Odisha improves child and mental health faster; UP, Bihar lag behind

In Odisha, stunting--low height for age and a sign of malnutrition--reduced from 46.5% of children below five years in 2005-06 to 35.3% in 2015-16.

Odisha, one of India's poorest states, has made significant progress in reducing child undernutrition—less than India as a whole, but more than other poor states, such as Bihar, Uttar Pradesh and Madhya Pradesh, according to government data studied by the International Food Policy Research Institute (IFPRI).

In Odisha, stunting--low height for age and a sign of malnutrition--reduced from 46.5% of children below five years in 2005-06 to 35.3% in 2015-16; the proportion of underweight children decreased from 42.3% of children below five years to 35.8%; and the Integrated Child Development Services (ICDS), the government’s child nutrition and education program, reached 34% more people in 2017 than it had in 2014.

As National Nutrition Week gets under way on September 1, 2019, and the Indian government prepares to launch Poshan Abhiyaan with an aim to improve nutrition among children, pregnant women and lactating mothers and make India malnutrition-free by 2022, we examine the success of Odisha. IFPRI, a research advocacy based in Washington D.C., studied the progress of several countries and 28 Indian states, identifying Odisha as a "nutrition champion", along with Thailand, Brazil, Bangladesh, Nepal, Peru, Vietnam and Ethiopia.

Odisha performed better than other poorer states

India’s ICDS programme is the world’s largest nutrition programme, launched in 1975 to address health, nutrition and pre-school education of children under the age of six years. The programme operates through a network of anganwadi centres that provide services for pregnant and lactating women, and for children aged six months to six years. The programme mandates one anganwadi per village or for a population of 1,000.

Odisha’s performance on delivering health and education services to children and mothers through this programme was among the best in India and got progressively better between 1992 and 2014, found a study, part of a book, ‘Nourishing millions: Stories of Change in Nutrition’, published by IFPRI.

“Odisha has demonstrated significant commitment to reducing undernutrition, expanded nationally sponsored nutrition-specific programmes, and launched state-led initiatives relevant to improving nutrition,” said Rasmi Avula, research fellow at IFPRI. Odisha also decentralised service delivery through self-help groups and focused on equitable access to interventions for the entire population, she explained.

The study on India, India’s Integrated Child Development Services programme; equity and extent of coverage in 2006 and 2016, and part of the book, was co-authored by researchers at IFPRI and the University of Washington, US, using data from three rounds of the National Family Health Survey (NFHS) and the Rapid Survey on Children (RSOC).

Bihar population problem: 94% women know about contraception, 20% use them

In roughly five years, or by 2024, the population of India is expected to surpass that of China, according to a 2017 United Nations (UN) projection.

Married early, Premlata Devi had had four children by the time she was 24 years old--a boy and three girls. A homemaker from Tikari block in southern Bihar’s Gaya district, she had had a copper intrauterine device (IUD, the most common brand name being Copper-T) inserted for contraception after the birth of her second child.

Six years later, she had got it removed because of abdominal pains and increased uterine bleeding, both known side-effects of the device. “I no longer want to use Copper-T,” she said.

After the removal of the IUD, Premlata Devi went on to have two more children that she had not planned for. Neither she nor her husband know of alternative methods of contraception, she said. And the health workers, who under the National Health Mission are supposed to counsel women like her, never did show up.

Stories like these are common in Bihar, India’s fifth poorest state and third most populous, with India’s highest total fertility rate (TFR)--3.4 children per woman, according to 2015-16 government data, the latest available. This TFR exceeds that of India’s most populous states: Uttar Pradesh (2.74) and Maharashtra (1.87). The national average is 2.18. (Sikkim and Kerala had the lowest TFR for 2015-16: 1.17.)

In roughly five years, or by 2024, the population of India is expected to surpass that of China, according to a 2017 United Nations (UN) projection. China’s population will peak at 1.44 billion in 2029 and then start declining.

Due to what is called population momentum--a higher proportion of people in the reproductive age group--as well as higher life expectancy, India’s population will only peak in the 2060s, before it starts to decline, according to current estimates.

However, Indian fertility rates are declining, and some of these estimates are revised constantly. For example, according to earlier UN estimates, India was to overtake China in 2022. Ten years ago, India had a TFR of 2.68; today, according to the National Family Health Survey 4 (NFHS 2015-16), out of the 36 states and union territories (UTs), only four--Uttar Pradesh (UP), Bihar, Meghalaya and Nagaland--have a TFR more than or equal to 2.68.

Yet, as many as 12 states have a TFR above 2.1, termed the replacement-level rate, at which the population remains constant.

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