The recently released National Family Health Survey (NFHS)-6 report presents a mixed progress card for India, offering reasons to cheer while also sending clear signals to pause and reflect. On the bright side, stunting levels (for children under five), which indicate long periods of sub-optimal food intake with other deprivations, have declined from 35.5% to 29.3%. Though a modest decline, any gain is welcome given the complexity of the task that involves strengthening women’s access to knowledge and resources, improved water and sanitation, and ensuring access to healthy affordable diets. Wasting levels that indicate whether children have adequate weight for their height, show no change, except for severe forms of wasting. The pattern across indicators makes one thing clear: gains in child nutrition are due to better health-care access, immunisation coverage, maternal education and improvements in housing, water and sanitation, while feeding practices and access to quality diets remain weak and continue to limit progress.

Institutional births have reached 90%, with public health facilities accounting for 58% of births; 91% of deliveries were attended by skilled medical personnel and 95% of mothers were visited at least once by health personnel during the antenatal period.

Equally gratifying is vaccination coverage for children — 87% of children between 12 and 23 months of age are now fully vaccinated. Since private facilities account for only about 3% of vaccinations, the high coverage reflects the strong outreach efforts of frontline workers — Accredited Social Health Activists (ASHA), Anganwadi workers (AWW), and Auxiliary Nurse Midwives (ANM). These national averages hide regional disparities, but access to health services has improved across States.

Poor feeding practices

Despite the high rate of institutional births, only about 50% of newborns are breastfed within the first hour of life, indicating that the health system must intensify efforts to support early initiation of breastfeeding. About 60% of children between the ages of six to eight months, receive solid/semi-solid food, while only 15% between six to 23 months receive an adequate diet. Improving the timely initiation of complementary feeding and ensuring that all children receive an adequate diet are key to reducing undernutrition. In India, complementary feeding is closely linked to the annaprasana ritual, typically performed between six and 12 months — any delay will result in growth faltering.

A growing and under-explored determinant of child nutrition in India is maternal time poverty. Women perform multiple roles within and outside the home. NFHS-6 reports that about 30% of women engaged in paid work during the past 12 months, but this significantly underestimates their overall work burden. A large proportion of women in informal economies engage in unpaid family labour, in farming/fisheries, livestock care, and domestic chores. There are no clear estimates of the percentage of young mothers with children between six-23 months who are in the work force and there is very little documentation on how women manage child feeding with their other work roles. In many rural areas, in the absence of crèches, women leave their infants and young children with older family members or the child’s older sibling (usually a girl), impacting both breastfeeding and complementary feeding, when they are out in the fields.

The processed food trap

Recent consumer expenditure survey results show that households are spending less on cereals and more on dairy, processed foods and beverages, with the latter two forming a large part of the expenditure. This creates an impression of diversity which is not the same as nutritional adequacy. A nutritionally adequate diet would have to follow the ICMR-National Institute of Nutrition (NIN) food-based dietary guidelines. Unfortunately, for a sizeable section of the population, a nutritious diet consisting of pulses, millets, fruits and vegetables, animal foods and nuts is unaffordable. Processed foods, in contrast, are easily available, ready to eat and packaged in affordable packs.

The first 1,000 days — from pregnancy to a child’s second birthday — form the most critical window for healthy physical and cognitive development (most brain growth occurs in the first five years). We need disaggregated data for the 0-2 age group, currently unavailable, as stunting typically peaks during the second year of life and growth faltering often begins much earlier. The Prime Minister’s Overarching Scheme for Holistic Nourishment (POSHAN) Abhiyaan programme currently focuses on identification and rehabilitation of severely malnourished children. Prevention of growth faltering must receive greater priority. Early identification of stagnation in weight or length, with timely counselling and support to mothers, is central to prevention.

Empowering frontline nutrition workers

Monthly anthropometric data for young children is collected by AWWs. Strengthening their skills in data collection would improve data quality. The huge volume of collected data should be analysed locally and feedback provided to the ASHAs and AWWs for timely action.

For this task, recruitment of a nutritionist and a data analyst at the district level is needed. Where possible, digital tools can be used to supplement in person counselling, by providing both workers and mothers practical information on how, when and what to feed young children at different ages, based on locally available healthy foods.

Behaviour change communication efforts should be culturally grounded, integrating practices such as annaprasana to reinforce timely and appropriate complementary feeding. Joint capacity building of AWWs, ASHAs, and ANMs in assessing feeding practices and advising families with effective communication materials on improving diets using locally available, affordable foods would enhance the quality of counselling and reduce the risk of undernutrition.

Multisectoral convergence is critical to addressing child malnutrition, yet it remains weak. Child nutrition should be a standing agenda item in Gram Sabha and Panchayat discussions. Local planning must prioritise improvements in Anganwadi infrastructure, safe drinking water, and sanitation facilities, as these foundational services directly influence child growth and health.

Engaging men in childcare, promoting shared domestic responsibilities, and strengthening support to mothers can significantly enhance feeding and caregiving behaviours. Many non-governmental organisations in India have developed crèche models that combine childcare, nutrition and early learning, and can be run by trained local women. From a gender perspective, crèches are not only child development interventions; they are social infrastructure that enables women’s economic participation and reduces unpaid care burdens. With coordinated action across sectors and communities, meaningful and sustained progress in child nutrition is entirely achievable.

Soumya Swaminathan is Chairperson, M.S. Swaminathan Research Foundation, and Principal Adviser to the National Tuberculosis Elimination Programme, Government of India. Rama Narayanan is Senior Research Fellow at the M.S. Swaminathan Research Foundation