National Nutrition Policy
National Nutrition Policy
National Nutrition Policy
POLICY, 1993
Abstract
The National Nutrition Policy adopted by the Government of India in 1993 under the aegis of
the Department of Women and Child Development, advocated a multi-sectoral strategy for
eradicating malnutrition and achieving optimum nutrition for all. The implementation strategy
involves setting up Inter Sectoral Coordination mechanism at Centre, State and District levels,
Advocacy and sensitisation of policy makers and programme managers, intensifying
micronutrient malnutrition control activities, reaching nutrition information to people,
establishing nutrition monitoring and mapping at State, District and Community level, and
developing district-wise disaggregated data on nutrition. Development of State Plans of
Acton on Nutrition by respective States was also an important mandate.
On critical analyzing the National Nutrition Policy, it is apparent that it mainly targets
severely malnourished children. All the intervention programs listed are mainly based upon
supplementary nutrition which has been proved to be beneficial only for severe grades of
malnutrition. Just supplementary nutrition as a strategy without active interventions to
promote behavioral change is indicative of the inherent short sightedness of the policy.
Context
The policy makers accepted that, widespread poverty resulting in chronic and persistent hunger
was the single biggest scourge of the developing world. Extreme poverty resulted in under
nutrition of large sections of the poor, wherein women and children were highly vulnerable.
There was a vicious cycle of poverty and under nutrition that was operating. Poverty resulted in a
continuous low intake of nutrients, and repeated insults from under nutrition related diseases and
infections ultimately caused stunted development of children who as adults has impaired
productivity, hence low earning capacity.
Under nutrition has been seen as a part of larger set of processes that produces and consumes
agricultural commodities on farms, transforms them into food in the marketing sector and sells
the food, to customers to satisfy nutritional, aesthetic and social needs (nutrition policy). Under
this larger set there were three subsets Agriculture, Food and Nutrition. The policy makers aimed
at devising interventions that influenced these three sectors. Even though India was a food
surplus nation in 1980s, the policy document stresses at availability of food as a key issue
especially for the 29.2% of the population that was below poverty line. Apart from availability it
recognizes that micronutrient deficiency could also be a perspective that needs to be looked at.
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Objectives
To reduce the incidence of severe (8.7 per cent) and moderate (43.8 per cent)
malnutrition by half by the year 2000 A.D.
All adolescent girls from poor families to be covered through the ICDS by 2000 A.D. in
all CD blocks of the country and 50% of urban slums
To increase per capita availability of 215Kg, for that , to achieve production targets of
230 MT by 2000
At least 100 days of employment created for each rural landless family, employment
opportunities in urban slum dwellers and urban poor
Distribution of iodized salt to cover all endemic areas
Nutritional blindness to be completely eradicated by 2000 A.D.
To expand the Nutrition intervention net through ICDS so as to cover all vulnerable
children in the age group 0 to 6 years
Critical Analysis
On critical analyzing the National Nutrition Policy, it is apparent that it mainly targets severely
malnourished children. All the intervention programs listed in the policy are mainly based upon
supplementary nutrition which has been proved to be beneficial only for severe grades of
malnutrition (Grade IV & V Gomez Classification, weight-for-height < -3 Z-scores or < 70% of
the median NCHS/WHO reference).
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among preschool children decreased from 1.3% to 0.1% over the period, while that of
kwashiorkor was conspicuously absent. The prevalence of clinical forms of other nutrient
deficiencies such as angular stomatitis indicative of B-complex vitamin deficiencies decreased
from 6% to 2%. Though the overall prevalence of Bitot spots decreased from about 2% to about
0.7%, it remained more than 0.5% in all the States barring Kerala and Orissa, a cut off-level
suggested by WHO, to indicate public health significance of the problem. The prevalence was
observed to be relatively more among those children belonging to SC/ST communities, those
belonging to households engaged in labor activities, and families where the adult woman is
illiterate. (NNMB)
Though the policy has taken the mild and moderate cases of malnutrition into account but the
intervention programs do not depict the same picture. A recent study by Kulkarni MN; Pattabhi
YN evaluating the effectiveness of ICDS in 7 anganwadi centers on the health status of pre-
school children showed that impact of the programme on nutritional status was seen only in
severely malnourished children (Grade III & IV). Severely malnourished children constituted 9.3
percent of total initially and 3.9 percent at the end of the study. The number of children
belonging to Grade I & II malnutrition were 74 percent initially and 81.5 percent at the end of
the study.
In yet another study (Mridula, D., Mishra, C. P., Tyagi, S. K.) the nutritional status of 273
children from ICDS and 262 children from non-ICDS urban slum areas in Varanasi City, Uttar
Pradesh, India, was assessed over a year. The results showed that 60.5% of children fell in
different categories of undernutrition. Protein energy malnutrition was more prevalent in non-
ICDS than ICDS children (62.67 vs. 58.33%), however the difference was not significant. The
percentage of ICDS children with normal nutritional status (based on weight for age and IAC
classification) decreased from 40% at baseline to 19% at final assessment; among non-ICDS
children, the percentage decreased from 36.26 to 18.07%. Statistically similar rate of nutritional
status deterioration was observed in both ICDS (44.69%) and non-ICDS (41.6%) children. The
rate of improvement in nutritional status was marginally higher in ICDS (6.59%) than non-ICDS
(3.82%) children. Only 33.33% of children with severe grade of malnutrition improved in a year.
These results indicate that not enough emphasis was given to growth monitoring of children in
the ICDS areas to detect disease, evidence of malnutrition, infection etc., and to provide
immediate corrective measures to improve the nutritional and health status of children. It is
suggested that the implementation of the entire package of the ICDS scheme should be
improved, focusing on protein energy malnutrition in children of slum areas.
1. The nutritional supplementation under ICDS was marginally successful in improving the
status of severe grades of malnutrition.
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4. The food supplementation in ICDS is untargeted since no screening is done before the
nutritional supplementation
On similar lines, analyzing other intervention programs mentioned in the policy we can
observe a general pattern that these intervention programs have been designed keeping into
account only the severe grades of malnutrition or specific nutritional deficiencies.
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Programme
Thus, the data collected by NNMB over a period of time has shown that in spite of phenomenal
increase in food production through 'green', 'white' and 'yellow' revolutions, the problem of
undernutrition in India continues to be a public health problem. Though severe forms of
undernutrition is decreasing considerably, significantly higher proportion of populations suffer
from mild to moderate forms of undernutrition. The increase in population size, low literacy
level, recurrent drought conditions, increasing unemployment, and decreasing household food
security status could be contributing to the dilution of the effects of development trickling down
to the grass root level. Therefore, there is need to strengthen the existing nutritional and other
developmental programmes such as supplementary feeding, micronutrient supplementation, rural
employment generation, public distribution system etc. There is need to improve health and
nutrition education activities in the communities, through various media. Health and nutrition
education has to be included in the educational curriculum. There is need to establish National
Nutrition Surveillance system through existing ICDS infrastructure at various levels, right from
household to district or State level, to assess the nutritional problems.
Food Security
In order to ensure aggregate food security per capita availability of 215 kg/person/year of food
grains needs to be attained. This requires production of 250 million tones of food grains per year
by 2000 AD. Also policy suggested the following:
• Improving the dietary pattern by promoting the production and increasing the per capita
availability of nutritionally rich foods.
• Production of pulses,oilseeds and other food crops will be increased.
• The production of protective food crops. such as vegetables. fruits, milk, meat, fish and
poultry. shall be augmented.
• Preference shall be given to green leafy vegetables and fruits such as guava,papaya and
amla with the help of latest and improved techniques.
PRESENT SCENARIO: Net per capita availability of food grains has decline to 159.2 kgs
in 2002-03 from 170 kgs in 1998-99. Success of the Green Revolution was largely limited to
wheat and rice. According to Economic survey of India, per capita availability of pulses, poor
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man’s rich source of protein has declined. Horticulture has also been neglected, one third of the
vegetables and fruits perish before reaching customers. Intensive agricultural technologies which
were the part of Green revolution contributed to the depletion of soil nutrients like zinc.
Recommendation:
• Strengthening agricultural policies: Insufficient food production, inadequate food
handling, processing, storage, distribution or marketing should be tackled.
Small and medium enterprises (SME): Small and medium enterprises are essential for
dynamic economic growth and job creation. Improving access to finance for this sector will be
key factor for growth.
Agriculture and rural development: Some two-thirds of India’s people depend on rural
employment for a living. While the agriculture sector grew at only about 2.5 percent a year for a
number of years, recent growth has touched 4.7 percent a year, facilitated by good monsoons,
greater production of high-value crops, an increase in the minimum support prices for grains, and
the rise in global prices for agricultural products. Rural livelihoods projects support the
empowerment of the rural poor and the development of their livelihoods. . Encouraging policies
that promote competition in agricultural marketing will also ensure farmers receive better prices.
Informal Sector Jobs: While the services sector has been offering promising job opportunities
for skilled workers, some 90 percent of India’s labor force remains trapped in low-productivity
jobs in the informal sector. India’s labor regulations - among the most restrictive and complex in
the world - have constrained the growth of the formal manufacturing sector, where these laws
have their widest application. Better-designed labor regulations can attract more labor-intensive
investment and create jobs for India’s unemployed millions and those trapped in poor quality
jobs.
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Government responsibility is to assure that food will not cause harm to the consumer when it is
prepared and/or eaten according to its intended use.
Under the provision of the PFA Act, the Government of India has promulgated PFA rules which
specifies the following details
The above statement by the Planning Commission has lot of meanings and expresses a desire to
know the utility and implementation process of PDS scheme.
Current study is undertaken to answer some of questions raised by the Planning Commission on
PDS, such as:-
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The objectives of PDS are laudable. However, foregoing analysis shows that there are certain
weaknesses in the system, which needs urgent attention
Land reforms
Implementing land reform measures so that the vulnerability of the landless and the landed poor
can be reduced. It includes both tenured reform and ceiling laws.
Land reforms have been a national agenda of rural reconstruction since independence. The major
objectives of land reforms have been:
Land reforms are an attempt by the Government to achieve social equality and optimum
utilization of land by redistributing the land holdings. These reforms are intended to eliminate
exploitation and social injustice within the agrarian system, to provide security for the tiller of
the soil and to remove obstacles arising from the agrarian structure that has been inherited from
the past.
But despite this vision of the leaders of the nation, there was inertia, lack of sincerity by
governments and pressure tactics of powerful land owning class discouraged land reforms in
most of the states. Tenancy reforms are one of the major aspects of the land reforms. Tenancy
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reforms relate to the rights and conditions of holding land. They aim at the abolishing
intermediaries and bringing the actual tiller in direct contact with the State, regulation of rent,
security of tenure for tenants and providing ownership on them. It also focuses on land ceiling
and land holdings. Land reforms include redistribution of land ownership in favor of the
cultivating classes so as to provide them a sense of participation in rural life, improving the size
of farms, providing security of tenure to them. The purpose of land reform and thus the tenancy
reform is twofold.
On one hand, it aims to optimum utilization of land by affecting conditions of holdings,
imposing ceilings and floors on holdings so that cultivation can be done without any waste of
labor and capital. On the other hand, it is a means of redistributing agricultural land in the favor
of less privileged classes of tillers and cultivators, and of improving the terms and conditions on
which the land is held for cultivation by the actual tillers, with a view to end exploitation.
The big land reform success story is Operation Baraga in Marxist-ruled West Bengal. The
operation which was launched in 1978 led to the emergence of 1 500 000 share croppers. West
Bengal's tenancy law provides the recorded share croppers permanent and heritable rights.
Land reform is necessary but not the sufficient measure to improve the condition of the poor.
Nutrition education
World bank reports that Indonesia spent only .15% of its national budget on nutrition education
and they reduced the prevalence of under-nutrition by 40%. Hence it is a very cost effective
method in the Indian context also.
The myth that is to be addressed is that ‘if problem is malnutrition, solution is make more food
available’. Just food security and robust economic growth will not ensure removal of the tag of
being a malnourished nation.
The education strategies to make nutrition the central talking point are :
• Social marketing
• Communication for behavior change
• Advocacy
The services of nutrition specialists and local community leaders should be used to counsel about
improving the dietary practices, sanitation and hygiene, encourage breast feeding, birth spacing,
deworming of children, gender sensitivity promoting use of fortified foods, mineral and vitamin
supplements.
Advocacy and sensitizing health personnel for capacity building, focusing on women and IYCF
practices, addressing the socio-cultural and economic barriers.
Strong networking between govt., international organizations, medical colleges, home science
and media for advocacy and nutrition communication.
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Recommendations
• Focus on 3-6 yr age group children rather than since birth in ICDS because malnutrition
already sets in by then.
• Focus on mild to moderate malnutrition and not just on severe malnutrition.
• Establish regional, zonal centers' with nutritionists/ scientists and use the expertise of
biotechnologists and genetic engineers.
• Empower Panchayati raj institutions and form village level nutrition committees for
micro planning and formulating short term goals.
• A compulsory course on nutrition literacy at the UGC level.
• Form a nutrition council of India like MCI for quality management of training.
• 5 states and 50% villages contribute to more than 80% of malnutrition cases. Special
focus on these hunger hot spots and tribal areas. Obtaining information using civil
registration system for audit. Vigorous awareness campaigns and setting up community
grain banks accordingly.
• Over-nutrition, obesity and lifestyle related diseases are emerging as a threatening
menace with rapid urbanization. The target population should be sensitized about this
cause of concern.
• There is an urgent need to expand focus of services, referral systems, IEC and research
beyond FP to include safe motherhood, abortion services, services for gynecological and
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obstetric morbidity; infertility; sexual behavior and STDs; and even non-terminal
contraception.
• Quality outreach services delivered in ways which are sensitive to a cultural milieu which
inhibits women from expressing reproductive health needs or seeking health services.
• While women are generally underserved, among the most neglected women, as shown
earlier, are adolescent girls. A focus on the health needs of adolescent girls -- their
reproductive health needs, their nutritional status, the risks of early marriage and
childbearing -- is urgently required. More generally, efforts to enhance the status of
adolescent girls, through measures to keep them in school, to provide non-formal education
to drop-outs and provide skill development and income generating opportunities is an
integral part of a really holistic approach.
There are gains of green revolution in terms of national food security and situation of extreme
hunger and starvation, what still remains is a different degree endemic hunger which, in context
of prevailing patterns of intra-household food distribution particularly in rural families. This
translates into grave danger for nutritional status of women and children in risk population.
Following are the proposed points for the status of various sectors that can be beneficial
implementing the nutrition policy more effectively-
1. Agriculture sector- The food production potential is still greatly underutilized, it must keep
pace with population growth. The present agriculture policies that are being implemented
need to be re-framed, presently the policies deal more with the aspect of high production
rather than nutrition (nutrition policy instrument 1993). It is imperative that we extend high
technology to farmers at the production levels are always maintained high. This implies
expansion of cultivated areas the use of fertilizers, better seeds, undertaking of irrigation
projects and so on. (park)The variety of crops grown must also be regulated such that only
high yielding variety nutritional crops are encouraged. There has been a proposal for the
introduction of a second green revolution because the first one focused exclusively on growth
of cereals. It is essential to focus this time on the production of fruits, vegetables and milk
products.
2. Food policy- Stringent laws on adulteration should be laid down. Since the distribution
consists of a highly interlinked web, it is very hard to maintain uniform quality standards.
The pricing levels must be maintained at a consistent level.
3. Industrial sector- Encouraging the production of shark liver oil, carotene and other sources of
vitamin A that would be reasonably priced and available in plenty. The industrial sector can
introduce regulatory plans for the maintenance of standards of goods.
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5. Health sector- Camps must be organized in rural parts of the country where lactating mothers
and malnourished children below the poverty line are provided with information regarding
their health needs. A policy can be made to periodically monitor the nutritional and status of
the population to form a developmental and nutritional policy in accordance with the results
obtained. Since malnutrition is closely related to infection, all programmes related to
immunization and improvement of environmental sanitation will inevitably have a beneficial
effect on nutrition. Several programme within the field of health, seemingly unrelated to
nutrition, may have profound impact on nutritious policy so various health programmes must
be included in nutrition policy as they have alternate approaches to improve nutritional
status of people.
6. Rural development-The nutrition up-liftment of people, especially in a country like India, can
come about only as a part and parcel of an overall socio-economic development of rural areas
where 80%of people live. Even an impressive increase in total food production will not solve
the problem of under nutrition if the income levels of vast section of people continue to be
low that they cannot afford to buy required nutritious food it is therefore necessary to raise
living standard and purchasing power of the people. This requires implementation of broad
based nutrition schemes in the policy.
A co-ordination expert committee on nutrition can be established which would monitor if all
the above sectors are functioning properly and review the implementation of nutrition
intervention measures and decision making in policy matters to achieve the desire goals .A
nutritional policy should be immediately translated into realistic sectoral action programmes.
Indicators of performance:
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Various organizations like NNMB, NIN, NSSO, and NIPCCD form the major source of
information. The surveys and assessment conducted provide vital information to decision
makers.
And also GLOBAL WARNING AND INFORMATION SYSTEM can play a major role.
Since, we know as our government failed to monitor all programmes were not effective.Thus, we
need to emphasize on process monitoring and evaluation of all programmes along with impact
and outcome.These were only few important recommendations of the lot suggested by nutrition
policies of India.
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Thus, on analyzing the entire policy we as group hope that very soon a more effective and
efficient policy with well coordinated programmes will be implemented to deal with problems of
nutrition in India.
FIVE YEAR CONTRIBUTIONS TO THE FIELD OF NUTRITION
PLANS
1st Research in the field of nutrition, Recommended manufacturing of synthetic
vitamins.
7th ICDS
From the above data one can clearly comment that the problem of nutrition was recognized since
years. The government had made efforts to tackle the problem. There were many programmes
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implemented by the government. Various strategies were adopted and modified from time to
time.
Insipte of all the efforts the problem of malnutrition persisted. Thus to combat the problems
related to malnutrition the national nutrition policy was introduced in 1993. Many programmes
were extended and emphasized. Few new strategies were adopted.
References
1. CLAESON, Mariam et al . Reducing child mortality in India in the new millennium. Bull World Health
Organ, Genebra, v. 78, n. 10, 2000
3. NFHS I
4. NFHS II
5. NFHS III
9. United Nations Childrens Fund (UNICEF). The State of the World's Children 2004. New York; Unicef:
2003.
12. WHO (1985): ‘Energy and Protein Requirements: Report of a Joint FAO/WHO/UNO Expert Consultation’, Geneva, pp 34-52.
13. Ramachandran, K (1987): ‘Food Consumption in Rural Indian Households: Has It Increased in the Recent Years?’ in C
Gopalan (ed), Combating
14. Undernutrition: Basic Issues and Practical Approaches, New Delhi
15. Why Are Levels of Child Malnutrition Not Improving? : A K SHIVA KUMAR
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17. Urban Bias in Indian Public Distribution System ,Stephen Howes and Shikha Jha
18. Alderman, H (1986), The Effect of Food Price and Income Changes on the Acquisition of Food by
Low Income Households, IFPRI, Washington DC, May.
19. World Bank (1986), 'Poverty and Hunger: Issues and Options for Food Security and Developing
Countries'. World Bank Policy Study, Washington D C.
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