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Gragnolati, Michele; Shekar, Meera; Das Gupta, Monica; Bredenkamp, Caryn; & Lee, Yi-Kyoung (2005). India's Undernourished Children: A Call for Reform and Action. Washington: World Bank.


The prevalence of child undernutrition in India is among the highest in the world, nearly double that of Sub-Saharan Africa, with dire consequences for morbidity, mortality, productivity and economic growth. Drawing on qualitative studies and quantitative evidence from large household surveys, this paper (i) explores the dimensions of child undernutrition in India, and (ii) examines the effectiveness of the Integrated Child Development Services (ICDS) program in addressing it. We find that although levels of undernutrition in India declined modestly during the 1990s, the reductions lagged far behind that achieved by other countries with similar economic growth rates. Nutritional inequalities across different states, socioeconomic and demographic groups are large – and, in general, are increasing. We also find that the ICDS program appears to be well-designed and well-placed to address the multidimensional causes of malnutrition in India. However, there are several mismatches between the program’s design and its actual implementation that prevent it from reaching its potential. These include an increasing emphasis on the provision of supplementary feeding and preschool education to children aged four to six years, at the expense of other program components that are crucial for combating persistent undernutrition; a failure to effectively reach children under three — the age window during which nutrition interventions can have the most effect; and, ineffective targeting of vulnerable children such as poorer households and lower castes. Moreover, the poorest iv states and those with the highest levels of undernutrition still have the lowest levels of program funding and coverage. In addition, ICDS faces substantial operational challenges and suffers from a lack of high-level commitment. The paper concludes with a discussion of a number of concrete actions that can be taken to bridge the gap between the policy intentions of ICDS and its actual implementation.

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Gragnolati, Michele
Shekar, Meera
Das Gupta, Monica
Bredenkamp, Caryn
Lee, Yi-Kyoung