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Introduction

Malnutrition is a health condition resulting from a diet lacking or having excess of certain nutrients, leading to health issues. Despite India’s economic growth, malnutrition remains a persistent issue. Recently India ranked 107 out of 121 countries on the Global Hunger Index in which it fares worse than all countries in South Asia barring war-torn Afghanistan.

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Causes of malnutrition in India

• Poverty: Poverty is a significant factor contributing to malnutrition. Poor families often can’t afford nutritious foods like fruits, vegetables, and dairy products. A 2021 report by the World Bank found that 21.9% of the Indian population lives below the poverty line.
• Gender Inequality: Many Indian households prioritize men and boys over women and girls when distributing food, leading to nutritional deficiency in females. The National Family Health Survey (NFHS) found that 53% of women of reproductive age were anaemic.
• Poor Maternal Health: Malnutrition in mothers leads to low birth-weight babies, starting a cycle of malnutrition. The same NFHS data reveals that 22% of Indian children are born underweight.
• Inadequate Breastfeeding Practices: Many infants aren’t exclusively breastfed for the first six months, which is crucial for obtaining essential nutrients. The NFHS states that only 58% of children under 6 months are exclusively breastfed.
• Limited Dietary Diversity: Many Indian diets lack diversity and heavily depend on cereals, contributing to deficiencies in essential nutrients. The Comprehensive National Nutrition Survey found that only 6% of children aged 6-23 months receive a minimum acceptable diet.
• Food wastage: Inefficient storage, transportation, and distribution systems contribute to food wastage and losses, leading to food scarcity for vulnerable populations. Example– 50 kg per person food gets wasted in indian households annually.

Various initiatives implemented to tackle malnutrition in India

• Integrated Child Development Services (ICDS): Started in 1975, this program provides food, preschool education, and primary healthcare to children under 6 and their mothers. It has significantly improved nutrition levels, especially in states like Kerala and Tamil Nadu.
• National Health Mission (NHM): It aims to provide accessible, affordable, and quality healthcare, including nutritional interventions. A study by the Indian Journal of Public Health found that NHM interventions decreased malnutrition among children in rural areas.
• Mid-Day Meal Scheme: Implemented nationwide in 1995, this scheme provides free lunches on school days for students in primary and upper primary classes. It has been effective in increasing school attendance and improving children’s nutrition.
• Public Distribution System (PDS): The PDS distributes essential commodities like rice, wheat, and sugar at subsidized rates to vulnerable populations. The diversification of PDS to include nutritious food items has shown improvement in nutritional outcomes.
• Poshan Abhiyaan: Its objective is to achieve malnutrition-free India by 2022. It focuses on holistic development and adequate nutrition for pregnant women, mothers, and children. Some states like Chhattisgarh have seen notable improvements in child nutrition parameters under this initiative.
• Anganwadi Services: These provide basic health care and nutrition education in Indian villages. A 2019 study published in the Economics & Political Weekly found significant reductions in stunting and wasting among children who accessed Anganwadi services.
• National Food Security Act (NFSA): It legalizes a citizen’s right to food and aims to provide subsidized food grains to approximately two-thirds of India’s population. While implementation varies across states, it has helped in ensuring food security and improving nutrition.

Persistent challenges to understand the barriers hindering effective resolution of malnutrition:

• Insufficient Funding: Many nutrition programs suffer from budget constraints, affecting their scale and effectiveness. India’s public health expenditure is still only about 1.3% of its GDP.
• The Double Burden of Malnutrition: India is grappling with both undernutrition and a growing obesity problem. As a recent Lancet study, highlighted that obesity prevalence has doubled in India over the past decade.
  
• Climate Change and Environmental Degradation: These exacerbate malnutrition by affecting food production, particularly of nutrient-rich crops. Rising CO2 levels have also been found to reduce the nutritional content of major food crops. Example– The researchers found that increases in CO2 were associated with a decrease of anywhere between 3 and 17 percent in zinc in the tested crops.
• Inadequate Data and Monitoring: There’s a dearth of high-frequency, reliable data on nutrition. This hinders effective monitoring, planning, and implementation of interventions.
• Regional Disparities: High levels of malnutrition persist in states like Bihar, Jharkhand, and Uttar Pradesh, indicating that regional disparities are a significant barrier to addressing malnutrition evenly across the country.
• Corruption and Leakage in Public Systems: Despite well-intentioned programs, corruption and inefficiencies often hinder their effectiveness. For instance, studies have found that up to 40% of the grains distributed through PDS do not reach intended beneficiaries.

Suitable way ahead in this regard

• Strengthening Public Systems: Enhancing the efficiency of the Public Distribution System, ICDS, and healthcare services is paramount. The computerization of PDS in Chhattisgarh exemplifies how technology can curb corruption and improve service delivery.
• Inter-sectoral Collaboration: Better collaboration between various ministries and programs can increase efficiency and reach. Brazil’s Zero Hunger program, which coordinated efforts across multiple sectors, is a shining example that can be replicated.
• Investing in Education: Greater emphasis on nutrition education can catalyse improvements in dietary practices. Kerala’s success in health indicators, attributed to its high literacy rate, can serve as a model for other states.
• Community Participation: Greater involvement of local communities ensures solutions are tailored to local needs. Maharashtra’s significant reduction of malnutrition, partly attributed to the active participation of village health and nutrition days, exemplifies this approach.
• Addressing the Double Burden of Malnutrition: Policies must simultaneously tackle undernutrition and overnutrition. Mexico’s sugar tax policy is a successful example that can be adopted to curb overnutrition.
• Enhancing Agricultural Diversity: Encouraging the cultivation and consumption of a diverse range of crops improves nutritional intake. Bioversity International’s work in promoting diverse food systems in several countries, including India, is a good model to replicate.

Conclusion

Thus, we can say that adopting a multi-dimensional approach is key to addressing malnutrition in India. Drawing from best practices within India and globally, and adapting strategies based on local contexts and needs, can pave the way for substantial progress in this area.

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