Whether child nutrition is prioritized in Kerala? An exploration of the Integrated Child Development Services Programme

Abstract

Abstract Background Kerala, a southern state of India well-known for its human development, is lagging to tackle undernutrition among children below five years in the last decade even though one in five children experience at least one form of nutritional deficiency. The present paper examines the prioritization of child nutrition in the political agenda of Kerala and the implementation of the Integrated Child Development Services (ICDS) programme. Methods Thirty in-depth interviews with ICDS service providers and policymakers, and document analyses (ICDS Manual for District-level Functionaries − 2017, Legislative Assembly questions, and field diaries) were done. The interviews were conducted and transcribed in Malayalam and later translated into English. A thematic analysis of the interviews and content analysis documents were done. Results Major themes that emerged from the analysis were inadequate facilities; undue importance of perfect documentation rather than the operationalization of ICDS services; parents’ expectations about their children’s education; the helplessness of AWWs to persuade parents to give their children supplementary nutrition or send them to AWCs; job burden of AWWS and ICDS supervisors and the lack of earnestness with regard to the importance of adequate nutrition; cutting the budget for implementing ICDS; timely disbursal of allocated budget and stopping the training for AWWs; and poor cross-sectoral convergence were found to affect the achievement of nutrition goals of ICDS. Conclusion The study revealed that child nutrition is not a prioritised political agenda, which is reflected in the implementation of ICDS and services rendered through the programme. Parents’ perspectives on the need and functions of ICDS matter in terms of service utilization. Reforms without considering them will not help to achieve the objectives.