No. 16 | SEPTEMBER 2018

Coverage of Nutrition and Health Interventions in Insights from the National Family Health Survey-4

ABOUT THIS DATA NOTE Nutrition-specific interventions are aimed at improving the proximal food, health, and care environment for women and children during the first 1000 days. They can help improve maternal and child health, improve diets and other nutrition practices, and reduce infections. These interventions span pregnancy, postnatal, and early childhood periods and include food and micronutrient supplementation, nutrition education and/or counselling, growth monitoring and promotion, as well as routine immunization, deworming, and care during illness. At 90% coverage, these interventions can contribute to 20% reduction in stunting and 61% reduction in severe wasting1.

India’s policy framework for health and nutrition is robust and includes most evidence-based nutrition and health interventions. Two large-scale national program platforms – the Integrated Child Development Services and the National Health Mission together provide the public sector delivery platforms with the mandate to deliver these interventions across the country. ’s efforts at scaling up nutrition interventions are now also supported by the National Nutrition Mission.

This Data Note describes the coverage of a set of key nutrition and health interventions. The findings here are based on data from the National Family Health Survey 2015-2016. Indicators to capture the coverage of the interventions here are all calculated for women (15-49 years) with a child under five years of age. All analyses are based on the last-born child for each woman and indicator definitions are provided in Annex 1 of this Note. For some indicators, age categories may vary.

FIGURE 1 Coverage of interventions across the continuum of care, in 2016

100 90 80 70 60

% 50 40 30 20 10 0 ≥ 4ANC Weighing Weighing Vitamin A Vitamin Deworming Iodized salt Deworming Pediatric IFA Any ANC visits Tetanus injection Institutional birthInstitutional Full immunization Received MCP card MCP Received Zinc during diarrhea Care seeking for ARI for seeking Care ORS during diarrhea Skilled birth attendant Skilled birth Received IFA tab/syrup Food supplementation Food supplementation Food supplementation Demand for FPDemand for satisfied Postnatal care for babies Postnatal care for Consumed IFA 100+Consumed days Breastfeeding counselling Postnatal care for mothers Postnatal care for Counselling on child growth Health & nutrition education Health & nutrition education

Pre- Pregnancy Delivery and postnatal Early childhood pregnancy Note: ANC = Antenatal care; ARI = Acute respiratory infection; FP = Family planning; IFA = Iron and folic acid; MCP = Mother and child protection; ORS = Oral rehydration salts; The bars represent state average, the dots represent India average. Source: NFHS-4. 1Bhutta, Z.A., J.K. Das, A. Rizvi, M.F. Gaffey, N. Walker, S. Horton, P. Webb, A. Lartey, R.E. Black, Lancet Nutrition Interventions Review G, et al. 2013. “Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?” The Lancet 382(9890):452-477. MAP 1 Percentage of women who received 4 or more ANC visits, by district, 2016

Top 5 districts, %

Kodarma 57.4 Purbi Singhbhum 50.4 Khunti 43.1 40.1 39.5

Bottom 5 districts, %

Garhwa 11.6 Chatra 11.8 Pashchimi Singhbhum 12.7 Simdega 12.9 Latehar 15.0

Source: NFHS-4. MAP 2 Percentage of women who were weighed during pregnancy, by district, 2016

Top 5 districts, %

Hazaribagh 92.4 84.7 84.1 Ranchi 83.7 Saraikela Kharsawan 82.2

Bottom 5 districts, % Pashchimi Singhbhum 37.4 Chatra 39.9 Latehar 42.4 Palamu 45.7 Garhwa 48.4

Source: NFHS-4. MAP 3 Percentage of women who received or bought any IFA during pregnancy, by district, 2016

Top 5 districts, %

Lohardaga 84.6 Ranchi 83.8 Simdega 83.7 Saraikela Kharsawan 83.0 Purbi Singhbhum 82.2

Bottom 5 districts, %

Giridih 55.9 Pashchimi Singhbhum 61.6 Palamu 61.8 Latehar 62.3 Sahibganj 62.8

Source: NFHS-4. MAP 4 Percentage of women who consumed IFA for 100+ days during pregnancy, by district, 2016

Top 5 districts, %

Ranchi 34.9 Khunti 24.9 Saraikela Kharsawan 24.6 Bokaro 24.2 Lohardaga 23.2

Bottom 5 districts, %

Garhwa 3.3 Chatra 6.9 Simdega 7.3 Sahibganj 7.5 Latehar 8.5

Source: NFHS-4. MAP 5 Percentage of women who received breastfeeding counselling during pregnancy, by district, 2016

Top 5 districts, %

Khunti 63.3 52.7 Giridih 51.9 Dumka 49.2 Saraikela Kharsawan 48.3

Bottom 5 districts, % Pashchimi Singhbhum 12.8 Palamu 14.4 Chatra 17.6 Garhwa 18.1 Dhanbad 23.2

Source: NFHS-4. MAP 6 Percentage of women who received food supplements during pregnancy, by district, 2016

Top 5 districts, %

Jamtara 85.1 Dumka 85.1 Khunti 84.6 Saraikela Kharsawan 81.6 Simdega 81.6

Bottom 5 districts, %

Palamu 47.6 Chatra 54.3 Dhanbad 59.5 Latehar 60.0 Purbi Singhbhum 61.1

Source: NFHS-4. MAP 7 Percentage of women who gave birth in a health facility, by district, 2016

Top 5 districts, %

Kodarma 83.7 Purbi Singhbhum 83.3 Hazaribagh 79.5 Ranchi 77.3 Ramgarh 73.4

Bottom 5 districts, % Pashchimi Singhbhum 39.6 Sahibganj 48.6 Pakur 51.7 Simdega 51.8 Latehar 53.6

Source: NFHS-4. MAP 8 Percentage of women who received food supplements during lactation, by district, 2016

Top 5 districts, %

Jamtara 84.5 Khunti 82.7 Dumka 80.9 Simdega 72.3 Hazaribagh 70.8

Bottom 5 districts, %

Palamu 41.9 Chatra 50.5 Lohardaga 55.0 Dhanbad 56.2 Ranchi 57.6

Source: NFHS-4. MAP 9 Percentage of mothers who received postnatal care within two days of childbirth, by district, 2016

Top 5 districts, %

Kodarma 65.0 Giridih 60.3 Hazaribagh 58.6 Bokaro 52.8 Ranchi 51.7

Bottom 5 districts, % Pashchimi Singhbhum 25.3 Simdega 29.1 Palamu 30.1 Latehar 33.3 Sahibganj 34.1

Source: NFHS-4. MAP 10 Percentage of children (0-59 months) who received postnatal care within two days of their birth, by district, 2016

Top 5 districts, %

Giridih 39.7 Hazaribagh 37.2 Ramgarh 32.2 Pakur 31.0 Dumka 26.0

Bottom 5 districts, %

Purbi Singhbhum 7.0 Latehar 8.4 Pashchimi Singhbhum 9.4 Lohardaga 12.1 Chatra 12.3

Source: NFHS-4. MAP 11 Percentage of children (12-23 months) who were fully immunized, by district, 2016

Top 5 districts, %

Dumka 76.6 Khunti 73.6 Hazaribagh 73.5 Dhanbad 73.1 Pakur 70.6

Bottom 5 districts, %

Chatra 41.1 Giridih 47.8 Pashchimi Singhbhum 50.0 Latehar 53.5 Garhwa 57.3

Source: NFHS-4. MAP 12 Percentage of children (6-35 months) who received food supplements, by district, 2016

Top 5 districts, %

Khunti 87.8 Jamtara 84.5 Dumka 84.3 Simdega 81.8 Hazaribagh 81.7

Bottom 5 districts, %

Palamu 46.1 Kodarma 58.0 Purbi Singhbhum 58.2 Lohardaga 61.7 Deoghar 62.4

Source: NFHS-4. MAP 13 Percentage of children (6-59 months) who received vitamin A supplements, by district, 2016

Top 5 districts, %

Hazaribagh 71.1 Gumla 68.9 Khunti 66.1 Giridih 65.2 Pakur 64.5

Bottom 5 districts, % Pashchimi Singhbhum 38.3 Deoghar 43.1 Garhwa 45.2 Jamtara 47.2 Godda 47.4

Source: NFHS-4. MAP 14 Percentage of children (0-59 months) with diarrhea who received ORS, by district, 2016

Top 5 districts, %

Giridih 66.4 Hazaribagh 62.7 Purbi Singhbhum 60.0 Khunti 56.5 Jamtara 55.8

Bottom 5 districts, %

Deoghar 16.6 Sahibganj 23.0 Kodarma 23.1 Palamu 29.4 Pakur 34.0

Source: NFHS-4. MAP 15 Percentage of children (0-59 months) who were weighed in the last 12 months, by district, 2016

Top 5 districts, %

Hazaribagh 67.9 Khunti 64.5 Jamtara 64.3 Pakur 62.3 Giridih 60.8

Bottom 5 districts, %

Chatra 20.8 Palamu 20.9 Pashchimi Singhbhum 30.1 Dhanbad 30.8 Lohardaga 31.5

Source: NFHS-4. MAP 16 Percentage of mothers with children (0-59 months) who were counselled about child growth after their child was weighed, by district, 2016

Top 5 districts, %

Hazaribagh 50.6 Khunti 45.3 Pakur 41.4 Giridih 40.7 Kodarma 40.6

Bottom 5 districts, %

Palamu 5.3 Chatra 6.0 Pashchimi Singhbhum 11.4 Lohardaga 15.2 Dhanbad 15.5

Source: NFHS-4. DASHBOARD: Coverage of nutrition-specific interventions, by district, 2016

<25% 25-<50% 50-<75% ≥75% Pakur Gumla Chatra Giridih Godda Khunti Dumka Bokaro Garhwa Latehar Jamtara Deoghar Dhanbad Kodarma Lohardaga Hazaribagh JHARKHAND State/District

Demand for FP satisfied 65.0 72.1 65.1 67.7 77.4 63.7 60.7 67.8 65.7 45.6 78.0 66.3 62.0 74.7 53.8 52.8 57.1 Pre- Iodized salt 97.3 98.6 98.0 96.4 98.2 96.7 93.0 98.5 97.1 98.4 98.2 97.2 97.5 95.5 97.8 97.9 97.0 pregnancy

Any ANC visits 76.5 84.5 4 9.4 82.3 83.6 80.6 57.1 88.4 86.0 67.6 95.5 84.2 72.5 92.7 48.6 74.2 87.2

≥4ANC 30.2 38.6 11.8 25.5 40.1 29.1 11.6 35.8 28.8 24 .4 39.3 29.3 43.1 57.4 15.0 16.7 29.7

Received MCP card 71.2 69.9 51.3 59.9 70.3 75.2 55.7 78.1 86.7 63.2 87.7 71.1 78.7 83.7 62.4 74.3 84.3

Received IFA tab/syrup 69.5 71.2 63.3 63.8 72.5 75.3 63.3 55.9 63.2 80.4 68.7 63.6 81.8 67.9 62.3 84.6 66.6

Consumed IFA 100+ days 15.4 24 .2 6.9 20.8 20.7 14.3 3.3 9.7 8.8 20.0 13.5 14.3 24 .9 11.2 8.5 23.2 9.2

Deworming 12.5 10.8 4.6 8.8 7.2 13.9 8.3 15.0 12.4 17.8 17.4 9.4 35.7 9.9 14.8 15.2 17.8 Pregnancy Weighing 70.0 79.3 39.9 75.2 75.4 76.6 48.4 84.7 70.9 59.9 92.4 78.7 70.9 84.1 4 2.4 68.6 82.0

Breastfeeding counselling 33.5 27.8 17.6 29.9 23.2 4 9.2 18.1 51.9 4 2.4 33.0 52.7 44.5 63.3 32.6 30.3 47.8 45.2

Food supplementation 68.7 66.3 54.3 69.8 59.5 85.1 66.0 70.9 79.7 74.3 74.7 85.1 84.6 63.7 60.0 63.2 71.5

Health & nutrition education 40.1 35.2 17.4 45.7 37.1 55.2 32.4 4 6.8 54.3 4 9.1 56.9 4 6.1 62.3 43.3 33.3 40.2 4 6.4

Tetanus injection 89.8 95.0by78.6 district,91.5 94 .8 93.4 86.7 201691.9 93.4 86.2 91.2 93.9 88.6 94 .9 73.8 88.0 93.5

Institutional birth 64 .2 65.1 58.3 60.3 67.3 54.7 58.7 65.8 62.3 72.3 79.5 62.9 66.5 83.7 53.6 72.4 51.7

Skilled birth attendant 71.8 76.0 64 .9 65.0 78.1 61.3 67.4 75.6 70.6 75.8 85.0 75.7 75.8 89.0 61.6 75.3 57.6

Postnatal care for mothers 44.3 52.8 38.5 39.6 45.4 43.5 35.0 60.3 45.3 43.3 58.6 43.8 44.5 65.0 33.3 4 6.7 45.5

Postnatal care for babies 21.8 20.7 12.3 24 .2 23.9 26.0 18.0 39.7 25.1 24 .3 37.2 18.1 17.8 16.7 8.4 12.1 31.0

Delivery & postnatal & Delivery Food supplementation 63.1 64 .7 50.5 61.7 56.2 80.9 63.4 66.2 65.8 69.3 70.8 84.5 82.7 58.3 59.9 55.0 64 .7

Health & nutrition education 35.1 31.1 13.3 41.5 32.9 41.0 28.5 45.4 45.6 4 2.3 55.3 4 2.3 60.3 37.2 35.4 26.8 4 2.2

Full immunization 62.2 65.9 41.1 66.7 73.1 76.6 57.3 47.8 59.9 59.5 73.5 63.4 73.6 67.7 53.5 59.1 70.6

Vitamin A 52.7 4 9.2 52.7 43.1 48.7 50.5 45.2 65.2 47.4 68.9 71.1 47.2 66.1 48.7 52.5 58.7 64 .5

Paediatric IFA 17.7 10.8 17.7 26.5 6.0 12.1 6.8 23.6 18.6 27.9 31.9 12.1 31.3 22.6 15.7 34.3 22.6

Deworming 22.2 15.7 17.2 19.5 9.5 27.9 10.1 35.4 27.0 32.9 32.1 21.1 47.1 21.7 23.5 22.6 34.6

Care seeking for ARI 67.9 70.2 58.7 67.4 73.5 59.2 63.2 80.4 81.3 60.5 63.6 56.2 79.9 85.1 65.4 74.6 59.0

ORS during diarrhea 43.4 48.6 50.5 16.6 38.8 44.0 47.2 66.4 35.0 45.0 62.7 55.8 56.5 23.1 48.8 55.6 34.0 Early childhood Early Zinc during diarrhea 19.6 20.1 4.1 0.0 16.2 30.2 27.8 48.5 5.7 18.9 36.3 32.6 47.7 0.0 40.4 11.0 16.4

Food supplementation 68.8 68.9 63.4 62.4 63.6 84.3 70.8 77.0 78.5 71.9 81.7 84.5 87.8 58.0 65.9 61.7 79.4

Weighing 44.5 4 6.8 20.8 41.5 30.8 56.7 37.9 60.8 47.5 4 6.8 67.9 64 .3 64 .5 4 9.4 39.1 31.5 62.3

Counselling on child growth 26.7 27.6 6.0 23.4 15.5 33.4 20.1 40.7 31.7 30.9 50.6 38.0 45.3 40.6 20.3 15.2 41.4

Source: NFHS-4 DASHBOARD: Coverage of nutrition-specific interventions, by district, 2016

<25% 25-<50% 50-<75% ≥75% Ranchi Palamu Ramgarh Simdega Sahibganj State/District Purbi Singhbhum Purbi SaraikelaKharsawan Pashchimi Singhbhum Pashchimi

Demand for FP satisfied 55.9 41.1 62.4 68.8 64.7 63.5 53.8 49.9 Pre- Iodized salt 94 .8 99.4 98.6 97.3 97.7 97.9 92.2 99.5 pregnancy

Any ANC visits 61.8 41.6 74.8 77.3 88.9 70.7 85.6 64.8

≥4ANC 24 .2 12.7 50.4 34.0 39.5 20.1 25.7 12.9

Received MCP card 47.5 66.0 69.5 72.4 75.5 76.1 87.8 78.6

Received IFA tab/syrup 61.8 61.6 82.2 77.9 83.8 62.8 83.0 83.7

Consumed IFA 100+ days 9.3 11.0 15.8 19.4 34.9 7.5 24.6 7.3

Deworming 5.4 4.5 37.0 13.5 11.2 5.5 8.6 11.4 Pregnancy Weighing 45.7 37.4 73.5 69.3 83.7 65.2 82.2 58.9

Breastfeeding counselling 14.4 12.8 27.6 32.7 34.4 24.1 48.3 32.3

Food supplementation 47.6 74.2 61.1 69.3 64.7 71.6 81.6 81.6

Health & nutrition education 12.6 21.2 34.1 41.5 40.3 43.2 53.7 41.0 by district, 2016 Tetanus injection 78.3 80.3 89.5 93.8 95.3 88.7 92.3 92.5

Institutional birth 56.3 39.6 83.3 73.4 77.3 48.6 67.5 51.8

Skilled birth attendant 66.8 43.0 86.7 82.9 84.6 56.1 74.9 58.8

Postnatal care for mothers 30.1 25.3 37.3 46.7 51.7 34.1 51.7 29.1

Postnatal care for babies 12.8 9.4 7.0 32.2 24.6 20.5 14.7 14.1

Delivery & postnatal & Delivery Food supplementation 41.9 70.0 59.7 61.0 57.6 60.6 63.4 72.3

Health & nutrition education 12.0 18.1 33.1 29.0 35.1 35.3 34.9 37.2

Full immunization 59.0 50.0 68.0 65.1 67.5 60.4 65.0 57.3

Vitamin A 48.8 38.3 48.1 50.0 53.6 50.7 54.2 55.9

Paediatric IFA 10.9 5.9 14.7 14.1 28.0 2.4 29.1 19.9

Deworming 10.8 6.2 26.6 16.1 28.4 14.5 25.9 25.5

Care seeking for ARI 62.4 48.4 87.6 61.9 67.4 60.5 67.4 69.3

ORS during diarrhea 29.4 51.6 60.0 40.0 40.0 23.0 53.8 42.8 Early childhood Early Zinc during diarrhea 11.7 22.0 35.0 11.6 8.2 27.4 23.8 15.8

Food supplementation 4 6.1 64 .8 58.2 62.9 63.7 68.0 70.8 81.8

Weighing 20.9 30.1 41.5 40.7 45.0 35.4 46.7 56.4

Counselling on child growth 5.3 11.4 29.1 21.5 26.5 21.9 25.7 28.7

Source: NFHS-4 Summary of findings

• High coverage (≥75%): Sustained efforts are required to maintain the high coverage for the following interventions: • Before & during pregnancy: iodized salt, any ANC visits, tetanus toxoid injection. • Delivery & postnatal: no interventions achieved high coverage. • Early childhood: no interventions achieved high coverage.

• Low coverage (<50%): The state should focus efforts on increasing coverage of the following interventions: • Before & during pregnancy: at least 4 ANC visits, consuming 100+ IFA, deworming, breastfeeding counselling, health & nutrition education. • Delivery & postnatal: postnatal care for mothers and babies, health & nutrition education. • Early childhood: IFA supplementation, deworming, ORS and zinc during diarrhea, weighing and counselling on child growth.

• Missed opportunities: Coverage of postnatal care is higher for mothers than for babies. Many women receive some IFA but fewer are consuming IFA for at least 100 days during pregnancy. Though ORS is provided during childhood diarrhea in some cases, zinc is provided less frequently. Sometimes when children are weighed, the mother does not receive counselling on the child’s growth.

ANNEX 1 Definition of indicators used in the analyses

Indicators Definition Pre-pregnancy Demand for FP satisfied Percentage of women (15-49 years) who have their need for family planning satisfied with modern methods. Iodized salt Percentage of households with children under 5 years of age using iodized salt. Pregnancy Any ANC visits Percentage of women (15-49 years) with children under 5 years of age who were attended by any trained provider ever or at least once, when they were pregnant with their youngest child. ≥ 4ANC Percentage of women (15-49 years) with children under 5 years of age who were attended by any trained provider 4 or more times, when they were pregnant with their youngest child. Received MCP card Percentage of women (15-49 years) with children under 5 years of age who received the Mother and Child Protection card after pregnancy registration, whenby they district, were pregnant with their2016 youngest child. Received IFA Percentage of women (15-49 years) with children under 5 years of age who received or bought any IFA tablets/syrup, when they were pregnant with their youngest child. Consumed IFA for 100+ Percentage of women (15-49 years) with children under 5 years of age who consumed IFA tablets/syrup for 100 days or more, days when they were pregnant with their youngest child. Deworming Percentage of women (15-49 years) with children under 5 years of age who received any deworming drug, when they were pregnant with their youngest child. Weighing Percentage of women (15-49 years) with children under 5 years of age who were weighed when they were pregnant with their youngest child. Breastfeeding counselling Percentage of women (15-49 years) with children under 5 years of age who received advice on breastfeeding from any provider, when they were pregnant with their youngest child. Food supplementation Percentage of women (15-49 years) with children under 5 years of age who received food supplements from the anganwadi center (AWC), when they were pregnant with their youngest child. Health & nutrition Percentage of women (15-49 years) with children under 5 years of age who received health and nutrition education from the AWC, education when they were pregnant with their youngest child. Tetanus injection Percentage of women (15-49 years) with children under 5 years of age who received at least 2 TT injections when they were pregnant with their youngest child. Delivery and postnatal care Institutional birth Percentage of women (15-49 years) with children under 5 years of age who delivered their youngest child in a health facility. Skilled birth attendant Percentage of women (15-49 years) with children under 5 years of age who were attended by skilled health personnel when they delivered their youngest child. Postnatal care for mothers Percentage of women (15-49 years) with children under 5 years of age who received postnatal care, while in facility or at home, two days after they delivered their youngest child. Postnatal care for babies Percentage of last-born children (0-59 months) in the last 5 years, who received postnatal care within two days after they were born. Food supplementation Percentage of women (15-49 years) with children under 5 years of age who received food supplements from the AWC, when they were breastfeeding their youngest child. Health & nutrition Percentage of women (15-49 years) with children under 5 years of age who received health and nutrition education from the AWC, education when they were breastfeeding their youngest child. Early childhood Full immunization Percentage of last-born children (12-23 months) in the last 5 years who received one dose of BCG vaccine, three doses of polio vaccine, three doses of DTP3 vaccine, and one dose of measles vaccine. Vitamin A Percentage of last-born children (6-59 months) in the last 5 years, who received vitamin A supplements in the six months preceding the survey. Pediatric IFA Percentage of last-born children (6-59 months) in the last 5 years, who received iron supplements in the last 7 days prior to the survey. Deworming Percentage of last-born children (12-59 months) in the last 5 years, who received albendazole or any other deworming drug in the last 6 months prior to the survey. Care seeking for ARI Percentage of last-born children (0-59 months) in the last 5 years, with suspected ARI symptoms in the last two weeks, who were taken to a health care provider. ORS during diarrhea Percentage of last-born children (0-59 months) in the last 5 years, with diarrhea in the last two weeks, who received ORS. Zinc during diarrhea Percentage of last-born children (2-59 months) in the last 5 years, with diarrhea in the last two weeks who received zinc. Food supplementation Percentage of last-born children (6-35 months) in the last 5 years, who received food supplements from the AWC in the last 12 months prior to the survey. Weighing Percentage of last-born children (0-59 months) in the last 5 years, who were ever weighed in the last 12 months. Counselling on child Percentage of women (15-49 years) with children under 5 years of age, who were counselled about their youngest child’s growth growth after they were weighed in the last 12 months prior to the survey. ABOUT POSHAN Partnerships and Opportunities to Strengthen and Harmonize Actions for Nutrition in India (POSHAN) is a multi-year initiative that aims to support the use of data and evidence AUTHORS in decision-making for nutrition in India. It is supported by the Bill & Anjali Pant, Research Analyst, IFPRI Melinda Gates Foundation and led by IFPRI in India. Rasmi Avula, Research Fellow, IFPRI

Phuong Hong Nguyen, Research Fellow, IFPRI ABOUT DATA NOTES Samuel Scott, Associate Research Fellow, IFPRI POSHAN Data Notes focus on data visualization to highlight geographic Purnima Menon, Senior Research Fellow, IFPRI and/or thematic issues related to nutrition in India. They draw on multiple sources of publically available data.

SUGGESTED CITATION CONTACT US Pant, A., R. Avula, P.H. Nguyen, S. Scott, and P. Menon. Email: IFPRI [email protected] 2018. Coverage of Nutrition and Health Interventions in Jharkhand: Insights from the National Family Health Survey- 4. POSHAN Data Note 16. New , India: International IFPRI-NEW DELHI Food Policy Research Institute. INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE NASC Complex, CG Block, Dev Prakash Shastri Road, Pusa, New Delhi 110012, India T+91.11.66166565 F+91.11.66781699

ACKNOWLEDGEMENTS IFPRI-HEADQUARTERS Lan Mai Tran, Independent Researcher, for support with INTERNATIONAL FOOD POLICY district-level data extraction from National Family Health RESEARCH INSTITUTE Survey factsheets. 1201 Eye Street, NW, Washington, DC 20005 USA T. +1.202.862.5600 F. +1.202.467.4439 Skype: IFPRIhomeoffice [email protected] www.ifpri.org

This publication has been prepared by POSHAN. It has not been peer reviewed. Any opinions stated herein are those of the author(s) and do not necessarily reflect the policies of the International Food Policy Research Institute.

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