Is Child Nutrition a Priority in Kerala? An Exploration of the Integrated Child Development Services Programme

Background: Kerala, a southern state of India, is well known for its better health indicators, including child nutrition. However, the state’s efforts to tackle malnutrition have been relatively stagnant in the last decade. 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), the universal nutrition supplementation programme for children below five years in India. 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 conducted. Thematic analysis was done and the findings from interviews and document analysis were corroborated to generate final themes. Results: Location of the Anganwadi Centres (AWC) and inadequate facilities; undue importance of perfect documentation rather than the operationalization of ICDS services; parents’ expectations about their children’s education; helplessness of Anganwadi workers (AWW) 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 concerning 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: There are lacunae in implementing ICDS at many levels, from political will to ground-level hurdles faced by the Anganwadi workers in delivering the services. Priority to be given to real action rather than focusing on making the programme success on paper.