India's poor performance on critical food and nutrition security indicators despite substantial economic prosperity has been widely documented. These failings not only hamper national progress, but also contribute significantly to the global undernourished population, particularly children. While the recently passed National Food Security Act 2013 adopts a life-cycle approach to expand coverage of subsidized food grains to the most vulnerable households and address food security, there remains much to be desired in the legislation. Access to adequate food for 1·24 billion people is a multifaceted problem requiring an interconnected set of policy measures to tackle the various factors affecting food and nutrition security in India. In the present opinion paper, we discuss a fivefold strategy that incorporates a life-cycle approach, spanning reproductive health, bolstering citizen participation in existing national programmes, empowering women, advancing agriculture and better monitoring the Public Distribution System in order to fill the gaps in both access and adequacy of food and nutrition.

With over 1.3 million Anganwadi centres (meaning “courtyard shelter”), the Indian government runs a nationwide intervention providing nutrition supplement to pregnant mothers to improve the health of their children. Using two successive rounds of the nationally representative cross-sectional National Family Health Survey data (collected during 2005-2006 and 2015-2016) of India, we assessed whether nutrition supplements given to pregnant mothers through Anganwadi centres were associated with select child health indicators – extremely low birthweight (ELBW), very low birthweight (VLBW), low birthweight (LBW) and neonatal mortality (death during day 0-27) stratified by death during day 0-1, day 2-6, and day 7-27. A total of 148,019 children, and 205,593 children were eligible for analysing birthweight and neonatal mortality, respectively. Odds ratio (OR) with 95% confidence interval (CI), estimated from multivariate logistic regression models suggest that receipt of nutrition supplements was associated with decreased risk of VLBW (OR:0.73, CI: 0.63-0.83, p<0.001), LBW (OR: 0.92, CI: 0.88-0.96, p<0.001), but not ELBW (OR: 0.80, CI: 0.56-1.15, p= 0.226). Women who always received nutrition supplements during their pregnancy saw lower risk of death of their neonates (OR: 0.67, CI: 0.61-0.73, p<0.001), including death on day 0-1 (OR: 0.66, CI: 0.58-0.74, p<0.001), day 2-6 (OR: 0.69, CI: 0.58-0.82, p<0.001), and day 7-27 (OR: 0.68, CI: 0.53-0.87, p=0.002). Therefore, nutritional supplementation to pregnant mothers appears to be helpful in deterring various stages of neonatal mortality, VLBW, and LBW, though it might not be effective in mitigating ELBW. Findings were discussed considering possible limitations of the study.

Recognising the importance of infant and young child feeding practices during the first 2 years of life, the World Health Organization's Global Nutrition Monitoring Framework developed a minimum dietary diversity (MDD) indicator for feeding children aged 6–23 months. MDD is defined as the consumption of food items from five or more groups out of a total of eight food groups. Food intake from less than five food groups is considered minimum dietary diversity failure (MDDF). Using the nationally representative National Family Health Survey (NFHS) dataset, the present study assessed the trend in MDDF between 2005–6 and 2015–16 and the factors associated with MDDF among children aged 6–23 months during 2015–16. The NFHS conducted in 2005–6 and 2015–16 covered a sample of 14 419 and 74 078 children aged 6–23 months, respectively. Overall, the MDDF reduced from 87⋅4  % (95  % confidence interval (95  % CI) 86⋅8  %, 87⋅9  %) in 2005–6 to 80⋅6  % (95  % CI 80⋅1  %, 81⋅0  %) in 2015–16. Multivariable logistic regression analysis revealed that increased child's age, second and third birth order children, higher maternal age and education, mass media exposure of mothers and more than four antenatal care visits had a negative association with the MDDF. Children living in rural areas and residing in high-focus states of India were observed with higher odds of experiencing MDDF. Exposure to community healthcare services was negatively associated with MDDF, and anaemic children were more likely to have MDDF. Socioeconomic status of mothers and children and encouragement of maternal and child healthcare use could be helpful in devising context-specific intervention to mitigate MDDF.

Despite several efforts by the Government of India, the national burden of anaemia remains high and its growing prevalence (between 2015-2016 and 2019-2021) is concerning to India’s public health system. This article reviews existing food-based and clinical strategies to mitigate the anaemia burden and why they are premature and insufficient. In a context where multiple anaemia control programmes are in play, this article proposes a threefold strategy for consideration. First, except the Comprehensive National Nutrition Survey, 2016-2018, which measured haemoglobin (Hb) concentration among children and adolescents aged 1-19 years using venous blood samples, all national surveys use capillary blood samples to determine Hb levels, which could be erroneous. The Indian government should prioritize conducting a nationwide survey for estimating the burden of anaemia and its clinical determinants for all age groups using venous blood samples. Second, without deciding the appropriate dose of iron needed for an individual, food fortification programmes which are often compounded with layering of other micronutrients could be harmful and further research on this issue is needed. Same is true for the pharmacological intervention of iron tablet or syrup supplementation programmes which is given to individuals without assessing its need. In addition, there is a dire need for robust research to understand both the long-term benefit and side-effects of iron supplementation programmes. Third and final, the World Health Organization is in process of reviewing the Hb threshold for defining anaemia, therefore the introduction of new anaemia control programmes should be restrained.

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