5-Year Extension to PMGKAY: An Acknowledgment of India’s Nutrition-access Crisis

Our incapacity to recognise malnourished children and enrol them in vital nutritional programmes is a challenge.

Image used for representation only.

(Photo: PTI)

As the national ruling party of the BJP gears up for the upcoming state assembly polls, Prime Minister Narendra Modi, in what could be seen as a pre-electoral promise, announced an extension of the Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY) free ration scheme for another five years, while addressing poll rallies in Madhya Pradesh and Chhattisgarh. 

It is critical to position this announcement in light of a recent controversy that broke when the Global Hunger Index report ranked India at 111 out of 125 nations. The Indian government, then was quick to respond by attacking the GHI’s methodology and dismissing its findings. 

Union Minister Smriti Irani, who heads the women and child development department, responsible for the nutrition of women and children in the country went a step further in criticising GHI’s methods and findings by ridiculing the report’s method and findings.

Notwithstanding the government’s response to the GHI findings, we have the Prime Minister now implicitly acknowledging the deep-rooted nature of the nutritional crisis afflicting the Indian poor by making the announcement of extending what was a crisis-response food security plan, for another 5 years (the scheme covers over 80 crore beneficiaries or those with a ration card).  

In a recent explainer by the InfoSphere team at the Centre for New Economics Studies (CNES), we had looked closely at the nutritional access-landscape for India at the national level. For background reference to this analytical exercise, a few years ago CNES created an Access Inequality Index (AEI) where state-wise ‘Access to Nutrition’ was studied as one of the pillars defined under ‘Access to Basic Amenities’, ranking Indian states on their performance. More details on the study and index are accessible from here.

The issue of ‘undernourishment’ and ‘malnourishment’ across India, especially in the states that are going up for polls soon (MP, Chattisgarh, Rajasthan), has arisen from various factors. 

A Variety of Factors Leading to Food Security Issues

To begin with, rising income poverty and wealth-inequality is a key factor, as a substantial section of the population lacks the financial resources to obtain a sufficient amount of food. There are distributional issues too in terms of food-security access because of which the Public Distribution System emerged under the UPA regime for providing free ration to a substantively higher number of poor people across the country (as part of a national food security plan).

Also, India's heterogeneous topography and volatile agri-productivity levels, combined with fluctuating climatic conditions and monsoon-led changes (which is still the main source of agri-irrigation), lead to aggravated concerns around food security, rendering the country vulnerable to disruptions in food production caused by occurrences like droughts, floods, and other natural calamities.  

Source: CNES-Infosphere 

From 2014 to 2018, there was a significant decrease in the number of people suffering from undernourishment, indicating progress in tackling this problem. However, starting in 2018, the number of malnourished individuals in India began to increase. Note how this trend starts in the pre-lockdown (induced by COVID) phase (i.e. prior to 2020).

In 2020, this worrisome pattern took a more ominous trajectory once the nationwide lockdown measures were introduced. The prevalence of undernourished individuals had a remarkable 24 percent increase from 2017, which marked the year with the lowest recorded number of undernourished people within this timeframe.

Multiple reasons may contribute to this undesirable change in the proportion of rising malnourished individuals in India. Factors such as economic volatility, external disruptions such as the COVID-19 pandemic, oscillations in climate impacting agricultural output, and societal challenges including food availability and distribution have contributed to this pattern more recently.

The crisis of unemployment and lowering real wages that afflicts India’s rural population and urban poor makes the situation worse. When we consider the nourishment percentages of men and women in both rural and urban India, a stark disparity in inequality becomes evident. 

Nutrition and the Urban-Rural Divide

The data extrapolated from the fourth and fifth surveys undertaken by the National Health and Family Survey (NHFS) reveal a notable discrepancy in nutrition levels, particularly between rural and urban areas. What we observe is rising undernourishment, which refers to individuals falling below the standard level of nutrition, is more prevalent in rural areas than in metropolitan areas.

Source: CNES-Infosphere 

In the fourth national survey, 20.7 percent of women and 18.6 percent of men had suboptimal nutrition levels, falling below the established threshold for normalcy. When analysing the data based on whether individuals reside in urban or rural regions, it is evident that 15 percent of women and 14.3 percent of men in urban areas experienced undernourishment. In contrast, the prevalence of undernourishment was significantly greater in rural areas, with 31.3 percent of women and 26.3 percent of men being affected. 

Nevertheless, the fifth survey reveals a slight amelioration in the circumstances.  At the national level, the proportion of women who did not meet the standard nutrition level was 18.7 percent, while for men it was 16.2 percent. However, there has been a minor decline in these figures.

When analysing the disparity between urban and rural areas, it was found that 13.2 percent of women and 13 percent of men in urban areas suffered from undernourishment. In rural areas, the prevalence of undernourishment was greater, but still decreased, with 21.2 percent of women and 17.8 percent of men experiencing this condition.

Each of these empirically backed data tells a tragic tale of widening inequality, and worsening food security for the vulnerable and the poor across India. 

What about the role played by different government-supported nutrition-centric access schemes?

Overview of Important Schemes 

The Integrated Child Development Scheme (ICDS) launched in 1975, provides supplementary nutrition, immunisation, and pre-school education to children. It is one of the largest programmes in the world, providing services for holistic child development. Along with supplementary nutrition, it also provides immunization, health check-ups, pre-school and non-formal and health education. 

The Supplementary Nutrition Programme (SNP) is provided under the ICDS Scheme and is aimed at closing the gap between what people should be consuming for optimal nutrition (RDA - Recommended Dietary Allowance) and what they are consuming (ADI - acceptable daily intake). The SNP scheme provides 2 types of food, that is, hot-cooked meals (HCM) and take-home ration (THR) to children, pregnant women, and lactating mothers. The SNP acquires the highest share of the budget of the ICDS scheme. In FY 2021-22, it accounted for a 47 percent share of the ICDS scheme.

The Scheme for Adolescent Girls (SAG) is a centrally sponsored scheme which caters to the nutritional and non-nutritional requirements of adolescent girls aged 11-14 years. Launched in 2010, the scheme was implemented under ICDS through Anganwadi Centres. In 2020-2021, around 5,03,309 beneficiaries availed the scheme. 

The POSHAN Abhiyaan was launched in March 2018 Its key components include technology, coordination, and communication through Jan Andolan. The program also establishes nutri-gardens (PoshanVatikas) nationwide for easy access to nutritious foods and herbs, aiming to reduce stunting, wasting, and anaemia in children and women. Its main aim is to assist in improved coordination between ministries catering to nutrition and health services. 

Anganwadis are government-funded child and mother care development centres in India. They were started as a part of the ICDS scheme to improve the nutritional status of pregnant women, nursing mothers, and children in the age group of 0-6 and adolescent girls 14-18 years of age (in Aspirational Districts and sortheastern states) in India. ICDS, SNP and Poshan Abhiyaan services are all availed through Anganwadi centres. Around 4.37 lakh Anganwadi centres have set up Poshan Vatikas. Additionally, so far, 1.10 lakh medicinal saplings have also been planted in some states.

Volatile Fiscal Outlays 

The graph depicts the summation of Budget Allocations of ICDS, SAG & POSHAN Abhiyaan from FY 2017 – FY 2020, the summation of Budget Allocations of Mission Saksham Anganwadi and Poshan 2.0 from FY 2021 – FY 2023 and the percentage of allocated funds that were released from FY 2021 – FY 2023. 

Source: Centre for Policy Research Report - Mission Saksham Anganwadi and Poshan 2.0

The 2023 budget allocation has just gone up 1% from 2022. Considering, India's malnutrition situation, this is hardly a significant increase. The sum allotted for FY 2023–2024, around 20,554 Crore—is smaller than that for FY 2018–2019. However, since 94% of the budget has been released, this offsets the smaller amount that was allotted and guarantees that a significant amount of money is utilised efficiently to address the issue of malnutrition. 

Source: Open Government Data Platform India; CNES-Infosphere 

From FY 2016 to FY 2021, there has been a continuous reduction in the number of people availing of ICDS services. The rise in 2021-22 can be on account of the pandemic when many people, especially daily wage earners, faced financial difficulties.

The vulnerability of children, pregnant women, and lactating mothers to malnutrition increased, leading to a higher uptake of ICDS services by this demographic. Since schools were closed during the pandemic, midday meals were disrupted, which was a significant source of nutrition for children. This heightened the significance of ICDS in delivering crucial nutrition support. However, there has been a general decline in the number of recipients, dropping from 102.31 million to 89.48 million individuals.

A study conducted in poor urban settlements of Delhi shows that the ICDMS scheme is not being used to its full potential because of ineffective distribution across the health system and beneficiary doubts about its utility. It states that only 57.8 percent of women availed of supplementary nutrition services offered by ICDS. 

The health system's incapacity to recognise malnourished children and enrol them in vital nutrition-related programmes is a critical challenge. The structural problem facing the delivery of governmental health and nutrition services in villages primarily revolves around the fragmentation of responsibilities and oversight where ASHAs, Anganwadis and local community-health service providers lack support, critical cooperative training, and capacity building. 

Unfortunately, the BJP Government, at a national level, fails to even acknowledge some of these structural issues and ends up either criticising any hard ‘truth’, when reports like the GHI highlight the issue of under-nourishment in India. Alternatively, it responds in terms of electorally-sensitive, short-term scheme-based roll outs (like PMGKAY) to provide ‘free ration’ without introspecting or investigative the structural issues of mal/under-nourishment affecting our young, older demographics across states.  

(Deepanshu Mohan is a Professor of Economics and Director, Centre for New Economics Studies. This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)