National Nutrition Policy and Programmes

Malnutrition has consistently been associated to poverty, with greater rates of chronic and
persistent hunger reported in chronically poor communities. Poverty affects individuals in a
variety of ways, including food insecurity, undernourishment, more prone to diseases, lower
production capacity, and negatively impacted physical and cognitive development.

Furthermore, those living in poverty lack access to basic needs such as balanced diet, a

sanitary surroundings, suitable shelter, and affordable healthcare. As a consequence, while
food insecurity and malnutrition is a worldwide crisis, people living in poverty bear a
disproportionate share of the burden. Human capital is an essential asset for every country,
and the process of building it begins in infancy and continues throughout an individual's
life. It is greatly influenced by nutritional status. The logic is straightforward: higher
nutritional status is crucial for getting out of poverty, as good health is required to boost
productivity, boost the economic growth, and enhance a nation's overall wellbeing. Human
capital begins to deteriorate without adequate nutritional support. Malnutrition has an adverse
influence on an individual's physical and mental development, intellectual ability,
performance, and economic potential, which leads to even more poverty, and the vicious
cycle continues.
 The vicious cycle of poverty

Low
earning Poverty
capacity

Impaired Low intake of

productivity food and
nutrients

Small body size

for adults Undernutrition & Repeted
insults from nutrion related
diseases and nfections
Stunted
development of
childen and
growth faltering

In order to reach its full potential and play a role as a superpower, India must emphasize on
overcoming poverty and malnutrition so that the future generation can be healthy, have better
work potential, and be more productive. It is a crucial element that demands strategies to
address these issues. The Indian government has implemented a number of programmes and
policies listed below to overcome this situation:

 Integrated Child Development Services Scheme

 Midday Meal Programme
 Special Nutrition Programme (SNP)
 National Nutritional Anemia Prophylaxis Programme
  National Iodine Deficiency Disorders Control Programme
 National Goitre Control Programme
 Mid-Day meal programme
 Applied Nutrition Programme
 Akshaya Patra Programme
 Recently the Government of India has established the POSHAN Abhiyaan (National
Nutrition Mission), which was inaugurated by the Honourable Prime Minister on
March 8, 2018 from Jhunjhunu, Rajasthan. The programme aims to reduce stunting,
undernourishment, anaemia, and low birth weight in children by utilising technology,
a targeted strategy, and convergence, as well as focusing on adolescent girls, pregnant
women, and breastfeeding mothers, thus tackling malnutrition holistically.

National Nutrition Policy

The National Nutrition Policy, developed by the Government of India's Department of

Women and Child Development, was approved by the Cabinet in April 1993. The policy
advocates a "comprehensive, integrated and inter-sectoral strategy for alleviating the
multifaceted problem of malnutrition and achieving the optimal state of nutrition for the
people ". In 1995, the National Plan of Action on Nutrition (NPAN) was established to
enforce the National Nutrition Policy, to combat the problem of micronutrient deficiency
prevention and control initiatives.

Aims of the National Nutrition Policy

The National Nutrition Policy is based on the premise that decreasing malnutrition and
improving nutritional intake will greatly support the development of human resources and the
nation's overall economic and social goals. The main aims of the National Nutrition Policy
are:

 to bring attention to the immediate need to decrease malnutrition in the country,

 to emphasise the importance of inter-sectoral collaboration in order,
 to accomplish nutritional goals, to orient key sectors to view nutrition as an effect of
their sectoral operations, and
  to establish short-term, intermediate-term, and long-term strategies to accomplish
nutritional goals via direct changes in policy or indirect institutional or structural
changes

The NNP's fundamental strategy is to address the nutrition problem through direct nutrition
interventions for disadvantaged groups as well as various development policy tools that will
enhance access and create circumstances for optimal nutrition.

1. Expanding support systems, supporting behaviour change among mothers, reaching

adolescent girls, and guaranteeing better coverage of expectant women; nutrition
programmes for specially vulnerable groups such as children under the age of six,
adolescent girls, and pregnant and lactating women;
2. Essential dietary items are fortified with the necessary nutrients;
3. Introduction of low-cost, nutritious cuisine made from locally sourced, indigenous
ingredients;
4. Micronutrient deficiency prevention among susceptible groups.

Long-term indirect nutrition interventions that contribute to structural and institutional

changes include:

1. ensuring food security through increased availability of food grains;

2. improving dietary patterns through increased production and availability of highly
nutritious foods.
3. Policies for implementing income transfers in order to increase the rural and urban
poor's entitlement package by increasing buying power and improving the public
distribution system
4. Measures to reduce the fragility of the landless and landed poor through land reform
5. Reinforcing the health-care and family-welfare programmes
6. Essential health and nutrition education is imparted, with an emphasis on good infants
feeding practises.
7. eliminate Adulteration of food
8. strengthened Nutritional surveillance
9. regular evaluation of Nutritional programme 
10. Nutritional research on a variety of topics
11. Equal pay for men and women
 12. For effective execution of the nutrition policy, communication through established
media is required.
13. Public Nutrition is responsible for making sure an efficient, minimum-wage
administration.
14. Participation of the community in raising NNP awareness and community
involvement in the management of nutrition programmes and related interventions
through benefactors committees, continued participation of women in food production
and processing, promotion of kitchen gardens, food preservation, weaning food
preparation, and generating demand for nutrition services
15. Education and literacy
16. Improvement of the status of women

The National Nutrition Policy was established in 1993. Dating back to that, the government
initiated a variety of nutrition intervention programmes to combat malnutrition throughout
the last four decades. The Applied Nutrition Programme (ANP) was one of the earliest
nutrition programmes created by the government. The Applied Nutrition Programme (ANP)
was launched as a pilot project in Orissa in 1963, and was later expanded to Tamil Nadu and
Uttar Pradesh, with the goals of:

a) encouraging the yield of protective foods such as vegetables and fruits, and

b) ensuring their intake by pregnant and lactating mothers and children. It was expanded to

cover the entire country in 1973.

The primary focus was nutritional education, and efforts were made to teach rural populations
how to produce food for their own needs through demonstration. Children aged 2 to 6 years,
as well as pregnant and nursing mothers, are among those who benefit. For 52 days out of the
year, nutrition worth 0.25 rupees each child and 0.50 rupees per mother is offered.

Following that, a slew of new programmes were launched. Some of these programmes are
active, while others are not. The government has also launched some new programmes aimed
at achieving universal food security as well as employment-based programmes.

Integrated Child Development Service (ICDS) Programme

On October 2nd, 1975, the Integrated Child Development Service (ICDS) Scheme was
launched. It was introduced to provide supplemental nutrition, preschool education, primary
healthcare, immunisation, health check-ups, and referral services to children under the age of
six years old and their mothers. The programme aims to eliminate gender inequality, in
addition to boosting child nutrition and immunisation. It is one of the largest programmes in
the world to provide an integrated bundle of services for a child's whole development. It is a
federally sponsored programme that is implemented by state and territorial administrations.
The following were the goals of the programme:

• To help children aged 0 to 6 years improve their dietary and health status.

• To build the groundwork for the child's proper psychological, physical, and social growth.

• Lower mortality, morbidity, malnutrition, and lower educational attainment.

• To improve the ability of the mother to care for the child's normal health and nutritional
needs via proper nutrition and health education; and 

• To establish effective coordination of policy and implementation across the many

departments to promote child development.

Target Audiences

The following are the primary beneficiaries of the ICDS programme:

 Infants
 Children aged 1-6 years
 Women who are pregnant or breastfeeding
 All women up to 45 years of age 
 Adolescent Girls
Components of the Programine The ICDS programme is a collection of services. The
programme provides the following services:

 Immunization
 supplementary nutrition
 Health checkups on a regular basis, treatment for minor disorders, and referral
services
 Surveillance of growth
 in-formal Preschool education
 Education on health and nutrition
 Scheme for adolescent girls

Nutrient Deficiency Control Programs

To combat malnutrition, the Indian government has created a number of prophylaxis

(preventive) programmes. Under these programmes, commercially made vitamins and
minerals are distributed to vulnerable parts of the population through structured programmes.
Nutrient Deficiency Control Programs are the name for these programmes.

National Vitamin A prophylaxis program

Vitamin A is necessary for normal growth, cellular differentiation and proliferation,

development regulation, and the maintenance of visual and reproductive capabilities. Vitamin
A intake in young children, adolescent girls, and pregnant women has been found to be much
lower than the recommended daily requirement. India has one of the highest rates of clinical
and subclinical vitamin A deficiency in the world.
In the 1950s and 1960s, numerous states reported that Vitamin A deficiency was one of the
leading causes of blindness in children under the age of five. A five-year field study
undertaken by NIN found that giving children aged one to three years old a huge dose of
Vitamin A (200,000 units) once every six months decreased the incidence of corneal
xerophthalmia by nearly 80%. Given the magnitude of the problem of Vitamin A deficiency-
related blindness, it was decided that immediate remedial measures, such as huge dose
Vitamin A supplementation for the overall population of vulnerable youngsters, should be
taken. The National Prophylaxis Programme Against Nutritional Blindness was established in
1970 as a government-sponsored programme. All children aged one to three years were to get
200,000 IU of Vitamin A orally once every six months under this programme.

Aim: The goal is to reduce the incidence of Vitamin A insufficiency.

Objective:

Prevention of vitamin A deficiency

 Promoting consumption of Vitamin A rich food: Increasing local production and

consumption of green leafy vegetables and other plant foods that are rich sources
of carotenoids in order to promote regular dietary intake of Vitamin A rich foods
by all pregnant and breastfeeding women and children under the age of five.
 Increasing awareness of the need of preventing Vitamin A deficiency among
women who attend antenatal clinics, immunisation sessions, and mothers and
children who are enrolled in the ICDS programme.
 Vitamin A prophylaxis according to the following dosing schedule:
o With measles immunisation, 100000 IU at 9 months
o 200000 IU at 16-18 months, with a DPT booster 
o 200000 IU every 6 months until the child reaches the age of five.

From the age of 9 months to 5 years, a total of 9 mega doses have to be given.

Vitamin A deficiency in children's treatment:

 All children suffering with xerophthalmia must be treated in a medical facility.

 If they have not taken Vitamin A in the previous month, all children with measles
should receive one dose.
  One additional dose of Vitamin A should be provided to all patients of severe
malnutrition.

National Nutritional Anaemia Prophylaxis Program

The National Nutritional Anaemia Prophylaxis Program is a national initiative that aims to
prevent anaemia.The Ministry of Health and Family Welfare began this initiative in 1970 as
part of the 4th 5-year plan to avoid nutritional anaemia in mothers and children. Under the
new policy, the National Nutritional Anaemia Prophylaxis Program is now operated as part of
the RCH programme.

The program's specific objectives were to:

 estimate Hb levels to determine the baseline prevalence of nutritional anaemia in

mothers and young children;
 administer IFA prophylactic and therapeutic dosages to mothers and children;
 maintain a constant eye on the tablet composition, distribution, and intake of IFA
supplement;
 Monitor the beneficiaries' haemoglobin levels on a regular basis, and
 encourage moms to take pills by providing useful nutritional education (as well as
giving their children the proper dose).

The following are the dosage recommendations for various age groups:

 A liquid formulation with 20 mg elemental iron and 100 ugs folic acid per ml will be
offered for newborns and children.
  Children aged 6 to 59 months: If the child is clinically anaemic, 20 mg elemental iron
+ 100 ug folic acid is given for 100 days.
 Children aged 6 to 10 years who are in school For 100 days, take 30 mg elemental
iron and 0.250 mg folic acid.
 Adolescents and adults, 100 mg elemental iron + 0.500 mg folic acid for 100 days,
with a higher emphasis on girls.
 Pregnant women should take one tablet of 100 mg elemental iron + 0.500 mg folic
acid daily as a preventative measure, and if they are clinically anaemic, they should
take two tablets daily for 100 days.
 One tablets providing 100 mg elemental iron + 0.500 mg folic acid daily for 100 days
for breastfeeding moms and family planning acceptors.

The programme also included health and nutrition education to enhance total dietary
consumption and promote the consumption of iron and folic acid-rich foods, and also foods
that aid absorption of iron.

National Iodine Deficiency Disorders Control Programme (NIDDCP)

Iodine is essential for the formation of the thyroid hormones thyroxine (T4) and
triiodothyronine (T3), and is necessary for all humans' appropriate growth and development.
It is a micronutrient that is essential for appropriate growth and development in amounts of
100-150 micrograms. Iodine deficiency can lead to various problems such as:

 Goiter 
 dysfunctional Intellect 
 Neuromuscular degeneration
 Endemic cretinism
  Congenital hypothyroidism
 pregnancy loss
 Hypothyroidism
 deaf-mutism
 Vision, hearing, and speech problems
 Psychomotor retardation
 Cognitive impairment

In 1962, the Government of india grasped the gravity of the problem and started the National
Goitre Control Programme (NGCP), which was funded entirely by the national government.
With a view to a wide range of Iodine Deficiency Disorders, the National Goitre Control
Programme (NGCP) was renamed the National Iodine Deficiency Disorders Control
Programme (NIDDCP) in August 1992.

The objectives and components of National Iodine Deficiency Disorders Control Programme
(NIDDCP) are:

 Surveys to determine the scope of the Iodine Deficiency Disorders problem.

 Iodated salt is used instead of regular salt.
 Every 5 years, conduct another survey to determine the degree of Iodine Deficiency
Disorders and the influence of lodated salt.
 Iodated salt and urine iodine excretion are monitored in the lab.
 Public awareness and health education

It was discovered that the Total Goiter Rate (TGR) in the entire country has decreased
dramatically over time. Iodized salt production also increased by 65.00 lakh MT. At the
household scale, appropriate iodized salt consumption has risen from 51.1 percent (as per the
NFHS III report 2005-06) to 71.1 percent (as per CES report, 2009).

Mid-Day Meal Programme

The Midday Meal Scheme is an Indian school meal programme aimed at improving the
nutritional status of school-aged children across the country. The program's origins may be
linked back to the pre-independence era, when a midday meal programme was implemented
in Tamil Nadu in 1925.

In the 1962–63 school year, state governments started their efforts to help children by
launching a midday meal programme in primary schools. By the mid-1980s, three states,
Gujarat, Kerala, and Tamil Nadu, as well as the UT of Pondicherry, had applied universally a
cooked Midday Meal Program by their own resources for children in primary school. By
1990-91, twelve states had implemented the midday meal programme with their own
resources on a universal or massive scale.

On August 15, 1995, the National Programme of Nutritional Support to Primary Education
(NP-NSPE) was started as a Centrally funded Scheme in the country with the goal of
increasing enrollment, persistence, and participation while also boosting nutritional levels
among children. The NP-NSPE had been implemented across the country by 1997-98. In
2002, it was expanded to include children in grades I to V of government, government-aided,
and local-body schools, as well as children enrolled in EGS and AIE centres.

The scheme's central aided included a free supply of food grains (100 g per child every
school day) and a reimbursement for food grain shipment up to a maximum of Rs 50 per
quintal.

The following measures have been taken to enhance the scheme's implementation since 2009:

 Food guidelines have been revised to ensure a healthy and balanced diet for children
in upper primary school by increasing the quantity of pulses from 25 to 30 g,
vegetables from 65 to 75 g, and oil and fat from 10 g to 7.5 g.
  The expense of cooking (except personnel and administrative fees) has been reduced
to make it easier to serve meals to eligible children in the required amount and
quality. Cooking costs Rs. 2.69 per child per day in primary school and Rs. 4.03 in
higher primary school.
 A separate component was created for the payment of an allowance of Rs.1000 per
month every cook-cum-helper. Moreover, in other states, cook-cum-helpers receive
an allowance of more than Rs.1000/- from their state fund.
The following guidelines for hiring a cook-cum-help kitchen staff:
o For schools with up to 25 kids, one kitchen staff
o For schools with 26 to 100 kids, two kitchen staff are required.
o For every additional 100 pupils, one additional cook/assistant is required.

During 2016-17, the state/UTs employed about 25.25 lakh cooks/helpers for the cooking and
processing of the Midday Meal to children in elementary schools.

Tithi Bhojan

The Gujarat State Government implemented "Tithi Bhojan," a community outreach

programme, in the midday meal programme, based on the traditional offering food to large
groups of people on particular occasions such as festivals, anniversaries, birthday
celebrations, weddings, and national holidays, among other things. This is entirely
volunteered, and members of the community bring either a whole dinner or additional food
items such as sweets, namkeens, fruits, or sprouts, among other things. Tithi Bhojan is not a
replacement for a mid-day meal. This is merely a supplement or complement to the Mid-Day
Meal. The Ministry of Human Resource Development has also addressed letters to all states
and UTs to promote the Tithi Bhojan concept. It has been suggested that States/UTs replicate
the Tithi Bhojan practise under the Mid-Day Meal using the same nomenclature or adopt a
local nomenclature that is appropriate for them. Eleven states and UTs have embraced
principles similar to Tithi Bhojan.

Significance of Tithi Bhojan:

 Creates a sense of community togetherness.

 Nutritional value of MDM food supplementation.
 Relationships with the local community are being established.
 Establishing an equality in all youngsters from all sort of backgrounds.

POSHAN Abhiyaan

The Prime Minister's Overarching Scheme for Holistic Nutrition, often known as the
POSHAN Abhiyaan or National Nutrition Mission, is the Government of India's flagship
programme targeted at enhancing nutritional outcomes for children, pregnant women, and
breastfeeding mothers. The Prime Minister launched the initiative on March 8, 2018, in
Jhunjhunu, Rajasthan, in honour of International Women's Day.

The POSHAN Abhiyaan is a multi-ministerial harmonization mission with the goal of

 To make India malnutrition-free by 2022, with the ultimate goal of creating a people's
movement (Jan Andolan) around the issue
 to eliminate stunting in India's most malnourished districts by increasing the use of
important Anganwadi services and enhancing the quality of Anganwadi service
delivery
 to guarantee that pregnant women, mothers, and children receive proper nourishment

POSHAN Abhiyaan is being implemented by the Ministry of Women and Child

Development (MWCD) in 315 districts during the first year, 235 districts in the second year,
and the remaining districts in the third year. There are a variety of programmes that affect the
nutritional status of children (0-6 years old), pregnant women, and breastfeeding moms
directly or indirectly. Despite this, the nation's malnourishment and associated concerns are
widespread. There is no shortage of schemes, but there is a lack of synergy and bringing them
together to reach a shared aim.

The mission's four point strategy/pillars for implementing POSHAN Abhiyaan are:

 Inter-sectoral convergence for better services.

 Technology (ICT) is being used to measure and monitor women's and children's
growth in real time
 For the first 1000 days, health and nutrition services will be enhanced
 Jan Andolan