Nutrition and the first thousand days

Nutrition is where health, education and poverty meet. A child who is undernourished in the first thousand days — from conception to the second birthday — suffers damage that later schooling and feeding cannot fully reverse: stunted growth, weaker immunity, and reduced learning capacity. India's numbers show how large the problem remains. The National Family Health Survey-5 (2019-21) found 35.5 per cent of children under five stunted (short for their age), 19.3 per cent wasted (thin for their height) and 32.1 per cent underweight, with about two-thirds of children aged 6-59 months anaemic.

The causes are multiple, which is why no single programme can fix them. Poor maternal nutrition and early marriage affect birth weight; exclusive breastfeeding for six months is not universal; complementary feeding after six months is often inadequate — NFHS-5 found only about 11 per cent of children aged 6-23 months receiving a minimally adequate diet; repeated infections from unsafe water and poor sanitation waste nutrients; and poverty limits dietary diversity, since pulses, eggs, milk and vegetables cost more than cereals. Stunting has fallen over decades, from 52 per cent in 1992-93 to 35.5 per cent in 2019-21, but wasting has barely improved.

India's institutional response runs through the Integrated Child Development Services (ICDS), launched in 1975, which provides supplementary nutrition, preschool education, immunisation and health check-ups through Anganwadi centres across the country. POSHAN Abhiyaan, launched on 8 March 2018 as the National Nutrition Mission, set targets to reduce stunting, undernutrition, anaemia and low birth weight, and introduced technology-based monitoring of Anganwadi services. The mid-day meal programme in schools, now PM POSHAN, adds a cooked meal for schoolchildren, supporting both nutrition and attendance.

The debate is about delivery and measurement. Anganwadi coverage is wide, but food quality, worker training and regular supply vary; newer administrative data from the Poshan Tracker, which covers only Anganwadi-enrolled children, shows lower malnutrition figures than NFHS-5, and the two cannot be directly compared. The lesson for civil studies is to distinguish a survey of the whole population from a register of programme beneficiaries — and to judge nutrition policy by outcomes in children's bodies, not by meals served or centres opened.