Dr. Devendra Kothari
Population and Development Analyst
Forum for Population Action
India must convert its young population to a competitive
advantage, and nutrition is one of the most important stimulants to that outcome.
Nutrition plays a
critical role in human resource development since deficiencies in essential
nutrients lead to malnutrition, which affects an individual's mental and
physical state, resulting in poor health and poor work performance. In addition,
a hungry, malnourished child may have mild to serious learning disabilities,
resulting in poor school performance; a sick, poorly nourished individual will
not respond well to treatment, could lose many working hours and may continue
to drain family and national resources. Thus, malnutrition may undermine
investments in education, health and other development sectors.
The Ministry of Health and Family
Welfare, Government of India has released the results from the first phase of
the National Family Health Survey-4 (NFHS-4), conducted in 2015-16. The results
indicate that fewer children are dying in infancy and early childhood. After
the last round of National Family Health Survey in 2005-06, infant mortality
has declined for which trend data are available. All States/Union Territories
have rates below 51 deaths per 1,000 live births, although there are
considerable variations. [1]
However, NFHS-4
reveals that India’s high economic growth rate in the past decade has not been
fully reflected in the health status of its people with 20 per cent of its
population undernourished. More than half of the children and women are still anaemic.
The “Global Nutrition Report 2016” collaborates the
findings of the NFHS-4. It once again demonstrates India’s slow overall
progress in addressing chronic malnutrition, manifest in stunting (low weight
for age), wasting (low weight for height), micronutrient deficiencies and
over-weight. “Our track record in reducing the proportion of undernourished
children over the past decade has been modest at best, and lags what other
countries with comparable socio-economic indicators have achieved”, as noted by
Vinita Bali, Director, Alliance for Improved Nutrition.[2]
According
to the Report, in a ranking of countries from lowest to highest on stunting,
India ranks 114 out of 132 countries, with the incidence of stunting at 38.7
per cent, compared with Germany and Chile at 1.3 per cent and 1.8 per cent,
respectively. Even Bangladesh and Nepal rank marginally higher than India. On
wasting, India ranks 120 out of 130 countries, at 15.1 per cent, compared with
Australia and Chile at number 1 and 2, with 0 per cent and 0.3 per cent, and
South Sudan at 130 with 22.7 per cent. On the prevalence of anaemia in women of
reproductive age, India ranks 170 out of 185 countries at 48.1 per cent,
compared with Senegal which is the worst at 57.5 per cent and the U.S. which is
the best at 11.9 per cent.
The segments most at risk continue to
be adolescent girls, women and children, and among them Scheduled Castes and
Tribes are the worst off, reflecting the insidious economic and socio cultural
deprivation so prevalent in India. The most
important national effort is yet to address these deficiencies in India.Despite being one of the biggest producers of food supplies, India is home to
25 percent of the world’s hungry poor, according to a U.N. agency.
The
International Food Policy Research Institute (IFPRI) [3]
makes the annual calculations of
Global Hunger Index (GHI). Basing its readings on the most recent data, the 2016
GHI for India was derived from the fact that an estimated 15 per cent
population is undernourished - lacking in adequate food intake, both in
quantity and quality. the report states that “Countries worse than India
include extremely poor African countries such as Niger, Chad, Ethiopia and
Sierra Leone besides two of India's neighbors: Afghanistan and Pakistan. Other
neighbors Sri Lanka, Bangladesh, Nepal and China are all ranked above India”.[4]
According to the Report that the
malnutrition is a complex problem that contributes to 45 per cent of deaths
among children under the age of five in India annuall. Chronically malnourished
children are, on average, nearly 30 percent less literate than those who have a
nutritious diet. The share of under-5 children who are `wasted' is
about 15% while the share of children who are `stunted' is a staggering 39 percent. This
reflects widespread and chronic lack of balanced food. This is partially
reflecting the fatal synergy of inadequate nutrition and unhealthy
environments.
Although India runs two of the
world's biggest children's nutrition programmes, the ICDS for children under 6
years (launched in 1975) and the mid-day meal programme (1995)
for school going kids up to the age of 14, malnutrition continues to haunt India.
No doubt, nutrition is a big issue.
Many health problems could be resolved by proper nutrition. For example, a tuberculosis control
strategy that is merely treatment-based would be ineffective unless under-nutrition,
which compromises immunity and leads to the latent TB infection turning active in
millions, is addressed. Prof
Anurag Bhargava, who has been working for decades on TB, pointed out that in
India where 40 per cent of the population or about 500 million is estimated to
have latent TB infection, it would be logistically impossible to treat them
with drugs for 6-9 months. It is always malnutrition and vitamin deficiency
that leads a person to TB. A body must have adequate vitamins, minerals and
other natural substances in the food it takes to avoid TB. In other words, TB is a
nutritional disease, argues
Prof Bhargava, that can be prevented by placing nutrition
(including adult nutrition) at the heart of the global developmental and public
health agenda and implementing appropriate economic and agricultural policies,
social protection measures and targeted nutritional interventions". [5]
One of the reasons for persistent under nutrition in
India, despite the creation of the Integrated Child Development Services (ICDS)
in 1975 and national coverage of the Mid-Day Meal Scheme in 1995, is that there
is no structure for multi-sectoral coordination which is essential to address
the inter-generational and multifaceted nature of malnutrition. Both schemes
should be revamped looking to the needs of beneficiaries.[6]
Of these, the intent to revamp the ICDS has already been
announced by the Government and must move into action mode quickly. This must
include streamlining the work in the 1.34 million anganwadi centres by investing
in training the 2.5 million workers and helpers at these centres, standardizing
the nutrition component of the supplementary food offered and focusing on the
overall dissemination of information and education to pregnant and nursing
mothers on healthy eating habits, hygiene and sanitation,
Similarly, the mid-day meal is an excellent structure to
reach 120 million children with continuity and regularity. A single
intervention in that scheme to focus on nutrition in addition to food will make
a critical difference. This can easily be accomplished by the addition of
micronutrients to cooked food or by adding universally liked and accepted
products such as milk, biscuits, etc. fortified with micronutrients as a
mid-morning or afternoon snack. Therefore, extend large-scale food
fortification beyond salt to other staples like flour, oil, dairy, etc. and
establish mandatory standards by category.
In
addition, endemic poverty coupled with growing number of unwanted
childbearing,[7]
unemployment, lack of sanitation and safe drinking water, and lack of effective
healthcare are main factors for the sorry state.
The human dividend or demographic dividend on which we are
banking is actually a huge liability given that one out of every three children
is born underweight and unable to realize the full potential for physical
growth and cognitive development, leading to lower levels of productivity. The
World Bank estimates that India loses 2-3 per cent of its annual GDP by way of
lower productivity, the underlying cause of which is malnutrition.
In sum, the need to systemically address underlying causes
of malnutrition in India is an urgency that cannot be postponed. Poor nutrition
will fracture the dreams and aspirations of India to become a global player in
manufacturing and other sectors. Hope policy makers are listening!
[1] Refer: National Family Health
Survey 2015-16 (NFHS-4): states fact sheets, International Institute of
Population Studies, Mumbai, 2016.
[2] Refer article by Vinita Bali: We need a Nutrition
Mission at: http://www.thehindu.com/opinion/lead/We-need-a-Nutrition-Mission/article14503108.ece
[3] The International Food Policy Research Institute (IFPRI)
makes the annual calculations of GHI.
[4] For details, refer article at:, http://www.ifpri.org/news-release/india-ranked-97th-118-global-hunger-index-times-india. Also see: http://timesofindia.indiatimes.com/india/India-ranked-97th-of-118-in-global-hunger-index/articleshow/54822103.cms
[5] Refer article: To control TB, under nutrition
must be tackled’ by Rema Nagarajan (2016) at: http://timesofindia.indiatimes.com/india/To-control-TB-undernutrition-must-be-tackled/articleshow/55216307.cms
[6]
For further details, see article by Vinita Bali: We need a Nutrition Mission at: http://www.thehindu.com/opinion/lead/We-need-a-Nutrition-Mission/article14503108.ece
[7] Kothari,
Devendra. 2014. “Managing
Unwanted Fertility in India: Way Forward”, Institute of Economic
Growth (ed.): National
Rural Health Mission: An Unfinished Agenda, New Delhi: Book Well, pp.25-36. Also refer, author’s post entitled - India: Why
population matters? at http://kotharionindia.blogspot.in/2015/04/india-why-population-matters.html
