Today's Editorial

Today's Editorial - 28 December 2023

Growth charts — WHO standards versus India-crafted

News Excerpt:

Despite improved per capita income, health facilities, and nutrition in India, the country remains among the worst-performing nations in terms of stunting (low height for age) and wasting (low weight for height) among children below five years of age which presents the issues in how the 'normal' height-to-weight ratio is measured in Indian kids compared to Western countries. The article tries to look at the pros and cons of shifting from World Health Organization child growth standards to a nationally compiled one.

More About News: 

  • Basis of WHO Standards: The WHO Growth Standards, derived from the Multicentre Growth Reference Study (MGRS), aimed to set growth 'standards' rather than 'references'. This approach defined how children should ideally grow under healthy conditions. India was part of the WHO Multicentre Growth Reference Study (MGRS) in 2003, which established growth standards that are currently in use.
  • Sample Selection Concerns: Criticism arises due to the MGRS sample drawn from privileged households in India, representing an environment not reflective of the broader socio-economic diversity prevalent across India. Some experts advocate for revisiting local anthropometric measurements and establishing benchmarks based on indigenous characteristics to better gauge malnutrition in India. This raises doubts about whether these standards are applicable to all segments of the population.
  • Sampling and Norms Disparity: Surveys like the National Family Health Survey (NFHS) and the Comprehensive National Nutrition Survey (CNNS) show varying levels of stunting among children under five, using WHO standards for assessment. Stunting is a reflection of chronic undernutrition during critical growth periods. Comparing the MGRS standards with prevalent studies in India could be misleading, as the former included specific interventions like counseling for appropriate feeding practices, absent in other surveys.
  • Genetic and Maternal Influence: The debate includes concerns about genetic growth potential, maternal heights, and the intergenerational transmission of poverty influencing child growth. These factors are non-modifiable and indicative of an environment of deprivation.
  • Regional Disparities: Variances in stunting prevalence among different states within India, as well as progress in reducing stunting, suggest that environmental factors and socio-economic development play significant roles in child growth.
    • Regional differences within India, both in the prevalence of stunting as well as increases in adult heights, also indicate that some States such as Odisha, Chhattisgarh, Tamil Nadu and Kerala are achieving much faster reductions than others.
  • Overdiagnosis Concerns: Overestimation of undernutrition might lead to misdiagnosis and potential overfeeding under government nutrition programs, contributing to overweight/obesity issues. However, the quality of existing nutrition schemes needs improvement to address dietary gaps effectively.
    • Nevertheless, given the dietary gaps that children have and the poor coverage of schemes such as mid-day meals and supplementary nutrition in anganwadis, such fears appear largely unwarranted. 
    • Indeed, the quality of the meals under these schemes must be improved to ensure that they are not cereal-heavy, include all nutrients, and contribute to dietary diversity. 
    • Recommendations such as including eggs in meals for children and pulses in the Public Distribution System must be acted upon urgently. 
    • It is also well understood that along with improving diets, multiple interventions such as better sanitation, access to health care, childcare services and so on are required for better nutritional outcomes.
  • Comprehensive Approach Needed: Addressing nutritional outcomes requires not just dietary improvements but also interventions in health, sanitation, education, women's empowerment, and poverty alleviation.
    • These goals are inextricably linked to the overall development of the country, with equitable distribution of resources.
    • It is relevant to acknowledge that individual children grow uniquely, and trained child health personnel such as treating physicians can apply judgement calls on the interpretation of growth charts in the context of individual children in their care.
    • Using the appropriate standards is also important for international comparisons and intra-country trends — an advantage that would be lost with any new country-specific standard.
  • ICMR's Response: The Indian Council of Medical Research has formed a committee to reconsider growth references for India and may conduct a comprehensive study to potentially devise national growth charts.
    • India-Specific Growth Charts: ICMR has been instrumental in developing India-specific growth charts widely used by pediatricians across the country. These charts consider the unique growth patterns observed in Indian children compared to those in Western countries.
  • Different Growth Patterns: Indian children exhibit a slightly different growth pattern compared to children in Western countries. Growth in Indian kids is relatively slower up to the age of four, picking up around four or five years of age, which might affect how their growth is measured against international references.
  • Parameters for Normal Development: The new variants of growth charts for Indian children now consider the height of the parents to determine a normal range for a child's growth, providing valuable insights for assessing development.
  • Importance of Growth Charts: These charts aid in identifying deviations in growth and development. If a child's growth falls outside the acceptable range, early medical intervention can help improve their height and weight.
  • Observations from Studies: Studies conducted between 1988-89 and 2015 revealed an increase in average height for boys by 1.7cm per decade and a lower increase for girls at 0.5cm per decade. This disparity might be attributed to factors such as nutrition and access to health facilities.
  • Recommendation: While acquiring updated data is crucial, maintaining the high yet achievable standards set by the WHO-MGRS is suggested for continuity in assessing population trends, international comparisons, and intra-country analyses.


There is a need to understand that growth standards should ideally depict how children should grow under optimal conditions, not just how they have grown historically. The debate regarding the utilization of WHO Growth Standards in India encompasses concerns about representativeness, genetic influences, disparities across regions, potential misdiagnosis, and the necessity for a holistic approach to address child undernutrition. While seeking updated data, maintaining standards aligned with international benchmarks appears prudent for now.


Mains PYQ

Q. There is a growing divergence in the relationship between poverty and hunger in India. The shrinking of social expenditure by the government is forcing the poor to spend more on non-food essential items squeezing their food budget. Elucidate. (UPSC 2019)

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