India lags on malnutrition, infant mortality and other key indicators of child health

India is likely to miss the 2030 deadline for achieving sustainable development goals related to children’s health – reducing the prevalence of stunting, and under-five and neonatal mortality – according to the Goalkeepers 2024 report released by the Bill and Melinda Gates Foundation.

The report is based on estimates from the Institute of Health Metrics and Evaluation, United Nations Children’s Fund and the World Bank.

Malnutrition is the most pervasive health crisis facing the world, and is the cause of half of all childhood deaths in the world, the report says. This will only be aggravated by changing climate, it added.

“Stunting [where a child is short for his/her age] is a proxy for overall cognitive and physical underdevelopment,” according to a September 2017 report by the Bill and Melinda Gates Foundation, as IndiaSpend reported in January 2018. “Stunted children will be less healthy and productive for the rest of their lives, and countries with high rates of stunting will be less prosperous.”

Increased funding for nutrition and innovative solutions such as fortifying food, providing better prenatal supplements and investing in agriculture could help the world to meet the SDGs like reducing child mortality, infant mortality and maternal mortality, said the report.

Further, India is on track to meet SDG targets on reducing maternal mortality, and has already met the target on reducing malaria incidence, data from the report show.

Off track

Nine years after world leaders agreed to the 2030 deadline to end poverty, fight inequality and stop climate change, the world is off track, said the report.

As of 2023, India’s neonatal mortality – that is, deaths within 28 days of birth – is 22 deaths per 1,000 live births. By 2030, this is estimated to decline to 18 deaths per 1,000 live births, 50% more than the target of 12. Globally, by 2030, neonatal mortality is expected to be 15.

Similarly, India’s early childhood mortality – that is, deaths within five years – is estimated to decline from 35 deaths per 1,000 live births to 29, which is 16% more than the target of 25. The global average is estimated to fall to 31 deaths per 1,000 live births.

Worldwide, 23% of children will be stunted in 2030, about 1.5 times the target of 15%. India’s figure is expected to be 35%.

“India’s targeted approach to improving child health through nutrition programs and vaccinations provides a hopeful outlook,” a spokesperson for the Bill and Melinda Gates Foundation told IndiaSpend, adding that initiatives like Mission Poshan 2.0 are at the forefront of combating malnutrition, reaching over 95 million beneficiaries.

Climate change

Worldwide, an additional 40 million children will be stunted and 28 million will be wasted – where a child has lower-than-expected weight for height – by 2050 because of climate change, found the report. “The kids who survive malnutrition never truly escape it,” Bill Gates, co-chair of the Foundation, wrote in the foreword to the report.

Adults who were stunted at age two spent nearly one year less in school than non-stunted individuals, according to this study conducted by University of Atlanta in 2010, as IndiaSpend reported in July 2016.

Similarly, a study of Guatemalan adults found that those stunted as children had less schooling, lower test performances, lower household per capita expenditure and a greater likelihood of being poor. For women, stunting in early life was associated with a lower age at first birth and more pregnancies and children, according to this 2008 World Bank study.

A 1% loss in adult height due to childhood stunting is associated with a 1.4% loss in economic productivity, according to World Bank estimates. Stunted children earn 20% less as adults compared to non-stunted individuals, we had reported.

Further, experts say that early childhood malnutrition increases the risk of developing non-communicable diseases such as hypertension, diabetes and heart disease in adult life, as IndiaSpend reported in October 2019.

“In terms of mortality, we may meet the 2030 deadline for the SDGs, or at least not be too far off the mark, but undernutrition goals seem further off,” said Dipa Sinha, professor of economics at Ambedkar University in Delhi.

In the 90 days between June and August 2024, about 19.5 million Indians experienced above-average temperatures for at least 61 days. Children are vulnerable to climate change even before they are born: Climate-related hazards can increase the risk of low birth weight, increase the risk of death due to air pollution and extreme heat, and intensify infectious disease like malaria. Climate change will also increase food insecurity and contamination.

“Drought-like situations have impacted agriculture, leading to compromised nutrition for children,” said Subhendu Bhattacharjee, Director, Research and Knowledge Exchange and Child Rights and You. “They are particularly vulnerable to extreme heat because their bodies heat up faster and cool down slower than adults.”

Children born today will face the effects of climate change for the rest of their life, as we reported in 2019.

TB incidence high

India will also miss its targets on tuberculosis incidence, the report estimated. In the next six years, India’s TB incidence will fall from 216 cases per 100,000 people to 194, which is 80% higher than the world average of 107.

The disease, which kills over 300,000 and infects 2.6 million Indians each year, is a ‘social’ disease in that the malnourished, living in areas with poor hygiene, are more vulnerable to the disease, as IndiaSpend reported in June 2024.

The lack of nutrition and the risk of contracting TB are interrelated, we reported in October 2022. The lack of nutrition makes a person more susceptible to TB, while having TB increases the chance of malnutrition. Malnourished patients also find it harder to recover from TB.

India’s containment of TB is more or less on par with the 2% fall in the incidence rate globally, we had reported in May 2023. However, the decline is well below the 10% drop the World Health Organization had targeted to be achieved by 2025, and the 17% decline projected for the following decade, to end TB by 2035.

Further, family planning services will be available to 75% of the people, up from 74% in 2023, the report estimated. The SDG sets a target of universal access to family planning. India has a 76% demand for family planning, but it also has a 9% unmet need for family planning, according to the fifth National Family Health Survey, 2019-’21.

Unmet need reveals the gap between a woman’s reproductive intentions and her contraceptive behaviour. The gap could be caused by lack of access to contraceptives, but it could also reflect cultural, social and religious beliefs that forbid contraception or do not allow women to take independent decisions about family planning, as we reported in July 2019.

Women bear the brunt of contraception in India, as IndiaSpend reported in 2020. Female sterilisation is the most popular form of contraception in India, we reported in July 2024. While two in three women reported using any form of family planning methods in NFHS-5, more than half of them – or 37.9% of married women in the reproductive age group – chose sterilisation.

India is also expected to fall short on a composite index of universal healthcare, with an estimated score of 56 compared to the world average of 62.

Funding health, nutrition

Undernutrition causes $3 trillion in productivity loss by stunting children’s physical and cognitive capabilities, according to the report. Malnutrition costs low income countries 3%-16% of their gross domestic product, which is equivalent to a permanent 2008-level recession for them.

More economists should track malnutrition because poor nutrition can hamper economic growth, the report said.

Covid-19 may have undone decades of progress on childhood nutrition, as we reported in December 2020. In January 2022, we reported that India underspends on nutrition.

About 40% of all children in India live in severe food poverty, meaning that they eat two or fewer food groups out of the eight recommended.

India, along with Ethiopia, Kenya, Nigeria and Tanzania, can protect 109 million people from being stunted by increasing dairy productivity, found the report. Other solutions being implemented worldwide include double fortifying salt and other pantry staples and providing supplements that contain essential vitamins and minerals to pregnant women.

”Relying on fortification is a piecemeal approach. For sustainable improvement in nutrition we need more comprehensive interventions. Wages and livelihoods affect stunting much more than supplements and fortified food,” said Sinha.

More recent research suggests that the gut microbiome can help with absorption of nutrients, according to the report. “Studies have found that providing pregnant women with micronutrient supplements can help babies gain additional weight and develop healthier gut microbiomes, preventing malnutrition and improving overall health outcomes,” explained the spokesperson from Bill and Melinda Gates Foundation.

IndiaSpend has written to the Ministry of Health and Family Welfare on the success of initiatives aimed at reducing child mortality, HIV incidence, TB incidence and the inclusion of UN Children’s Fund’s multiple micronutrient supplements in the antenatal care programme. We will update this story when we receive a response.

Nushaiba Iqbal works as a reporter and analyst at IndiaSpend.