Nida Yamin, a student at TERI University, explores the long-prevalent issue of malnutrition in India and its effects on growth and development of the country as a whole, and suggests how community-based programs can improve the situation and lead to national nutrition security.
Malnutrition is an invisible and silent emergency. Its persistence has profound and frightening implications for children, society and the future of humankind. Three quarters of the children who die worldwide have causes related to malnutrition (UNICEF, 1998). According to International Food Policy Research Institute (IFPRI)’s global hunger index, India ranks 66 out of 88 countries, i.e., around 200 million people are under-nourished in India. Despite India’s great economic growth, under-nutrition has assumed epidemic, shameful proportions. Nutritional deficiencies plague nearly 3/4th of all women and children in the country (WHO).
Under-nutrition stunts growth, children who suffer under-nutrition have lower chances of survival and much likely to suffer from serious infections and to die from common childhood illnesses such as diarrhoea, pneumonia and measles. More than a 3rd of all deaths in children aged 5 years or younger can be attributable to under-nutrition (WHO). Even though those children who survive under-nutrition do not perform as well in school as their well nourished peers, and as adults also, they are less productive.
The profile of malnutrition in India is one where the distribution of children’s age standardized weight is dramatically to the left of the global reference standard, suggesting a major malnutrition problem. Its prevalence is higher in rural areas (50 per cent) than in urban areas (38 per cent), higher among girls (49 per cent) than among boys (46 per cent), higher among schedule castes (53 per cent) and schedule tribes (56 per cent) than among other castes (44 per cent), and is as high as 60 per cent in the lowest quintile (Michel et al, 2005). Also, inter-state variations are large, with six states (Bihar, Madhya Pradesh, Maharashtra, Orissa, Rajasthan and Uttar Pradesh) having at least 50 per cent children under-weight (Michel et al, 2005).
The age-wise pattern of malnutrition is an important dimension of the problem in India: growth retardation originates early in life, and most of this early damage is irreversible. Most growth-faltering occurs either during pregnancy, such that approximately 30 per cent of children in India are born with low birth weight, and the rest of the damage happens during the first two years of life. Indeed by the age of two years, most growth retardation has already taken place. Inadequate dietary intake and illness tends to create a vicious circle of malnourished child whose resistance to illness is compromised, falls ill very often, and malnourishment worsens (World Bank, 2005).
Good nutrition is the key to healthy development of individuals, families and societies. Improving the nutrition of women and children will contribute to overcoming some of the greatest health challenges. It is most likely to result where there is equitable growth, when social services become affordable and accessible, and when adequate investment is made in human resources, including the empowerment of women.
Hunger in India does not exist because there isn’t enough food; rather the problem is getting food to those who need it. And that is where the government’s myriad programmes and vast, corrupt infrastructure is failing. There is critical window of opportunity to intervene when mothers are pregnant and during children’s first two years of life. Overcoming such problems is central part of the exercise of development.
The national costs of malnutrition are very high: a vicious intergenerational cycle of poor health, high death rates, poor quality of life, decreased mental capacity and reduced worker productivity. Productivity losses are estimated at more than 10 per cent of lifetime earnings for individuals and 2-3 per cent of gross domestic product for the nation (Swaminathan et al, 2008). This means that improvements in nutrition are important for a healthy and productive life as well as for continued economic growth and development.
The most important national nutrition programmes in India are the Integrated Child Development Scheme (ICDS), Targeted Public Distribution System (TPDS), Food for Work, National Mid-day Meals Programme (NMMP) and Micronutrient (iron folate and Vitamin A distribution, salt iodization) Schemes. These programmes aim to address significant segments of India’s under-nourished population: poor households, through the TPDS and employment schemes, young children and mothers through the ICDS and health efforts, and school children through the NMMP.
Efforts under ICDS to expand access to supplementary feeding, immunization against preventable diseases of childhood, health check-ups and referral, health and nutritional education to adult women and pre-school education to 3 to 6 years in recent years, have led to marked increases in coverage. However, coverage is necessary but not sufficient to bring about health benefits for vulnerable population. Various evaluations of ICDS have found its impact on nutrition status to be limited.