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The first Millennium Development Goal signed by 189 nations in 2000, aimed to “halve hunger by 2015”. Unfortunately, even two years after that deadline, the recent Global Hunger Index (GHI) report released on October 12, 2017, by Washington-based International Food Policy Research Institute (IFPRI), ranked India at a dismal 100th position.

In a statement, IFPRI said, “Given that three-quarters of South Asia’s population resides in India, the situation in that country strongly influences South Asia’s regional score (30.9). India’s consistent fall into the upper half of the serious hunger levels is one of the main factors pushing South Asia to the category of worst performing region on the GHI this year, followed closely by Africa South of the Sahara.” Surprisingly, even Iraq and North Korea are ranked higher at 78 and 93, respectively, while Cuba, Chile, and Turkey, with a score of less than 5, are ranked best among all developing nations.

Global trends

According to the Food and Agriculture Organisation (FAO) report on the State of Food Security and Nutrition in the World, 2017, “the estimated number of undernourished people across the world has increased from 777 million in 2015 to 815 million in 2016. Even as the prevalence of stunting fell from 29.5% to 22.9% between 2005 and 2016, global trends reveal that as many as 17 million children were affected by child wasting in 2016. Favourably, the rate of breastfed infants has seen an increase from 36% in 2005 to 43% in 2016.Considered to be one of the single largest preventive impact on child mortality, improving rates of breastfeeding is expected to prevent up to  8,20,000 child deaths every year.”

India’s dismal state

Despite years of rapid economic growth, malnutrition continues to be one of the enduring challenges of contemporary India. Now in its 12th year, the Global Hunger Index (GHI) report shows 14.5% of the India population as under-nourished. While poverty rates could have played a major role in increasing the burden of malnutrition, there is very little evidence to suggest that state interventions, either in the form of broad-based programmes such as the public distribution system (PDS) for food grains or targeted child nutrition programmes such as the Integrated Child Development Services (ICDS) are doing enough to fight this menace.

India’s status on child stunting and wasting is 38.4% and 21.0% respectively. Although stunting is said to have declined as compared to the last decade, the stagnation in wasting requires careful analysis of the factors that underlie wasting, and relevant policy implementation. According to the IFPRI report, “It is also useful to examine the inequities in progress in some of these indicators across India’s states. Progress in some of India’s larger states needs to be accelerated in order to ensure that India’s performance as a whole is accelerated.” A National Family Health Survey in 2015 revealed that the states where aggravates malnutrition is most prominent are Uttar Pradesh, Tamil Nadu, Madhya Pradesh, Jharkhand, and Bihar. What furthers the problem is lack of proper sanitation that reduces the nutritional value of the food consumed.

Surprisingly, child mortality in India has shown a sharp decline to 4.8%. These results are in tune with Lancet, a national representative survey, led by Professor Prabhat Jha of the Centre for Global Health Research at St. Michael’s Hospital in Toronto conducted in 2015 that showed a 62% fall in child mortality in the last two decade from 125 per thousand live births in 1990 to 47 in 2015. This is slightly less than the Millennium Development Goal’s target of 66% reduction in child mortality rate by 2015. According to the Lancet report, the most effective results were seen in states of Tamil Nadu, Maharashtra, and Karnataka.

Major challenges

A research by Rapid Survey on Children (RSOC), conducted by the ministry of women and child development in 2013-14 in league with UNICEF highlighted two key drivers of malnutrition. One includes the absence of sanitation, which leads to rampant spread of diseases followed by the low social status of women, which is reflected in low birth weights. While poverty is not the only cause of malnutrition, it is an essential one, not just because the poor may lack adequate access to food but also because they often have less time and resources to care of their children. Naturally, the proportion of malnourished children among the lowest wealth groups is significantly higher than those among the highest wealth groups. The proportion of underweight children among the lowest wealth quintile declined 14.5% to reach 42.1% while the same proportion among the highest wealth quintile fell 1.1% to reach 18.6%. Also, the privilege of various government schemes and programmes, aimed at helping the underprivileged is enjoyed only by those slums that are notified. Due to increasing rural-urban migration, around 50 % of the urban slums are not notified and hence, are deprived of most government schemes. People from these un-notified areas have to buy their food from the common market at competitive prices and are devoid of the subsidised food made available through Public Distribution System (PDS).

The deserving candidates for subsidy under the Targeted Public Distribution System (TPDS) are arbitrary and vary from state to state. What is often inaccurately classified as above poverty line (APL) and below the poverty line (BPL) categories has resulted in a big decline in the off take of food grains. Besides this, low quality of grains and poor management of the Public Distribution System shops has further escalated the problem. Nobel Prize winner Angus Deaton, also pointed out that malnutrition in India is not just related to calorie intake, but India’s dependence on carbohydrate-based diet with low protein and fat content.

In spite of several national nutrition programmes, lack of intersectional co-ordination between various ministries and unmonitored implementation like the selective adoption of Mid-Day Meal Schemes (MDMS) across various states in India, have slacked the effectiveness of these policies.

The way ahead

Operationalisation of the concept of nutrition security, which implies physical, economic and social access to balanced diet, clean drinking water, safe environment, and health care, is the need of the hour. Ensuring food security will only aid in reducing hunger but will not eliminate malnutrition or impact nutrition status largely if other components such as sanitation and health care are also not addressed simultaneously. Annual surveys and rapid assessments surveys need to be conducted efficiently. Evaluations must be timely performed and should provide relevant information regarding the effectiveness of interventions. The Global Nutrition Report (GNR) of 2016 that aims to end malnutrition by 2030, is an independent accountability mechanism for progress and action on nutrition, by IFPRI. It calls on all the state and non-state actors to make SMART Commitments to Nutrition Action, i.e., commitments that are specific, measurable, achievable, relevant, and time bound. It is now up to India to work in conjunction with the stated guidelines of GNR to get its house in order.