Sure cure: how to tackle India's undernutrition crisis in 10 steps
India is the epicenter of a global stunting crisis. At least 39% of the country's children under five - about 47 million souls - suffered from stunting in 2015. That's more stunted children, proportion-wise, than in all of Africa, where the figure is 32%.
Simply put, stunting is abnormal weight-height ratio. It's inter-generational in that it often starts in the womb.Also read - Malnourished children still a problem for India, but things looking up
One way to address the crisis is through nutritional schemes for pregnant women and children. While such programmes exist, state support to them hasn't been adequate of late, as laid out in a report titled Under Nutrition In India - A Nutrition Budget Disconnect.
Indeed, this year's budget made no significant increase in the allocation for nutrition-related schemes. The Centre, in fact, passed the burden on to the states, asking them to set their own nutrition priorities and pay up to half the funds needed for programmes like the ICDS.
Here's what the report - released on 11 March by the Centre for Budget and Governance Accountability and UNICEF and partly written by prominent food rights experts - prescribes for tackling the crisis.
1) Ensure better coordination among various ministries
To tackle malnutrition, it's imperative that the following ministries work together:
Public Distribution and Civil Supplies
Health and Family Welfare
Women and Child Development
Drinking Water and Sanitation
By coordinating their efforts, these ministries will ensure that essential nutrition services reach the most deprived communities.
The finance ministry and the planning departments, the report points out, can play an overarching role by ensuring such programmes get sufficient budgets, resources and a policy framework.
2) Improve data collection on stunting and obesity
Although the practice of measuring malnutrition, through the ICDS, on the "underweight criterion" - weight for age - is expedient at the village level, it doesn't count stunted and wasted children with the same frequency, Aarti Ahuja, a food rights expert, argues in the report.Another area of neglect is the measurement of obesity. According to the WHO, India's obesity rate rose from 4% to 4.9% between 2010 and 2014, sending India off-course in meeting the WHO's obesity reduction targets.
The report notes that appropriate policies can only be designed if proper and timely information and data is collected not just on underweight children but the overweight ones as well.
3) Invest heavily in social welfare programmes
What do Kerala, Tamil Nadu and Himachal Pradesh have in common? Good nutrition indicators.
In a paper titled Child Development Index: How Have Different States Fared, the economists Reetika Khera and Jean Dreze analyse the key reasons for the rapid progress made in these states.
First, a major expansion of elementary education. Two, the constructive role of the state in extending a wide range of essential services and facilities, from healthcare and clean water to social security and basic infrastructure. Three, active social policies that enabled disadvantaged groups to have a voice in the democratic process, and in turn led to broad-based support for social development across political parties.
India's obesity rate increased from 4% to 4.9% from 2010 to 2014, according to the WHO. Why?
And all this, Khera and Dreze point out, didn't prevent any of these states from registering decent economic growth.
No surprise then that despite being regularly warned that this approach isn't "sustainable", Kerala, Tamil Nadu and Himachal keep expanding the reach and quality of public services. Tamil Nadu, for instance, recently launched potentially pioneering schemes of maternity entitlements, community kitchens and even nursing rooms at bus stands.
4 ) Make welfare delivery mechanisms more accountable
The report details the state's utter neglect of Adivasis who suffer from acute malnutrition, and in far greater numbers, than most other communities.
The report blames the lack of accountability of government officials in remote and sometimes inaccessible regions for the poor delivery of state programmes to these people.
A study conducted by UNICEF in 2014 confirmed loss of their land and displacement without adequate rehabilitation as the key causes for tribal impoverishment. Apart from poor utilisation of funds, the tribals have suffered due to poor quality of governance.
"The Indian planner unfortunately has still to understand the difference between planning and budgeting. This is where a systemic change is needed in India. In addition to spending budgets, we need to give equal importance to non-monetary issues such as institutions, laws and policies," the report report argues.
5) Allow panchayats a bigger say in running welfare schemes
The ICDS Anganwadi programme is plagued by massive systemic corruption. In the report, Vrinda Krishna argues that a key reason for this is that accounting, budgeting, clearing bills, auditing and all such functions are centralised. She advocates delegating powers to gram panchayats or local elected bodies to clear bills and make payments to the food suppliers.
"This would involve considerable decentralisation and democratisation of decision-making. Budgets would have to be directly made available to the gram panchayats."
6) Diversify the Public Distribution System
Making only rice and wheat available through the subsidised PDS has adversely affected the consumption pattern of poor people, the food rights activists Dipa Sinha and Shikha Nehra argue in the report, adding that we must put the focus back on millets.
"Due to shortages in pulse and oil production in India, the prices of these commodities are highly volatile and have recently been seeing increasing inflation, making it more difficult for the poor to access. Hence, not only are the factors of availability and absorption not taken into account, access too is defined narrowly in the NFSA" they write, advocating a more diversified food basket to provide better nutrition through the National Food Security Act.
7) Strengthen and expand on nutrition schemes for adolescent girls
Undernutrition among adolescent girls requires immediate attention. More than 44% of India's adolescent girls are underweight, that's they have a body mass index of less than 18.5. In most states, the proportion of adolescent girls with anaemia is alarmingly high, ranging between 76% and 92.9%.
"The nexus between gender discrimination and nutrition cannot be ignored. Malnourished girls become malnourished adolescents who marry early and have children who become malnourished, and so the cycle continues," the report points out.
Yet, the focus on these girls is limited. The report advocates for the Kishori Shakti Yojana, which is limited to 2-3 adolescent girls per Anganwadi, to be expanded substantially. Other schemes such as the National Programme for Adolescent Girls - which provides underweight adolescent girls 6 kg of free food grain per month - and Sabla need be expanded beyond the 51 and 200 districts, respectively, they have been rolled out in.
8) Strengthen MGNREGA to ensure better food security
In Rajasthan, it's said that one season of drought can send an entire generation back into poverty. Staying true to its roots as a drought relief scheme, the MGNREGA continues to play a vital role in mitigating the disastrous effects of droughts in rural areas.
Citing Rajasthan's Sahariya tribals as an example, Nikhil Dey of the MKSS writes in the report, "The Sahariyas are infamous for the highest number of starvation deaths at the time of distress. These extra work days for vulnerable groups like them has not just helped them fight hunger, it has enabled many of them to free themselves from bondage".
Not just budgets, give equal importance to institutions, laws, policies to tackle undernutrition: Report
"This is a powerful example of the political and economic impact of MGNREGA on a vulnerable community and its fight against extreme deprivation and exploitation."
Since this rural job guarantee programme has great potential for "improving food security on the whole", the report advocates stronger budgetary support to it.
9) Revive and safeguard forests as sustainable sources of food
The months from April to September are especially difficult for most of India's villagers when it comes to household food security. They neither get full-time employment nor are able to take up daily wage work owing to the extreme heat. Moreover, a substantial part of the household food stocks goes into sowing the fields. The subsidised rice from the PDS only meets the food needs of a family of five for about 5-6 days a month. Therefore, forest foods are critical for these communities.
In a chapter titled Forests: A Food Producing Habitat, Debjeet Sarangi, Bichitra Biswal and Pradeep Patra describe the tradition of collecting and cultivating in forests to meet local food requirements. Indeed, communities across the country have been growing over 60 varieties of crops - millets, maize, sorghum, lentils, sesame, flaxseed, spices and vegetables - through mixed-cropping on hill slopes. They also raise local varieties of paddy and collect hundreds of uncultivated foods from the forests - edible flowers, fruits, tubers, leaves, stems, seeds, wild mushrooms, tamarind, bamboo shoots, edible insects.
According to a study by Living Farms, an average of 0.725 kg of forest foods" goes into the cooked food of a forest-dwelling household a day. The dependence of such communities on forest foods, which provide a critical supplement to and diversity in their diets, ranges from 20% to 50%.
"The current land use or forest policies and even food security programmes do not appreciate the traditional forest foods in the diet of tribal folk. Instead, the focus has been on using plantations as a revenue-generating measure at the expense of minor forest produce and unmarketed forest foods. These practices have led to a hugely reduced diversity of traditional food and degradation of forest and agro-biodiversity," the report concludes.
10) Improve access to public healthcare for poorer communities
Tribal migrant labourers - who constitute a significant proportion of the urban poor in places like Ahmedabad and Surat - are exposed to health risks by their excruciating living and working conditions in the city. To make the situation worse, they lose access to decent healthcare and welfare benefits when they move locations.
Most of them are engaged in work that puts them at high risk of getting ill - marble cutting, construction, tile-fitting and cutting. Absence of nutritious food and overcrowded living conditions only heighten the risk.
To address this problem, the report advocates for providing better public healthcare facilities in places with high migrant populations. It also calls for "a judicious optimisation mix of human resources, engaging tribal providers and establishing good transport referral systems".