India’s Nutrition Challenges

Context

• Third meeting of National Council on India’s Nutrition Challenges as part of Poshan Abhiyan held recently in New Delhi.
• Despite being one of the fastest growing economies in the world, India has been ranked at 103 out of 119 countries, with hunger levels categorised as “serious”, in the Global Hunger Index 2018.

Background

Why nutritional balance is important for India: The rationale for investing in nutrition is globally well recognised both as a critical developmental imperative, as well as crucial for the fulfilment of human rights especially of the most vulnerable such as children, girls and women. 

• It constitutes the foundation for human development, by reducing susceptibility to infections, related morbidity, disability and mortality burden.
• It is critical to prevent under- nutrition, as early as possible across the life cycle. Nearly every fifth young child in the world lives in India and nutritional intake is crucial for materialising this human resource pool in the future.
• It helps in enhancing cumulative lifelong learning capacities and adult productivity.
• It is the most effective means for poverty reduction and economic development with high economic return.
• It is central to the achievement of Sustainable Development Goals (SDGs).

Extent of under nutrition in India

India’s performance on key nutrition indicators is poor according to national and international studies.

• India’s child malnourishment level is not only the highest in the world but varies considerably across States. As per National Health Survey-4 2015-16:
  • The proportion of stunted (low height for age) children under five is significantly higher (38.4%) than global (22.9%) averages.
  • The underweight (low weight for age) children rate (35.7%) is a lot higher than the global average (13.5%) too.
  • India is home to over 53.3 million stunted, 49.6 million underweight and 29.2 million wasted (low weight for height) children under five.
• According to United Nations system in India (2015):
  • With nearly 195 million undernourished people, India shares a quarter of the global hunger burden.
  • Nearly 47 million or 4 out of 10 children in India are not meeting their full human potential because of chronic under-nutrition or stunting.

Causes of Malnutrition

High levels of maternal and child under-nutrition in India have persisted, despite strong constitutional, legislative policy, plan and programme commitments. The causes for malnutrition are various and multi-dimensional. These include:

• Poverty and food insecurity: According to Multi Dimension Poverty Index (MPI) 2018 of UNDP, 364 million Indians continue to experience acute deprivations in various social indicators. Over one in four multi-dimensionally poor in India are under ten years of age.
• Poor access to health services: According to a The Lancet study (2016) India ranks 145th among 195 countries in terms of quality and accessibility of healthcare, behind its neighbours like China, Bangladesh, Sri Lanka and Bhutan.
• Lack of education and information: As per Annual State of Education Report 2017, India’s 125 million children between 14 and 18 years of age are ill-equipped to read, write or even do basic arithmetic. It stated that the gender divide in cognition levels worsens with rise in age, as girls are often compelled to drop school for a variety of reasons.
• Poor sanitation and lack of availability of fresh drinking water: According to Niti Aayog’s Composite Water Management Index 2018, 600 million people face high-to-extreme water stress; 75 per cent of the households do not have drinking water; and 84 per cent do not have piped water access; and 70 per cent of our water is contaminated. When water is available, it is likely to be contaminated, resulting in nearly 2, 00, 000 deaths each year.
• Climate change and environmental degradation: According to Inter-governmental Panel on Climate Change (IPCC) Assessment Report-5 2014, in India, the estimated countrywide agricultural loss in 2030 is over $7 billion due to climate change. It will severely affect the income of 10 per cent of the population. Agriculture, the mainstay of the Indian economy, will see dramatic changes in yields, affecting people’s right to food security.
• Social ills like early child marriage and forced labour: According to the latest figures of UNICEF India, 27% per cent marriages in India in 2016 were child marriages. Child marriage affects society as a whole since child marriage reinforces a cycle of poverty and perpetuates gender discrimination, illiteracy and malnutrition as well as high infant and maternal mortality rates.
• Poor breastfeeding: According to a report (2017) by UNICEF and WHO in collaboration with the Global Breastfeeding Collective, India is among the world’s five largest emerging economies where investment in breastfeeding is significantly low resulting in an annual loss of $14 billion due to child deaths and cognitive losses from poor breastfeeding practices.
• Economic and financial disability of women: Despite economic and educational growth, female participation in the labour force of India has fallen to 24% in 2011, from 31% in 2004. India is 11th from the bottom in the world in women’s labour-force participation rates
• Increase in inequality: India ranked 147 out of 157 countries in terms of its commitment to reducing inequality according to Commitment to Reducing Inequality Index developed by Oxfam and Development Finance International.

Government initiatives

• Accessibility and Affordability of Food: National Food Security Act 2013, Mid-Day Meals and supplementary nutrition under Integrated Child Development Scheme (ICDS).
• Water and Sanitation: National Rural Drinking Water Programme and Swachh Bharat Mission.
• Maternity Benefits: Compensate wage loss during pregnancy-Pradhan Mantri Matru Vandana Yojana.
• Full immunization: Mission Indradhanush and roll out of Rotavirus and Pneumococcal vaccines.
• Deworming initiative
• Initiation of Early Breastfeeding- MAA National Breastfeeding Programme.
• Delaying the age of marriage and ensuring gap between pregnancies-Beti Bachao Beti Padhao and National Health Mission IEC.
• Weekly Iron Folic Acid (IFA) Supplementation

Therefore, it is widely recognized that a multi sectoral approach is necessary to tackle the problem of malnutrition.

Further steps

• ICDS System Strengthening: There should be a mechanism for growth monitoring which would include, early registration and weight monitoring, monthly weight monitoring, quarterly height/length monitoring.
• Improved Service Delivery: Will include convergence of services such as Immunisation, institutional delivery, drinking water and sanitation and efficient service deliver.
• Use of information technology (ITC): use of ICT interventions for addressing under nutrition includes
  • Real time monitoring-Population, target groups etc.
  • Nutrition Mapping
  • Data Analysis-Connecting Gaps.
• Infant and young child feeding promotions (IYCF): This will include
  • Behaviour change
  • Multi-media creatives– Exclusive breastfeeding, Early initiation of breastfeeding and complementary feeding
• Proper implementation of National Nutrition Mission (POSHAN Abhiyan).
• Diversified food: Diversifying the diet which should include required amount of nutrients is a better way to contain under-nutrition at the base.
• An inclusive and holistic approach: including controlling/regulating food price, strengthening the public distribution system (PDS) and income support policies for making food cheaper are important steps.
• In order to improve their income and food situation, it is therefore crucial that women obtain access to resources, that is, to credit, land, and agricultural means of production.
• Gender equality is one of the means to improve the income thereby diverse food basket of the people. The Food and Agriculture Organization of the United Nations estimates that if women farmers had the same resources as men, it would have led to 150 million fewer hungry people.

Practice Question:

High levels of maternal and child under-nutrition in India have persisted, despite strong constitutional, legislative policy, plan and programme commitments. Elaborate.