New Delhi, Feb 28 : India's flagship programme, Integrated Child Development Services (ICDS), which though showed significant strides, has not benefitted all groups equally, a study said on Thursday, showing fewer gains in high malnutrition states of Uttar Pradesh and Bihar.
Women with low education and the poorest households are relatively more excluded from accessing the programme benefits, said researchers of the International Food Policy Research Institute, who conducted an in-depth analysis of the world's largest child nutrition programme.
Their main focus was on the historically disadvantaged castes and tribes from 2006 to 2016.
Among states too, while overall utilisation has improved, high malnutrition states are relatively lagging.
The programme provides food, pre-school education, and primary healthcare to children under six and pregnant and lactating women.
It continues to be India's flagship program to tackle undernutrition, and key actions under India's new nutrition mission, the POSHAN Abhiyaan, are anchored in the programme.
"Even though overall utilisation has improved and reached many marginalised groups such as historically disadvantaged castes and tribes, the poor are still left behind, with lower utilisation and lower expansion throughout the continuum of care," IFPRI Research Fellow and study co-author Kalyani Raghunathan said.
"These gaps are especially pronounced in the largest states of Uttar Pradesh and Bihar, which also carry the highest burden of under-nutrition.
While both states have shown improvements in 2016, they still fall behind national averages, suggesting that overall poor performance in high poverty states could lead to major exclusions."
"Even in better performing states exclusion of poor could be due to challenges of reaching remote areas, despite attempts to close district-wise equity gaps or local challenges of exclusion within villages due to caste or location-based exclusion," Raghunathan said in a statement to IANS.
The study, "India's Integrated Child Development Services programme; equity and extent of coverage in 2006 and 2016", co-authored by IFPRI's Raghunathan, Harold Alderman, Purnima Menon and Phuong Nguyen and University of Washington's Suman Chakrabarti.
It will be published in the April edition of the Bulletin of the World Health Organisation.
Using data from two rounds of the National Family Health Survey conducted in 2005-06 and in 2015-16, the researchers examine equity in programme expansion and factors that determine utilisation.
The study found a dramatic increase in utilisation of ICDS services from 2006 to 2016 in four key areas: supplementary food (9.6 to 37.9 per cent); health and nutrition education (3.2 to 21 per cent); health check-up (4.5 to 28 per cent); and child-specific services (10.4 to 22 per cent).
The frequency of monthly supplementary food for children also increased during this period by eight percentage points.
At the state level, the study highlights an increase in utilisation of ICDS services between the two survey rounds.
With the exception of Tamil Nadu, Chhattisgarh and Jharkhand, the coverage of food supplementation during pregnancy and lactation was less than 25 per cent in most states in 2006 but increased in almost all states by 2016.
The greatest expansion in ICDS services was seen in food supplementation during childhood, which reached more than 50 per cent coverage in the central and southern states of Jharkhand, Madhya Pradesh, Uttaranchal, Tamil Nadu and Andhra Pradesh.
"Given the significant implementation challenges such as state-level implementation decentralisation, population size and diversity, financial constraints and community awareness, the large-scale expansion in ICDS in India is laudable.
It seems India is well on its way to scale up at least some key nutrition-specific interventions using ICDS," said Alderman.