58 RJMCHN Mission 5 Nutrition

59 60 | Nutrition

Overview

Children under six years of age require appropriate nutrition and adequate care in order to reach their full growth and development potential. Under nutrition jeopardizes children’s survival, health, growth and development, and it slows national progress towards development goals.

The nutrition situation in is slightly better than the national average and the state has demonstrated a notable reduction of 27% in the underweight prevalence of children under three years between NFHS-2 and NFHS-3. The establishment of a State Nutrition Mission will further contribute towards addressing child under nutrition in the state.

The Integrated Child Development Services (ICDS)45 programme provides nutrition and health services for children under six years, pregnant and lactating women, as well as preschool activities for children age 3-5 years. Village Health and Nutrition Day (VHND) and services of ASHA46 is also contributing in improving nutritional status of child and mothers.

Mid Day Meal (MDM) programme is also provides cooked meal to school going children and is contributing to improving their nutritional status. ©UNICEF/NYHQ2005-2395/Anita Khemka Nutrition | 61

ICDS programme in Maharashtra

Status of Anganwadi Centers (AWC) (as on April,2011) Status of human resources

Sanctioned Functioning Percentage of Sanctioned Filled post Percentage of functioning post filled posts AWC 97,462 93,115 95.54 CDPO 553 379 68.54 Mini AWC 10,724 8,957 83.52 ACDPO 119 119 100.00 Supervisor 3,898 3,273 83.97 Number of beneficiaries in Anganwadi Centers (as on April,2011) AWW 97,462 90,533 92.89 AWW for mini 10,724 7,834 73.05 Source: ICDS, MPR, Supplementary Nutrition Pre Primary AWC April 2011, www.icds. Helper 97,462 86,192 88.44 6 Months to 3 31,47,792 3 to 6 years 31,77,275 gov.in years • Vacancies are higher in management and supervisory level positions. 3 to 6 years 31,99,326 Pregnant & 11,79,076 Trends in budget provisions for child nutrition, Government of Maharashtra Nursing Mother

Source: ICDS, MPR, April 2011, www.icds.gov.in , Maharashtra

• 553 ICDS projects (364 rural,104 urban and 85 tribal) have been sanctioned in the state and almost all are functional.

Source: Budget in brief, 2011-12, Government of Maharashtra

(Rs. in Crore) * Revised, $Estimated

• Significant improvement in budget for child nutrition observed during the last three years. • Budget increased by 80% from 2009-10 to 2011-12. Nutrition’s share in the total budget also improved and reached 1.48% ( 2011-12 ) from 1.04% (2009-10). 62 | Nutrition

Percentage of children who received Colostrum/Khees 47, 2007-08

Index No. of districts Less than 80% 05 80-90% 21 More than 90% 09

Source: DLHS, 2007-08

• 86.1% children received colostrum/khees in the state. • No significant difference exist across social groups. However, the percentage is www.hetv.org slightly lower in lowest wealth index group , tribal districts and division. Nutrition | 63

Percentage of children who started breastfeeding within one Percentage of children (age 6-35 months) exclusively hour of birth (children under 3 years), 2007-08 breastfed for at least 6 months48, 2007-08

Index No. of districts Less than 25% 08 25-35% 11 35-45% 07 More than 45% 09

Source: DLHS, 2007-08

Nandurbar 37.7 Gondiya • In Maharashtra 34.7% children (age 6-35 months) had been exclusively breastfed. 56.7 60.8 • This percentage was lower in districts of division. 42.2 62.4 44.3 Wardha 61.8 Buldana 60.2 68.4 • Disparities exist among districts. It is the lowest (16.4%) in and highest Nashik 48.8 54.4 Aurangabad 50.6 58.3 63.1 40.0 (54.8%) in Wardha. Jalna Hingoli 57.4 52.6 46.4 (Suburban) Ahmadnagar 49.7 49.6 48.8 Bid 62.3 49.5 Mumbai 45.3 Index No. of districts 50.6 58.1

Raigarh 46.0 Less than 45% 05 53.9 55.9 43.1 Osmanabad 45-55% 16 65.4 Ratnagiri 55-65% 11 45.4 50.5 More than 65% 03

Sindhudurg 74.0 50.8 Source: DLHS, 2007-08

• 52.7% children started breastfeeding within one hour of birth. No significant difference exist across the areas, social groups and wealth indices. • P ercentage of children who started breastfeeding within one hour of birth is slightly lower in tribal districts and in . 64 | Nutrition

Percentage of children aged 12-35 months who received at Household using adequately iodized salt, 2005-06 least one dose of Vitamin A, 2007-08

61.0

Source: NFHS, 2005-06

• 61% households are using adequately iodized salt, the usage is similar to that in 1998-99. • The usage is significantly low in rural areas, SC and ST social groups and lowest wealth index group.

Index No. of districts Less than 65% 05 65-75% 07 75-85% 12 More than 85% 11

Source: DLHS, 2007-08

• 74.9% children aged between 12-35 months received at least one dose of Vitamin A. No significant differences exist across areas and sex but differences are notable in social groups and wealth index groups. • P ercentage of children aged between 12-35 months who received at least one dose of Vitamin A is significantly lower in Nashik division and . • Only 29.3% children between 12-35 months received 3-5 doses. Nutrition | 65

Percentage of women (15-49 years ) having Body Mass Index (BMI)49 less than 18.5, 2005-06

Source: NFHS, 2005-06

• 36.2% women (15-49 years) have a Body Mass Index (BMI) less than 18.5. • T he concentration of such women is significantly higher in rural areas, ST social group

and lowest wealth index group. RJMCHN Mission 66 | Nutrition

Prevalence of any type of anaemia 50 among women Prevalence of any type of anaemia among children (15-49 years), 2005-06 (6-59 months), 2005-06

Source: NFHS, 2005-06 Source: NFHS, 2005-06

• 48.4% women (15-49 years) suffered from any type anaemia, the percentage is • 63.4% children (6-59 months) suffer from anaemia. Anaemia prevalence is similar to 1998-99. significantly higher in lowest wealth index group. • Anaemia prevalence is slightly higher in rural areas, ST social group and lowest wealth • Prevalence of any type of anaemia among children (6-35 months) slightly improved index. between 1998-99 to 2005-06 ( 76% to 72.2%). Nutrition | 67

Nutritional status51,52,53 of children under three years of age, 2005-06

India and Maharashtra, 2005-06 NFHS-2 and NFHS-3, Maharashtra

Source: NFHS, 2005-06 Source: NFHS, 2005-06

• In Maharashtra, the nutritional status of children under three years of age is better • There has been an improvement in all the three nutrition indicators from NFHS-2 to than the national average whereas the status of underweight children is significantly NFHS-3. The reduction in proportion of underweight children is significant. lower. 68 | Nutrition

Prevalence of stunting51 (moderate and severe ) Prevalence of underweight53 (moderate and severe ) among children under five years, 2005-06 among children under five years, 2005-06

Source: NFHS, 2005-06 Source: NFHS, 2005-06

• 46.3% children are stunted and this figure is significantly higher among SC and ST • 37 .0% children are underweight and it is significantly higher in rural areas, ST social social groups and lowest wealth index group. group and lowest wealth index group. • St unting prevalence increases with increasing age. It was 10.4% for children in the • Underweight prevalence increases with age. It was 29.7% for children in age group age group 6-11 months but 26.3 % for children in the age group 36-47 months. 6-11 months but 42.8% for children in age group 48-59 months. Nutrition | 69

Prevalence of undernutrition among children Underweight prevalence (moderate55 and severe56 ) among under two years, 2005-06 children under five years, April 2011

• A s per ICDS data of April, 2011, a total of 83,34,555 children in the age group of 0-6 years are in the catchment areas of Anganwadi center (AWCs), while as per Census 2011, the total population in 0-6 age group is 12,84,83,75. • A total 63,85,854* children in the 0-5 age group (76.62% of total surveyed children) were weighed in April, 2011 and distribution of children is as follows :

Project Normal Moderately Severely Total children Under Weight Under Weight weighed Rural 35,85,547 7,62,754 87,605 44,35,906 Tribal 6,46,496 2,39,527 39,895 9,25,918 Urban 7,19,339 2,78,182 26,509 10,24,030 Grand Total 49,51,382 12,80,463 1,54,009 63,85,854

• 1 2,80,463 children are moderately and 1,54,009 children are severely underweight in Source: NFHS, 2005-06 the state (Total underweight children: 14,34,472).

• Nutritional status in the state may have improved over the years in aggregate, but * Information of 54 projects was not available for April 2011, hence information for these blocks has been taken 67% children under two years are still undernourished54. from the previous months.

Source: ICDS, MPR, April 2011, www.icds.gov.in . 70 | Nutrition

Underweight prevalence (moderate and severe) Underweight prevalence (moderate and severe) among among children under five years, April 2011 children under five years by districts and talukas, April 2011

Index No. of districts Less than 20% 10 20-22.5% 05 22.5-25% 08 More than 25% 12

• Underweight prevalence is very high (more than 25%) in 12 districts (mostly tribal districts and Mumbai). Disparities exist among districts, varying from 11.60% in Sangli Source: ICDS, MPR, April 2011, www.icds.gov.in to 42.64% in district.

• 2.41% children are severely underweight. The concentration is highest in tribal areas (4.31%) followed by urban areas (2.59%). • 20.05% children are moderately underweight. The concentration is highest in urban areas (27.17%) followed by tribal areas (25.87%).

Index No. of taluka Less than 20% 154 20-22.5% 047 22.5-25% 047 More than 25% 107

Source: ICDS, MPR, April 2011, www.icds.gov.in

• Underweight prevalence is very high (more than 25%) in 107 talukas, concentrated mainly in Nashik, Amravati, Nagpur and Aurangabad divisions. It varies from 5.10% in Chandvad (Nashik ) to 62.56% in Jawhar (Thane) taluka. Nutrition | 71

Underweight prevalence (moderate and severe) Underweight prevalence (moderate and severe) (in number) (in percentage) among children under five years, April 2011 among children under five years, April 2011

The following five districts have the highest percentage of underweight The following five districts have the highest number of underweight (moderate and (moderate and severe) children: severe) children:

District Number of Percentage of District Number of Percentage of children children children children Nandurbar 58,124 42.64 Nashik 1,16,190 28.42 Gadchiroli 29,327 36.93 Thane 94,651 21.76 Mumbai 52,528 30.31 Pune 69,610 18.77 (suburban) Jalgaon 64,256 20.23 Mumbai 32,740 30.14 Nandurbar 58,124 42.64 Amravati 47,944 28.63 The following ten talukas have the highest number of underweight (moderate and The following ten talukas have the highest percentage of underweight severe) children : (moderate and severe) children: District Taluka Number of Percentage of District Taluka Number of Percentage of children children children children Mumbai Mumbai 52,528 30.31 Thane Jawhar 8,887 62.56 (suburban) (suburban) Nashik Trimbkeshwar 9,285 50.67 Mumbai Mumbai 32,740 30.14 Nandurbar 12,967 49.65 Nagpur Nagpur (urban) 24,597 33.05 Gadchiroli Bhamragad 1,765 48.36 Thane Thane 23,775 26.68 Nashik Peint 5,315 48.23 Dhule Dhule 21,759 31.94 Nashik Surgana 9,652 47.01 Pune Pune city 16,564 28.50 Nandurbar Akrani 11,492 45.34 Nashik 16,212 34.22 Nandurbar Taloda 5,322 43.32 Aurangabad Aurangabad 15,514 28.41 Amravati Dharni 7,840 43.19 Nandurbar Shahade 14,051 42.45 Nandurbar Shahade 14,051 42.45 Nashik Baglan 13,475 25.01

Source: ICDS, MPR, April 2011, www.icds.gov.in. Source: ICDS, MPR, April 2011, www.icds.gov.in. 72 | Nutrition

Underweight prevalence (moderate) among children under five years by districts and talukas, April 2011

Index No. of districts Index No. of taluka Less than 17.5% 10 Less than 17.5% 141 17.5-20% 06 17.5-20% 061 20-22.5% 09 20-22.5% 053 More than 22.5% 10 More than 22.5% 100

Source: ICDS, MPR, April 2011, www.icds.gov.in Source: ICDS, MPR, April 2011, www.icds.gov.in

• Under weight prevalence (moderate) is very high (more than 22.50%) in 10 districts • Underweight prevalence (moderate) is very high (more than 22.50%) in 100 talukas (tribal districts and Mumbai). Disparities exist among the districts varying from 11.11% and concentrated mainly in Nashik, Amravati, Nagpur and Aurangabad divisions. It in Sangli to 35.76% in Nandurbar district varies from 5.76% in Chandvad (Nashik) to 45.71% in Jawhar (Thane) taluka. Nutrition | 73

Underweight prevalence (moderate) (in percentage) Underweight prevalence (moderate) (in number) among children under five years, April 2011 among children under five years, April 2011

The following five districts have the highest percentage of underweight The following five districts have the highest number of underweight (moderate) children: (moderate) children:

District Number of Percentage of District Number of Percentage of children children children children Nandurbar 48,739 35.76 Nashik 1,01,168 24.74 Gadchiroli 24,390 30.71 Thane 85,218 19.59 Mumbai 48,401 27.93 Pune 64,181 17.31 (suburban) Jalgaon 59,243 18.65 Mumbai 29,567 27.22 Aurangabad 50,761 21.80 Nashik 1,01,168 24.74

The following ten talukas have the highest percentage of underweight The following ten talukas have the highest number of underweight (moderate) children : (moderate) children :

District Taluka Number of Percentage of District Taluka Number of Percentage of children children children children Thane Jawhar 6,494 45.71 Mumbai Mumbai 48,401 27.93 (suburban) (suburban) Nandurbar Akkalkuwa 10,743 41.14 Mumbai Mumbai 29,567 27.22 Nashik Surgana 8,432 41.07 Nagpur Nagpur (urban) 22,437 30.15 Nashik Peint 4,363 39.59 Thane Thane 21,868 24.54 Nashik Trimbkeshwar 7, 11 6 38.83 Dhule Dhule 18,699 27.45 Gadchiroli Bhamragad 1,383 37.89 Pune Pune city 14,903 25.64 Nandurbar Akrani 9,568 37.75 Nashik Malegaon 14,394 30.39 Nandurbar Taloda 4,411 35.91 Aurangabad Aurangabad 13,441 24.62 Nandurbar Shahade 11,714 35.39 Nashik Baglan 11,984 22.24 Gadchiroli Etapalli 2,650 35.36 Nandurbar Shahade 11,714 35.39

Source: ICDS, MPR, April 2011, www.icds.gov.in Source: ICDS, MPR, April 2011, www.icds.gov.in 74 | Nutrition

Underweight prevalence (severe) among children under five years by districts and talukas, April 2011

Nandurbar

Dhule Amravati Nagpur Gondiya Jalgaon Bhandara Akola Wardha Buldana Nashik Washim Yavatmal Chandrapur Aurangabad Jalna Gadchiroli Thane Hingoli Mumbai (Suburban) Parbhani Ahmadnagar Nanded Mumbai Bid

Raigarh Pune Latur Osmanabad Solapur Satara Index No. of taluka Ratnagiri Sangli Less than 1.5% 114 Index No. of districts 1.5-2.5% 104 06 Less than 1.5% Kolhapur 2.5-3.5% 066 1.5-2.5% 12 Sindhudurg More than 3.5% 071 2.5-3.5% 10 More than 3.5% 07

Source: ICDS, MPR, April 2011, www.icds.gov.in Source: ICDS, MPR, April 2011, www.icds.gov.in

• Under weight prevalence (severe) is very high (more than 3.50%) in 7 districts. • Underweight prevalence (severe) is very high (more than 3.50%) in 71 talukas Disparities exist across the districts, varying from 0.49 % in Sangli to 6.89 % in concentrated mainly in Nashik, Amravati, Nagpur and Aurangabad divisions. It varies Nandurbar district. from 0 % in Khalapur (Buldana) to 16.84% in Jawhar (Thane) taluka. Nutrition | 75

Underweight prevalence (severe) (in percentage) among children under five years, April 2011

The following five districts have the highest percentage of underweight The following five districts have the highest number of underweight (severe) children: (severe) children:

District Number of Percentage of District Number of Percentage of children children children children Nandurbar 9,385 6.89 Nashik 15,022 3.67 Gadchiroli 4,937 6.22 Thane 9,433 2.17 Amravati 7,074 4.22 Nandurbar 9,385 6.89 Hingoli 4,092 4.19 Aurangabad 7, 11 7 3.06 Parbhani 4,837 4.03 Amravati 7,074 4.22

The following ten talukas have the highest percentage of underweight The following ten talukas have the highest number of underweight (severe) children : (severe) children

District Taluka Number of Percentage of District Taluka Number of Percentage of children children children children Thane Jawhar 2,393 16.84 Mumbai Mumbai 4,127 2.38 Nashik Trimbkeshwar 2,169 11.84 (suburban) (suburban) Gadchiroli Bhamragad 382 10.47 Mumbai Mumbai 3,173 2.92 Nashik Peint 952 8.64 Dhule Dhule 3,060 4.49 Nandurbar Akkalkuwa 2,224 8.52 Thane Jawhar 2,393 16.84 Amravati Dharni 1,503 8.28 Nandurbar Shahade 2,337 7.06 Gadchiroli Armori 580 8.28 Nandurbar Akkalkuwa 2,224 8.52 Nandurbar Akrani 1,924 7.59 Nashik Trimbkeshwar 2,169 11.84 Amravati Chikhaldara 829 7.48 Nagpur Nagpur (urban) 2,160 2.90 Nandurbar Taloda 911 7.42 Aurangabad Aurangabad 2,073 3.80 Nandurbar Akrani 1,924 7.59

Source: ICDS, MPR, April 2011, www.icds.gov.in Source: ICDS, MPR, April 2011, www.icds.gov.in