Hunger and Malnutrition

What is Hunger?

Hunger is a condition in which a person cannot eat sufficient food to meet basic nutritional needs for a sustained period. Hunger can manifest itself in different ways – undernourishment, malnutrition and wasting.

Goal 2 of the 2030 Sustainable Development Agenda seeks to end hunger and all forms of malnutrition, and double agricultural productivity between 2015-2020.

Global Hunger Index 2021

India has slipped to 101st position in the Global Hunger Index (GHI) 2021 of 116 countries, from its 2020 position of 94th.

Reasons behind India’s persistent problem of hunger:

1. Poverty: Poverty restricts food choices and has been the causative factor of hunger-related deaths.

2. Multidimensional nature: Hunger and undernutrition result from various associated factors ranging from water, sanitation, and access to food items.

3. Ineffective food policy implementation: The Integrated Child Development Services (ICDS) and the National Health Mission (NHM) lack adequate coverage.

4. Climate change impact: Erratic rainfall and increasing frequency of extreme events have impacted agricultural activities everywhere creating unfavourable conditions for food production.

5. Corruption: Corruption in PDS is widely recognised. PDS a food distribution scheme is mired with inefficiencies and corrupt practices denying food to many.

6. Issues with agriculture: The change from multi to mono-cropping systems limits the diversity of agricultural products.

7. Food wastage: It undermines the efforts to end hunger and malnutrition. According to the FAO, the global volume of food wastage is estimated at 1.6 billion tonnes of primary product equivalents.

8. Unstable markets: Rising food prices make it difficult for the poorest people to get nutritious food consistently which is exactly what they need to do.

9. Natural disasters: Natural disasters such as floods, tropical storms and long periods of drought are on the increase with catastrophic consequences for the hungry poor in developing countries.

10. Gender inequality: In many parts women’s nutritional requirements are often unmet as they consume whatever is left after everyone else has eaten.

11. A person’s ‘nutritional quotient’ is also dependent on demographic factors like gender, caste, age, etc. For instance, the nutritional needs of girl children and the elderly are not adequately addressed in our society.

Malnutrition (Undernutrition, Overnutrition, Micro-nutrient deficiency)

Malnutrition includes both undernutrition as well as overnutrition and refers to deficiencies, excesses or imbalances in the intake of energy, protein and/or other nutrients.
Child malnutrition is a chronic problem and a longstanding challenge for the public administration of India. Despite decades of investment to tackle this malaise, India’s child malnutrition rates are still one of the most alarming in the world.

Data related to Malnutrition

The Global Hunger Index (2020) — which is calculated based on total undernourishment of the population, child stunting (low height-for-age), wasting (low weight-for-height) and child mortality — places India at the 94th spot among 107 countries.
The bane of child and maternal malnutrition is responsible for 15 per cent of India’s total disease burden.
In the fifth round of NFHS (2019-2021) from the 22 states surveyed so far, only nine showed a decline in the number of stunted children, 10 in wasted children and six in underweight children. The percentage of stunted, wasted and underweight children increased or remained unchanged in the remaining states.

Concerns/Effects

Malnutrition costs India at least $10 billion annually in terms of lost productivity, illness, and death and is seriously retarding improvements in human development and further reduction of childhood mortality (World Bank)
While mortality has declined by half and fertility by two-fifths, malnutrition has only come down by about one-fifth in the last 40 years. The inescapable conclusion is that further progress in human development in India will be difficult to achieve.
Malnourishment can also significantly lower cognitive development and learning achievement during the preschool and school years, and subsequently result in lower productivity.
Nutritional anaemia is implicated in low physical and mental performance.
Malnutrition not only blights the lives of individuals and families but also reduces the returns on investment in education and acts as a major barrier to social and economic progress.
According to UNICEF, one in three malnourished children in the world is Indian. It is estimated that reducing malnutrition could add some 3% to India’s GDP.
This inter-generational cycle of undernutrition transmitted from mothers to children greatly impacts India’s present and future.
Widespread child undernutrition greatly impedes India’s socio-economic development and potential to reduce poverty.

Reasons for High Child Malnutrition in India

Historical antecedents such as poverty, illiteracy, inequality, poor sanitation and food shortage.
The inadequate political focus on budgetary allocation was made to tackle this issue. The contemporary trends in budgetary allocations to nutrition appear to be counterintuitive (allocation towards child nutrition dropped by 18.5 per cent compared to 2020-21).
Malnutrition rates in some parts of the country are highest among children and women, due primarily to inadequate food intake, illness, and such harmful childcare practices as delayed complementary feeding. Underlying these are household food insecurity, inadequate preventative and curative health services, and insufficient knowledge of proper care.
Coverage: While the PDS, for example, absorbs 0.5 per cent of GDP, it fails to reach the segments of the population that need it most.
Exclusion: While migration creates geographical exclusion, bureaucracy and its need for documentation creates a form of social and economic exclusion.
Poor status of women and mother’s lack of education
Social and cultural factors may also affect malnutrition
Beneficiaries refused to consume food because lower caste people prepared food under Hausla Poshan Yojana, 2016 (UP).
Prevalent child marriage is acting as a limiting factor in improving the health of children. (India has the highest absolute number of child brides in the world – UNICEF)
Ineffective Targeting
Most Indian women are anaemic and poor and since malnourished mothers give birth to undernourished babies, the worsening rate of malnutrition could be a result of women struggling to access nutrition benefits.
Evidence points to numerous shortcomings in comprehensive policy implementation structure:
The 2020 Comptroller and Auditor General of India audit of ICDS revealed that out of Rs 1,042 crore allocated, only Rs 908 crore was disbursed to state governments
Shortcomings in implementation have also been found in the case of Common Application Software (CAS).
Food Insecurity – its availability and accessibility
Climate Change: Nearly 2/3r d of all malnourished people live in countries with high exposure to climate extremes.
Poor Quality of Food: According to the Global Nutrition Report, only 21% of food in India is rated as being healthy.
Erratic and irregular income of landless workers

Micronutrient deficiencies: India’s Comprehensive National Nutrition Survey (CNNS 2016-18) has highlighted the role of micronutrient malnutrition – anaemia and other micronutrient deficiencies.
Implementation: Lack of data, Lack of real-time data monitoring, sustainability and accountability may impact the National Nutrition Mission (NNM), Thus there is a need to strengthen monitoring and delivery systems.
Lack of coordination: Various ministries and departments related to healthcare often operate in isolation.
Under-utilisation of funds: The scheme also suffers from underutilization of allocated funds (only 16% of allocated resources for 2018-19).
Human Resources: NNM requires a huge human resource input. In a low-and-middle-income country with challenges around the power supply, literacy, and handling technology sensitively and sensibly may require a long period of handholding and capacity building.
Intra-state variation: Misuse of funds under the MP Local Area Development Scheme has been one of the factors which brought out differences between states and, sometimes, within states across parliamentary constituencies (PCs). For e.g., Across parliamentary constituencies, stunting ranged from 13.7 to 61.7 per cent etc.

The cross-cutting challenges of urbanization and growing overweight and obesity

Way Forward

Ensure Food Security

Food security means the availability, accessibility and affordability of food to all people always. Poor households are more vulnerable to food insecurity whenever there is a problem of the production or distribution of food crops. Food security depends on the Public Distribution System (PDS) and government vigilance and action at times when this security is threatened.
India achieved self-sufficiency in food grains in the 1970s. Since the mid-1990s it has consistently been able to ensure that there is enough food (in terms of calories) available to feed its entire population. It is the world’s largest producer of milk, pulses and millet, and the second-largest producer of rice, wheat, sugarcane, groundnuts, vegetables, fruit and cotton. Annual grain production has also remained relatively stable, with a decline in production between 2014 and 2016 caused by drought.
India is self-sufficient in several food crops including rice and wheat, which are among the national staples, and there is enough food to meet demand. Despite this, hundreds of millions of Indians have poor nutritional health.

Dimensions of Food Security

Availability of food means food production within the country, food imports and the previous year’s stock stored in government granaries.
- Accessibility: means food is within reach of every person.
- Affordability: implies that an individual has enough money to buy sufficient, safe and nutritious food to meet one’s dietary needs.

Who is food insecure?

Landless people with little or no land to depend upon, traditional artisans, providers of traditional services, petty self-employed workers and destitute including beggars.
In the urban areas, families whose working members are generally employed in ill-paid occupations and casual labour market.
The social composition and the inability to buy food also play a role in food insecurity. The SCs, STs and some sections of the OBCs (lower castes among them) who have poor land bases or very low land productivity are prone to food insecurity.
The people affected by natural disasters, who must migrate to other areas in search of work
A large proportion of pregnant and nursing mothers and children under the age of 5 years constitute an important segment of the food-insecure population.
The food insecure people are disproportionately large in some regions of the country, such as economically backward states with high incidences of poverty, tribal and remote areas, regions more prone to natural disasters etc.

Concerns

36% of children under the age of five are underweight (too light for their age) and 21 % are wasted (too light for their height).
Vitamin deficiencies are common in India, with 75 % of the population not getting enough from their food intake.
Rates of anaemia are also high, as 51 % of women of reproductive age have low levels of iron.
14.8% of the population is undernourished in India (FAO)
India ranked 76th in 113 countries – The Global Food Security Index (GFSI), 2018
India was ranked 103rd out of 119 – Global Hunger Index, 2018
Starvation deaths are also common in some parts of Jharkhand and Bihar

Challenges to food security in India

Lack of dietary diversity: India has been successful in ensuring that its population has access to food, but it has failed to ensure that it includes the necessary diversity in the types of food available.
Micronutrient deficiencies: Micronutrient deficiencies are common in India, mainly because of a focus on calorie availability and not dietary diversity.
Poor Storage: It is estimated that about 62,000 tonnes of stored grain, mainly rice and wheat, were damaged between 2011 and 2017 due to pest infestations and exposure to rain.
Water mismanagement: Poor water management and subsidies that encourage wasteful practices in agricultural production could come to present a threat to Indian food security. Together the lowest-performing states on the Composite Water Management Index (Niti Aayog) are home to about half of the Indian population (some 600 million people) and are the country’s breadbaskets.
Low Agriculture Productivity: Attention was drawn to this “yield gap” in the Indian Ministry of Finance’s 2015-16 Economic Survey.
Disproportionate Subsidies: Subsidies disproportionately benefit owners of large landholdings also adversely impacting the environment. According to the Indian National Sample Survey Office, most Indian farmers possess less than one hectare of land, which is not enough to achieve food security through subsistence farming.
High levels of hunger: Declining relative incomes, low produce of small and marginal farmers, which does not last year long, and the absence of a universal public distribution system (PDS)
Ecological crisis: Can cause irreversible damage to natural resources and a loss in productivity, if left unchecked.
Other: Rapidly growing population, resource constraints agrarian distress and continued agitation by farmers accompanied by the impacts of the COVID-19 pandemic

Malnutrition and COVID-19: No Time to Waste

The covid-19 pandemic has highlighted that the vulnerability of Indian citizens against the pandemic is much more because of the high incidence of malnutrition in the country.

Vulnerability of malnourished

1) India has already one of the highest burden of malnutrition in the country. This risk is increased by the fact that there is a simmering obesity pandemic in India.

2) Population i.e., malnourished is at greater risk of morbidity due to the infection.

3) High incidence of diseases such as Tuberculosis, HIV and other non-communicable diseases such as diabetes, hypertension etc.

4) Very high incidence of Anaemia in women.

5) High incidence of poverty and lack of proper healthcare access among the needy.

Vulnerability of children

1) Children are more vulnerable to infection if they are malnourished.

2) India has a high burden of pneumonia deaths among children U5MR which is attributed to the high incidence of malnutrition.

3) Schools were closed denying children of access to the Mid-day meal scheme.

4) Anganwadi centres were shut which denied children access to supplementary nutrition.

5) The economic impact of the COVID-19 pandemic was high in the districts which have higher rates of population engaged in the informal economy. Thus, these parents often overlooked the nutrition of their children.

6) Girl children would have worst suffered as they are usually ignored first.

Government Initiatives for food security

Food and Nutrition Security: National cooked Mid-day Meal Program, ICDS, Kishori Shakti Yojana, a Nutrition program for Adolescent Girls and Pradhan Mantri Gramodaya Yojana.
Mid-Day Meal Program: It is the world’s largest school feeding program reaching out to about 12 crore children across the country. The program aims at enhancing enrolment, retention and attendance and simultaneously improving nutritional levels among children.
National Food Security Act, 2013: With the objective to provide for food and nutritional security in the human life cycle approach, by ensuring access to adequate quantity of quality food at affordable prices to people to live a life with dignity. The Act also has a special focus on nutritional support to women and children.
Mahatma Gandhi National Rural Employment Guarantee Act (MNREGA 2005): Provides a legal guarantee for one hundred days of employment to enhance livelihood security.
Public Distribution System (PDS): It plays an important role in the provision of food security, the PDS in India is perhaps the largest distribution network of its type in the world.
Antyodaya Anna Yojana (AAY): It contemplates the identification of one crore poorest of the poor families from amongst the BPL families covered under TPDS within the States and providing them food grains at a highly subsidized rate
Poshan Abhiyan: Aims to reduce malnutrition, through a life-cycle concept, adopting a synergised and result-oriented approach.

Measures to be Taken

Systemic overhaul of the public administration and service delivery systems, as well as engagement from the community.
Need to invest in the infrastructure of ICDS and the Anganwadi centres as well as improve their coverage.
Need to better target nutritional programs and substantially increase their quality and impact.
Inclusion of all vulnerable groups (children, adolescent girls, mothers, expectant women) under the safety cover of ICDS.
Fortification of essential food items with legal provisions (e.g., twin fortification of salt with both iodine and iron).
Popularize low-cost nutritious food.
Control of micro-nutrient deficiencies with a special focus on vulnerable groups. Some district-level interventions have aimed to address this issue. For instance, Angul district in Odisha, which has a large geographically isolated tribal population, has periodic grievance redressal camps set up in areas far from the Anganwadi centres to provide ICDS services.
Need to address gaps and inefficiencies in the present setup through public awareness, community engagement and empowerment, while such an intervention would assist the community in realising their rights and entitlements, and then act as a deterrent to inefficiencies and gaps, it would also help in developing community-based solutions to malnutrition, unburdening the stressed public healthcare and ICDS infrastructure.
Strengthen inter-departmental convergence and resource allocation based on real-time data. In this regard, the approach undertaken by Bangladesh has been successful and replicable in India.
WHO calls for policy action across 6 key areas:

creating sustainable, resilient food systems for healthy diets;
providing social protection and nutrition-related education for all;
aligning health systems to nutrition needs, and providing universal coverage of essential nutrition interventions;
building safe and supportive environments for nutrition at all ages; and
strengthening and promoting nutrition governance and accountability, everywhere.

Ensuring that trade and investment policies improve nutrition;
WHO on The Relation Between Sanitation And Nutrition

According to the World Health Organisation, 50 per cent of all mal- and under-nutrition can be traced

to diarrhoea and intestinal worm infections, which are a direct result of poor water, sanitation and hygiene. Nutrition and water, sanitation, and hygiene (WASH).
WHO has estimated that access to proper water, hygiene and sanitation can prevent the deaths of at least 8,60,000 children a year caused by undernutrition.

Conclusion

For solving the malnutrition challenges in India requires the nutrition policy and program to have lasting and old challenges, as well as keep pace with new and emerging challenges. Mission Poshan 2.0 (Saksham Anganwadi and Poshan 2.0) has been announced in the Budget 2021-2022 as an integrated nutrition support program is the right step in this direction.