India's Malnutrition Woes

India is among 88 countries that are likely to miss global nutrition targets by 2025, according to the Global Nutrition Report 2020 released recently. It also identified the country as one with the highest rates of domestic inequalities in malnutrition.

Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.The condition encompasses undernutrition, overweight and Obesity along with micro-nutrient deficiency.

Statistics Paint a Gloomy Picture

• According to the Global Nutrition Report 2020, India will miss targets for all four nutritional indicators for which there is data available, i.e. stunting among under-5 children, anaemia among women of reproductive age, childhood overweight and exclusive breastfeeding.
• India is identified as among the three worst countries, along with Nigeria and Indonesia, for steep within-country disparities on stunting, where the levels varied four-fold across communities.
• In addition, stunting prevalence is 10.1% higher in rural areas compared to urban areas. The same applies for overweight and obesity, where there are nearly double as many obese adult females than there are males (5.1% compared to 2.7%).
• In the 2019 Global Hunger Index India ranks 102nd out of 117 qualifying countries. With a score of 30.3, India suffers from a level of hunger that is serious.

Reasons of Malnutrition 

• Poverty: The entrenched poverty in India has made affordability of food difficult despite the fact that India is self-sufficient in food grains especially after the green revolution.
• Accessibility: Even though overall production of food grains in India has touched the roof, but these is a visible pattern of surplus and deficit states. This makes accessibility of food to poor people in deficit areas all the more difficult. Additionally, public distribution system which is entrusted with the task of distributing food grains suffers from the problem of corruption, pilferage, faulty biometric authentication system and high-handedness of shopkeepers.
• Absorption: Poor Sanitation is one of the major causes for water borne diseases in India. This in turn leads to poor absorption of nutrients in the body thereby adding to the problem of chronic malnutrition. The problem is further compounded by the lack of clean drinking water and poor hygiene practices.
• Monoculture in Agriculture: Green revolution promoted mainly two crops rice and wheat. This led to neglect of other nutritious food grains like millets and consumption of only two staple crops. As a result cases of micro-nutrient deficient people saw a rapid increase in India.
• Junk Food Culture: In recent few years, there is a visible increase in the consumption of fast food and high-sodium containing junk food in India. This has afflicted not only urban households but rural households also.
• Inequity: There is a link between malnutrition and different forms of inequity, such as those based on geographic location, age, gender, ethnicity, education and wealth malnutrition in all its forms. Inequity is a cause of malnutrition — both under-nutrition and overweight, obesity and other diet-related chronic diseases. Inequities in food and health systems exacerbate inequalities in nutrition outcomes that in turn can lead to more inequity, perpetuating a vicious cycle.
• Gender Disparity: When there is limited access to food, many studies have shown that female members of the house get the least amount for consumption. The quality of food intake also shows perceptible gender discrimination with high protein rich diet for men and poor quality meals for women.
• Socio-Cultural Practices: Early marriage and teenage pregnancies result in malnourished children and poor culture of breastfeeding adds to this problem.

Effects of Malnutrition

  

Measures to Tackle Malnutrition

• United Nations Decade of Action on Nutrition: On 1 April 2016, the United Nations General Assembly proclaimed 2016–2025 the United Nations Decade of Action on Nutrition. It sets a concrete timeline for implementation of the commitments made at the Second International Conference on Nutrition (ICN2) to meet a set of global nutrition targets and diet-related NCD targets by 2025, as well as relevant targets in the Agenda for Sustainable Development by 2030—in particular, Sustainable Development Goal (SDG) 2 (end hunger, achieve food security and improved nutrition and promote sustainable agriculture) and SDG 3 (ensure healthy lives and promote wellbeing for all at all ages).
• Pradhan Mantri Matru Vandana Yojana (PMMVY): Rs.6,000 are transferred directly to the bank accounts of pregnant women for availing better facilities for their delivery.
• Poshan Abhiyaan: It is the flagship scheme of government to fight malnutrition which aims to reduce stunting, under-nutrition, anaemia and low birth weight babies through synergy and convergence among different programmes, better monitoring and improved community mobilisation and make India malnutrition free by 2022. However, it does not take case of over-nutrition.
• Poshan Atlas: The ministry of Women and Child Development (WCD) in association with the Bill & Melinda Gates Foundation and Deendayal Research Institute is developing a POSHAN atlas under POSHAN abhiyan. In a bid to tackle malnutrition, government is developing an Atlas to map the crops and food grains grown in different regions of the country so that nutritious protein rich food in local areas can be promoted.
• Anaemia Mukt Bharat Programme: It aims to fight anaemia and the 6X6X6 strategy (six target beneficiary groups, six interventions and six institutional mechanisms) of the programme aims to use anaemia testing and treatment as the entry point to provide information on healthy diets.
• National Food Security Act , 2013: It aims to ensure food and nutrition security for the most vulnerable through its associated schemes and programmes, making access to food a legal right.
• Mid-Day Meal Scheme: It aims to improve nutritional levels among school children which also has a direct and positive impact on enrolment, retention and attendance in schools.
• Weekly Iron and Folic Acid Supplementation Programme: Its objective is to meet the challenge of high prevalence and incidence of anaemia amongst adolescent girls and boys.
• Swachh Bharat Abhiyan: It is directed towards improving Sanitation facilities as there is a direct link between cleanliness and nutrition.

Suggestions to Improve the Dismal State of Affairs

• Community Management: Community management of acute malnutrition is a proven approach to manage severe acute malnutrition and moderate acute malnutrition in children under five. It involves timely detection of acutely malnourished children in the community and provision of treatment for those without medical complications with nutrient-dense foods at home.
• Ensure Availability: Encourage and incentivise agricultural diversification, promote innovative and low-cost farming technologies, increase the irrigation coverage and enhance knowledge of farmers in areas such as appropriate use of land and water and government should improve policy support for improving agricultural produce of traditional crops in the country.
• Ensure Accessibility: Improve the targeting efficiency of all food safety nets should be improved, especially that of the Targeted Public Distribution System (TPDS), to ensure that the poorest are included, Fortify government-approved commodities within the social safety net programmes to improve nutritional outcomes and improve the child feeding practices in the country, especially at the critical ages when solid foods are introduced to the diet.
• Ensure Utilisation: Improve the storage capacity to prevent post-harvest losses, make all the major welfare programmes gender sensitive and aim for funds for food to all as it yields great returns and help in unlocking the full potential of citizens besides strengthening the workforce.
• Promote Regional Crops: The solution to tackling malnutrition lies in promoting regional cropping patterns and embracing local food that is rich in protein. The atlas will help tackle malnutrition by effective mapping and evidence based policy formulation.
• Promote Equity: COVID-19 pandemic has exposed different forms of socio-economic inequities. Therefore it is imperative to promote equity to address malnutrition.

To make India malnutrition free, a multidimensional approach is the need of the hour, which covers not only personal but also social, economic and environmental aspects with due diligence.