Successful stories of change across India suggest investment in girls and women and heightened delivery of health and nutrition interventions in bringing down malnutrition.
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Breaking the Intergenerational Cycle of Undernutrition is one of the key pillars towards eliminating malnutrition from the country. For India, breaking the Intergenerational Cycle of Undernutrition has seen a history of neglect. Intergenerational influences are defined as “conditions, exposures, and environments experienced by one generation relate to the health, growth and development of the next generation.” Significant incidence of early marriage and childbearing are amongst the important causes of undernutrition, due to the adverse intergenerational bearing on health, education and employment. Investment in maternal and child health, and adolescent well-being, (Figure 1) yields a high cost to benefit ratio, with a triple dividend in both low and upper-middle income countries.
Figure 1: Benefit Cost Ratio-return on every dollar invested
India has seen impressive gains in the past decades in reducing marriages in children below 18. Looking at the phase 1 data of 22 states/Union Territories (UTs) from the National Family Health Survey (NFHS) 5, there is a stagnation in early marriage but a rise in teenage pregnancies, indicating concerns that this would lead to complications at birth, low birth weight, and higher maternal and child mortality rates. Figures 2 and 3 indicate the data for child marriage and teenage pregnancies from the 22 states/UTs.
Figure 2: Trends in early marriage (below 18 years) in 22 states/UTs
Figure 3: Trends in teenage pregnancies in the 22 states/UTs
Of concern is Tripura, showing a steep incline in both child marriage and teenage pregnancies. Assam and Manipur also show a rise in child marriage. Other than Tripura, Andhra Pradesh, Himachal Pradesh, Manipur, Sikkim and Lakshadweep a show rise in teenage pregnancies. Lakshadweep, at 1.1 percent teenage pregnancies, has risen from zero percent since the last survey prior to the NFHS-5 (2015-16).
Malnutrition trends are alarming, with eleven states show a rise in stunting in children under five; the highest being reported from Meghalaya (46.5%), and Bihar (42.9%). The NFHS-5 shows a sharp rise in stunting for Kerala, Goa and Tripura, which is a cause for concern. Wasting remains stagnant or shows a rise in most of the states/UTs. Underweight population is on the rise in 11 states. The threat of double burden of malnutrition  is evident from the increasing trend in overweight prevalence in children under five. A steep incline in overweight children under five has been observed in the states of Himachal Pradesh and Mizoram, and the union territories of Ladakh and Lakshadweep. The data on nutritional status of women on the one hand indicates a decline in percentage of women who are thin (BMI less than 18.5), and a sharp incline in…