This document summarizes India's national nutrition policy and status. It discusses that calorie intake is lower in rural vs. urban areas and that poverty perpetuates poor nutrition. The policy focuses on direct interventions like nutrition programs for vulnerable groups, food fortification, and controlling micronutrient deficiencies as well as indirect long-term strategies like ensuring food security, improving diets, purchasing power, and the public distribution system. It also outlines developments under India's 11th and 12th five-year plans and constraints facing effective policy implementation like lack of a dedicated ministry and weak program delivery.

1. Dr Soni Rani
PGT- 2nd Year
Department Of Community Medicine
Katihar Medical College

2. The Nutrition Status of India

3. Calorie Intake ( NSSO)
Rural- 2400 Kcal
Urban- 2100 Kcal

4. Poverty- a vicious cycle

5. Nutritional Programme In India

6. Nutrition Policy Interventions
• The Strategy: Nutrition is a multi-sectoral issue
and needs to be tackled at various levels.
• Nutrition affects development as much as
development affects nutrition.
• It is therefore important to tackle the problem
of nutrition both through-
• Direct nutrition intervention for specially
vulnerable groups and
• Indirect or long term interventions.

7. Nutrition Policy Interventions
A. Direct Intervention-Short Term
1. Nutrition Intervention for specially vulnerable
groups.
2. Fortification of Essential Foods
3. Popularisation of Low Cost Nutritious Food
4. Control of Micro-Nutrient Deficiencies
amongst vulnerable Groups

8. Nutrition Intervention for specially
vulnerable groups.
• Expanding the Safety Net:- The Universal
Immunization Programme,Oral Rehydration Therapy
and the Integrated Child Development Services (ICDS)
have had a considerable impact on child survival and
extreme forms of malnutrition.
• Presently ICDS covers around 15.3 million children (most
of them in the rural areas).
• It should be our conscious policy to cover the remaining
15.46 million children who arc nutritionally at risk by
extending ICDS to all the remaining 2388 of the country.

9. Nutrition Intervention for specially
vulnerable groups.
• Presently growth monitoring has become a one-way
process and the mothers are mere passive observers
of the entire process.
• This needs to be changed because after all nutrition
management of the children will have to be done by
the mothers at home.
• Growth monitoring combined with adequate
nutrition and health education empower mother to
manage the nutrition needs of her children
effectively.

10. Nutrition Intervention for specially
vulnerable groups
• Reaching the Adolescent Girls- Including the
adolescent girl within 'the ambit of' ICDS should be
intensified so that they are made ready for a safe
motherhood.
• Their nutritional status (including iron supplementation in
the body) is improved and they are given some skill up
gradation training in home-based skills and covered by
non-formal education (particularly nutrition and health
education.)
• All adolescent girls from poor families should be covered
through the ICDS in all CD blocks of the country and
50% of urban slums.

11. Nutrition Intervention for specially
vulnerable groups
• Ensuring better coverage of expectant
women:
• In order to achieve a target of 10% incidence of
low birth weight better coverage should include
supplementary nutrition right from 1st trimester.
• This should continue during the major period of
lactation at least for the first one year after
pregnancy.

12. Fortification of Essential Foods
• Essential food items shall be fortified with
appropriate nutrients. for example, salt with
iodine and/or iron.
• Research in iron fortification of rice and other
cereals should be intensified.
• The distribution of iodized salt should cover all
the population in endemic areas of the country
to reduce the iodine deficiency to below
endemic levels.

13. Popularization of Low Cost Nutritious
Food
• Efforts to produce and popularize low cost
nutritious foods from indigenous and locally
available raw material shall be intensified.
• It is necessary to involve women particularly in
this activity.

14. Control of Micro-Nutrient Deficiencies
• It is necessary to intensify all these efforts and
work on a specific time frame.
• Nutritional blindness should be completely
eradicated by the year 2000 A.D.
• The National Nutritional Anaemia Prophylaxis
Programme should be extended and
strengthened to reduce anaemia in expectant
women to 25% .

15. Nutrition Policy Interventions
B. Indirect Intervention-Long Term
 Food Security-
• A per capita availability of 215 kg/person/year
of food grains needs to be attained.
• This requires production of 250 million tonnes
of food grains per year and buffer stocks of 30-
35 million tonnes in order to guard against
exigencies such as flood and droughts.

16. Improvement of Dietary pattern
• Improving the dietary pattern by promoting the
production and increasing the per capita
availability of nutritionally rich foods.
• The Green Revolution has bias towards wheat,
coarse grains and pulses, which constitute the
poor man's staple & protein requirements, have
not received adequate attention.

17. Improvement of Dietary pattern
• The prices of pulses, which were below cereal
prices before the Green Revolution are now
almost double the price of cereals.
• Our Food Policy should be consistent with our
national nutritional needs .for this there is need
for the introduction of appropriate Incentives.
pricing and taxation policies.

18. Improving the purchasing power
• Poverty alleviation programmes, like the Integrated
Rural Development Programme (IRDP) and
employment generation schemes like Jawahar
Rozgar Yojana, Nehru Rozgar Yojana and DWCRA
are to be re-oriented and restructured to make a
forceful dent on the purchasing power of the
lowest economic segments of the population.
• In all poverty alleviation programmes nutritional
objectives shall be incorporated explicitly and the
nutritional benefits of income generation shall be
taken for granted.

19. Public Distribution System
• Ensuring an equitable food distribution, through
the expansion of the public-distribution system not
only in urban areas but throughout the country.
• The Public Distribution System should be
strengthened especially during the monsoon
months for 'giving special rations at specially
subsidized rates for at least four months (July -
October) to the seasonally hat risk" population.
• The beneficiaries of this programmes should be
landless laborers , their families and the migrant
labourers and their families.

20. Land Reforms
• Implementing land reform measures so that the
vulnerability of the landless and the landed poor
could be reduced.
• This will include both tenural reforms as well as
implementation of ceiling laws.

21. Health & Family Welfare
• The population in the reproductive age group
shall be empowered through education to be
responsible for their own family size.
• Through intensive family welfare and
motivational measures: small family norm and
adequate spacing shall be encouraged so that the
food available to the family is sufficient for
proper nutrition of the members.

22. Basic Health and Nutrition Knowledge
• Basic health and nutrition knowledge With
special focus on wholesome infant feeding
practices, shall be imparted to the people
extensively and effectively.
• Nutrition and health education concepts shall be
effectively integrated into the school curriculum
as well as into all nutrition programmes.

23. Prevention of Food Adulteration
• Prevention of food adulteration must be
strengthened by gearing up the enforcement
machinery.

24. Nutrition Surveillance
• The NNMB and NIN of ICMR need to be
strengthened so that periodical monitoring of
the nutritional status of children adolescent girls,
and pregnant and lactating mothers below the
poverty line takes place.
• it is necessary for the NNMB to be accountable
to Ministry of women and child development so
far as Nutrition Surveillance is concerned.

25. Monitoring of Nutrition Programmes
• Monitoring of Nutrition Programmes (viz
ICDS) and of Nutrition Education and
Demonstration by the Food & Nutrition Board,
through all its 67 centers & field units, should be
continued.
• The transfer of food and nutrition board to
MOWCD has already ensure an integrated set
up to deal with the problem of nutrition with
adequate technical & field level set up.

26. Research
• Research into various aspects of nutrition, both
on the consumption side as well as the
supply side, is another essential aspect of the
strategy.
• Research should enable selection of new
varieties of food with high nutrition value
which can be within the purchasing power of
the poor.

27. Equal Remuneration
• Special efforts should be made to improve the
effectiveness of programmes related to women.
• The wages of women shall be at par with
that of men in order to improve women's
economic status.
• This requires a stricter enforcement of the
Equal Remuneration act with Special emphasis
will have to be given for expanding employment
opportunities for women.

28. Communication
• The Department of Women, and Child Development will
have a well-established, permanent Communications
Division with adequate staff and fund support.
• The existing facilities in the Song and Drama
Division and the Directorate of Advertising and
Visual Publicity (DAVP) in the Ministry of
Information and Broadcasting could help in a big
way to improve nutrition and health education.
• The media policy shall focus on ways and means to
combat malnutrition among girl children, adolescent girls
and women in the reproductive age group.

29. Minimum Wage Administration
• A special legislation should be introduced for
providing agricultural women laborers the
Minimum support, and at least 60 days leave by
the 'employer in the last trimester of her
pregnancy.
• The legislation should take care of Excessive
loss of energy during the working seasons has
serious nutritional implications.

30. Community Participation
• Generating awareness among the community.
• involving the community through their Panchayats
• Actual participation, particularly of women in food
production and processing.
• promoting schemes relating to kitchen gardens,
food preservation , preparation of weaning foods
and other food processing units both at the home
level as well as the community levels
• Generation of effective demand at the level of the
community.

31. Education and Literacy
• Education & Literacy particularly that of
women, is a key determinant for better
nutritional status.
• Ex- Kerala State which has the highest literacy
level, also has the best nutrition status despite
the fact that calorie intake in Kerala is not the
highest among all States in the country.

32. Improvement of the Status of Women
• women's employment ,does beneficial
household nutrition , both through increase in
household income as well as through an increase
in women's status, autonomy and decision-
making power.
• Educated women have greater roles in
household decision making, particularly those
relating to nutrition and feeding practices.

33. Administration and Monitoring
• For administration and monitoring National
Nutrition Council under chairmanship of Prime
minister and a coordination committee, under
the secretary, Department of women and child
development, has been recommended.
• Nutrition surveillance shall be task of NIN and
NNMB.
• Similar set up has been recommended at the
state level.

34. National Nutrition Policy Goals

35. National Plan Of Action On Nutrition
• As a follow-up of national nutrition policy, a
national plan of action was formulated in 1995
with sectoral commitments by fourteen nutrition
related ministries and departments.
• Action was started by these fourteen
departments/ministries to fulfill their
commitments.

36. National Plan Of Action On Nutrition
• Ministry of agriculture started training
programme related to kitchen gardens, rearing
of goat, sheep, pig, fish culture
• The aim is to promote production and increased
availability of green leafy vegetables and other
nutritious food at household level.

37. National Plan Of Action On Nutrition
• Ministry of forests and environments
involved local communities in growing nitration
rich fruits .
• Distributing seedling of plants producing fruits
rich in Vit- A.
• Ministry of civil supply has recast public
distribution system as TPDS, so that people
below poverty line were specially benefited.

38. National Plan Of Action On Nutrition
• Ministry of tribal welfare launched a special
program of grain banks in the most inaccessible
tribal areas inhabited by primitive tribes.
• Ministry of education launched a nation wide
programme of nutrition support to primary
education ( MDM Scheme) in 1995.
• Ministry of information has been supporting by
developing, telecasting and broadcasting messages
on nutrition, family welfare, and other related
themes.

39. National Plan Of Action On Nutrition
• Ministry of health and family welfare
involved in prevention, early detection and
management of micronutrient deficiencies,
health and nutrition education, infection control
and promotion of small family norm to achieve
improved nutritional status.
• The goal of policy has been revised according to
11th and 12th five year plans.

40. Developments during 11th Plan( 2007-
12)
• The WHO child growth standards were introduced
in 2008 under ICDS/NRHM for monitoring of
growth and development of young child.
• The ICMR expert committee revised the RDA for
Indians in 2010.
• Recommendations were made for energy
requirements for reference children as well as
energy requirement per KG to calculate the gap
between requirement and intake.
• This is important measure as the country has
entered the dual nutrition burden era.

41. Developments during 11th Plan( 2007-
12)
• NHM village and health sanitation committee were
expanded in July 2011 to include nutrition and
ICDS ( Now Village health, sanitation and nutrition
committee).
• Recognized as sub- committee of gram Panchayats.
• The use of double fortified salt ( DFS) was
mandated in government food supplementation
programme ( ICDS/MDM) for nutritional anemia.

42. Developments during 11th Plan( 2007-
12)
• RMNCH+A revised the strategy for IFA
supplementation in Feb 2013.
• It includes national iron plus initiative, weekly
iron and folic acid scheme and preventive use of
folic acid in planned pregnancies during the pre
conception phase.
• The national food security act passed in 2013 for
ensuring food and nutritional security for
people.

43. National Food Security Act- 2013.
• NFSA gives right to the people to receive
adequate quantity of food grains at affordable
prices.
• About two third, up to 75% of rural and 50%
of urban population will benefited by subsidized
food grains under TDPS, with uniform
entitlement of 5 kg per person per month.
• Eligible households to be identified by state.

44. National Food Security Act- 2013.
• The poorest of poor households would continue to
receive 35 kg food grains per household per month
at subsidized prices under Antyodaya Anna Yojana.
• The eldest women of eighteen years of age or
above will be head of households for issue of
ration cards.
• If not available, the eldest male is to be head of
household.
• Identification of beneficiaries will be done through
Aadhar card.

45. National Food Security Act- 2013.
• Food grains under TDPS will at be made available
at subsidized prices of rupees 3/2/1 per kg for rice,
wheat and coarse grains for a period of three years
from the date of commencement of the act.
• Thereafter prices will be suitably linked to
minimum support Price ( MSP).
• Food security allowance will be provided to entitled
beneficiaries in case of non supply of entitled food
grains or meals.

46. National Food Security Act- 2013.
• There will be state and district level redressal
mechanism with designated officers.
• Provision have also been made for disclosure of
records related to PDS, social audits and setting up
of vigilance committee in order to ensure
transparency and accountability.
• The bill provides for penalty to be impose on public
servant or authority, if found guilty of falling to
comply with relief recommended by the District
Grievance redressal Officer ( DGRO).

47. Strategy during 12th five year Plan
Following strategies planned in 12th plan-
• The ICDS requires strengthening and restructuring
• A multi-sectoral programme to address maternal
and child malnutrition in selected 200 high-burden
districts would be prepared.
• This programme will bring together various
national programmes through strong institutional
and programmatic convergence at the State,
District, Block and Village levels.

48. Strategy during 12th five year Plan
• A nation-wide information, education and
communication campaign will be launched
against malnutrition.
• The Ministries that deal with Health, Drinking
Water Supply and Sanitation, School Education,
Agriculture and Food and Public Distribution
will bring strong nutrition focus to their
programmes.

49. Nutrition goal under 12th plan
Indicator Current level Twelfth plan
goal
1. Prevalence of
malnutrition in children
0-3 years ( Weight for age
below 2 SD)
45.9% 50% of NFHS
3 ( 2005-06)
levels
2. Prevalence of anemia
among women ( 15-49
years)
56.1% 28.0%

50. Constraints of National Nutrition Policy
• Malnutrition is till to be focused as a national
problem.
• Nutrition does not have the status of a separate
ministry nor even a department, and all existing
departments have their own mandates.
• Nutrition is not seen as an explicit goal by the
concerned sectors.

51. Constraints of National Nutrition Policy
• Nutrition is invariably seen as synonymous with
feeding.
• State level actions on nutrition policy
instruments depend on directions supported by
resource allocations.
• ICDS need restructuring, focus on children 0-3
years, when malnutrition sets in and is most
prevalent.

52. Constraints of National Nutrition Policy
• Growth monitoring not done in more than one
third children.
• Supplementary food of good quality often not
available and considered as replacement of
family food not supplement.
• Irregular supply of IFA tablets for many years
and only one fifth of pregnant lady consume
them regularly.

53. Constraints of National Nutrition Policy
• Consumption of adequate iodized salt has
increased only 2 % between NFHS II and III.
• The PDS and subsequently TDPS have failed in
their objectives.
• Food stocks are currently at their lowest.
• The policy has failed to achieve its outcome
goals.

54. Constraints of National Nutrition Policy
• More than half of pregnant women continue to
have anemia and its increased among children
less than 3 years of age.
• Proportion of underweight children is still very
high and one third of married women have BMI
below normal.
• From these observations it can be concluded
that policy has failed to bring improvement in
nutritional status of people.

55. Achievements
• National nutrition policy is based on logical
consideration that nutrition is an outcome of
complex array of factors i.e. agriculture, food
production, purchasing power, market prices,
knowledge, gender differences and food fads.
• Most of the short term and long term
interventions envisioned in the policy have been
implemented.
• ICDS has been universalized.

56. Achievements
• Kishori Shakti Yojana ( KSY) is being
implemented in all the 6118 ICDS projects since
2006-07.
• Nutritional programme for them is operational
only in 51 most backward districts.
• Mid day meal programme, national nutritionl
anaemia prophylaxis programme and national
iodine deficiency disorder control programme
have been in operation throughout the country.

57. Achievements
• Decline in prevalence of nutritional blindness
from about 1% to 0.6%.
• Neonatal hypothyroidism has been decline from
100/1000 live births to 18/1000 live births in
endemic districts.
• Zinc supplementation has been introduced
recently in RCH program.

58. Comments
• The largest PDS in world is desirable to introduce
state specific designs and implementation strategies.
• NNP should incorporate the measures directed at
emerging diet related problems like obesity, DM,
and Cardio vascular diseases.
• The policy should have long term perspective of
production and consumption of food in adequate
quantity and qualitatively rich in micronutrients,
vitamins and other protective elements.

59. Comments
• UN FAO has warned the goal of halving the
number of undernourished people by 2015 can
not be reached at present rate.
• It said India and Pakistan are among 17
countries where hunger has risen after falling
steadily in early and mid 1990s.
• Globalization and modernization do not have
any beneficial effect on the poor and under
nourished people.

60. References

61. References