Abstract
India has been food secure and children had access to essential health and nutrition services for four decades but under-nutrition rates in children continue to be high. Despite the high prevalence of low birthweight (LBW) and under-nutrition, under-five mortality rates are relatively low: the ‘South Asian enigma’.
Data from research studies and large-scale nutrition and health surveys were analysed and reviewed to assess:
- dimensions, determinants and time trends of under-nutrition in under-five children,
- functional decompensations associated with LBW and under-nutrition,
- factors responsible for ‘South Asian enigma’, and
- progress towards Sustainable Development Goals (SDG) for child nutrition and health.
Neonates born with low weight and length, follow a lower trajectory of growth throughout childhood; this was the major factor responsible for the high under-nutrition rates in children. Breast feeding was nearly universal; about 2/3rd of infants were solely breast-fed at 5 months; but both complementary feeds and adult food given to children were inadequate and lacked diversity. This resulted in a rise in under-nutrition rates between 12-23 months. In 24-59 months there was no further rise in under-nutrition rates. Moderate under-nutrition is not associated with increase in risk of infections; health care for infection was available and utilised; therefore, mortality rates were low.
India will not be able to achieve the SDG targets for reduction in low birthweight or under-nutrition but is likely to achieve the targets for reduction in food insecurity and under-five mortality.