Policy Update
Kirti Ranjan
This article highlights the prevalence of stunting, wasting, and undernutrition among children under five across various wealth quintiles using NFHS-5 (2019-2021).
Understanding Undernutrition
Stunting means low height for age, and it is impaired growth of children caused by improper intake of required nutrition over the long term, repeated infection and Inadequate psychological stimulation (WHO,2015).
The World Health Organization (WHO) defines a child as being stunted if their height-for-age is more than two standard deviations below the WHO Child Growth Standard median. Stunting is largely determined by a child’s first 1000 days, i.e. 2.7 years (Ritchie, 2022).
Stunting affects the physical and cognitive development of children, which may result in poor academic performance, low wages, low productivity and an increase in risk of nutrition-related chronic disease in adult life.
Wasting means low weight for height. According to the World Health Organization (WHO), the prevalence of wasting (weight for height < (-2) standard deviations from the median of the World Health Organization (WHO) Child Growth Standards among children under 5 years of age. Wasting is commonly known as a form of “acute malnutrition”. It can be caused by acute but severe food shortages or disease, or both (Ritchie, 2022).
Underweight means low weight for age. According to the World Health Organization (WHO), the prevalence of underweight (weight for age < (-2) standard deviations from the median of the World Health Organization (WHO) Child Growth Standards) among children under 5 years of age. It leads to long-term consequences, including impairments in physical and mental health, behavioural issues, and poor educational outcomes (Acquah et al., 2019).
Higher Prevalence of Undernutrition In India
Globally, 22.3% of children under five experience stunting, 6.8% face wasting, and 2.1% suffer from severe wasting (UNICEF-WHO, 2022). In South Asia, stunting is 30.7%, while wasting is 14.1%. Comparatively, in India, stunting affects 35.5% of children under five, wasting impacts 19.3%, and severe wasting is observed in 7.7%. India has higher rates of stunting and wasting among children under five compared to both global and South Asia averages. (Global Nutrition Report, 2022)
However, in India, the level of stunting, wasting, and undernutrition has reduced over time, according to NFHS rounds. Still, India has a higher prevalence of malnourished children than the global average.
Figure 1: Prevalence of stunting, wasting and underweight among under-five children across wealth quintiles in India.(NFHS-5)
Factors for malnutrition
Malnutrition among children stems from lack of proper nutrition, safe drinking water, food shortage and inadequate water intake. The reason for malnutrition also includes biological and socio-economic factors like the mother’s nutrition and education, status, household income, residence type, gender, and caste.
Poverty is a significant contributing factor and serves as a “proximate determinant of malnutrition, influencing it through insufficient dietary intake, inadequate medical care, limited access to sanitation and hygiene, and an unhealthy environment.” (Panda et al., 2020)
India has been ranked 105th out of 127 countries in the 2024 Global Hunger Index (GHI), with a score of 27.3, indicating a “serious” hunger level.
A Greater Divide between Rich & Poor
This article highlights the prevalence of stunting, wasting, and undernutrition among children under five across various wealth quintiles (Poorest, Poorer, Middle, richer, Richest). The data used in this article is from the National Family Health Survey – 5 (NFHS-5) conducted during the period 2019-2021.
Table 1: Prevalence of stunting, wasting and underweight among under-five children across wealth quintiles in India.(NFHS-5)
The wealth index in the Demographic Health Survey (DHS), designed to account for urban-rural differences, is created in three steps. First, common indicators for both areas(Urban & Rural) are analyzed using principal components analysis (PCA) to generate a common factor score, with categorical variables converted into dichotomous (0-1) indicators and discrete variables grouped accordingly. Second, area-specific factor scores are calculated separately for urban and rural households using relevant indicators. Finally, these scores are combined into a national wealth index by regressing area-specific scores on the common factor score. The index, standardized with a mean of zero and a standard deviation of one, is used to rank individuals into five wealth quintiles, each comprising approximately 20% of the population (DHS).
Table 1 & Figure 1 shows that for children belonging to the “poorest” household, the prevalence of stunting is 46.1%, wasting is 22.5%, and for underweight is 43.1%, to “richest” stunting is 22.9%, wasting is 16.2% and underweight is 20.1%. The Indian average for stunting under 5-year children is 35.5%, wasting is 19.3%, and underweight is 32.1%. The prevalence of stunting and wasting is comparable to the global average. But when we look at the poorest section, it is manifold higher. Undernutrition and poverty are linked, and inadequate nutrition is linked to both severe micronutrient shortages and stunted growth in children. Food security is especially susceptible to shifts in the economic landscape and disparities in the distribution of income (Varadharajan,2013).
A concerning trend is highlighted by the high prevalence of malnutrition, even among children from wealthier families. This may indicate a move away from conventional, balanced meals and an increasing reliance on processed and packaged foods, which are frequently heavy in calories but poor in vital nutrients. To effectively combat malnutrition, this dietary shift emphasizes the necessity of nutrition education and awareness across all income levels.
Figure 2 shows severe stunting, severe wasting and underweight prevalence across wealth quintiles. The severe category is defined when the indicator has less than a -3 standard deviation from the median. Among children belonging to the “poorest”, the prevalence of severe stunting is 21.79%, severe wasting is 8.59%, and severe underweight is 15.42%. Among the children belonging to the “richest” section, the prevalence of severe stunting is 9.08%, severe wasting is 7.02%, and severely underweight is 6.69% The percentage of severely malnourished children among the poorest section is concerning and needs immediate policy attention.
A holistic Approach towards elimination of Undernutrition
The eradication of malnutrition (a target set by WHO by 2030) requires a holistic approach. Apart from nutrition, mother’s health & education, sanitation facilities, safe drinking water, and clean cooking fuel also play an important role. The government has launched several schemes that help in achieving these goals. Swachh Bharat Abhiyan aimed at improving sanitation.
Figure 2: Prevalence of stunting, wasting underweight and severe stunting, severe wasting, and severe underweight among children under five across wealth quintiles in India.(NFHS-5) 
Pradhan Mantri Matru Vandana Yojana, which is a centrally sponsored programme, provide a Rs 5000 cash incentive to pregnant and lactating mothers. Janani Suraksha Yojana promotes institutional delivery among poor pregnant women. Anemia Mukt Bharat includes periodic deworming, testing & treatment of anaemia using digital methods. Poshan Abhiyan focused on improving the nutritional status of adolescents, pregnant women, lactating mothers and children.
Integrated Child Development Services (ICDS) is a comprehensive programme addressing malnutrition, health, and developmental needs for young children, pregnant women, and nursing mothers. Mid-day meals at schools provide nutrition to school-going children. Pradhan Mantri Ujjwala Yojana (PMUY) provides clean cooking fuel to rural and marginalized households to improve health and reduce environmental impact. Several pre-existing government programmes target the problem of undernutrition among children; there is a need for the optimum allocation of funds and effective implementation of the scheme.
References
- Acquah, E., Darteh, E. K. M., Amu, H., & Adjel, D. K. A. (2019). Predictors of underweight in children under-five years in Ghana. Ghana medical journal, 53(1), 71-78. https://pmc.ncbi.nlm.nih.gov/articles/PMC6527829/#R3
- Ritchie, H. (2022, February 4). What is childhood stunting? Our World in Data. Retrieved January 5, 2025, from https://ourworldindata.org/stunting-definition
- Ritchie, H. (2022, February 6). What is childhood wasting? Our World in Data. Retrieved January 8, 2025, from https://ourworldindata.org/wasting-definition
- Panda, B. K., Mohanty, S. K., Nayak, I., & et al. (2020). Malnutrition and poverty in India: Does the use of public distribution system matter? BMC Nutrition, 6(41). https://doi.org/10.1186/s40795-020-00369-0
- Varadharajan, K. S., Thomas, T., & Kurpad, A. V. (2013). Poverty and the state of nutrition in India. Asia Pacific Journal of Clinical Nutrition, 22(3), 326–339. https://doi.org/10.6133/apjcn.2013.22.3.19
About the contributor: Kirti Ranjan is currently an Intern at IMPRI and a PhD student in Economics at the Centre for Economic Studies and Planning (CESP), Jawaharlal Nehru University (JNU). Her areas of interest are gender and behavioural economics.
Acknowledgement: The author sincerely thanks Dr Arjun Kumar for the invaluable opportunity and to Ms Aditi and Mr Arjun for their informative inputs.
Disclaimer: All views expressed in the article belong solely to the author and not necessarily to the organisation.
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