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In accordance with the “National Policy for Children”, the “Integrated Child Development Services” (ICDS) Scheme was launched on October 2, 1975. (NSC). The state ensures a child's physical, mental, and social development before, during, and after birth. As a result, the Scheme sought to provide holistic development for children aged 0 to 6 years, as well as pregnant and lactating mothers. India's performance on important child development and health measures fell short of expectations in these and other areas.

“The Infant Mortality Rate (IMR) was 48 per 1000 live birth and the Child Mortality Rate (CMR) 63 per 1000 live birth in 2010 as against the targets of 30 and 31 respectively. These indicators (IMR and CMR) for the neighboring countries were: China (IMR: 16, CMR: 18) and Sri Lanka (IMR:14, CMR: 17).” In industrialized countries, the IMR and the CMR were as low as 5 and 6 respectively. Further, 43 per cent children were underweight in India during the period 2006-10 and 16 per cent children were severely underweight. These indicators (underweight and severely underweight children) when compared to the neighboring countries viz. Bangladesh (41 and 16) and Sri Lanka (21 and 4) or even with sub-Saharan Africa (20 and 7), were poor. About a decade ago, our audit report on ICDS (No. 3 of 2000 (Civil)) had revealed that the policy of universalization of ICDS Scheme remained unattained and the scheme could not achieve the desired goals.

The formation of the National Children’s Board and the 1974 National Policy for Children Resolution demonstrates the government's concern for the growth and development of pre-school children (Govt. of India, 2009). Several expert bodies have been formed to develop child welfare policy. These committees gathered data on children's needs and concerns, evaluated current programs and services, and proposed long-term activities to qualitatively and quantitatively improve and strengthen them.

Supplemental nutrition is the most visible and well-known service provided by the ICDS. It also offers other services that are probably more important and should be investigated. The ICDS program covers dietary supplements, preschool education, immunizations, referral services, and nutrition and health counseling. The ICDS system has recently gained popularity. In policy and civil society discussions, particularly after the “National Family Health Survey” (NFHS-3) indicated that 46% of children under the age of three were underweight. Worse, the number has stayed nearly unchanged since 1998-99, when the most recent NFHS-2 survey found that around 47 percent of children under the age of three were underweight. Because of the country's poor nutritional outcomes for children, the ICDS program must be rapidly extended and improved in terms of both coverage and quality.

A study by Jyoti Kumari and Venugopal (1985)was conducted to (I) measure environmental deprivation and ‘HOME’ (Home Observation for Measurement of Environment) stimulation provided to pre-school children and (ii) assess their nutritional status in relation to these factors.

The study was conducted in three anganwadis located in three slums (Singirigunta, Bandlamitta and Indira Nagar) of the urban ICDS block Tirupati. The study was undertaken on 144 pre-school children attending the anganwadis. A socio-economic sufficiency interview schedule and a modified version of Prolonged Deprivation Scale (PDS) of Gireswar Mishra and Tripathi were used to assess Socio-economic and environmental deprivation of pre-school children. ‘HOME’ inventory for preschoolers of cold well and Bradwell and Bradley (1979) was used to measure their home stimulation.

Nutritional status of children was assessed by calculating one-day (weighment) dietary intake by clinical examination and by taking anthropometric measurements like height, weight, head, chest and mid-arm circumference. indices like weight-for-age, height-for-age and weight-for-height were used to assess the nutritional status. The ICMR standard was used to assess the degree of malnutrition among well to do children and then the results were compared with the Harvard Standard. All the 104 children were below the 50th percentile of the ICMR standard for ail the five measurements.

In a study of urban ICDS block found that 97 per cent of children belonged to the deprived level of environment as measured by Prolonged Deprivation Scale (PDS) of Gireswar Mishra and Tripathi and 90 per cent children had very poor home stimulation. The homes were found to provide least stimulation. All the children were below the 50th percentile of the ICMR standard for measurements like height, weight, head, chest and mid-arm circumference.

A study by ChaMadar, Rao and others (1984)was conducted in 14 anganwadis, of which 12 were located in the rural ICDS block Udupi and two in the rural ICDS block Karkalla district, Dakshin Kannada, Karnataka. 378 children in the age group of 1 to 6 years were examined from total of 560 children registered in the anganwadis. Of these, 186 were boys and 192 were girts. A majority of children (72.6 per cent) were in the age group of 3 to 5 years.A study by ChaMadar, Rao and others (1984) was conducted in 14 anganwadis, of which 12 were located in the rural ICDS block Udupi and two in the rural ICDS block Karkalla district, Dakshin Kannada, Karnataka. 378 children in the age group of 1 to 6 years were examined from total of 560 children registered in the anganwadis. “Of these, 186 were boys and 192 were girts. A majority of children (72.6 per cent) were in the age group of 3 to 5 years”.

The control group comprised of 547 children below the age of five years selected from non-ICDS area, of which 260 were boys and 287 were girts. Anthropometric measurements of all the children such as height and weight were recorded and compared with national average. Their nutritional status was also assessed and the malnourished children were graded according to the recommendations of the Nutrition sub-committee of the Indian Academy of Pediatrics. The immunization status was assessed from the records maintained by AWWs.

The services provided in the anganwadis were not utilized by expectants and nursing mothers, as they were not registered. The results showed that the mean height of ICDS and non-ICDS children in the age group of two years and above was significantly higher when compared with the national average. Again, the mean height of ICDS group was more as compared to non-ICDS group but the difference was not significant in the age groups 1 to 2 years and 3 to 4 years.

There was no significant difference in weight of ICDS and non-ICDS children in ail the age groups. However, there was a marginal difference in weight in the age group 3 to 4 years and 4 to 5 years when ICDS and nonICDS children were compared with national average. The nutritional status of ICDS non-ICDS children was not significantly different. The children from ICDS area were immunized with OPV (66.4 per cent) DPT (68 per cent) and BCG (41.6 per cent) vaccines. The immunization coverage was good but considering that the registered anganwadi children constituted only 25 percent of the child population, the benefits of immunization were derived by only 10-16 percent children in the age group 0 to 6 years.

Sunder Lal (1981)undertook a study to know the enrolment pattern and dropout rate of children who had attended the anganwadis in their early childhood.

The study was conducted in four villages of the rural ICDS block Kathura, Haryana. The sample comprised 1707 children who had left the anganwadis between 1977 and 1981. The parents and 28 primary school teachers were interviewed to assess the performance of the children in school. School enrolment date was corroborated with the number of children completing six years and leaving the anganwadis. The teachers were given a 15-point scale to ascertain the scholastic performance of the children. Date regarding enrolment and dropouts was also analysed in relation to variables like sex and caste. The duration of stay of the children in the anganwadis ranged from six months to three years. The results indicated that 70 per cent children who had received pre-school education in the anganwadis were enrolled in the Primary School. Enrolment of children was slightly better in the higher caste (82 per cent) than in the economically weaker sections (80 per cent). The enrolment of male children was higher than that of female.

Over 80 per cent children who had received pre-school education in the anganwadis were well adjusted and their scholastic performance was better as compared to other children. Forty percent children had dropped out of school over a period of four years. The dropout was maximum in the first two years of schooling.

Muralidharan and Kaur (1987)conducted a study to assess the relationship between indices of physical, language and cognitive development of tribal pre-school children. The study was conducted in 12 randomly selected anganwadis of the tribal ICDS Block in Tokapal, district Bastar, Madhya Pradesh. “Twelve children in the age group of 3 to 6 years with an equal sex representation were selected randomly from each anganwadi thus making a total sample of 144 children. The indices for language development were object vocabulary, action picture reading, oral expansion, listening comprehension and acquaintance with environment.” The cognitive indices included sequential thinking, time perception, shape discrimination and color discrimination. Children were also examined physically and their height, weight, mid-arm and head circumference were recorded.

The study's findings revealed that the relationships between weight and language and cognitive development of children were not significant for three years old children. However, they were significant for four-year-olds in all the cognitive tests and in two language tests (action picture reading and listening comprehension) and in the case of five-year-old’s, they were so for all language tests except listening comprehension but it did not reach the level of significance in two cognitive tests (time perception and sequential thinking). In the case of three- and four-years old children the correlation with height proved significant in three out of five language tests and in two out of four cognitive tests. Similarly, correlation proved significant in three language tests and one cognitive test in five years old children. Significant positive relationships were found between mid-arm circumference and only two cognitive tests i.e., color and Shape Discrimination. Significant positive relationships were also found between head circumference and color discrimination and sequential thinking scores amongst the cognitive tests and action picture reading and listening comprehension scores amongst language tests.

Data from Kerala, Maharashtra, Rajasthan and Uttar Pradesh as well as from other states yield very little evidence that these healthy behaviors are more common in villages with AWCs than without (Breden and Akin 2004). It is with this view; the present study was carried out to know what the perceptions of the people about Anganwadi Centers are so that program can be improved accordingly.

A research plan is created to collect and analyze fresh data in order to interpret previously existing information in a novel way. Making suitable accommodations for systematic research activity is part of the process of preparing a study design. The researcher plans the numerous procedures while keeping in mind the theoretical framework and the availability of the necessary resources.

i. Study design: Cross-sectional study.

ii. Study site: Kakori Block of Lucknow district, UP.

iii. Sample selection: Mothers/fathers whose children were attending the Anganwadi centre to receive the ICDS scheme.

The present study was carried out in Lucknow district where ICDS Scheme has been in operation since1981.“Lucknow is centrally placed district of Uttar Pradesh, spread over an area of 2528 sqkms, which constitute 0.85% of the total area of country. In 2011, the district Lucknow has a population of about 4,588,455.” There are 906 females per 1000 males.

iv. Study Unit: Village with an Anganwadi center. The mothers/Fathers of children of age 3-6 years in the selected village of Kakori block constituted the unit of the study.

v.Selection of Block: There are 9 blocks in Lucknow district. Out of 9 blocks, one block namely Kakori, was selected randomly for the present study.

vi. Selection of Respondent: The primary respondent of the child was mother. In absence of mother, grandmother/father of the child was interviewed.

vii. Study Instruments: The study was carried out using a quantitative instrument. The quantitative instrument was used to collect the information on demographic profile of the respondents, dietary pattern of the child and anthropometric parameters. The information was also collected regarding the perception about the program particularly regarding various aspects, of the program including limitations as well as recommendation for improvement. The information was collected by a pre-designed & pre-tested questionnaire developed for this purpose.

The quantitative data so collected was entered in the Microsoft Excel computer program. The data was cleaned for any inconsistency. Proportions/percentages were calculated. And presented in pie-Diagrams and Bar graphs.

A total of 150 mothers/Father of children were interviewed of which 100 mothers/Father of children utilizing the ICDS services and 50 mothers/fathers of children were not utilizing the ICDS services. Thus, the data on 100 mothers/fathers is being analyzed and presented in this paper.

Socio-demographic characteristics of the respondents

The majority of the respondents belonged to Hindu (82%) community followed by Muslims (18%) and belonged to SC/ST category (54%). About more than half (62%) of the respondents were from nuclear type of family and38 percent of them were from joint type of family. Majority (64%) of the respondents had 5 and above family size. (14%) respondents were illiterate and 14 percent were educated up to junior high school. Almost one third were involved in agriculture (32%) and more than one third in business (40%) and 8% were laborers. About 35% had family income below Rs.3000 per month and only 8 percent had above Rs.5000. Majority (62%) of the respondents belonged to lower socio-economic status (SES) followed by middle (28%) and upper (10%) (Table-1).

Table-1: Socio-demographic - characteristics of the respondents

Socio-demographic characteristics	No. (n=100)	%
Religion
Muslim	18	18
Hindu	82	82
Caste
SC/ST	54	54
OBC	16	16
General	30	30
Type of family
Nuclear	62	62
Joint	38	38
Family size
<5	36	36
>5	64	64
Education
Illiterate	32	32
Junior high	14	14
school
High school	24	24
Intermediate	16	16
Graduate & above	14	14
Occupation
Agriculture	32	32
Business	40	40
Labor	08	08
Service	20	20
Family income per month (in Rs.)
<3000	33	33
3000-4000	18	18
4001-5000	24	24
>5000	19	19
Socio-economic status
Lower	62	62
Middle	28	28
Upper	10	10

 

1.6 Perception about services offered by AWCs

“About one third (30%) of the respondents perceived that the purpose of enrolment atAWCs of their children was learning.” However, 62% perceived that they get enrolled their children to take food. Very less (8%) of the respondents said that they get enrolled their children because there was nobody at home to take care of children (Table-2).

Table-2: Perception about main services offered by AWCs

Services of AWCs	No. (n=100)	%
To avail food	62	62
For Education/learning	30	30
No body at home to take car of child	08	08

 

1.7 Amount and frequency of food items received/ consumed

More than half (63%) of the respondents viewed that their children received one full glass measured (approx. 80 grams) per day. However, 23 percent of them viewed that they did not weigh the food items received and 10 percent viewed that their children received only one glass (approx. 50 grams) per day. More than half (64%) of the respondents viewed that their children received food items at AWC 6 days in a week.

However, 14 percent told that their children receive5 days in a week and 10 percent told that their children received 4 days in a week.  Only 12 percent of the respondents viewed that their children received food items 3 days in a week. “More than half (68%) of the respondents viewed that their children consumed food items at the AWCs itself and 23 percent viewed those children brought partially at home. However, 9 percent of them viewed that they brought all the food items at home whatever they received. More than one third (45%) of the respondents viewed that the food items given to the children was not good in taste.” However, 23% viewed that it was not properly cooked and 32% perceived that it was palatable (Table-3).

Table-3: Perception towards food items Received

N0. (n=100)	%
Amount of food received
One full measure	63	63 (approx.80 gram)
% Of measure	10	10 (approx.50 gram)
Not measured amount	23	23
Do not know	4	4
Frequency of receiving food/ week
3 days	12	12
4 days	10	10
5 days	14	14
6 days	64	64
Consumption pattern
Consumed at AWCs	68	68
Partially brought to home and shared	23	23
Bring it to home and shared with others	09	09
Quality of food
Not good in taste	45	45
Not properly cooked	23	23
Palatable	32	32

1.8 Benefits of AWCs

Majority (82%) of the respondents viewed that there were the benefits of AWC in the village. The main benefit was receiving additional nutrition (53%) for the children followed by learning (23%), immunization (12%) and child became healthy (12%) (Table-4)

Perception about Benefits	(n=100)	%
No Benefit	18	18
Yes Benefit	82	82
Specific Benefits
Additional nutrition	53	53
Education/Learning	23	23
Immunization	12	12
Child becomes healthy	12	12

 

1.9 Discussion and Conclusions

The ICDS scheme after 35 years of its existence and progressive expansion has entered in to a new and more exciting phase for the mother's and child care.

Nutritional inadequacies in any or all of these categories are detrimental to health, cognitive function, and academic achievement. All of these elements have an impact on an individual's productivity, income, and hence standard of living.ln the present study, 63percent of the respondents viewed that their children received one full glass measured (80 grams) per day. However, 25 percent of them viewed that they did not measure the food items received and 10 percent viewed that their children received only 3/4 of one measured (approx. 50 grams) per day. “However, Sobha (2003) reported that from 7th month onwards, the child received approx. 80 grams of supplementary food daily and if the child was in 3rd& 4thgrade of malnutrition, they received double the share of food”.

Kumar (2008) reported that high calorie food was given for four days whereas, semi-cooked amylase energy rich food was given for two days in a week and supplementary food was given for 300 days in a year. However, in our study, 14 percent told that their children received 5 days in a week and 10 percent told that their children received 4 days in a week. “Only12 percent of the respondents viewed that their children received food items 3 days in a week.  In our study, 45% of the respondents viewed that the food items given to the children was not good in taste.” However, 23% viewed that it was not properly cooked and only 32% perceived that it was palatable. “Dash et al (2006) reported that 92% mothers mentioned that the quality of food was good and Dixit et al (2010) reported that though the quality of food was acceptable to be the beneficiaries, shortage of food was a problem at the centers”.

In my study, “68% of the respondents viewed that their children consumed food items at the AWCs itself and 23 percent viewed those children brought partially at home. However, 9 percent of them viewed that they brought all the food items at home whatever they received. In a study in Delhireported that only 2.9% of the beneficiaries were taking food in the center and 76% shared supplementary food with their family members & rest took to their home and consumed themselves”.

The ICDS system is appealing, but the recipients are unaware of it. Beneficiaries who receive adequate nutritional assistance may live healthier lives and combat malnutrition. Importantly, the food quality and quantity must be appropriate to encourage children to consume as much as possible at the centers in order to optimize the ICDS benefits.

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3. NFHS-2. National Family Health Survey. International Institute of Population Sciences, Mumbai; 1998-99.

4. Breden Kemp C, Akin JS. India's Integrated Child Development Services scheme: Meeting the health & nutritional needs of children, adolescent girls and women: Background Report; 2004.

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6. KumarAshwani. Nutritional status assessment of under-five beneficiaries of Integrated Child Development Services program in rural Karnataka. Australasian Medical Journal. July; 2010.

7. Dash NC et al. Impact assessment/evaluation of ICDS program in the State of Orissa. Bhubaneshwar: Centre for Rural Development; 2006.

8. Dixit S et al. Evaluation of functioning of ICDS project areas in Indore and Ujjain divisions of the State of Madhya Pradesh. Online Journal of Health and Allied Sciences. 2010.

9. FORCES, New Delhi. ICDS in Delhi: A reality check. FORCES; 2007.

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11. Chamadar, B K; Phaneendra, Rao R S; Krishna Rao & Jyoti Kumari (1984). Assessment of Impact of ICDS Scheme on Pre-school Children, Udupi Project, Karnataka. Researches on ICDS: An Overview, Vol.I, 1975-85, 306-307, NIPCCD, New Delhi.

12. Sunder Lai, Rajawati (1981). Early Childhood Education: An Effect to Enhance School Enrolment, Researches on ICDS: An Overview, Vol.l, 1975-86, 234, NIPCCD, New Delhi.

13. Muralidharan, Rajalaxmi& Kaur, Baljit (1987). A Study of the Relationship Between Physical Development and Language and Cognitive Development of Tribal Pre-school Children, Bombay Psychologist, 9 (1&2): 7-17.

14. Antia NH, Bhatia K (1993) editors. People's Health in People's Hands: Indian Experiences in Decentralized Health Care, a Model for Health in Panchayati Raj. Foundation for Research in Community Health.

15. Census of India. Chapter 3. Child population in the age group 0-6 years.