Geographic Disparities in ICDS Implementation and Child Malnutrition in India

Abstract

This study investigates the socioeconomic, demographic and geospatial factors influencing the utilisation of Integrated Child Development Services (ICDS) and the prevalence of malnutrition among children under five in India. Using data from the National Family Health Survey (3 & 4), which includes a nationally representative sample of 238,945 children aged 0–59 months from 601,509 households, the findings highlight a slow decline in malnutrition rates, with stunting and underweight prevalence reducing by 9 per cent and 7 per cent respectively since NFHS-3 was conducted a decade ago. Analysis of spatial variation reveals significant clustering in ICDS utilisation and malnutrition, strongly associated with maternal education levels, higher proportions of scheduled castes and scheduled tribes and children of higher birth orders (three or more). Regression models incorporating spatial weights significantly improved predictive accuracy, underscoring the role of geospatial determinants in shaping health outcomes. Key factors negatively impacting children’s nutritional status included maternal low body mass index, low birth weight, higher birth order and caesarean deliveries, all exhibiting notable spatial dependence with stunting and underweight. These findings underscore the need for geographically targeted, equity-focused interventions to enhance ICDS utilisation and address persistent disparities in child nutrition outcomes across India.