ABSTRACT
India's malnutrition burden, though improved, is still alarming, with the prevalence of stunting (35.5%), wasting (19.3%), and underweight (32.1%) among children in 2019–2021. The challenge persists despite various efforts by the government and non-governmental agencies. A comparison with other successful developing nations’ experience with the nutrition challenges underscores the importance of a decentralised decision-making and implementation approach. However, the ‘projectized’ Integrated Child Development Scheme (ICDS), with its Anganwadi Sevikas, has remained a standalone scheme, far from converging towards a community-owned decentralised programme with the flexibility to adapt to local challenges. This can have serious repercussions for future policies as it is well established that undernutrition creates irreversible changes in the growth and learning abilities of a child, along with heightened susceptibility to diseases as they grow. There is an urgent need for an integrated approach involving key stakeholders – local bodies and communities – to improve health and nutritional outcomes. The study presents an overview of the performance of the ICDS implementation in the last five decades. It is an attempt to explain that limited success has been achieved in improving nutritional outcomes in India. The chapter draws attention to the factors that hinder success in reducing malnutrition in India while acknowledging the positive aspects of the programme. The study also highlights some of the community-based initiatives operating in various regions of the country and their effectiveness in addressing the challenges related to improving nutritional outcomes. The chapter makes a case for an alternative approach that is decentralised and flexible with a strong community connection. The achievements and shortcomings highlighted in this chapter can help design and implement future policies aimed at addressing malnutrition in India. Finally, the study asserts that one cannot tackle the nutrition challenge without inducing behavioural change within society and empowering women, the latter being an important deterrent to the nutrition challenge. Increasing women's participation in intra-household decision-making and improving gender relations can provide a much-needed boost to the organisational efforts of addressing undernutrition among children and young adults. Thus, the study argues for a stronger approach involving the ‘whole of government’ and the ‘whole of society’ approach, leveraging support from local government institutions and the community for a convergent action towards eliminating all forms of malnutrition in India.
