Global Hunger Index: We need significant improvements to dent malnutrition

The release of the Global Hunger Index (GHI) has once again brought the poor state of nutrition in India onto the spotlight. Although there are improvements in India’s hunger and nutrition indicators, on the whole its rank has gone down compared to earlier years. India ranks 100 out of 119 countries, coming below neighbouring countries such as Bangladesh and Nepal. With a GHI of 31.4, India is at the high end of the “serious” category and this highlights the need for an urgent focus on interventions towards reducing malnutrition in the country. This report has come close on the heels of Government of India’s launch of a nutrition strategy through the Niti Aayog’s policy paper and the National Nutrition Mission.

While the nutrition strategy rightly recognises the need for multi-sectoral interventions to address the problem of malnutrition in the country, it is yet to be seen whether it will be backed up with sufficient funds and resources to strengthen some of the critical programmes for nutrition such as the ICDS. It is unfortunate that the debate has been mainly around proposals to introduce packaged foods or cash transfers to replace decentralised food distribution in anganwadi centres. Such proposals not only favour commercial and vested interests more than malnourished women, children and communities, but they also divert attention away from the real issues of unequal access to food, livelihoods and natural resources.

It is welcome that the theme of this year’s report of the GHI is on “The Inequalities of Hunger”. As the report rightly points out, “Examining hunger through the lens of inequality brings into sharper focus those populations, at all levels, who have so far been left behind. As we make progress in combating hunger, we should apply lessons learned and concentrate attention and resources on the areas where hunger and undernutrition are still unacceptably high in order to further decrease hunger in the future.” Inequalities in nutrition outcomes exist not just between different countries but within nations too. In India, there are stark inequalities not only in wealth and incomes but also in health and nutrition outcomes.

The data from the National Family Health Survey (NFHS 4, 2015-16) points to some of these inequalities which need to be taken into consideration when policy is being formulated. Although the overall rate of stunting (low height for age) prevalence among children under five years of age has come down to 38 per cent (NFHS-4) from 48 per cent (NFHS-3); the inequalities amongst different social and economic categories are still very high. Therefore, 51per cent of children of mothers who had no education are stunted compared to 31per cent of children of mothers who have completed secondary education or more. Similarly, while 44 per cent of children belonging to Scheduled Tribes (STs) are stunted, 31 per cent is the rate of stunting amongst those belonging to the General category. There are severe inequalities by wealth too, with 51 per centof children in lowest wealth quintile being stunted compared to 22 per cent children in the highest quintile. Further, regional inequalities are also significant with the prevalence of stunting ranging from 48.3 per cent in Bihar to 19.7 per cent in Kerala. The NFHS-4 data shows similar differences in the data for underweight children as well; another indicator of malnutrition.

With the little data that is available from the NFHS-4 factsheets, it is clear that there are a number of areas which need significant improvement to make a dent on malnutrition in the country. Poor sanitation, inadequate access to health facilities, low levels of maternal education and health etc. all play an important role in determining nutrition status of a child through their impact on infections, care, intrauterine growth and so on. Less than half the households use improved sanitation facility (48.4 per cent) or clean fuel for cooking (43.8 per cent). Only about one third (35.7 per cent) of women in the reproductive age, covered by the NFHS-4, had completed 10 or more years of schooling and 27 per cent of women aged 20-24 were married before the age of 18. All of these contribute to the outcome of poor child malnutrition.

One of the factors that get highlighted is that very small proportion of children in the age group of 6 to 23 months in the country get adequate diets (9.6 per cent). Although there are variations, this is low across the country – 30.7 per cent in Tamil Nadu to 3.4 per cent in Rajasthan. Therefore, there needs to be some serious introspection on why we have not achieved sufficient and diverse diets for children. Along with everything else, adequate quantity and quality of food for young children remains a critical issue.

The author teaches economics at Ambedkar University and is associated with the Right to Food campaign