that the PD programme has made a definite difference in the way that she takes care of her son. She used to feed him three meals earlier as well but, she admits, it was not nourishing enough. The meals would earlier comprise vegetables or dal (lentils) or suji kheer (a sweet dish, made from semolina and milk) but all given separately. Now, she makes sure that she feeds her son khichdi at least twice a day and adds fresh green vegetables, eggs, potatoes and dal.

Happy and healthy

The improvement in the children's health status is statistically proven.

“I give him khichdi twice and rice once a day and I can see the difference. He used to be very irritable and cranky. Now he is happy and healthy,” she says.

Other mothers can also see the difference between the time the centre started and a few months later. Ameera Bibi’s two-year old daughter was not able to walk; three months at the centre has helped her to walk and also has improved her overall health, moving her from the second stage of malnutrition to the first.

In fact, there are some mothers who cook food at home but make it a point to attend the feeding session. Lalbano Bibi’s daughter Shenaz is not malnourished but she likes to bring her to the centre because of the useful advice that she gets from the others. “I like coming here so that my child continues to remain normal. She also eats better when she is with all the other children,” she says.



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