State-level trends in infant and young child feeding practices and child undernutrition in India: An ecological analysis of three rounds of National Family Health Survey

Rajarshi Pandey & Rupsa Banerjee

Volume 2 Issue 3, September 2026

Abstract

Child undernutrition remains a major public health concern in India, despite sustained efforts over the past two decades. While national-level improvements have been reported, substantial variation persists across states. This descriptive ecological study analysed state- and union territory-level data from three rounds of the National Family Health Survey (NFHS-3, 2005–06; NFHS-4, 2015–16; and NFHS-5, 2019–21). Trends in underweight, stunting, and wasting among children under five years of age were assessed. States and Union Territories were classified based on underweight trajectories as either sustained decrease or mixed/increasing trend. Percentage-point changes were calculated for selected IYCF and maternal health indicators, and average changes were compared across state groups. In addition, selected social and contextual indicators were descriptively examined to provide a broader perspective on the enabling environment for child nutrition. Results showed that, at the national level, underweight and stunting declined across survey rounds, whereas wasting showed slower and less consistent improvement. Substantial inter-state variation was observed. States with sustained declines in underweight prevalence generally showed more favourable improvements in breastfeeding practices and maternal healthcare utilization compared with states showing mixed or increasing trends. However, anaemia among women remained persistently high. Social and contextual indicators, including women’s participation in decision-making, financial inclusion, and sanitation coverage, showed improvement over time, although adverse conditions such as spousal violence and low maternal BMI persisted. India has made measurable progress in reducing child undernutrition, but improvements remain uneven and incomplete. Strengthening maternal nutrition, improving early-life care, and addressing structural inequalities will be essential for achieving sustained and equitable improvements in child nutrition outcomes.

Keywords

Author information & Contribution

Rajarshi Pandey. Corresponding Author. Fellow Programme in Management (FPM) Scholar, International Institute of Health Management Research (IIHMR), Delhi, India. Email: rajlife.rishi@gmail.com

Rupsa Banerjee. Associate Professor. International Institute of Health Management Research (IIHMR), Delhi, India. Email: rupsa@iihmrdelhi.edu.in

"All authors equally contributed to the conception, design, preparation, data gathering and analysis, and writing of the manuscript. All authors read and approved the final manuscript.”

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Funding

Institutional Review Board Statement

Data and Materials Availability

AI Declaration

The authors used artificial intelligence tools (ChatGPT, OpenAI) solely for language editing, grammar correction, formatting assistance, and improving the clarity and readability of the manuscript. AI tools were not used to generate study data, conduct analyses, interpret findings, or develop the scientific conclusions of the study. All study design decisions, data analysis, interpretation of results, and manuscript content were independently developed and verified by the authors. The authors take full responsibility for the accuracy, integrity, and originality of the work.

Notes

Acknowledgement

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Cite this article:

Pandey, R. & Banerjee, R. (2026). State-level trends in infant and young child feeding practices and child undernutrition in India: An ecological analysis of three rounds of National Family Health Survey. Journal of Allied Health Sciences & Medical Research, 2(3), 1-21. https://doi.org/10.53378/jahsmr.353340