Menu ENN Search

Integrating complementary food supplements at scale into national nutrition programmes: Insights from India

View this article as a pdf

Purnima Menon is a senior researcher with the International Food Policy Research Institute’s South Asia Regional Office in India.

Shariqua Yunus Khan is a medical doctor and public health practitioner managing the nutrition portfolio with the World Food Programme, India Country Office.

Rajan Sankar is with The India Nutrition Initiative (TINI) of the Tata Trusts, India 

Background

Every year 27 million babies are born in India. At any time, there is a cohort of over 50 million children under two years old. Good nutrition during the first two years helps to build bodies, brains and immunity for every child; yet, survey after survey tells us there is a real crisis in how babies across India are fed, especially around complementary feeding. Indeed, barely a tenth of Indian babies received a minimally adequate diet, even in 2018.  

Feeding babies well is no small task. Multiple times a day, every day, parents and caregivers must prepare, feed and clean their infants – adding up to an estimated 5,000 feeding moments in the first two years of life. Parents and caregivers need information, time, resources, skills and support to undertake what is a massive caregiving task over these first two years of a child’s life. 

Public programmes implemented by frontline health workers and medical professionals typically offer parents advice and information, with research finding varying degrees of impact. Indeed, programmes to provide breastfeeding and complementary feeding information and support to families are a common feature of public policy across South Asia. However, few countries in the region also offer families with young children specially formulated complementary food supplements – fortified cereals, cereal-pulse mixes, eggs – to support infant feeding. Evidence suggests that, in food-insecure populations, either food or cash should be provided to families to support infant feeding1. India and Sri Lanka are two of the countries in South Asia that include public provisioning of complementary foods in their nutrition programmes at national scale.

India’s Integrated Child Development Services (ICDS) programme

India’s flagship nutrition programme, the ICDS programme, is the world’s largest community-based nutrition programme focusing on pregnant and lactating women and children under six years of age. Fuelled by the work of over 1.4 million Anganwadi workers, the programme provides a range of services at community-based centres (Anganwadi centres). These services include food supplementation, provided either as take-home food rations or as hot cooked meals, depending on the programme client. Other services provided include growth monitoring, behaviour change communication activities through community-based events at the centres, and home visits by the workers for nutrition counselling, as well as linkages and referrals within the health system. 

A breastfeeding mother in Narharpur Block, Chhattisgarh, receives take home rations prepared by women from self-help groups. ©Shawn Sebastian, IFPRI

The programme began in 1972 as a pilot and today is a nationwide programme that has scaled up tremendously in the last 15 years, following a legal act that linked ICDS with the right to food and a range of programme and policy efforts related to nutrition2. It has been challenging to assess the impact of ICDS on nutrition outcomes, but evidence suggests that programme expansions and coverage have contributed to declines in stunting in several states. As of 2016, use of the programme is still highly variable across states; however, in some, close to 90% of the population use the programme services.

Provision of CF supplements

India’s experiences with scaling up the provision of complementary food supplements in the ICDS programme over the last 10-15 years offer lessons on a range of issues, including composition, production models, governance, financing, and reach and uptake. Based on recent reviews3, 4and a range of stakeholder discussions, we explore each of these briefly below:

Missing evidence

Unfortunately, a missing piece of evidence in the context of India’s programmes is how client populations perceive the food supplements and the programme, and how they integrate the food supplements into the daily diets of their infants. Little is known about whether client populations value the food supplements, whether they fit their cultural norms of what infants should consume, whether they feel they are safe to feed their infants and, last, but not least, whether they can easily integrate a publicly provided food supplement into their daily routines. Contrast this with the availability of evidence from Mexico’s nutrition programme, which successfully integrated high-quality food supplements and behaviour change into the programme through careful research that listened to client populations.  

Recommendations for improving the complementary food supplements

What does the evidence and experience to date imply for how India, and other countries in the region, should consider the role of complementary food supplements in their national nutrition programmes?   

First, in food-insecure populations, and especially in the context of the food insecurity that is anticipated as a result of the ongoing Covid-19 pandemic, complementary food supplements can play an important role in supporting parents with infant feeding. Indeed, studies suggest that appropriately formulated food supplements or high nutrient quality foods such as eggs, contribute critical nutrients without displacing breastmilk. Countries that aim to integrate these into national programmes should certainly explore whether client populations need additional food supplements to support infant feeding. Cash transfers could be explored as well, with the caveat that evidence across the region is still mixed.  

Second, even as countries consider adding complementary food supplements to the programmes, or consider updating their policies and programmes, attention is needed to issues of nutritional composition and to the range of programmatic, governance and financial arrangements that affect programme reach. These affect the translation of policy guidance and intent into actual food supplements in the hands of client populations and therefore need as much, if not more, care and attention.   

Third, food supplements are certainly not enough; efforts to strengthen the integration of food supplements with ongoing behaviour change communications and/or counselling elements of the programme are vital to help families use the supplements appropriately, ensuring that they do not displace breastmilk or other family foods.  

Finally, a continuous learning agenda that builds on ground-up research and listens to client populations is central to ensure that food supplements meet nutritional needs and food safety standards and are culturally acceptable. Families with young children bring valuable insights on programmatic features regarding the taste and acceptability of the supplements and on their integration into the diets of their infants. Listening to the parents of young children across India – and, indeed, all of South Asia – is important to ensure that the millions of dollars that go into nutrition programmes will drive impact.  

Read more...

Footnotes

1Bhutta et al. (2008). What works? Interventions for maternal and child undernutrition and survival. The Lancet, 371(9610), 417-440.

2Chakrabarti et al. (2019). India’s Integrated Child Development Services programme; equity and extent of coverage in 2006 and 2016. Bulletin of the World Health Organization, 97(4), 270.

3Vaid et al. (2018). A review of the Integrated Child Development Services’ Supplementary Nutrition Programme for Infants and Young Children: Take home ration for children. POSHAN Research Note.  Intl Food Policy Res Inst.

4World Food Programme. (2019). Review of Take-Home Rations under the Integrated Child Development Services in India. New Delhi, India: World Food Programme, India.

5Saxena, N. C., & Srivastava, N. (2009). ICDS in India: policy, design and delivery issues. IDS Bulletin, 40(4), 45-52.

6Chakrabarti et al. (2017). Achieving the 2025 World Health Assembly targets for nutrition in India: What will it cost? (Vol. 2). Intl Food Policy Res Inst.

7Avula et al. (2018). District-level coverage of interventions in the ICDS scheme during pregnancy, lactation and early childhood in India: Insights from the National Family Health Survey-4 (No. 4). IFPRI.

More like this

FEX: Continuum of care for children with wasting in India: Opportunities for an integrated approach

View this article as a pdf Lisez cet article en français ici By Arjan de Wagt, Eleanor Rogers, Praveen Kumar, Abner Daniel, Harriet Torlesse and Saul Guerrero Arjan...

Translating the Home-Based Care for the Young Child initiative into action for young child feeding in Bihar, India

View this article as a pdf Manoj Kumar is an Indian Administrative Service Officer, Executive Director of the State Health Society, Bihar under the Department of Health,...

FEX: Ensuring pregnancy weight gain: An integrated community-based approach to tackle maternal nutrition in India

View this article as a pdf Lisez cet article en français ici By Sreeparna Ghosh Mukherjee, Pia Sen and Dr Nagma Nigar Shah Sreeparna Ghosh Mukherjee is Senior...

FEX: Challenges in addressing undernutrition in India

By Ajay Kumar Sinha, Dolon Bhattacharyya and Raj Bhandari Ajay Kumar Sinha (left) is the Founder Secretary and Executive Director of FLAIR. He is an expert on public policy...

FEX: Managing severe acute malnutrition in India: prospects and Challenges

By Biraj Patnaik Biraj Patnaik is the Principal Adviser to the Commissioners of the Supreme Court of India in the right to food case. He is also associated with the Right to...

FEX: Treatment of severe acute malnutrition through the Integrated Child Development Scheme in Jharkand State, India

By Grana Pu Selvi and Colleen Emary View this article as a pdf Lisez cet article en français ici Click here to listen to an interview with the authors on the ENN...

FEX: Severe acute malnutrition management in India’s children: the riddle

By Anne-Dominique Israel de Monval and Yara Sfeir Anne-Dominique Israel is a senior nutrition and health advisor with ACF France. She holds a nursing degree and a Master's in...

FEX: Community management of acute malnutrition in Rajasthan, India

By Daya Krishna Mangal and Shobana Sivaraman Daya Krishan Mangal is Professor and Dean of Research at the IIHMR University, Jaipur. Dr Mangal has a Doctorate in Medicine and...

Blog post: Nutrition in Jharkhand - A new beginning

Greetings! I am Dr Charulatha Banerjee, one of ENN's Regional KM specialists working in Asia. On the 9th of January I visited the Indian state of Jharkhand to meet...

FEX: Addressing poverty and undernutrition in India

Women collect drinking water in West Bengal Gram Panchayat Summary of research1 There appears to be a paradox between the headline messages on inequality and what is actually...

FEX: Action to improve infant and young child feeding in nutrition and child health programmes

A mother prepares porridge from soy-fortified bulgur in Guatemala Proceedings of meeting1 Over 50 researchers, programme implementers, infant feeding experts and...

Blog post: The private sector in nutrition - a player by default or choice? Reflections from a multi-stakeholder meeting

I participated in a Round Table organised by South Asia Food and Nutrition Security Initiative SAFANSI In Colombo in June which was titled “Putting the Lens on the...

FEX: CMAM in India: What happened next?

By Bernadette Feeney and James Lee Bernadette Feeney is a Technical Advisor with Valid International. She is a nurse and public health nutritionist and provides technical...

Combining a mid-day meal, health service package and peer support in Karnataka State, India

Combining a mid-day meal, health service package and peer support in Karnataka State, India View this article as a pdf Uma Mahadevan is Principal Secretary in the Department...

FEX: Continuity of information in nutrition interventions in India: Experiences from Jharkhand

View this article as a pdf Lisez cet article en français ici By Ipsha Chaand Ipsha Chaand is pursuing a PhD at the Centre of Social Medicine and Community Health,...

FEX: Development and use of alternative nutrient-dense foods for management of acute malnutrition in India

By Praveen Kumar, Raja Sriswan Mamidi, N Arlappa, Khyati Tiwari, Shivani Rohatgi, G Sarika, Dripta Roy Choudhury, Jaga Jeevan Babu Geddam and R Hemalatha Praveen Kumar is...

FEX: Lipid-Based Nutrient Supplement Research Network Meeting

By Sarah Style Sarah Style is part of the ENN team working with UNHCR on the Anaemia Control, Prevention and Reduction Project In April 2011, the International Lipid-Based...

FEX: Biofortification: Helping meet nutrition needs worldwide

News By Dr Erick Boy, Nutrition Head, HarvestPlus Dr Erick Boy is a public health practitioner and has a doctoral degree in nutrition from University of California, Davis. He...

NEX: Integrated programme achieves good survival but moderate recovery rates among children with severe acute malnutrition in India

Victor Aguayo et al. American Journal of Clinical Nutrition 2013; 98:1335-42 At any point in time, an average 8 million Indian children suffer from severe acute malnutrition...

en-net: Using PD Hearth in place of SFP

Has anyone had any experience with using PD Hearth in place of SFP for treating/preventing moderate malnutrition? I have very important msg to tell you all. Our company has...

Close

Reference this page

Purnima Menon, Shariqua Yunus Khan, Rajan Sankar (2020). Integrating complementary food supplements at scale into national nutrition programmes: Insights from India. Nutrition Exchange Asia 2, June 2020. p27. www.ennonline.net/nex/southasia/2/indiasupplements

(ENN_6697)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.