Dr Anura Kurpad, Senior Advisor to Tata Trusts and Professor of Physiology and Nutrition, St John’s Medical College, Bengaluru stresses that investing in nutrition from conception through early childhood is both a health obligation and an economic investment
India has made measurable progress in raising awareness around nutrition and its successful policies such as The POSHAN Abhiyaan and Integrated Child Development Services (ICDS), PM Garib Kalyan Anna Yojana (PMGKAY) and the National Food Security Act are successfully covering over 800 million people, over 90 million children and mothers and are promoting locally produced protein foods, and behavior change communication. Unfortunately, India still lies at the center of the nutrition paradox with urban areas experiencing rising rates of obesity and overnutrition and rural regions continuing to struggle with persistent undernutrition and micronutrient deficiencies in children and women. In 2025, around 12% of the population is undernourished, while nearly 43% cannot afford a healthy, diversified diet as food prices have risen.
According to the latest National Family Health Survey (NFHS-5), more than one-in-three children under five are still stunted and wasting persists, while anemia remains endemic among children and women. Tackling malnutrition during pregnancy and in the first 1,000 days of life is therefore an urgent health priority, not only for survival but to secure cognitive development, schooling outcomes, and future economic productivity.
The first 1000 days: The crucial point
The 1,000 days between a woman’s pregnancy and her child’s second birthday offer a brief but critical window of opportunity to shape a child’s development. It is a time of both tremendous potential and enormous vulnerability. How well or how poorly a child fares during his first 1,000 days can mean the difference between a thriving future and one characterised by struggle.
There are three crucial stages in the first 1,000 days: pregnancy, infancy and toddlerhood. At each stage, the developing brain is vulnerable to poor nutrition either through the absence of key nutrients required for proper cognitive functioning and neural connections and/or through the “toxic stress” experienced by a young child whose family has experienced prolonged or acute adversity caused by food insecurity.
As research highlighted in publications like The Lancet has shown, 100-150 calories/kg/day are essential for growth of both fetus and child, but without the necessary nutrients, they are not sufficient for normal brain development. Although all nutrients are necessary for brain growth, key nutrients that support neurodevelopment include protein; zinc; iron; choline; folate; iodine; vitamins A, D, B6, and B12; and long-chain polyunsaturated fatty acids. Failure to provide these in adequate daily quantities during this critical period may result in lifelong deficits in brain function despite later nutrient repletion.
Where India stands today
Per the recent NFHS-5 (2019-21), nutrition indicators for children under 5 years have improved. Stunting has reduced from 38.4% to 35.5%, wasting from 21.0% to 19.3%, and underweight prevalence is now 32.1%, a drop from 35.8%. While these figures point to progress, significant regional disparities remain. Certain states and districts continue to face acute malnutrition, emerging as critical hotspots that demand focused attention.
Highlighting the gravity of the situation while examining a prompt solution, the Government of India has prioritised child nutrition through a well-defined policy architecture. At the center of it lies the POSHAN Abhiyaan, or Mission POSHAN 2.0, which adopts a convergent approach to consolidate multiple services and place a strong emphasis on maternal and child nutrition, acknowledging its central role in the development of the future generation.
One of their key elements is the Saksham Anganwadi and POSHAN 2.0 campaign, which has transformed around 57,000 Anganwadi centers into early childhood hubs and upgraded them to not only deliver nutrition but also to provide early childhood development (ECD) services, a link reinforced by the new National Framework for Early Childhood Stimulation (2024). This integration of responsive caregiving and stimulation with nutritional outcomes is a powerful strategy, creating a holistic delivery backbone for health and development.
Practical programmatic levers that deliver
It all begins with the mother’s nourishment. Essentials antenatal micronutrients, balanced energy protein along with breastfeeding support and counselling into the antenatal care (ANC) services are paramount to the 1,000 day window when the fetus’ brain is developing quickly and is vulnerable to low nutrition. This foundational focus ensures that the mother and her developing child receive the necessary nourishment from the very beginning.
Following childbirth- another crucial component includes transforming Anganwadis into nutrition and Early Childhood Development (ECD) hubs. Through the government’s Saksham Anganwadi initiative, these centers deliver age-appropriate hot meals, fortified take home rations while regularly monitoring growth by integrating early stimulation sessions alongside nutrition to support cognitive development.
Furthermore, the expansion of childcare facilities such as creches under the National Creche Scheme or Palna are crucial to enable mothers to pursue livelihoods without compromising daily nutrition or safe care, thereby addressing the issue from both a health and socio-economic perspective.
Effective implementation relies on data and digital monitoring. Platforms like the Poshan Tracker and digitised growth registers are indispensable tools for real-time monitoring. They help identify geographical hotspots with high nutritional needs, enable targeted interventions, and provide the necessary data to accurately evaluate the impact of these efforts.
The role of partnerships
While government initiatives provide the framework, civil society and philanthropic partners amplify the execution. Initiatives such as the government-Tata Trusts-led Swasth Bharat Prerak highlight the need for non-promotional technical assistance to support managerial capacity and implementation at the district level. This model of support, focused on innovation and on-ground execution, is a powerful complement to scale the states’ POSHAN efforts.
Need for policy recommendations
Prioritising maternal nutrition funding and using the first 1000 days as key performance metrics for the ANC and ICDS will ensure that the most vulnerable period of a child's development - conception to age two - receives the necessary financial and programmatic focus.
Investing in Anganwadi and creche workforce will enable professionalisation of these front-line workers through upskilling, improved honoraria and digital literacy which in turn will allow for efficient program delivery along with a higher quality of care.
As a final step, the seamless integration of nutrition with early childhood development, water and sanitation, along with female labour policies will create a supportive ecosystem that ensures access to quality and nutrition and fortified systems while enabling childcare, allowing mothers to participate in the workforce without compromising their child’s well-being.
Child nutrition: A moral and an economic imperative
Investing in nutrition from conception through early childhood is both a health obligation and an economic investment. It nurtures the effective building of brains and muscles, while preventing deficits, to equip the upcoming generation with a strong cognitive and physical foundation for resilience against future adversity. It also safeguards children’s rights, reduces social inequality, yielding substantial economic returns, including higher future earnings, productivity, and reduced healthcare expenditures. India’s policy architecture is in place; what we need now is a determined scale-up that aligns finance, workforce and data so every child gets the 1,000-day start they deserve.
The article was first published on page 23 of the October edition of expresshealthcare.in.
