The Government of India has stated that malnutrition is not recorded as a direct cause of infant and child mortality in official data, a clarification that has drawn attention to how child deaths are classified and addressed in the country. The information was shared in a written reply in the Rajya Sabha by Minister of State for Women and Child Development Savitri Thakur.
According to data from the Sample Registration System of the Registrar General of India, the leading causes of infant and child deaths are linked mainly to medical and birth related conditions. These include prematurity and low birth weight, which account for over 30 percent of deaths, followed by pneumonia at 16.3 percent. Other documented causes include birth asphyxia and trauma, diarrheal diseases, fever of unknown origin, injuries and causes that remain ill defined.
The minister clarified that while malnutrition remains a serious public health concern, it is not specifically recorded as an individual cause of death in the mortality classification system. Instead, deaths are attributed to immediate medical causes such as infections or complications related to birth.
Despite this classification, the government stressed that it continues to treat malnutrition as a critical issue affecting child health outcomes. Savitri Thakur highlighted that multiple nutrition schemes have been merged under Mission Saksham Anganwadi and Mission Poshan 2.0 to strengthen delivery and monitoring across the country.
The mission follows a multi sectoral approach involving more than 18 ministries and departments. It focuses on improving nutrition, healthcare access, sanitation, drinking water and education, all of which influence child survival and growth.
Under the programme, supplementary nutrition is provided to children aged six months to six years, as well as to pregnant women, lactating mothers and adolescent girls between 14 and 18 years of age. These services follow updated nutritional norms under the National Food Security Act.
Explaining this distinction, public health expert Dr. Suneela Garg, MD Community Medicine, noted,
“Malnutrition makes children vulnerable to many diseases and infections. The direct cause becomes the immediate event responsible, though in underlying causes malnutrition should also get reflected.”
To address micronutrient deficiencies, the government has introduced fortified rice in supplementary meals and promoted the use of millets as a nutritious alternative. A joint protocol issued by the Ministries of Women and Child Development and Health and Family Welfare outlines guidelines for identifying and managing malnutrition in children, including severe and acute cases.
Around two lakh Anganwadi Centres have been approved for upgradation into Saksham Anganwadis to improve service delivery. The Poshan Tracker, a digital monitoring system, has also been rolled out to track beneficiaries and ensure timely nutrition support.
MedBound Times connected with Dr. Deepika Bishnoi, MD Community Medicine:
The statement in the said news is technically correct but contextually incomplete.
In India’s official mortality classification (SRS cause-of-death reporting), malnutrition is rarely coded as the direct cause of death.
Instead, deaths are attributed to immediate causes like pneumonia, diarrhoea, prematurity, sepsis, or birth asphyxia.
However, malnutrition operates silently in the background.
In your clinical experience, how often does malnutrition act as an underlying factor in infant or child deaths, even if it is not listed as the direct cause?
Very frequently especially in urban slums and vulnerable populations. At the grassroots level, we routinely see children who are underweight or wasted, have recurrent infections, present late to healthcare facilities, deteriorate rapidly despite treatment.
In many such cases the death certificate may say pneumonia or diarrhea, but the child had chronic undernutrition, low immunity, and poor physiological reserves
Globally, studies estimate that undernutrition contributes to ~45% of under-five deaths, even though it is rarely named as the cause. So clinically speaking, malnutrition is very often the invisible co-factor.
Do you think current mortality data in India adequately captures the real impact of malnutrition on child health outcomes?
No because the system captures “what killed the child,” not “why the child couldn’t survive.”
Reasons could be
Single-cause reporting: Only one cause is recorded, contributing factors are almost always ignored
Verbal autopsy constraint- Nutritional status is difficult to quantify retrospectively
Under-recognition of chronic malnutrition: Especially stunting, which doesn’t look acutely sick
How does malnutrition influence a child’s ability to recover from pneumonia, diarrhoea or low birth weight?
Malnutrition affects recovery at multiple biological level like in Pneumonia it reduces immune response, there is poor muscle strength leading to weaker breathing effort and higher risk of treatment failure. For Diarrhoea there is Gut lining damage, leading to poor absorption & prolonged illness, faster dehydration and electrolyte imbalance. In Low Birth Weight & Prematurity there are limited energy reserves with higher risk of hypothermia, infections and poor growth catch-up.
From a public health perspective, what changes are needed in how malnutrition is identified, recorded or addressed in child mortality data?
1. Recognise malnutrition as a contributing cause by making sure to strictly following the MCCD protocol where in contributing factors are recorded
2. Link nutrition surveillance with mortality data for example nutritional status before death should be reviewed in Child Death Reviews (CDRs)
3. Poshan Tracker + HMIS + child death review systems can be the areas for implementing integration, but taking into consideration the contributing factors as well.
4. Earlier identification of wasting and growth faltering
5. Treating not just by food supplementation, but contributing factors as well:
Infection control
Maternal nutrition
Safe water & sanitation
Care-seeking behaviour
The government also highlighted targeted interventions under the PM JANMAN Mission, which focuses on Particularly Vulnerable Tribal Groups across 18 states and one Union Territory. The initiative includes 11 key interventions implemented by nine ministries, including Women and Child Development.
As part of this effort, 2,500 new Anganwadi Centers have been sanctioned, with Maharashtra receiving approvals for 178 centers to improve access to nutrition and early childhood care services in underserved areas.
(Rh/ARC/MSM)
