OccasionalPaper

IssueNO.315MAY2021

?2021ObserverResearchFoundation.Allrightsreserved.Nopartofthispublicationmaybereproduced,copied,archived,retainedortransmittedthroughprint,speechorelectronicmediawithoutpriorwrittenapprovalfromORF.

The5thNationalFamilyHealthSurveyofIndia:ASub-NationalAnalysisofChildNutrition

SheilaC.VirandShobaSuriAbstract

InDecember2020,thegovernmentreleasedtheresultsoftheNationalFamilyHealthSurvey(NFHS)5for2019-20,covering22statesandUnionTerritories(UTs).Contrarytoexpectations,NFHS5foundanincreaseinthepercentageofstuntedchildrenin13statesandUTs,comparedtotheresultsofNFHS4.Thispaperanalysessuchreversalofthethree-decadalprogressthatIndiahadpreviouslymadeinreducingstuntinginchildren.Itanalysesthedeterminantsofsucharegressionandproposesmeasuresthatneedurgentattention.Thepapernotesapercentage-pointincreaseinthecoverageofnutrition-sensitiveinterventionsthataddresstheunderlyingdeterminantsofchildundernutrition,includingimprovementinwomen’sstatusandtheprovisionofmaternalhealthservices,aswellaschildhealthservices.Itarguesforpositioningthereductionofchildundernutritionhighinthenationaldevelopmentagendaandaddressingtheimmediatedeterminantofundernutritionbystrengtheningthecomplementary-feedingcomponentofthenationalnutritionmission.

Attribution:ArchitSheilaCLohani,Virand“CounteringShobaSuri,Misinformation“The5thNationalandFamilyHateSpeechHealthOnline:SurveyRegulationofIndia:ASuband-UserNationalBehavioural

Change,”AnalysisofORFChildOccasionalNutrition,”PaperORFNo.Occasional296,JanuaryPaper2021,No.315Observer,May2021,ResearchObserverFoundation.ResearchFoundation.

012

Introduction

Globalevidencehasestablishedtheseriousimplicationsofmalnutritionaonachild’sphysicalandbraindevelopment;inturn,thishasanadverseimpactoncognitivedevelopment,andtheoverallproductivityandeconomicdevelopmentofanation.TheWorldBankstates,“A1%lossinadultheightduetochildhood

stuntingisassociatedwitha1.4%lossineconomicproductivity.”1Itisestimatedthatundernourishedchildren,asadults,haveareducedearningpotentialofatleast10percentoftheirlifetimeearnings,whileeveryadditionalcentimetregainofadultheightisassociatedwitha4.5-percentincreaseinwagerates.2,3Theadverseimpactofundernutritiononbrainstructureanddevelopmentcannotbecorrectedlaterinlifeandcanleadtocognitivedeficitsandcompromisedlearningabilities.4,5Undernourishedchildrenareatadisadvantagefromthestartandaremorelikelytobeenrolledinschoollate;theyhavehigherchancesofrepeatingagradeordroppingoutofschoolaltogether.6,7,8Thisissupportedbystudieswhichreportthatadultswhohaveahistoryofbeingstuntedatagetwo,endupcompletingonelessyearofschooling.9,10,11

Atthenationallevel,theimpactofundernutritiononpersistentpoverty,reductioninhumancapital,andlowergrossdomesticproduct(GDP)iswell-documented.12,13,14,15,16Expertshaveestablishedthatmalnutritioninfluencesthelackofprogressin14ofthe17SustainableDevelopmentGoals(SDGs).17Globally,thecostofmalnutritionispeggedatUS$3.5trillionperyear,orUS$500perperson.18

Indeed,stuntinghaslastingeffectsonfuturegenerations.Moreover,thehighrateofanaemia19amongstwomenresultsinenteringpregnancyinananaemicstage—thishaswell-documentednegativeimpactsonfetalgrowthandbirthweight,aswellasonthehealthstatusofthemother.Aftertheyareborn,andtheseinfantsdonotreceiveadequatenutrientsespeciallyinthefirst24monthsoftheirlife,theirmalnutritionandillhealthworsens.A2020reportintheLancethighlightsthefactthatabout68percentofunder-fivechildmortalityinIndiaisassociatedwithmalnutrition.20

Findingsfromlow-andmiddle-incomecountrieshaveestablishedthatthefirst1,000daysoflifeistheopportunewindowforinvestinginchildnutrition.21Thereturnoninvestmentinreducingstuntingandwastinginchildrenisalmostsixteen-fold(US$16)oneveryUS$1invested.22

AstudyofUttarPradesh(UP)asearlyasin1998,andthesubsequentNationalFamilyHealthSurvey3(NFHS3)andNFHS4in2015-16,23alsoconcurwiththeage-wisetrendinincreaseinundernutrition(stunting)ratein0-24months

Malnutritionismeasuredasstuntingorunderweightorwasting.

3

Introduction

(SeeFigure1).Itisnotedthatundernutritionratesinyoungchildrenincreasesharplybetween0-24monthsofage,andthenlevelsoff.24Researchhasalsofoundthatthestuntingthatoccursinthisearlyageoftwoyearsislargelyirreversible.25

Figure1

Childundernutritiontrends,byage(0-24months)

6to18monthscrucial:adultheightissetat2years

ofage

Stunted

%children

Wasted

Ageinmonths

Heightat2yearsdeterminesproductivityandincome

NFHS4:2015-16

Source:NationalFamilyHealthSurvey4,2015-1626

TheNFHSsurveys,particularlyNFHS3onwards,havecalledonthecountry’spolicymakerstoaddresstheimmediateaswellastheunderlyingdeterminantsofundernutritioninchildren(SeeFigure2).In2008,globaleffortsledtoaconsensusonasetofevidence-based,directessentialnutritioninterventions(ENIs)thatneededspecialattentiontoaddressmalnutrition.Fiveyearslater,in2013,theLancetNutritionseriesstressedontheneedtocoupleENIswithnutrition-sensitiveinterventions.27Specificmeasureswereinitiatedtopromoteearlyinitiationofbreastfeeding,exclusivebreastfeeding

4

Introduction

forthefirstsixmonths,andothermaternalandchildhealthservices.Therewasalsoanemphasisontheimportanceofbreakingthecycleofinfection/diseases/healthandmalnutrition,andtheintergenerationalcycleofmalnutritioninwomen.ThisledtotheconceptofamultisectoralprogrammetoaddresschildundernutritionbeingbuiltintothestrategyoftheNationalNutritionMissionorPOSHANAbhiyaan.28

Figure2

AConceptualFrameworkof

Malnutrition

Childnutrition,health

S

H

andsurvival

O

R

T

R

O

U

Hygiene

T

E

S

L

O

N

Incomegeneration

G

R

O

U

T

E

S

Source:UNStandingCommitteeonNutrition200829

5

Introduction

ReversalofPreviouslyDecreasingTrendinChildUndernutrition

PriortothefirstNationalFamilyHealthSurvey(NFHS1)in1992,theonlydataavailableonundernutritionwaslimitedto10statesthroughtheNationalNutritionMonitoringBureau(NNMB).FollowingtheNFHS1,fournationalsurveyshavebeenconducted:NFHS2(1998-99),30NFHS3(2005-6),31NFHS4(2015-16),32andNFHS5(2019-20).Thefifthsurvey33commencedin2019priortotheoutbreakofCOVID-19,andthephase1datafor22statesandUTswasreleasedinDecember2020.

AsshowninFigure3,therewasasubstantialdropnationallyinthepercentageofstuntedandunderweightyoungchildrenbetween1992and2015,34alongwithacorrespondingdeclineinunder-fivemortalityrate.In2015-16,38.4percentofchildrenbelowfiveyearswerestuntedand35.7percentwereunderweight.Inabsolutenumbers,however,Indiawasstillhometo46.6millionstunted

children,orone-thirdoftheworld’s144millionunder-fivestuntedchildren.35

Figure3

Stunting,underweightandunder-five

mortalitytrends(1992-2016)

StuntingandUnderweightTrendsinIndia

120

109

100

95

74

80

52

53

60

46

48

47

42.535.7

50

40

38

20

0

Stunting

Underweight

Under-5Mortality

1992-93

1998-99

2005-06

2015-16

Source:NationalFamilyHealthSurveys36

6

Introduction

ThelatestNFHSdataavailablefor22statesandUTsshowsthatthedecreaseintherateofstuntinghasnotbeensustained.Indeed,inmostofthe22statesandUTscoveredbyNFHS5,therehasbeenareversal:thepercentageofunder-fivechildrenwhoarereportedtobestuntedhasincreased.

ThefindingsofNFHS5,especiallytheincreaseinincidenceofstunting,haveraisedapprehensionsamongpublichealthnutritionexpertsanddevelopmentprofessionals.Thispaperpresentstheresultsofarapidtrendanalysisofthefindingsofthe5thNFHS.TheaimistofindwaysbywhichtimelyactionscanbeplannedandexecutedtoaccelerateimprovementinIndia’sgoalsforreducingstuntinginchildren.

Thereturnon

investmentinreducing

stuntingandwastingin

childrenis16-fold,or

US$16foreverydollar

invested.

7

onChildStuntingRapidTrendAnalysis

Theconceptualframeworkforthisreviewcomprisesthedeterminantsofchildundernutritionandtheevidence-basedglobalinterventions.AsshowninFigure2,theimmediatedeterminantsofchildundernutritionareinadequatefoodandnutrientintake,andpresenceofillhealthanddiseases.

Thispresentanalysisconsidersthefollowingimmediatedeterminants:infantandyoungchildfeedingpractices,andchildhealthservices.Meanwhile,theunderlyingdeterminingfactorswithreferencetotrendsinthecoverageofnutrition-sensitiveinterventionspertaintofoodandnutritionsecurity,healthandnutritioncareofwomen,empowermentofwomen,appropriatewater-sanitation-hygiene(WASH)practices,completionofatleast10yearsorsecondaryeducationbygirls,anddelayingageofmarriageofgirlstoover18years.

Thisanalysisfocusesonthenutrition-sensitivefactors,astheunderlyingdeterminantsofchildstunting.AregressionanalysisofdatafromIndia,NepalandBangladesh,foundthatthefivehighestriskfactorsthatcontributetochildstuntingwererelatedtothesituationofwomeninthesecountries.Thesefactorsincludethedecision-makingpowerofwomen,maternalhealthservices(antenatalservicesandinstitutionaldeliveries),percentageofmotherswithheightbelow145cm,education,domesticviolence,sanitation,andhygieneenvironment(SeeTable1).NFHS5datacapturesinformationonanumberofthesenutrition-sensitiveindicatorswhilesomeothersareconsideredproxyindicatorsforwomen’seconomicandsocialstatus.TheseincludeinformationprovidedbyNFHS5onwomenhavingbankaccountsormobilephones,andaccesstosafefuel.

Table1

HighestRiskFactorsforStuntinginyoungchildren:India,Nepal,andBangladesh

India

Bangladesh

Nepal

Noeducationofmothers

DomesticViolence

MaternalHeight

MaternalHeight

Decisionmakingpower

Water

MotherswithnoInstitutional

MaternalHeight

OpenDefecation

Delivery

Householdswithlowstandardof

SecondaryEducation

BorninHospital

living

Householdswithnotoiletfacility

WealthQuintile

ANCsvisits

--

--

MaternalEducation

Source:AdhikariViretetal2013;37Heady&Hoddinott2015;38andBhagowalietal202l.39

8

onChildStuntingRapidTrendAnalysis

ObjectivesoftheAnalysis

ThispreliminaryanalysisaimstounderstandthetrendsemergingfromtheNFHS5datacovering22statesandUTsofIndia,andtoprovideinputsregardingtheoveralldirectionsthatprogrammesonchildnutritionneedtotake.Thefollowingaretheobjectivesofthisanalysis:

Toanalysestate-wisetrendsinchildstuntingratesinNFHS5(2019-20)ascomparedtoNFHS4(2015-16).

Toundertakeastate-wisecomparisonofNFHS5andNFHS4andanalysetheemergingtrendsinprogressaswellasgapsinthecontextofconceptualframeworkcomprisingtheimmediate,underlying,andbasicdeterminantsofchildundernutrition.

Toanalyseprogressandgapsinthepercentagecoverageoftrendsofinterventionsdealingwiththedirectnutritioninterventionsaswellasthenutrition-sensitivemeasures.

Basedontheobservationaltrendanalysis,toidentifythefactorsthatmaybecontributingtotheunexpectedincreaseintherateofchildstunting.

Torecommendmeasuresthatrequireurgentattentionforreducingtheratesofchildstunting.

Findings

ThissectionhighlightstheNFHS5findings(2019-20)ascomparedtoNFHS4(2015-16)regardingmalnutritioninchildren,asmanifestedinstunting.Itpresentsinformationonthenutritionalstatusofwomenandthecoverageofvariousinterventionsthataddresstheunderlyingandimmediatedeterminantsthatimpactchildundernutrition(SeeFigure2).

Figure4showsthestate-wisepatternsinchildhoodstuntingratesfor22statesandUTs,asreportedinNFHS5.Stuntingratewashighestinunder-fivechildreninMeghalaya(46.5percent)andBihar(42.9percent);Sikkimwasnotedtohavethelowestchildstuntingrateat22.3percent.Acomparisonof

NFHS4

withNFHS5findingsrevealedthattherewereonlythreestates(Bihar,ManipurandSikkim)thatreportedadeclineintherateofstuntingbyatleast3percentagepoints,withBihardecliningfrom48.3percentin2015-16to42.9percentin2019-20.ThirteenstatesandUTsshowedariseinthepercentageofstuntedchildren.Ofthese,six(Goa,HimachalPradesh,Kerala,Nagaland,Meghalaya,

9

onChildStuntingRapidTrendAnalysis

andTelangana)showedanincreaseintherateofstuntinginchildrenbyatleast3percentagepoints.Thetwostatesthathadtheloweststuntingratesinchildrenin2015-16(NFHS4)butshowedasubstantialriseinstuntingrateaspertheNFHS5surveyareGoa(from20.1percentto25.8percent)andKerala(from19.7percentto23.4percent).

Figure4

Stuntingtrendsin22statesandUTs

100

90

80

70

60

46.5

50

42.9

39.4

39

40

35.3

35.4

35.2

32.7

33.1

32.3

33.8

32

31.2

25.8

30.8

28.9

26.9

30.5

30

23.4

23.4

22.3

22.5

20

10

31.4

36.4

48.3

20.1

38.5

26.3

36.2

19.7

34.4

28.9

43.8

28.1

28.6

29.6

28

24.3

32.5

23.3

37.2

27.4

30.9

26.8

0

NFHS-5NFHS-4

Source:NationalFamilyHealthSurvey4(2015-16)40and5(2019-20)41

AsseeninFigure5,thereisanincreasingtrendinoverweightprevalenceinunder-fivechildreninallthe22statesandUTs.Inonestate(Sikkim)whichrecordedadecreaseofover3percentagepointsinundernourishedchildren,therewasa1-percentincreaseinthepercentageofoverweightchildren.

10

onChildStuntingRapidTrendAnalysis

Figure5

Overweighttrendsinunder-five

childrenin22StatesandUTs

25

20

15

10

13.4

10.5

10

9.6

8.2

9.6

4.9

5.7

4.9

5.4

5

2.8

3.9

3.2

4

4.1

3.4

4

3.4

4.3

2.7

2.4

1.9

2.3

1.9

1.9

3.4

1.9

3.9

4.2

3.8

8.6

3

2.1

3

5.7

4

1.6

0

1.2

1.2

3.7

2.6

3.1

0.7

3.9

NFHS-5NFHS-4

Source:NFHS4(2015-16)42andNFHS5(2019-20)43

11

ChildUndernutrition

UnderlyingDeterminantsof

CoverageofInterventions:The

Datafromthe4thand5thNFHSwerecomparedtoanalysepatternsinthreeunderlyingfactorsforchildundernutrition:pooraccesstofood,poorwomen’shealthandchildcarepractices,andpoorhealthandenvironment.Thesearecommonlyacceptedastheunderlyingdeterminantsofundernutrition,whichinturn

impacttheimmediatedeterminantsofchildundernutrition(SeeFigure2).

Women’soverallstatus

AsshowninFigure2,women’snutritional,socio-economicrstatusincludingtheir‘empowerment’status,aswellastheiraccesstomaternalandchildhealthservices,arefundamentalunderlyingfactorsthatimpacttheirchild’snutrition.AspresentedinFigures6to9andTable2a,disaggregatedbystate,theresultsofNFHS4andNFHS5werecomparedwithreferencetothefollowingindicators:women’snutrition,ageofmarriage,ageofconception,motherswithminimumtenyearsofeducation,andwomenempowermentwithreferencetodecision-makingandtheirsocio-economicsituation.Dataonwomenpossessingmobilephones,andwomenhavingtheirownbankaccounts,arestudiedasproxyindicatorsofempowerment.Nodataondirectindicatorsthatmeasureddecision-makingpoweroreconomicsituationwasavailableinthepastorlatestNFHS.

Figure6

Prevalenceofgirlsmarriedbelow18yearsin22states&UTs(%)

25

20

15

10

13.4

10.5

10

9.6

8.2

9.6

4.9

5.7

4.9

5.4

5

2.8

3.9

3.2

4

4.1

3.4

4

3.4

4.3

2.7

2.4

1.9

2.3

1.9

1.9

3.4

1.9

3.9

4.2

3.8

8.6

3

2.1

3

5.7

4

1.6

0

1.2

1.2

3.7

2.6

3.1

0.7

3.9

NFHS-5NFHS-4

Sources:NationalFamilyHealthSurvey-4(2015-16)44and5(2019-20)45

12

ChildUndernutrition

UnderlyingDeterminantsof

CoverageofInterventions:The

Figure7

Prevalenceofteenagepregnanciesinadolescentgirls(15-19years)in22states&UTs(%)

25

21.9

20

16.4

15

12.6

11.7

11

10

7.6

8.6

7.2

18.8

18.3

11.8

13.6

12.2

5.2

5.4

4.1

3.8

5.8

4.3

5

3.4

3.1

10.6

3

2.8

2.4

8.3

8.6

8.5

7.8

7.4

7.2

6.5

5.7

4.7

1

1.1

2.9

2.6

3

2.8

3

01

0

0

NFHS-5NFHS-4

Sources:NationalFamilyHealthSurvey-4(2015-16)46and5(2019-20)47

13

ChildUndernutrition

UnderlyingDeterminantsof

CoverageofInterventions:The

Figure8

Womenhavingcompleted10yearsormoreofschoolingin22states&UTs(%)

100

90

77

80

71.5

65.9

67.8

70

60

52.5

51.3

50.2

50.4

48.1

50

49

45.5

50

50

44.4

39.6

33.8

35.1

35.

8

40

32.9

29.6

72.2

30

28.8

58.

2

59.

4

23.2

56.

45.

5

45.9

49.1

44.6

8

20

42

39.9

40.7

43.6

40.3

37.1

34.3

26.2

22.8

33

33.6

33.3

23.

4

26.5

10

0

NFHS-5NFHS-4

Sources:NationalFamilyHealthSurvey-4(2015-16)48and5(2019-20)49

14

ChildUndernutrition

UnderlyingDeterminantsof

CoverageofInterventions:The

Figure9

Womenwhoreporteddeliveryininstitutionalsetupinthe22states&UTs(%)

100

96.5

99.7

94.3

97

99.8

94.7

94.7

97

99

96.5

95.1

99.6

91.7

92.4

88.2

89.2

90

84.1

85.8

76.2

79.9

80

70

58.1

60

45.7

50

40

30

20

10

91.5

70.6

63.8

96.9

88.5

76.4

94

99.8

90.3

69.1

51.4

79.7

32.8

94.7

91.5

79.9

75.2

96.4

88.5

85.5

90.8

99.3

0

NFHS-5NFHS-4

Sources:NationalFamilyHealthSurvey-4(2015-16)50and5(2019-20)51

Nutritionalstatusofwomen(15-49years)

Women’spoornutritionisoneofthemostimportantdeterminantsofchildhoodstunting(SeeTable1).AsseeninFigure10,theprevalenceofthinnessinwomenhasdeclinedsinceNFHS4,exceptforKeralaandDadraandNagarHaveliwhichshowanincreaseof1.5and1.7percentagepoints,respectively.AccordingtotheWorldHealthOrganization(WHO),aprevalencerateofover20percentofwomenwithlowBMI(<18.5)showsthatwomenareundernourishedandrequirespecialcareandattention.InIndia,mostofthestatesshowaprevalencerateofundernourishedwomenoflessthan20percent,withtheexceptionofBihar(25.6percent),Gujarat(24.2percent),andDadra&NagraHaveli(25.1percent).ThelowestpercentageofundernourishedwomenisreportedinLadakhat4.4percent.

15

ChildUndernutrition

UnderlyingDeterminantsof

CoverageofInterventions:The

Figure10

PrevalenceofwomenwithlowBMI/thinnessin22states&UTs

35

30

25.6

25.2

25.1

25

17.6

18.8

20

17.2

16.2

16.214.8

14.8

13.8

13.9

15

10

10.8

5.37.55.8

9.4

8

10

7.2

5.2

4.4

5

17.625.730.414.78.519.18.812.18.411.56.422.918.921.313.123.412.210.513.5

0

AndhraPradesh

AssamBihar

Goa

GujaratHimachalPradeshKarnatakaKerala

MaharashtraManipurMeghalaya

MizoramNagalandSikkim

TelanganaTripuraWestBengalAndaman&NicobarDadra&NagarHaveliJammu&Kashmir

LadakhLakshwadeep

NFHS-5

NFHS-4

Sources:NationalFamilyHealthSurvey-4(2015-16)52and5(2019-20)53

Besidesundernutrition,overweightandobesityinmothersalsocontributetobirthofbabieswhoareeithersmallforgestationage(SGA)orhavealowbirthweight(LBW).Thetrendsinobesity/overweightinwomen(15-49years)showsasharpincreasein16ofthe22statesandUTs.ThemaximumincreaseisobservedinKarnatakaby6.8percentagepoints.ThoughNFHS5doesnotpresentdataonaccesstofood,arisingtrendinpercentageofoverweightwomeninmostofthestates(seeFigure11)showsthattheremightbeanoverallhigherintakeoffood,butnotnecessarilytherighttypeoffooditemsorwiththerightfooddiversity.

16

ChildUndernutrition

UnderlyingDeterminantsof

CoverageofInterventions:The

Figure11

Obesity/overweighttrendsinwomen(15-49years)in22states&UTs

45

40

36.3

36.1

38.1

38.1

34.1

34.7

33.5

35

30.4

30.1

30.1

29.3

28.3

30

26.8

22.6

23.4

24.2

22.7

25

21.5

20

15.2

15.9

14.4

15

11.5

10

5

33.2

13.2

11.7

33.5

23.7

28.6

23.3

32.4

23.4

26

12.2

21

16.2

26.7

28.6

16

19.9

31.8

23.3

29.3

16.3

40.6

0

NFHS-5NFHS-4

Sources:NationalFamilyHealthSurvey-4(2015-16)54and5(2019-20)55

Anaemiainwomenisawell-knowncauseofpoorfetalgrowthandlowbirthweight.However,thepercentagerateofanaemiainadolescentgirlsandwomenofreproductiveage(15-49years)showsanincreasingtrendin16statesandUTs;thehighestriseisinAssam(19percentagepoints),followedbyJammu

Kashmir(17percentagepoints),andLadakh(14.4percentagepoints).Asimilartrendinprevalencepercentagerateofanaemiaisnotedinadolescentgirls(15-19years),with16statesandUTsshowinganincrease.

17

ChildUndernutrition

UnderlyingDeterminantsof

CoverageofInterventions:The

AgeofmarriageandEducationalattainment

Thedatarevealsapositivetrendtowardstheloweringofincidenceofgirlsbeingmarriedbelow18years.(SeeFigure6)Theexceptionsarethreenorth-easternstates—Assam,Tripura,andManipur.However,thepercentageofadolescentgirlsmarriedremainshighbutstableinKarnataka,Meghalaya,WestBengalandthetwoUTs(Andaman&NicobarandDadra&Nagar-Haveli).Infivestates,includingWestBengalandTripura,almostoneintenadolescentgirlsisreportedtobepregnantatthetimeofthesurveys(SeeFigure7).

Itiswell-establishedthatgirlscompletingschooleducationisacrucialfactorinloweringtheincidenceofteenagemarriageorpregnancy.56Moreover,asshowninTable1,womencompletingatleast10yearsofeducationisanimportantfactorcontributingtoloweringtheprevalenceofchildstunting.57Unfortunately,therewasratherslowprogressinraisingthepercentageofgirlscompleting10yearsofeducationormore,between2015-16and2018-19.Theoveralltrendindicatesanimprovementinallthestates,exceptTripurawherethegirlsfallinginthiscategoryofeducationremainsalmoststagnantataboutaquarterofwomen.ThereareonlythreestatesandoneUT(SeeFigure

withovertwothirdsofwomenhavingcompleted10yearsofeducationatleast:Kerala(77percent),Goa(71percent),Lakshadweep(67.8percent)andHimachalPradesh(65.9percent).

Women’sempowerment

Table2a&bgivesanoverviewofthestate-wisecoverageofsomeofthenutrition-sensitiveinterventions,besidesschooleducation,thatimpactwomenempowerment.Thedatashowsanincreaseinthepercentagepointsofwomenhavingamobilephonefortheiruseaswellasabankorsavingsaccount,andaccesstocleanfuel.Theseimprovementscouldbeconsideredproxyindicatorsofimprovementinwomenempowerment.

Women’spoornutritionhasbeenfoundtobeoneofthemostimportantdeterminantsofstuntingintheirchildren.

18

19

Table2a

Coverageofnutrition-sensitiveinterventionsinwomen,by22States/UTs,NFHS4andNFHS5

States/UTs

HHusingcleanfuelfor

Womenhavingabank

Women

having

own

Women

facing

spousal

Mothers

had

4ANC

MothersconsumedIFA

WomenwithlowBMI

cooking

orsavingsaccount

mobilephone

violence

visits

for180daysormore

(<18.5kg/m2)

NFHS5

NFHS4

%(+/-)

NFHS5

NFHS4

%(+/-)

NFHS5

NFHS4

%(+/-)

NFHS5

NFHS4

%(+/-)

NFHS5

NFHS4

%(+/-)

NFHS5

NFHS4

%(+/-)

NFHS5

NFHS4

%(+/-)

Andhra

83.6

62

+21.6

81.8

66.