India?s needless malnutrition problem: Who to blame and who can solve

By Moin Qazi

Moin Qazi is the author of Village Diary of a Heretic Banker. He has spent more than three decades in the development sector.

A recent alarming signal in the health profile of Indian children went largely unnoticed. India, which has more than a fifth (21%) of its children suffering from wasting—having an insufficient weight-to-height ration—slipped three places to 100 in the 2017 Global Hunger Index (GHI) of 119 countries. This marks a fall of 45 places from India’s rank of 55 in 2014.

Proactive policies are cheaper than reactive policies

The dismal health of Indian women and children is primarily due to a lack of food security. Food security exists when all people at all times have physical, economic and social access to safe, adequate and nutritious food that meets their dietary needs for a healthy and active life. Food security is measured along a continuum, from the most severe state of starvation to acute enduring hunger, then chronic persistent hunger and finally hidden hunger. Much less investment is required to maintain adequate nourishment for children than is required to treat undernourished children.

India has the highest number of moderately and severely underweight children and adolescents in the world. Of all Indian children under five, one in three (35.7%) is underweight, one in three (38.4%) is stunted and one in five (21%) is wasted. This is worse than many sub-Saharan countries. Overall, India accounts for more than three out of every 10 stunted children globally. This is largely on account of a lack of quality food, poor care and feeding practices and inadequate water, sanitation, and health services in the country.

The problem starts with undernourished mothers

Many children are born to anemic and malnourished teenage mothers. Indeed, 33.6% of Indian women are chronically undernourished and 55% are anaemic. In addition, feeding practices among such mothers are poor and the environments they live in with their children are often rife with fecal matter. However, current public health programmes generally miss infants in the first two years of their lives, when malnutrition normally sets in. This despite the fact that malnutrition in the first two years of life can cause permanent mental and physical damage.

Fewer than half of all Indian children start nursing within their first 24 hours, although breast-milk helps to protect infants against infection. Rather, most children are given water and most spend their first few years subsisting on protein-poor and vitamin-poor diets of rice or bread. Children cannot achieve their full height on such restricted diets. Moreover, research in other countries has shown that supplementary nutrition given in the first two years of life can improve a child’s IQ by 10%.

Unsanitary environments aggravate the problem

But it is not just a lack of nutrition that causes stunting, the environment plays a significant part as well. Common enteric infections, which are generally due to lack of hygiene or sanitation, affect the gut’s ability to absorb nutrients. Thus, even if the child has access to nutritious food the body may not be able to absorb the nutrition. Also, diarrhoea in children from impoverished areas during the first two years of life has been linked to an eight cm reduction in height and a ten IQ point decrease in children seven to nine years old.

According to the development economist Jean Dreze, the most serious nutrition challenge in India is to reach out to children under three years of age: “It is well known that if a child is undernourished by age three, it is very difficult to repair the damage after that.” The costs of failing to do so—both in human and economic and terms—are huge. Pervasive long-term malnutrition erodes the foundations of the economy by destroying the potential of millions of infants. Children stunted on account of malnutrition are estimated to go on to earn an average of 20% less as adults.

The solutions are well-known

A package of basic measures—including programs to encourage mothers to exclusively breastfeeding their children for up to six months, fortifying basic foods with essential minerals and vitamins, and increased cash transfers with payments targeted at the poorest families—can turn the tide.

India already has two robust national programmes addressing malnutrition—the Integrated Child Development Service and the National Health Mission—but these do not yet reach enough people. The delivery system is also inadequate and plagued by inefficiency and corruption. Some analysts estimate that 40% of the subsidized food never reaches the intended recipients.

In order to consolidate its efforts towards tackling the malnutrition challenge, the government has approved the National Nutrition Mission (NNM). With a budget of Rs 9046 crores over a period of three years, the mission is expected to benefit 10 crore people. Through the programme, the government seeks to reduce stunting, malnutrition and low birthweight by 2% each year.

Poor choices are also a problem

However, a significant cause of malnutrition is also the deliberate failure of malnourished people to choose nutritious food.  One survey by the economists Duflo and Banerjeehas found that, overall, the poor in developing countries had enough money to increase their food spending by as much as 30% but that this money was spent on alcohol, tobacco, and festivals instead.

Progress is still slow and the political will patchy but there are signs that a new approach is taking root. NITI Aayog has drafted a National Nutrition Strategy that aims to eradicate malnutrition from the country by 2030.With this end in view it has set the following targets:

• To reduce undernutrition in children (0-3 years) by 3% per annum until 2022.
• To reduce the prevalence of anemia among young children, adolescent girls and women in the reproductive age group (15-49 years) by one-third of the NFHS 4 levels by 2022.

Some other recommendations are for programmes to promote breastfeeding for the first six months after birth, universal access to infant and young child care including ICDS and crèches, provisions to provide bi-annual critical nutrient supplements and programs aimed at de-worming children. In the area of maternal care, the strategy proposes that the government provides nutritional support—in particular, the adequate consumption of iodised salt—to mothers during pregnancy and lactation.

However, these policies can only reap the desired dividends if the government sets hard timelines and maintains stringent monitoring. Good intentions must be reflected by actions on the ground.

Featured Image Source: Flickr