Integrated Child Development Services Research Articles

Early Childhood Care and Education: A Systematic Literature Review in Indian Context

Early Childhood Care and Education (ECCE) is often regarded as A key element of universal education. This study delves into the landscape of Early Childhood Care and Education (ECCE) in India through a systematic review of literature. After extensive attempts, several nations throughout the world are making strides toward securing ECCE. Despite this, the majority of them were unable to reach or compromise on this aim owing to insufficient resources, bad planning, and weak strategies for implementation, particularly in a large and populated nation such as India. The development of quality standards and curriculum frameworks, plans, acts, constitutional amendments, schemes, and flagship programmes like, District Primary Education Programme (DPEP), Integrated Child Development Services (ICDS) and Sarva Shiksha Abhiyan are just a few of the initiatives the Indian government has launched to improve quality. It has resulted in both anticipated and unexpected concerns and obstacles due to India's compromise on the non- negotiable ECCE quality requirements. Consequently, the government's objective of guaranteeing quality in ECCE was not fully achieved. However, recent research indicates significant advancements in quality improvements. Of course, there are unsatisfactory results in certain areas and components, but there has also been progress in other areas, suggesting that maintaining quality is a realistic objective. This research aims to present an overview of the Government of India's operations, assess the situation on the ground, pinpoint the primary hurdles to ECCE quality development and offer workable solutions to overcome those hurdles.

Prevalence and predictors of minimum acceptable diet (MAD) feeding among tribal children aged 6–23 months in India

ABSTRACT Minimum acceptable diet (MAD) that combines minimum dietary diversity (MDD) and minimum meal frequency (MMF) is one of the eight core indicators for assessing infant and young child feeding (IYCF) practices for children aged 6–23 months. With low MAD, young children and infants are more susceptible to undernutrition. The study assesses the prevalence and predictors of MAD among tribal children aged 6–23 months in India. Descriptive, bivariate, and multivariate analyzes were performed on data from 6326 tribal children of the National Family Health Survey (2019–21). Stata was used for the analyzes, with a 5% significance level. Only 12% of tribal children were fed with a MAD, while 24% had MDD and 34% MMF. Children aged 18–23 months had a three times higher chance of MAD than their 6–8 months counterparts. Children receiving Integrated Child Development Services (ICDS), children of mothers with ten or more years of schooling, children whose mothers were exposed to mass media, and whose mothers had 4+ antenatal care visits in their last pregnancy had a higher likelihood of MAD. The study concludes that MAD among tribal children aged 6–23 months is unsatisfactory and varies significantly by socio-demographic characteristics, suggesting targeted intervention.

Utilization of Integrated Child Development Services (ICDS) and its linkages with undernutrition in India.

The Integrated Child Development Services (ICDS) programme has been the central focus of the POSHAN Abhiyaan to combat maternal and child malnutrition under the national nutrition mission in India. This paper examined the linkages between utilization of ICDS and underweight among children aged 6-59 months. The study utilized data from two recent rounds of the National Family Health Survey (NFHS-4 [2015-2016] and NFHS-5 [2019-2021]). Descriptive analyses were used to assess the change in utilization of ICDS and the prevalence of underweight at the national and state levels. Multivariable logistic regressions were performed to examine factors associated with the utilization of ICDS and underweight. Linkages between utilization of ICDS and underweight were examined using the difference-in-differences (DID) approach. Utilization of ICDS increased from 58% in 2015-2016to 71% in 2019-2021. The prevalence of underweight decreased from 37% to 32% in the same period. Changes in ICDS utilization and underweight prevalence varied considerably across states, socioeconomic and demographic characteristics. Results from decomposition of DID models suggest that improvements in ICDS explained 9%-12% of the observed reduction in underweight children between 2016 and 2021, suggesting that ICDS made a modest but meaningful contribution in addressing undernutrition among children aged 6-59 months in this period.

IJCM_253A: A cross sectional study to assess the coverage, impact and reasons for non- utilisation of supplementary nutrition among ICDS beneficiaries in the field practice area of a tertiary medical college in Mangalore

Background: Integrated Child Development Services (ICDS) scheme is world’s largest community-based Programme Objective: To assess the coverage, impact, and reasons for non-utilization of supplementary nutrition among ICDS beneficiaries Methodology: To assess the coverage, impact, and reasons for non-utilization of supplementary nutrition among ICDS beneficiaries Results: 66 % of the beneficiaries are aware of the supplementary nutrition availability, while only 52% of them acquire the services. Only 24% of the adolescents are aware of the supplementary nutrition being given in ICDS and none of them are availing it. 28.7 % of the beneficiaries are getting. Conclusion: 52% of the study participants were utilizing the services and the major reason for non-utilization was inferior quality of the grains and unawareness, mainly among adolescent females. Positive impact could be seen with reduction in SAM cases, immunization updation but nutrition education needs to be upgraded.

IJCM_416A: Health Profile of Anganwadi Workers: a camp-based study conducted at a Tertiary Hospital, Mumbai, India

Background: As part of the Integrated Child Development Services program, The Anganwadi system is mainly managed by the Anganwadi worker (AWW). The fundamental tasks performed by Anganwadi workers are crucial and must be completed as effectively as possible. Hence the good health of Anganwadi workers decides how efficiently they can do their allotted work. So, this study was conducted to assess the health profile of Anganwadi workers. Objective: To assess the health profile of Anganwadi workers attending a Health checkup camp at a Tertiary Hospital. Methodology: A cross sectional descriptive study was conducted at a free health camp in a Tertiary Hospital of Mumbai, India, by the staff and interns of the Department of Community medicine. All AWWs who attended the camp were included in the study. AWWs who attended the health checkup camp were assessed for morbidity. Data collected by semi structured questionnaire was entered into Microsoft Excel and analysed using SPSS version-17.0. Results: Most of AWWs were from the age group of between 41-50 years; more than half of them were matriculate and 34(69.38%) workers had an experience of more than 10 years. Around 49% of them were having abnormal BMI and 53% were anaemic. PAP smear findings were abnormal in 4% AWWs. Conclusion: AWWs are considered cornerstone in providing ICDS services, but in this study, we found that most of AWWs themselves were not at their good health. Regular health checkups of healthcare workers of each level should be done to efficiently deliver the healthcare services to people of our country.

Integrated child development service (ICDS) coverage among severe acute malnourished (SAM) children in India: A multilevel analysis based on national family health survey-5.

Severe acute malnutrition (SAM) can be fatal for children, and potentially limit their cognitive and physical growth. The last three National Family Health Survey (NFHS) in India shows an increase in the prevalence of SAM among under-five children. Given the specific mandates under ICDS (Integrated Child Development Service) for SAM children, it is important to validate the coverage efficiency of ICDS on SAM children. This paper examines a possible association between the coverage efficiency of ICDS on SAM children. The study further aims to identify the determinants of ICDS service utilization among SAM children. We used data from the fifth round of the National Family Health Survey. Descriptive statistics was used to estimate the SAM coverage under ICDS. Multilevel Logistic Regression was used to identify the determinants of ICDS service utilization among SAM children. The burden of SAM is higher among older children (3+ age). Coverage of ICDS was more among younger children and the poorest households in the rural areas. Results from multilevel logistic regression showed that age had a significant relationship with the outcome variable. SAM children living in the rural areas had a significantly higher odds of being covered under ICDS service (OR 1.57; CI: (1.35, 1.82)) than their urban counterparts. Pregnant and lactating mothers who received ICDS services were significant determinants of SAM coverage under ICDS. There is no evidence that ICDS is more efficient in identifying and covering SAM children than non-SAM children. Despite special provisioning in place for SAM children, coverage of different ICDS services was similar to that of non-SAM children, and were in fact lower than non-SAM children for some categories. The study suggests that improving coverage of ICDS services among pregnant and lactating mothers would increase the coverage of ICDS services among SAM children.

Malnutrition among children in India: exploring the contribution of the integrated child development service scheme

Malnutrition among children in India: exploring the contribution of the integrated child development service scheme

Effect of Inclusive Early Childhood Development (IECD) on Growth and Development of Children in the Rural Part of the Central India: A Cohort Study.

To compare the difference between the growth and developmental status of the children who were residing in the area where Inclusive Early Childhood Development (IECD) project was being implemented and who had received interventions through trained Anganwadi workers (Frontline workers) under Integrated Child Development Services (ICDS) scheme with the children who had not received the Inclusive ECD project interventions. It was a mixed method cohort study, nested in an ongoing project in a medical college in which Inclusive ECD was used as an intervention through International Guide for Monitoring Child Development (GMCD) which is a tool for both monitoring and assessment with the help of existing government structures and personnel such as Anganwadi workers, Anganwadi supervisors and their contact points with communities. A sample of 200 children was selected; 100 each from intervention group (IECD cohort) and comparison group (Usual care cohort) and were followed till the child became 2 y of age. IECD intervention showed statistically significant effect on weight (p = 0.04) and height (p = 0.03) of the IECD cohort. Overall developmental assessment showed that the identified developmental issues (Concerns + Delays) were approximately half in IECD cohort (9.67%+5.37%=15.04%) as compared to usual care cohort (17.20%+11.82%=29.02%). The results from binomial logistic regression performed for developmental outcomes were statistically significant (p = 0.04) suggesting that children with IECD intervention have lower odds of developing developmental issues. The study indicates that it is possible to implement IECD interventions through frontline workers, which significantlyimproves the growth and development of the children.

Adolescents and Psychosocial Issues: An Empirical Study

The adolescent period is a time of many upswings and downsides which requires constant support and guidance from parents, guardians and society. Moreover, adolescent girls face more psychosocial problems in contrast to boys, especially in India due to its different social and cultural environment. The psychosocial problems can have an adverse effect on the health of adolescent girls. Thus, social investment in adolescents is important not only for their well-being but also for society as a whole. The Integrated Child Development Services (ICDS) is one of the social investment programmes in India which seeks to address such problems in girls. The present research study has been carried out to explore the psychosocial issues of adolescent girl beneficiaries’ of the ICDS programme in Central Kashmir. Furthermore, the role of demographic and socio-economic factors in relation to psychosocial issues has also been examined. The research was both explorative and descriptive, and the data were analysed with quantitative techniques involving ANOVA in SPSS. The results obtained provide interesting insights into the research problems which can be beneficial for many stakeholders. The study results revealed that most of the beneficiaries had psychosocial issues such as somatic complications, adjustment problems, sleep problems, attention problems and sleep problems. However, these problems varied in relation to different demographic variables such as age, gender, education, district, economic status, etc. The research also provides interesting and valuable suggestions to different stakeholders regarding their role in solving the problems of adolescent girls.

Maternal and child nutrition services associated with nutritional knowledge and practices, India.

To evaluate whether maternal and child nutrition activities provided through the Indian Integrated Child Development Services scheme in India were associated with improved nutritional knowledge and practices among beneficiary women. We used a multistage sampling design to randomly select 4400 pregnant women or mothers of children younger than 2years for a cross-sectional telephone survey. The respondents were beneficiaries of the scheme from across 11 Indian states. We used multivariate regression models controlling for sociodemographic factors to estimate the association between: scheme activities and nutrition messages heard; and scheme activities and nutrition practices. We also estimated the proportion of the total association with nutrition practices which was mediated by nutrition messages. Among 110 regression models testing unique pairs of seven activities and 18 nutrition messages, 103 showed a statistically significant positive relationship (median risk ratio, RR: 1.14). For activities and nine nutrition practices, 39 out of 54 tested pairs were significantly associated (median RR: 1.16). We observed statistically significant mediation through nutrition messages for 28 out of 42 tested pairs of activities and nutrition practices. Receipt of the scheme's activities was associated with improved nutrition knowledge and practices. Improvements in practices were statistically mediated by improvements in knowledge. These findings suggest that a large-scale nutrition scheme with a strong counselling component could successfully change beneficiary behaviours.

Estimated effect of age of marriage on utilisation of India’s Integrated Child Development Service programme

BackgroundAge of marriage among women is considered an important indicator of their readiness for familial integration and parenting. This study estimated the effect of age of marriage of young mothers...

Assessment of Knowledge Regarding Antenatal Care among Men in Selected Rural Areas of Himachal Pradesh

Background: WHO defined health as the state of complete physical, mental, and social well-being and not merely an absence of disease or infirmity, but it includes ability to lead socially and economically productive life.1 Being a man or women has a significant impact on health, as a result of both biological as well as gender related differences. Antenatal care (ANC) is most important aspect of women‘s reproductive health. The antenatal care is the care provided by skilled health care professionals to pregnant women and adolescent girls to ensure best health conditions for mother and baby during pregnancy. It reduces maternal and perinatal morbidity and mortality both directly, through detections and indirectly, through the identification of women and girls at increased risk of developing complications during labour, delivery and ensuring appropriate level of care.1 As per NFHS- 4, the 21% of pregnant women utilised full ANC, ranging from 2.3–65.9% across states. Overall, 51.6% had 4 or more ANC visits, 30.8% consumed IFA for at least 100 days and 91.1% had one or more doses of tetanus toxoid. Full ANC utilisation was inequitable across place of residence, caste, and maternal education. Registration of pregnancy, utilisation of government‘s Integrated Child Development Services (ICDS) and health insurance coverage were associated with higher odds of full ANC utilisation. Lower maternal education, lower wealth quintile, lack of father‘s participation during antenatal visits, higher birth order, teenage and unintended pregnancy were associated with lower odds of full ANC utilisation. This study assesses the knowledge about the antenatal care among married and unmarried men of 18-35 years age in selected rural areas of Himachal Pradesh. Methods: The study was an unmatched case and control design where married men were considered as a case and unmarried men as comparator group. This study was a part of large study for which sample size of 268 men in each group was calculated assuming prevalence of female contraceptives 70% in unmarried men and 85% in married men. This was carried out by cluster-based sampling in villages of Nagrota Bagwan and Shahpur health blocks of DRPGMC Tanda at Kangra. Results: The 93.3% participants among case group are aware of anaemia in pregnancy while only 64.9% among control group are aware of anaemia in pregnancy. The knowledge about all three causes of anaemia was statistically more in case group (61.9%) as compared to control group (38.8%). Assessment about high-risk pregnancy, about 72.4% participants among case group were aware about the risk factors in pregnancy as compared to 43.3% in control group with statistically significant differences (P=0.000). All the causes of high-risk pregnancy were reported by the participants of case group (44.0% vs 29.9%) with statistically significant differences. Conclusions: Married men had significantly more knowledge about various components of antenatal care. The awareness approach for unmarried men needs to be designed regarding antenatal care.

A study to compare the performance of anganwadi workers in owned and rented anganwadi centers in a district of the western part of India

ABSTRACT Introduction: The Integrated Child Development Services (ICDS) scheme is one of the flagship programs, and under this, various activities like non-formal education on one hand and breaking the vicious cycle of malnutrition, morbidity, and mortality on the other hand are carried out by anganwadi worker (AWW). The aim of this study is to assess the AWWs performance and beneficiary participation in respect to the ICDS scheme. Methodology: This is a community-based, cross-sectional study done in two stages using a simple random sampling technique. Ahmedabad Municipal Corporation (AMC) area is divided into 10 parts called ghatak, and out of these 10 ghataks, 6 were chosen in the first stage, and in the second stage, 12 anganwadi centers were selected from these 6 selected ghataks using simple random sampling. Result: In this study, 58.3% of anganwadi workers were graduates. While talking about work related to “Home Visit” and “Immunization Sessions,” there was no statistically significant difference between owned and rented anganwadi center noted. While in “Nutrition & health education”-related work, there was a statistically significant difference between owned and rented anganwadi centers observed. Accuracy of weighing, plotting, and interpretation skill was more than 90% found in both the rented and owned anganwadi center. An almost similar level of nutritional status was observed in both owned and rented centers. Conclusion: In terms of performance and participation, there was not much difference between corporation own and rented anganwadi centers, although there were shared concerns related to frequent changes of place of rented anganwadi centers affecting the participation of beneficiaries.

Response and adaptations made by the integrated child development services stakeholders towards the digitalisation of its record keeping systems of the Anganwadi centres in urban Gujarat, India

Initiated on 12th February 2018, Anganwadi centres (AWC) of Gujarat adapted the integrated child development services common application software (ICDS-CAS), for real time monitoring and record keeping, for Anganwadi workers (AWWs), Anganwadi supervisors (AWS) and the child development project officers (CDPO).This application was abruptly discontinued in September 2020 and replaced by ‘Poshan tracker’ ,a mobile based application, launched by the ministry of women and child development, government of India on 1st March 2021. Documentation of challenges and benefits due to shift to software-based record keeping system by frontline workers of ICDS in urban Gujarat. Informal meetings were held with stakeholders like the CDPO, AWS and AWWs to discuss the challenges faced due to digitalisation of record maintenance. We planned to conduct two focused group discussions (FGD) for the same purpose. FGDs were conducted at two different Anganwadi, within city corporation area. Audio recordings of both FGDs were repeatedly played and analysed to prepare qualitative report. ‘ICDS-CAS’ didn’t store older records so the AWWs had to refer to their older registers. The software was English based but AWWs preferred Gujarati(local) language. ‘Poshan tracker had no ‘auto-update’ and ‘delete’ option, to rectify inaccurate entries. One could easily view all the information in one glance. Software database had compiled data from anganwadi, removing the need for supervisors to separately contact each AWWs for an anganwadi data. It was concluded that elder AWWs preferred old register entry system, while the younger AWWs preferred the software data entry system.

UNVEILING THE PRESENT LANDSCAPE OF MALNUTRITION IN INDIA: A COMPREHENSIVE ASSESSMENT

Achieving healthy diets and ending malnutrition, particularly among children, remains a formidable challenge, even as India, the worlds second-most populous nation, has witnessed consistent economic growth and attained food grain self-sufficiency. Despite these advancements, high poverty levels, food insecurity, and malnutrition persist. This article highlights the pressing issues of malnutrition in India. Undernourished children are more susceptible to infectious diseases, leading to higher mortality rates and diminished productivity in adulthood, further perpetuating the cycle of undernutrition. Based on NFHS surveys, the article presents a detailed analysis of crucial malnutrition indicators, including stunting, wasting, and underweight children. It reveals that Indias performance on global hunger indices remains a cause for concern, with the highest child-wasting rate globally and a serious hunger level. At the same time, some indicators have shown marginal improvement, but acute malnutrition in children under five remains challenging. The article emphasizes the role of non-economic factors such as gender discrimination, hygiene, and maternal education in perpetuating malnutrition. Additionally, it discusses the governments initiatives, including the Integrated Child Development Services (ICDS) and POSHAN Abhiyaan, in addressing the issue. The article calls for a renewed focus on the critical first 1000 days of a childs life and the effective promotion of intensive breastfeeding to combat malnutrition. It advocates for targeted interventions, improved data management, strengthened governance, and systematic monitoring to ensure a healthier future for Indias children and address the pressing issue of malnutrition.

Incidence of diarrhoea and household diarrhoea management among children of integrated child development services in Buldhana district of Maharashtra

Background: Adequate water and sanitation facilities are crucial in promoting good child health. Unfortunately, many children lack access to these resources. Thus, this study aimed to investigate the prevalence of diarrhoea among children and the household-level management of diarrhoea. Methods: The study utilized both qualitative and quantitative methods, quantitative analysis involved selecting a total of 300 samples using the stratified random sampling method. Twenty key informants were interviewed conducted to qualitative study. Results: The study found that, the prevalence of diarrhoea among ICDS children 24.5 percent. However, this prevalence varied depending on several factors, including gender, caste, education, occupation, and wealth. The findings highlighted the importance of a mother's education in preventing and addressing diarrhoea within the household. Additionally, the availability of improved water resources played a crucial role in the prevalence of diarrhoea, as a significant portion of the population had limited access to such resources. Unfortunately, many mothers lacked sufficient knowledge about diarrhoea, negatively impacting their children's health. Mothers commonly relied on traditional methods to manage diarrhoea, which could result in additional health complications for their children. Conclusions: Providing access to safe drinking water from a single source can help to reduce cases of diarrhoea. Overall, improving education, increasing access to clean water, and promoting better hygiene practices are essential steps to preventing and managing diarrhoea effectively.

Utilization and Satisfaction of Services Provided for Children under the Integrated Child Development Services Scheme in a Block of West Bengal, India

Background: The Integrated Child Development Services (ICDS) scheme is a community-based program in India for the betterment of health and nutrition of children aged 0-6, pregnant and lactating mothers, and women aged 15-44 years. This study aimed to investigate the pattern of the utilization of services and the level of satisfaction of mothers regarding the services provided to their children in a block of West Bengal, India.
 Methods: This descriptive cross-sectional study was conducted from August 2016 to November 2018, and simple random sampling was used to select ICDS centres. The centres’ were evaluated for determining the rate of utilization of the services. For evaluating satisfaction, a face and content-validated, pre-tested questionnaire was used. The first part of questionnaire was for collecting the socio-demographic profile of mothers. The second part was concerned about determining satisfaction regarding various services provided by centers to children below 6 years of age on a 5-point Likert scale. About 10% of children enrolled in each ICDS centre were selected, and their mothers were surveyed for satisfaction regarding supplementary nutrition services, informal education, immunization, and other health-related services and infrastructures. The data were expressed in number and percentages and the test of association between categorical variables was done using a chi-square test. The GraphPad Prism 6.01 (GraphPad Software, USA) was used for statistical test.
 Results: Among the surveyed 62 ICDS centres, service utilization rates were 98.04% for immunization, 90.56% for supplementary nutrition, 82.52% for informal education, 40.27% for health check-ups, and 13.32% for referral services regarding different health problems. A total of 89.63% of the mothers were satisfied with the supplementary nutrition, 83.46% with immunization and health-related services, 77.42% with informal education, and 56.5% with infrastructures.
 Conclusion: Using supplementary nutrition and informal education exceeded expectations, but immunization, other health-related services, and referral services need improvement to achieve the program's goal. ICDS center infrastructure needs improvement, and a holistic approach is necessary to meet the satisfaction of mothers regarding different services.

Evaluation of healthcare services of integrated childhood development services (ICDS) in a district of Western India

Background: Early years of the life are the most crucial period for the physical, mental, social, emotional, language development and lifelong learning. Integrated child development services (ICDS) program maintained its uniqueness as early childhood development program of the world. The objectives of study were to (1) evaluate the ICDS services & its utilization by the beneficiaries & (2) find out differences in health care services between rural & urban anganwadi centres (AWCs). Method: A cross sectional study involving selected 120 AWCs of Jamnagar was carried out using a pro forma having questions related to health care services provided under ICDS. Results: 67% of beneficiaries were regular in pre-school education (PSE). Percentage of mild, moderate & severe malnutrition varied between 82-85%, 7-12% &6-8% in children between 6m-6 years respectively. Referral services, nutrition and health care session, vaccination services, routine healthcare check-up of children at every 1-3 month and Minimum 4 ANC visits were provided in 60%, 82.5%, 62.5%, 75% and 77.5% AWCs respectively. Conclusion: About 2/3rd beneficiaries were regularly attending PSE with higher prevalence in urban than rural AWCs. Percentage of mild, moderate & severe malnutrition varied between 82-85%, 7-12% & 6-8% in children of 6 months to 6 years respectively. Rural AWCs had more ‘mild malnourished’ child & urban AWCs had more ‘severely malnourished child’.

Nourishing the Nation's Future: The Pioneering Role of Integrated Child Development Services in India's Effort to Combat Child Malnutrition

Background: In India, a considerable portion of the population suffers from undernutrition, contributing to poor health. Under and over-nutrition continue to pose a severe threat to the country despite the increase in economic development and significant measures taken by the Indian government to address the issue of the dual implications of malnutrition. India has the highest rates of underweight children worldwide. The Indian government has started several initiatives to address the issue of early childhood development. One such program with goals for nutrition intervention and early child development is called Integrated Child Development Services (ICDS). 
 Method: It focuses on the helping hand given by ICDS in reducing malnutrition in children aged 0-5 years by comparing data from the National Family Health Survey rounds conducted in India during 2005-06 and 2015-16. The study utilizes several parameters to highlight the program contribution, such as the nutritional status of children, Anemia, immunization coverage, antenatal care, health care, and child mortality. It also highlights the main issues and challenges the policymakers face in implementing the ICDS program.
 Results: ICDS program has significantly improved in providing services to the beneficiaries, including children aged 0-59 months and pregnant and lactating women.
 Conclusion: Despite several positive changes in ICDS schemes, the program failed to deliver the services efficiently nationwide. It has great potential to contribute to child development, but several loopholes need to be channelized properly.

A Qualitative Evaluation of the Micro-level Barriers to Better Delivery and Utilisation of Nutrition Services in Rural India

Malnutrition remains one of the most rigid outcomes to be addressed by policies and interventions. Although the forms and predictors of malnutrition have been extensively studied, relatively less focus has been placed on the micro-realities of policy implementation that can explain the barriers to achieving better service utilisation outcomes. To fill this gap and gain insights into the socio-environmental barriers to the supplementary nutrition programme, a micro-level qualitative study was undertaken on the beneficiary experience from one of the largest nutrition services in the world, the Integrated Child Development Services (ICDS) in India. Combining qualitative phenomenological with a retrospective design, the study compared the service experience of current ICDS to its erstwhile regime called the ‘UNICEF-Dular’ using data from a 2018 study in Bihar. Thirty beneficiaries, including 12 mothers with children in both regimes, 10 front-line workers (FLW) and erstwhile second-line workers, and two Bihar-UNICEF officials, were included in the FGDs and interviews. The analysis revealed that strategic changes in the programme regarding downscaling personnel by removing second-line workers, selective coverage in supplementary nutrition, hazardous work conditions, the low capability of FLW, and social incoherence are barriers to service delivery in nutrition.