Malnutrition in India

• 18 Oct 2019

This article is based on “For a wider food menu” (The Hindu) and “Nutrition is no puzzle” (The Indian Express). It talks about the status of malnutrition in India.

Recently, September 2019 was observed as ‘Rashtriya Poshan Maah’, that urged people to support the government’s nutrition campaign to ensure a healthier future for women and children.

However, even after a bunch of policies targeting malnutrition (Integrated Child Development Scheme 1975, the National Nutrition Policy 1993, the Mid Day Meal Scheme for school children 1995, and the National Food Security Act 2013), the malnutrition in India remains high.

Significance of Zero Hunger

• The reason for mapping hunger is to ensure that the world achieves “Zero Hunger by 2030”— one of the Sustainable Development Goals (Goal 2) laid out by the United Nations.
• Although, achieving zero hunger requires not only addressing hunger, but also the associated aspect of malnutrition i.e food and nutrition security.
  • World Food Day is observed annually on October 16 to address the problem of global hunger.

Status of Malnutrition in India

• The Food and Agriculture Organization (FAO) estimates that 194.4 million people in India (about 14.5% of the total population) are undernourished.
• India ranks 102 out of 117 countries in the Global Hunger Index 2019.

NOTE: Global Hunger Index is based on three leading indicators:

• Child undernutrition: The prevalence of wasting and stunting in children under five years of age.
• Child mortality: rate under five years of age.
• Inadequate food supply: The proportion of undernourished in the population.
• Within South Asia, Sri Lanka, Nepal, Bangladesh and Pakistan are all ahead of India.
• Further, there has been dismal progress from last year ranking in the Global Hunger Index, in 2018 India ranks 103 out of 119 countries.

• According to the Indian Council of Medical Research (ICMR), in 2017, malnutrition was the predominant risk factor for death in children younger than five in every state of India.
• According to the Global Burden of Disease Study 2017, malnutrition is among the leading causes of death and disability in India.

What are the reasons for prevalent malnutrition in India?

• Monoculture agricultural practices: While foodgrain production has increased over five times since Independence, it has not sufficiently addressed the issue of malnutrition.
  
  • This is because, for long the agriculture sector in India focused on increasing food production, particularly staples (wheat and rice).
  • This led to lower production and consumption of indigenous traditional crops/grains, fruits and other vegetables, impacting food and nutrition security in the process.
  • This intensive monoculture agricultural practices can perpetuate the food and nutrition security problem by degrading the quality of land, water and the food derived through them.
• Changing food patterns: Food consumption patterns have changed substantially in India over the past few decades, which has resulted in the disappearance of many nutritious local foods, for example, millets.
• Poverty: Though poverty alone does not lead to malnutrition, it affects the availability of adequate amounts of nutritious food for the most vulnerable populations.
• Lack of sanitation and clean drinking water: Lack of potable water, poor sanitation, and dangerous hygiene practices increase vulnerability to infectious and water-borne diseases, which are direct causes of acute malnutrition.
• Migration: Seasonal migrations have long been a livelihood strategy for the poorest households in India, as a means to access food and money through casual labour.
  
  • However, children and women are the most affected, suffering from deprivation during migrations impacting their health condition.
• Gender injustice: There is a correlation between gender discrimination and poor nutrition.
  
  • Malnourished girls become malnourished adolescents who marry early and have children who become malnourished, and so the cycle continues.
• Lacunae at policy level: There is a lack of real-time data that brings all these factors together to show the extent of India’s malnutrition.
• Lax implementation: Providing nutritious food to the country’s children is more a matter of political will and effective policy implementation at the grassroots level.
  
  • For example, the Acute Encephalitis Syndrome (AES) outbreak in Bihar marked the failure of the Integrated Child Development Scheme (ICDS) in the state.

Government Schemes to Tackle Malnutrition

• Integrated Child Development Services (ICDS) Scheme
  
  • The scheme provides specific interventions targeted towards the vulnerable groups include children below 6 years and women.
  • It is being implemented by the Ministry of Women and Child Development.
  • It provides a package of six services namely supplementary nutrition, pre-school non-formal education, nutrition & health education, immunization, health check-up and referral services.
• National Health Mission (NHM)
  
  • National Health Mission (NHM) was launched by the government of India in 2013.
  • It subsumed the National Rural Health Mission and the National Urban Health Mission.
  • It is being implemented by the Ministry of Health & Family Welfare.
  • It was further extended in March 2018, to continue till March 2020.
  • The main programmatic components include health system strengthening in rural and urban areas for - Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A), and Communicable and Non-Communicable Diseases.
• Mid Day Meal Scheme
  
  • It was launched in 1995 as a centrally sponsored scheme.
  • It provides that every child within the age group of six to fourteen years studying in classes I to VIII who enrols and attends the school shall be provided with a hot cooked meal, free of charge every day except on school holidays.
  • The Mid Day Meal Scheme comes under the HRD Ministry’s Department of School Education and Literacy.
• Indira Gandhi Matritva Sahyog Yojna (IGMSY)
  
  • The scheme aims to contribute to a better enabling environment by providing cash incentives for improved health and nutrition to pregnant and lactating mothers.
  • It is being implemented by the Ministry of Women and Child Development
• National Nutritional policy 1993
  
  • The National Nutrition Policy (NNP) was adopted under the aegis of the Ministry of Women and Child Development.
  • The strategy of NNP was a multi-sectoral strategy for eradicating malnutrition and achieving optimum nutrition for all.

Way Forward

• Multi-sectoral approach: Substantial improvements across malnutrition indicators in the states of India would require an integrated nutrition policy.
  
  • These improvements include providing clean drinking water, reducing rates of open defecation, improving women’s status, enhancing agricultural productivity and food security, promoting nutrition-sensitive agriculture.
  • Integrated nutrition policy can be brought by harmonization of efforts across ministries, political will and good governance.
  • Such coordinated efforts will ensure that essential nutrition services reach the most deprived communities.
• National Nutrition Mission (POSHAN Abhiyaan) seeks to ensure a “malnutrition free India” by 2022.
  
  • POSHAN Abhiyaan which is India’s flagship program, envisages improving nutritional outcomes for children, adolescents, pregnant women and lactating mothers, is a step in the right direction.
  • However, it would require long-term investments in health, sanitation and nutrition in preventing deaths due to severe acute malnutrition.
• Decentralisation: Panchayats should be allowed to have a bigger say in running welfare schemes.
• Diversification: Public Distribution System should be diversified, to include millets.
• Strengthen MGNREGA to ensure better food security.
  
  • MGNREGA can play a vital role in mitigating the disastrous effects of droughts in rural areas.

Drishti Mains Question

Even after having a number of schemes addressing malnutrition in India, malnutrition remains a mighty challenge for India. Discuss.