Utilization of Integrated Child Development Services (ICDS) and its linkages with undernutrition in India

The Integrated Child Development Services (ICDS) programme has been the central focus of the POSHAN Abhiyaan to combat maternal and child malnutrition under the national nutrition mission in India. This paper examined the linkages between utilization of ICDS and underweight among children aged 6-59 months. The study utilized data from two recent rounds of the National Family Health Survey (NFHS-4 [2015-2016] and NFHS-5 [2019-2021]). Descriptive analyses were used to assess the change in utilization of ICDS and the prevalence of underweight at the national and state levels. Multivariable logistic regressions were performed to examine factors associated with the utilization of ICDS and underweight. Linkages between utilization of ICDS and underweight were examined using the difference-in-differences (DID) approach. Utilization of ICDS increased from 58% in 2015-2016 to 71% in 2019-2021. The prevalence of underweight decreased from 37% to 32% in the same period. Changes in ICDS utilization and underweight prevalence varied considerably across states, socioeconomic and demographic characteristics. Results from decomposition of DID models suggest that improvements in ICDS explained 9%-12% of the observed reduction in underweight children between 2016 and 2021, suggesting that ICDS made a modest but meaningful contribution in addressing undernutrition among children aged 6-59 months in this period. This study examines linkages between Integrated Child Development Services (ICDS) utilization and underweight in 6-59 months old children in India, using nationally representative data. ICDS utilization increased by 13 pp and underweight prevalence decreased by 5 pp during 2016-2021. Improved ICDS coverage accounts for 9%-12% of observed underweight reduction, signifying a modest yet meaningful role in addressing child undernutrition. image Utilization of ICDS services among children aged 6-59 months increased from 58% (2015-2016) to 71% (2019-2021) nationally. The programme's expansion was prominent in urban areas, showcasing progress across states. The prevalence of underweight among children in India declined by 5 percentage points from 2016 to 2021, but almost one-third of children are still underweight. Increase in coverage and service delivery strengthening of ICDS explained 9%-12% of the observed reduction in underweight between 2016 and 2021. The findings suggest that optimizing quality of interventions under ICDS can have a modest but meaningful contribution in reducing childhood underweight in India.