India’s Nutrition Enigma: Growing Economy, Malnourished Children

The report, called The Future of Children in a Changing World, asks: What will the world be like for our 2.5 billion children in 2050, and what can we do to provide them the best future? 

There are many answers to this question, but one lies beneath the surface — quite literally. The nutritional foundation laid in the first few years of life shapes the strength, stamina and cognitive ability of an entire generation. If our children aren’t well-nourished, our potential — on the field, in school and in the economy — is fundamentally compromised.

India’s child nutrition story remains one of the most persistent puzzles in global development. Even as incomes rise and food availability improves, large numbers of Indian children remain chronically malnourished.

Malnutrition, A South Asian Enigma

This “South Asian enigma” — the paradox of economic growth without corresponding gains in child nutrition — continues to define the region. The problem of nutrition is deeply rooted in India.

According to World Bank statistics, 22 per cent of India’s disease burden is due to all forms of malnutrition. Malnutrition, as characterised by the WHO, is defined as nutrient deficiencies, excess of nutrients, imbalances and impaired utilisation. It is broadly divided into three groups:

1. Under-nutrition (which includes underweight, ie., low-weight for age), stunting (low-height for age), and wasting (low-weight for height);
2. Micro-nutrient related malnutrition (lack or excess of important nutrients and minerals); and
3. Overweight, obesity and diet related communicable diseases (such as stroke, diabetes and heart diseases).

As of 2022, globally, 149 million children are estimated to be stunted and 45 million are estimated to be wasted, according to WHO estimates. Of these children, 24.6 per cent and 8.8 per cent of all the world's stunted and wasted children are in India. In India, 1 in 3 children are underweight and 1 in 5 are wasted.

According to the latest NFHS survey (2019-2021), the percentage of stunted, wasted and underweight population under the age of 5 was 35.5 per cent (global average 22 per cent in 2022), 19.3 per cent and 32.1 per cent, respectively.

States like Gujarat (stunting: 39 per cent, wasting: 25.1 per cent), Jharkhand (stunting: 39.6 per cent, wasting: 22.4 per cent), and Bihar (stunting: 42.9 per cent, wasting: 22.9 per cent) have high prevalence rates.

These percentages are among the highest in the world. Despite improvement in the stunting numbers over the years, according to the Global Nutrition Report, India has shown little or no progress in the wasting category (17.3 per cent). The Asia average for wasting among children under the age of five is 8.9 per cent. 

Consequences Of India's Malnutrition Epidemic

The consequences are profound and lifelong. Malnutrition in early childhood impairs brain development, weakens the immune system, and limits physical growth. It affects school readiness, academic performance and ultimately, productivity in adulthood.

The World Bank has estimated that India loses billions each year in economic output due to the effects of undernutrition. These loses are preventable if we ensure optimal nutrition in the first 1,000 days, which starts from the mother's pregnancy till her child’s second birthday.

Why, then, does malnutrition persist in a country that is now the world’s fifth-largest economy? The answer lies in the complex web of factors that go beyond hunger. Under-nutrition in India is not only about food — it is about inequity, gender, sanitation, maternal health and social neglect. The poor are the worst affected, but even among better-off households, undernutrition is not uncommon. This is what makes the enigma so stubborn.

Gender Inequality As Underlying Factor

One key driver is gender inequality, which plays out both directly and indirectly. Gender inequality in nutrition refers to disparities in nutritional status of a person resulting from different social, economic, cultural and political factors.

Women and girls often face barriers to accessing quality nutrition in Indian households. Their nutritional needs are frequently ignored, especially during adolescence and pregnancy. As a result, underweight mothers give birth to underweight babies, beginning a cycle of stunting that’s hard to reverse.

The high rates of anaemia among women — over 57 per cent according to the latest national survey — point to a systemic neglect of women’s health (20 per cent of maternal deaths). Inadequate intake of vital nutrients like iron, Vitamin B12, folic acid, and excess intake of caffeine (tea and coffee) and spices, can lead to nutritional deficiency, resulting in anaemia.

Poor sanitation and health infrastructure are another part of the story. For decades, many children have grown up in environments where exposure to infection is routine — dirty water, open defecation and limited access to healthcare mean that even if children eat, they often don’t absorb nutrients effectively.

This is sometimes called “environmental enteropathy” — a chronic gut inflammation caused by unsanitary living conditions that leads to poor nutrient absorption. Many studies have found improved sanitation and better access to toilets can result in lowering stunting rates in children (3-29 per cent).

Dietary diversity (DD) remains a challenge too. To ensure that, a good quality of diet is as important as a good quantity of diet. For this, the WHO has suggested to use minimum diet diversity (MDD) — which measures a household's food consumption across different food groups — as an indicator.

According to the MDD score, children (of age 6 months-59 months) must be given at least 5-8 food groups so that they receive all essential micronutrients. If a child received less than 5 of the 8 food groups, he/she falls in the MDDF (failure category).

The nation-wide study reports reasons for higher diet diversity failures such as younger mothers (age group 15-24), low socio-economic conditions, family size, complementary feeding practices, low ANC (Ante-Natal Care) services for women, (lack of) maternal education, and more. Shockingly, states like Gujarat (84 per cent), Maharashtra (81.9 per cent), which are considered developed states, have high MDDF rates.

Unrecognised Environmental Factors

An emerging but under-discussed factor is exposure to environmental toxins, particularly lead. Studies show that India has one of the world’s highest numbers of children with elevated blood lead levels, often due to contaminated water, air, paint and even cookware.

Lead exposure impairs cognitive development and appetite, and may contribute to stunting. Children with iron or calcium deficiencies — common in poor households — are more likely to absorb lead. While more research is needed, the interplay between malnutrition and toxic exposure could be a crucial but overlooked piece in the puzzle. 

Government programmes have tried to address this problem. The Integrated Child Development Services (ICDS) scheme, POSHAN Abhiyaan, midday meals in schools, and the Pradhan Mantri Matru Vandana Yojana, all aim to tackle different aspects of maternal and child nutrition.

These efforts are commendable and have shown results. The latest NFHS data show modest declines in stunting and underweight children over the last five years. But the pace is not fast enough.

At the current rate of improvement, India will fall well short of the global nutrition targets set for 2025 and 2030. By 2025, projections indicate that 131 million children will be affected by stunting — 27 million more than the target for a 40 per cent reduction. 

What India Needs To Do

What’s missing is not effort, but urgency, coherence and accountability. Tackling malnutrition requires more than schemes — it requires a whole-of-society approach.

First, nutrition must be integrated into every relevant sector: Education, sanitation, agriculture, women’s empowerment and environmental regulation.

Second, the first 1,000 days of a child’s life — from conception to age two — must be treated as sacred. Focusing on pregnant women’s nutrition, encouraging exclusive breastfeeding, and ensuring timely introduction of diverse foods, should be top priorities.

Third, data must drive action. Nutrition outcomes should be monitored more frequently and at the district level. Community health workers must be trained and supported to detect and manage undernutrition early.

Fourth, we need to address the soft issues — the hard-to-measure but powerful factors like gender norms, intra-household food allocation, child feeding practices, and the stigma around malnutrition. Behaviour change communication, especially through women’s groups and local influencers, can shift these social norms over time.

Looking Ahead

India has made remarkable progress in many areas: Poverty reduction, food production, vaccine coverage and economic growth. But malnutrition remains the Achilles’ heel of its development story. It is a silent emergency, invisible in our cities and boardrooms, but etched into the bodies and futures of millions of children. 

Rabindranath Tagore once said, “Every child comes with the message that God is not yet discouraged of man.” If we are to honour that message, we must act with urgency and purpose.

India’s rise must not be measured only by Olympic podiums in 2036 — when we are likely to host the Games — but also by what we achieve in our classrooms, clinics, and communities. That rise begins with nourishing every child — with care, dignity and opportunity. We cannot afford to let their potential wither.

Nourishing our children is not just an act of compassion — it is a national necessity.

(Bhushan is a former bureaucrat who was the founding CEO of Ayushman Bharat and is Vice-Chairperson of Advanced Study Institute of Asia-ASIA, where Goutam is senior manager, Research Communications. Views are personal)