Malnutrition: How to overcome in India

Focussing on women’s education, Access to sanitation & potable water, diet rich in proteinaceous foods and biofortification of grains can curb malnutrition

President Donald Trump applauded India’s achievements in his address at the crowded Motera stadium. These ranged from religious freedom to reducing poverty to the giant emerging economy. This should have made every Indian feel proud, except that only in the next three days, riots in Delhi made us feel ashamed of our poor governance, lack of communal harmony, and intolerance of opposing ideas. In this piece, however, we want to focus on the UN’s top three Sustainable Development Goals (SDGs), namely poverty elimination, zero hunger, and good health and well being by 2030.

The World Bank’s estimates of extreme poverty, defined as $1.9 per capita per day at the 2011 purchasing power parity, show a secular decline in India from 45.9% to 13.4% between 1993 and 2015 (see graphic). If the overall growth process continues, as has been the case since, say, 2000, India may succeed in eliminating extreme poverty by 2030, if not earlier. Also, given the overflowing stocks of foodgrains with the government, and a National Food Security Act (NFSA) that subsidises grains to the tune of more than 90% of its cost for 67% of the population, there is no reason not to believe that India can also attain the goal of zero hunger before 2030.

The real challenge for India, however, is to achieve the third goal of good health and well being by 2030. India’s performance in this regard, so far, has not been satisfactory.

In 2015-16, almost 38.4% of India’s children under the age of five years were stunted, 35.8% were underweight, and 21% suffered from wasting, as per National Family Health Survey (NFHS) 2015-16. The situation is some states like Bihar, Jharkhand, and Uttar Pradesh is even worse (see graphic). No wonder, the Global Hunger Index (GHI) ranked India 102nd out of 117 countries in terms of severity of hunger in 2019.

How can India overcome this colossal challenge of malnutrition? The National Nutrition Strategy 2017 aims to reduce underweight prevalence in children (0-3 years) by 3 percentage points from the NFHS 2015-16 estimates every year by 2022. This is an ambitious target given that the decadal decline in underweight children from 42.5% in FY06 to 35.8% in FY16 amounts to less than 1% annual decline. Similar targets have been set by the National Nutrition Mission (renamed POSHAN Abhiyaan) 2017 for reducing stunting, undernutrition, anaemia (among young children, women and adolescent girls), and low birth weight by 2%, 2%, 3%, and 2% per annum, respectively.

Our research at ICRIER tells us to focus on four key areas if India has to make a significant dent on malnutrition by 2030. First and foremost is women’s education as it has a positive multiplier effect on child care, and access to health care facilities. It also increases awareness about nutrient-rich diet, personal hygiene, etc, and can help contain family size in poor, malnourished families. Thus, a high priority to female literacy, in a mission mode through liberal scholarships for the girl child, would go a long way to tackle this problem.

Second, is the access to improved sanitation and safe drinking water. From that angle, the Swachh Bharat Abhiyan and Jal Jeevan Mission would have positive outcomes in the coming years.

Third, there is a need to shift dietary patterns from cereal dominance to consumption of nutritious foods like livestock products, fruits and vegetables, pulses, etc. But, they are generally costly, and their consumption increases only with higher incomes and better education. Diverting a part of the food subsidy on wheat and rice to more nutritious foods can help.

Lastly, India must adopt new agricultural technologies of bio-fortifying cereals—zinc-rich rice and wheat, iron-rich pearl millet, and so on. The Indian Council of Agricultural Research has to work closely with Consultative Group of International Agricultural Research’s The Harvest Plus programme to make it a win-win situation and curtail malnutrition in Indian children at a much faster pace and a much lower cost than a business-as-usual scenario would achieve.

Global experience shows that with the right public policies focusing on agricultural, improved sanitation, and women’s education, a country can have much better health and well being for its citizens, especially children. In China, agriculture and economic growth significantly reduced the rates of stunting and wasting among the population, and lifted millions of people out of hunger, poverty, and malnutrition. According to the Food and Agriculture Organization, Brazil and Ethiopia have transformed their food systems, and have targeted their investments in agricultural R&D, and social protection programmes to reduce hunger in the country. Despite India’s improvement in child nutrition rates since FY06, it is way behind the progress experienced by China and other countries. According to the Global Nutrition Report 2016, at current rates of decline, India will achieve the stunting rates currently prevalent in China by 2055. India can certainly do better, but only if it focuses on this issue.