India's Growth Story Has a Child Nutrition Problem

"Stunting [where a child is short for his/her age] is a proxy for overall cognitive and physical underdevelopment," according to a September 2017 report by the Bill and Melinda Gates Foundation, as IndiaSpend reported in January 2018. “Stunted children will be less healthy and productive for the rest of their lives, and countries with high rates of stunting will be less prosperous.”

“Weight is such an important thing," said Veena Shatrugna, former deputy director of the National Institute of Nutrition (NIN) and adviser to Jan Swasthya Abhiyan (JSA). "If children are growing taller but not putting on weight proportionately, then underweight and wasting remain concerns. The weights are still low, and one-third of children remain underweight.”

The geographic divide

Improvements in nutrition outcomes have not been uniform. For instance, states such as West Bengal, Karnataka and Uttar Pradesh have seen about 10-percentage-point declines in stunting prevalence, while Haryana and Rajasthan’s rates fell 1-2 percentage points.

Similarly, Jammu & Kashmir saw 8.4-percentage-point decline in wasting, while Arunachal Pradesh and Meghalaya saw severe wasting prevalence rise by 1.5 percentage points. Chandigarh, Haryana and Puducherry were among states that saw increases in prevalence of underweight.

“The determinants of child nutrition are multiple and interconnected," said Purnima Menon, senior research fellow at the International Food Policy Research Institute (IFPRI). “Improvements in maternal health, healthcare access and child feeding practices can all contribute to better nutrition outcomes."

Nationally, the proportion of women receiving four or more antenatal care visits increased from 59% to 65%, while the share consuming iron-folic acid tablets for at least 100 days during pregnancy rose from 44% to 55%. Institutional deliveries increased from 89% to 91%.

States that recorded declines in child undernutrition also registered improvements in maternal health indicators. For example, Jharkhand, which reduced stunting by 4.6 percentage points, recorded the highest increase (20.6 percentage points) in antenatal care coverage. Similarly, Andhra Pradesh, which saw a 6.6-percentage-point reduction in stunting, had an 18-percentage-point increase in ANC coverage.

The access to and quality of maternal and child care also depends on whether one lives in urban or rural India. For instance, urban women are 14.4 percentage points more likely to get more than four antenatal care visits, and 17.1 points more likely to take iron and folic acid tablets for 100 days.

But, 83% of rural children are fully vaccinated, compared to 81% in urban India. In Maharashtra, nearly three in four rural infants are exclusively breastfed, compared to about half in urban areas.

Further, immunisation coverage increased from 77% to 83%. Assam increased coverage by 15 percentage points, Andhra Pradesh by 14.5 percentage points and Uttar Pradesh by 11.5 percentage points.

Some states and UTs such as Ladakh, Meghalaya, Bihar and Andhra Pradesh saw a decline in the percentage of children who had diarrhoea in the two weeks preceding the survey.

“A lot of stunting and anthropometric failures in South Asia come because children are born too small," said Menon. "What's happening during pregnancy, women's education and the conditions of women's lives matter enormously for child growth."

Repeated infections, particularly diarrhoeal disease and respiratory infections, can also impair nutrient absorption and affect child growth even when food intake is adequate.

"When children fall sick repeatedly, that's when they stop putting on height," said Shatrugna. "Immunisation and better treatment may reduce morbidity, and that may be one reason we're seeing some improvements."

Feeding practices improved, even when diets remained limited

Nationally, the proportion of children breastfed within one hour of birth increased from 41.8% in 2019-21 to 50.1% in 2023-24. "That increase is very significant," said Manmohan Singh, manager of MicroSave Consulting. "It shows that nutritional awareness programmes are improving outcomes.”

Early initiation of breastfeeding is important for both the mother and the child. The first breast milk contains colostrum, which is highly nutritious and has antibodies that protect the newborn from diseases. It is recommended that children be put to the breast immediately or within one hour after birth. IndiaSpend reported in 2019 that a delay of just a few hours can increase the risk of mortality.

Breastfeeding is one of the most effective ways to ensure child health and survival, according to the World Health Organization. Breast milk is the ideal food for infants since it contains antibodies which help protect against many common childhood illnesses, and is an uncontaminated nutritional source, as IndiaSpend explained in August 2023.

But, during the same period, exclusive breastfeeding of infants under six months of age fell from 63.7% to 55.8%. Exclusive breastfeeding is where infants receive only breast milk, without any other liquids or foods, not even water, except oral rehydration solution (ORS), vitamins, minerals or prescribed medicines. Haryana recorded a decline of 28.3 percentage points, Uttar Pradesh 25.1 percentage points and Madhya Pradesh 17.6 percentage points.

“Among 23 interventions considered by the Bellagio Child Survival Study Group, a group of scientists and policymakers, scale-up of exclusive breastfeeding of infants for six months and continued feeding until one year could prevent an estimated 1.3 million child deaths per year,” according to this 2015 paper published in the Open Journal of Preventive Medicine.

In the first six months of an infant’s life, in low and middle income countries, infants who received mixed feeding – that is, liquids and foods apart from breastmilk – were up to 2.8 times more likely to die than those that were exclusively breastfeed, according to this 2016 report by the United Nations Children's Fund (UNICEF).

Once they cross six months of age, babies often start losing weight because they are not introduced to the right kind of complementary foods, as IndiaSpend reported in May 2019. Between the fifth and the sixth NFHS rounds, the share of children aged 6-8 months receiving complementary foods increased from 45.9% to 59.5%. Uttar Pradesh, Haryana, Jharkhand and Jammu & Kashmir each improved complementary feeding coverage by more than 20 percentage points.

Improvements in complementary feeding and child care practices can influence nutrition outcomes even when broader dietary quality remains a concern, Singh noted.

The ‘adequate diet’ paradox

According to NFHS-6, only 15.3% of children aged 6–23 months receive what the survey defines as an "adequate diet" – a measure that combines both dietary diversity and feeding frequency.

In August 2023, IndiaSpend reported on an intervention by the Shrimati Malati Dahanukar Trust (SMDT) in Shrirampur, about 260 km north-east of Mumbai. Counsellors told mothers about foods rich in minerals and vitamins, held cooking demonstrations, and taught them how to make micronutrient powders for children using local ingredients.

Experts point to the fact that India has become better at preventing the most severe forms of undernutrition through improvements in maternal healthcare, disease prevention and child feeding practices, even if dietary quality remains poor.

"How can you improve dietary variety without improving incomes?" asked Shatrugna. "Varieties will only come if families have money. How will they buy eggs, milk, fruits and vegetables if incomes are stagnant?"

The adequate diet indicator is based on a child's food consumption in the previous 24 hours and requires both minimum dietary diversity and meal frequency, Singh explained. Many children may receive more food or a somewhat better diet without meeting the threshold on the survey day. It is a very stringent indicator, Singh said, adding that while stunting reflects cumulative conditions over time, the adequate diet indicator captures only a snapshot of what a child consumed in the preceding day.

The affordability question

"Malnutrition is fundamentally an economic problem," said Amulya Nidhi, national convener of Jan Swasthya Abhiyan India (JSAI). "Food diversity matters. The key question is whether families are actually able to access it."

Nutrition experts have long argued that dietary diversity depends not only on awareness and feeding practices, but also on whether families can regularly afford foods such as milk, pulses, fruits, vegetables and animal-source foods.

Overall, Indian food accounts for about 46% of monthly spending, data from the Household Consumption Expenditure Survey show. But while the share of cereals fell from 22% at the turn of the century to about 5% in 2022-23, other food groups have not seen increased spending.

In November 2023, the cabinet announced the extension of the benefits of the National Food Security Act (NFSA) for another five years. Accordingly, 794 million beneficiaries (more than half of India’s population) will get food grains up to 2029.

While the public distribution system supplies rice and wheat, NFSA beneficiaries in most states depend on the market for pulses, vegetables, dairy products, etc., IndiaSpend explained in October 2025.

"The challenge is not just about food," Menon said. "Children under two cannot feed themselves. They need to be fed, and complementary feeding requires time, patience and care from caregivers."

"Going forward, we need to move from food security to nutrition security," said Singh. "Ensuring calorie adequacy is important, but the next challenge is ensuring macro- and micronutrient adequacy.”