Early life nutrition sets the stage for the health, nutrition, and development of young children. Optimal infant and young child feeding (IYCF) practices begin with timely initiation of breastfeeding, followed by exclusive breastfeeding and complementary feeding. This Data Note provides an overview of trends and patterns in IYCF practices in India at the national-, state-, and district levels based on the 2015-16 and 2019-21 National Family Health Surveys (NFHS) data. IYCF indicators were created following World Health Organization and UNICEF’s 2021 guidelines.

Appropriate nutrition during early life, coming mainly from adequate infant and young child feeding (IYCF) practices, is essential for optimal growth and development. This Data Note describes the trends and patterns in key IYCF practices and food consumption patterns among children, summarizing state and district data from the third and fourth rounds of National Family Health Surveys (2006 & 2016).

BACKGROUND| Healthy diets are necessary for optimal growth and to carry out daily mental and physical tasks. Unhealthy diets drive all forms of malnutrition and dietary risks are the number one risk factor globally for deaths and disability (Global Burden of Disease collaborators, 2019). Given the importance of diet as a key driver of health and wellbeing, this Data Note examines available data from three rounds of India’s National Family Health Surveys (NFHS) on food consumption patterns of adult men and women. MEASUREMENT| NFHS asks women (15-49 years) and men (15-54 years) how frequently (daily, weekly, occasionally or never) they consume nine food groups including two unhealthy food groups (Figure 1). The 2020 Nutrient Requirements for Indians outlines the quantity per day of vegetarian foods to be consumed as part of a balanced diet (ICMR-NIN, 2020). The guidelines indicate that pulses can be replaced with animal-source foods for non-vegetarians. Thus, for this Data Note we constructed an additional indicator –daily consumption of pulses or egg or fish or chicken or meat –to estimate any protein consumption (Figure 1). Estimates are first presented at the national level to provide an overall view of how diets have changed from 2005-06 to 2019-21. On subsequent pages, we show trends between 2015-16 and 2019-21 by state and district. USE| This data note provides a broad view of diet patterns among adults and should be used for further inquiry by stakeholders including researchers, policymakers, and program staff at multiple levels. We recognize that NFHS is not a detailed dietary survey and does not ask about individual food items or the quantity of food consumed. Thus, this data note should be used as a starting point for discussion and to identify major areas of improvement in consumption and measurement.

Nutrition-specific interventions are aimed at improving the food, health, and care environment for women and children during the first 1000 days. These interventions span pregnancy, postnatal, and early childhood periods and include food and micronutrient supplementation, nutrition education and/or counselling, growth monitoring and promotion, as well as routine immunization, deworming, and care during illness. At 90% coverage, these interventions can contribute to 20% reduction in stunting and 61% reduction in severe wasting. India’s policy framework for health and nutrition is robust and includes most evidence-based nutrition and health interventions. Two large-scale national program platforms – the Integrated Child Development Services and the National Health Mission – together deliver these interventions across the country. India’s efforts at scaling up nutrition interventions are now also bolstered by the National Nutrition Mission. This Data Note describes the coverage of key nutrition and health interventions for which data are available in the National Family Health Surveys for 2015-2016 and 2019-2021. To examine coverage of interventions, indicators were created based on global definitions and making adaptations to Indian policy context where necessary. Data on women of reproductive age (15-49 years) with a child below five years of age from the most recent birth was used to compute these indicators. Indicator definitions are provided in Annex 1 of this Note.

A set of global nutrition targets for maternal and child nutrition together with diet related non communicable diseases ( to be achieved by 2025 was endorsed by the World Health Assembly in 2013 These targets provide goals against which progress towards ending malnutrition in all its forms can be measured and contribute to the Sustainable Development Goals This data note describes trends in multiple forms of malnutrition and NCD outcomes at the national, state, and district levels for India using survey data from NFHS 3 2005 06 NFHS 4 2015 2016 and NFHS 5 2019 2021 Insights on other malnutrition targets such as anemia and breastfeeding will be forthcoming

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A set of diet-related global non-communicable diseases (NCD) targets, to be achieved by 2025, was endorsed by the World Health Assembly (WHA) in 2013. A sub-set of those targets are directly nutritionrelated. This Data Note describes the current levels of a set of key NCD-related outcomes at the districtlevel in India, summarizing data from the recently released district fact sheets of the National Family Health Survey.