Growth charts — WHO standards versus India crafted – Debate on Child Undernutrition in India: Analyzing the Use of WHO Growth Standards | 28 December 2023 | UPSC Daily Editorial Analysis

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What's the article about?

  • It talks about the issue surrounding the child undernutrition in India.


  • GS2: Welfare Schemes for Vulnerable Sections of the population by the Centre and States and the Performance of these Schemes; Mechanisms, Laws, Institutions and Bodies constituted for the Protection and Betterment of these Vulnerable Sections


  • India faces a persistent challenge: high levels of child undernutrition. To monitor progress and guide interventions, the country relies on World Health Organization (WHO) Growth Standards to measure malnutrition. However, recent debates have questioned their suitability for India's unique context.
  • This analysis explores the arguments for and against using these standards, considering genetic differences, sampling concerns, and potential overdiagnosis.


  • On Using the MGRS as the Base: The WHO standards are based on the Multicentre Growth Reference Study (MGRS), which aimed to define growth patterns in children with optimal environments. However, critics argue that:
    • Sample Bias: The MGRS sample from India came from privileged South Delhi households, potentially overestimating the expected growth of the general population.
    • Misleading Comparisons: Datasets like NFHS lack the “favorable environments” criteria of MGRS, making direct comparisons misleading.
    • Study Design Differences: MGRS included interventions like feeding counseling, absent in standard surveys like NFHS, further complicating comparisons.
  • Genetic Growth and Maternal Heights: Another concern is the influence of genetic factors and maternal heights on child growth. Critics argue that:
    • Individual Variations: Maternal height is non-modifiable, limiting potential improvement in a single generation.
    • Deprivation Marker: Low average maternal heights reflect intergenerational poverty and women's status, highlighting environmental deprivation.
    • Standard Plasticity: The “one-size-fits-all” standard might be inaccurate considering genetic variations and maternal heights.
  • Counter-arguments: Despite these concerns, proponents of the WHO standards highlight:
    • Success Stories: Countries with similar economic conditions have achieved significant stunting reduction using these standards.
    • Regional Differences: India's own states show varying rates of stunting reduction, suggesting room for improvement within the existing framework.
    • Dynamic Gene Pools: Population-level genetic shifts occur with development, as shown by increasing average heights in countries like Japan.
    • Unwarranted Overfeeding Fears: Dietary gaps and poor program coverage make overfeeding less likely than feared.
    • Focus on Trends and Comparisons: The standards are primarily used for understanding population trends and comparisons, not individual diagnoses.
  • ICMR Recommendation and Conclusion: The Indian Council of Medical Research (ICMR) is considering revising the national growth references. However, this analysis suggests a cautious approach:
    • New Data Welcome: Conducting a rigorous study to understand child growth patterns in India is valuable for future reference.
    • Stick with WHO Standards: Given the advantages of comparability and potential for improvement within the existing framework, sticking with the WHO standards for now might be prudent.
    • Multi-pronged Approach: Regardless of the chosen standards, addressing broader determinants like poverty, education, and sanitation is crucial for long-term success in tackling child undernutrition.

Way Forward:

  • The debate on the use of WHO Growth Standards in India is complex, involving issues of sampling, genetic potential, and the potential misdiagnosis of undernutrition. While the ICMR has recommended a revision of the growth references for India, the article suggests that sticking to the WHO-MGRS standards may still be beneficial, provided that they are used in conjunction with improved interventions to address undernutrition.

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