In the Global Hunger Index (GHI) released in October 2022, India’s ranking fell by six places, to 107 out of 121 countries, compared to 2021. Immunisation and better nutrition are key to curbing child malnutrition, but what does the recent data on coverage reveal?

India’s GHI Performance

The GHI computes a score based on four parameters: overall undernourishment, child wasting, child stunting, and child mortality. While the Government of India (GoI) has dismissed the report, calling it a “one-dimensional view” and questioning the integrity of its methodology, the fact remains that India’s once stellar performance in the domain of health and nutrition has now stagnated.

According to GHI 2022, India’s performance in two of the indicators has worsened since 2014;  an increase in the proportion of undernourished people and children showing symptoms of wasting. Child wasting refers to a child who is too thin for their height, and this is the result of recent rapid weight loss or the failure to gain weight. It is often the result of poor nutritional practices, infections, poverty, and lack of access to safe, potable water. Growing evidence indicates that wasting occurs early in life and disproportionally affects children under 2 years of age. 

Relation between Immunisation and Malnutrition

Among several other factors, children with incomplete vaccination coverage are more likely to have poor nutritional outcomes, including being wasted or stunted. This is because infectious diseases can hamper the body’s ability to absorb nutrients and cause undernutrition. Similarly,  malnutrition can impact the effectiveness of immunisations, with malnourished children having weaker immune systems and a higher likelihood of disease compared to well-nourished children. Thus, both immunisation and nutrition are important drivers of a child’s healthy development.  

In India, to be considered fully vaccinated, an infant must be vaccinated against viruses such as the Rotavirus, which causes diarrhoea which is a major cause of malnourishment in low-income countries. 

India’s Immunisation Coverage

While India has been one of South Asia’s top performers in the last two decades in advancing immunisation coverage, COVID-19 has threatened to undo the impressive gains made.  During the Financial Year (FY) 2020-21, when multiple lockdowns were enforced nationally due to the pandemic, access to healthcare facilities was limited. Despite multiple catch-up sessions under Intensified Mission Indradhanush,  GoI’s flagship immunisation campaign aimed at increasing full immunisation coverage among children, there were 10 lakh fewer fully-immunised children (9-11 months), compared to FY 2019-20. 

A look at regular immunisations is revealing. Although 96% of planned immunisation sessions were held in FY 2020-21,  similar to the 98% seen in FY 2019-20, in actual terms,  approximately 9.4 lakh fewer sessions were held in 2020-21 compared to the previous year. Similarly, the number of Anganwadi centres and Urban Primary Health Care centres that reported conducting Village Health and Nutrition Day (VHNDs), Urban Health and Nutrition Day (UHNDs) or Outreach programmes in FY 2020-21 was almost 11 lakh fewer than in FY 2019-20.  VHNDs, which serve as a platform for providing preventative services (including immunisations), particularly for marginalised groups in rural areas, play a crucial role in fostering community-led impact and implementation. 

Immunisation and Institutional Births

In addition, the first chance an infant has at immunisation is at a hospital. Institutional births are associated with better immunisation rates among children, as well as lower maternal mortality rates. However, given the restriction on movement and access to healthcare facilities during the lockdown periods, the number of institutional deliveries decreased in FY 2020-21 by approximately 8 lakh. This figure is validated by RTI data on Janani Suraksha Yojana (JSY), a conditional cash transfer scheme with the objective of promoting institutional delivery among poor pregnant women, which saw 7 lakh and 10 lakh fewer institutional births in FY 2020-21 and FY 2021-22 respectively, compared to the non-COVID FY 2019-20. This detriment can be observed specifically for vaccines that are to be administered at birth, which saw a substantial decrease in FY 2020-21 such as for BCG (13 lakh lower), OPV (11 lakh lower), and Hepatitis-B (7 lakh lower) compared to FY 2019-20, signalling more home deliveries or births without proper medical assistance. 

While the Ministry of Family and Health Welfare (MoFHW) has not yet published the number of estimated births in FY 2020-21, given that India’s Total Fertility Rate is 2.18, one can clearly expect a greater number of live births in FY 2020-21, than in FY 2019-20. This implies that the increase in the number of unvaccinated infants will be much higher in percentage terms as well. Analysis for FY 2021-22 and 2022-23 could not be conducted due to the unavailability of recent data. 

Immunisation and improved nutrition have been critical in curbing child malnutrition and ameliorating children’s health globally, and in India over the last 30 years.  For real, resilient and inclusive growth, India needs to categorically ensure that immunisation outcomes of the past are maintained.

Jenny Susan John is a Research Associate at Accountability Initiative.

Also Read: Big Questions India Needs to Focus on About Implementing a Right to Health

Glossary

1. Child Mortality: The probability of a child dying between birth and exactly 5 years of age. (Source)
2. Child Stunting: The share of children under age five who have low height for their age. (Source)
3. Child Wasting: The share of children under age five who have low weight for their height. (Source)
4. Global Hunger Index: The Global Hunger Index is an annual report, jointly published by Concern Worldwide and Welthungerhilfe, designed to measure and track hunger at the global, regional, and country levels. (Source)
5. Immunisation: A process by which a person becomes protected against a disease through administration of a vaccine. (Source)
6. Institutional Birth: This refers to a child birth which has taken place in a medical institution, like hospital.
7. Malnutrition: Malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients. (Source)
8. Mission Indradhanush: The Government of India’s immunisation campaign which was launched in 2014 with the objective of achieving full immunisation coverage for at least 90 per cent Indian children by 2020.