ArticleBMC public health2025
Progress in child nutrition outcomes: insights from India's recent experience.
Article in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundImprovements in child nutrition outcomes have lagged behind India’s recent rapid economic growth, a phenomenon known as the ‘Indian enigma.’ Between 2015–16 and 2019–21, stunting and wasting rates declined only slightly, with some Indian states even experiencing worsening malnutrition. This study investigates the factors driving these trends, focusing on the impact of the COVID-19 pandemic, children’s dietary quality, access to water, sanitation, and hygiene (WASH), and the role of government nutrition programmes.
methodsThe study employs a mixed-methods approach, combining a quantitative analysis of data from India’s National Family Health Surveys (NFHS) IV (2015–16) and V (2019–21) with a qualitative comparative case study of Rajasthan and Himachal Pradesh—two states with contrasting malnutrition trends. Individual- and district-level regression models were used to assess the effects of dietary diversity, WASH access, and government programmes, whilst interviews with policy makers in Rajasthan and Himachal have provided insights into programme implementation and local responses during the pandemic.
resultsOur findings confirm that dietary diversity, particularly consumption of animal-sourced foods, and improved WASH access are key drivers of better nutrition outcomes in India. However, contrary to expectations, we do not find a consistently negative relationship between the COVID-19 pandemic and child malnutrition. Instead, flexible expansion of some of the welfare programmes during the pandemic along with reductions in children’s disease rates and improvement in some sanitation practices may have mitigated the expected deterioration. Findings from the comparative study of Rajasthan and Himachal further highlight the importance of tailoring welfare programmes to specific local conditions, such as the large proportion of migrant labourers in Himachal.
conclusionsOur study challenges assumptions about the pandemic’s uniformly negative effects on child nutrition and highlights the importance of resilient, locally tailored safety nets. The findings underscore the need for policy interventions that enhance dietary diversity, sustain WASH improvements, and strengthen the adaptability of food and nutrition programmes to crises.
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