The Plate, Not The Ration

The sixth round of the National Family Health Survey, released in May 2026, reports a finding for Odisha that is easy to misinterpret. Stunting among children under five has fallen to 26.8 per cent, down from 31.0 in the previous round and roughly 45 two decades ago. That is better than the national 29.3, and for a state at our income level, it is creditable. In the same survey, wasting has risen from 18.1 to 22.1 per cent, and underweight from 29.7 to 31.6.

These are not contradictory numbers. Read together, they are a diagnosis, and a precise one.

Stunting is a cumulative deficit in height. It answers to everything surrounding a child over months and years: maternal nutrition, birth weight, sanitation, infection load, income, and antenatal care. All of those improved here. Institutional delivery is above ninety per cent; four or more antenatal visits have risen from 51.2 to 65.2 per cent over the decade; rotavirus coverage has risen from 36.4 to 85. 4. Stunting fell alongside them, as the science predicts.

Wasting answers on something narrower and more stubborn. It is a weight-to-height ratio, reflecting what a child ate this month and whether she was ill. That indicator has not changed in Odisha for twenty years. The survey explains itself through its dietary data: only about fifteen per cent of children aged six to twenty-three months receive what nutritionists call a minimum acceptable diet, and exclusive breastfeeding has fallen nationally from 63.7 to 55.8 per cent in four years. (Why it has fallen in Odisha is a question for another day: too few crèches in a state whose female labour force participation is rising faster than the national average, more caesareans, more mothers steered toward formula. Each is plausible, none is established, and the remedies do not overlap.)

The honest summary is that we have improved everything we could without altering the food's composition and have now reached the limit of what that yields. The plate remains predominantly cereal-based, in a country where cereals already supply between half and seventy per cent of dietary energy, and where the ICMR-National Institute of Nutrition's 2024 guidelines identify protein quality, not quantity, as the deficiency to correct.

One consequence should be stated early, because this is where good intentions do the most damage. The instinct when wasting rises is to send more food. But the cheapest way to lift weight-for-height is refined carbohydrate, which moves the indicator without improving the child and feeds the other burden the same survey records. High blood sugar among Odia women aged fifteen and above has risen from about 14 to 21.7 per cent, and among men aged twenty-five and above from about 17 to 26.6, in one inter-survey interval. In a population with fifteen per cent dietary adequacy, the answer to wasting is protein density, not calories.

Odisha's response has been assembling for two years and is more coherent than it is usually credited with being.

The Mukhyamantri Sampoorna Pushti Yojana, with ₹3,354 crore over five years and running across all 338 ICDS projects, focuses on composition rather than volume. It adds eggs, bananas, roasted chana and til ladoo to the basket alongside the premix and provides severely acutely malnourished children with thirty eggs a month for 112 days under Purna Aahaara. Where no Anganwadi reaches, Pada Pushti Yojana does. Unique to Odisha, it carries freshly cooked meals into scattered padas and tribal hamlets beyond a centre's catchment, so geography alone no longer decides which child eats. The Suposhit Odisha Mission, currently in operation, shifts accountability from the district to the Anganwadi, certifying individual centres and working towards all 74,224 of them. Its first phase is being verified by six thousand trained NSS volunteers, who are collecting data from nearly 23,000 centres.

That last detail matters more than it sounds, because it rests on two established principles. The first is positive deviance: find the centres already succeeding under the same constraints as their neighbours, name them, reward them, and let the method spread outward. It is a deliberate shift from a punitive register to a recognising one, and for a cadre of honorary workers already carrying more than we pay them for, it is the only register that will hold. The second is independence of assessment. The measure by which a centre is judged should never be set by the person being judged. Bring in an outside hand, and the number becomes worth acting on.

T2T2 (Target 2 Transform 2), our hotspot approach, begins with the fact that a state average of 26.8 per cent masks blocks and habitations with rates well above forty. Chronic energy deficiency stands at 37.7 per cent among adult men and 44.3 per cent among adult women in our Particularly Vulnerable Tribal Groups. Turning the tide one step at a time means sequencing those hotspots and consolidating each before the next. If we fix the order in advance, we get something the nutrition administration almost never has: an evaluable design.

Around these sit the early childhood instruments. AAROHAN carries children across the break between Anganwadi and school, where records and routines are currently completely discontinuous. Ama Kuni Pila focuses on responsive caregiving for under-threes, where complementary feeding fails more often due to practice than to availability. Mo Bikas Patra makes the child, rather than the scheme, the unit of record. The Ghare Ghare Kuni Calendar places age-indexed feeding advice on a household wall, available when the mother is deciding what to cook rather than when she is instructed. ADVIKA reaches adolescent girls, where the intergenerational chain of low birth weight begins.

The case for spending here is not sentimental. James J. Heckman, the Nobel laureate whose work addresses precisely this question, holds that "the highest rate of return in early childhood development" comes from investing as early as possible in disadvantaged children. His long-run evaluations estimate the annual return on comprehensive birth-to-five programmes at about 13 per cent per child, with a benefit-cost ratio above six. The programmes that produced these results combined health, nutrition, family engagement, childcare and early learning in a single package. That is a description of what Odisha is now assembling, and it is a rate of return with no infrastructure proposal before this government can match.

Three directions follow. Change the specification: the norm has been expressed in calories and grams of protein since 1975; procurement follows the specification; and a norm expressed as food groups per week would alter the plate faster than any campaign. Treat measurement as infrastructure, since every classification and referral rests on two numbers taken with an instrument nobody calibrates. And accept that the largest gain available lies within the household, not the Anganwadi: persuading a family to add an egg and a bunch of greens daily delivers more than the scheme does, every day, for years.

Odisha has never lacked commitment to nutrition. The survey now asks something harder, namely, an opinion about what people should eat and the willingness to defend it.

About the Authors: Ms. Mrinalini Darswal is an IAS officer and Commissioner-cum-Secretary at the Department of Women and Child Development, Government of Odisha. Hanut Lal, the co-author, is an International Baccalaureate Diploma Programme student at Heritage Xperiential Learning School.

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