India’s Deeply Unequal Nutritional Landscape Needs Greater Fiscal Assistance

Despite a recommended daily intake of 2503 kcal/capita/day, most Indians fall short of this norm, except for the wealthiest 5 per cent of the population.

(Photo: PTI)

In the 2022 Global Hunger Index, India ranked 107th out of 121 countries. With a score of 29.1, India has a level of hunger that is categorised as ‘serious’.

Considering this, the government allocated significant financial resources to combat food security and child undernutrition through programs like the Integrated Child Development Services (ICDS), now called the 'Poshan-2', which has been running for over 40 years and is meant to provide supplementary nutrition to children and expecting/lactating mothers.

However, India, as a nation still contributes to a third of the global burden of undernutrition.

Despite a recommended daily intake of 2503 kcal/capita/day, most Indians fall short of this norm, except for the wealthiest 5 per cent of the population. This disparity is most glaring among households with the lowest consumption expenditures. Even the richest households in India lack enough fruits, vegetables, and non-cereal proteins in their diets, reflecting a nationwide pattern.

The COVID-19 pandemic only worsened the nutrition woes in India by increasing the risk of nutritional vulnerabilities among the population on account of the disruption in services, loss of livelihood, inflation, and extreme financial and mental distress. The pandemic further offset India’s progress towards achieving SDG 2 which is Zero Hunger by 2030 since it is now one of the 17 countries that would fail to meet the challenge on account of the widespread malnutrition and the disruption caused by COVID in access to proper nutrition.

We discuss here the reality of malnutrition across India and the inadequacies in current nutrition-related policies, adversely impacting the future of the country. 

The Undernutrition Challenge

UNICEF defines ‘undernutrition’ as the phenomenon that is caused by the insufficient intake or inadequate absorption of energy, protein, or vitamins and minerals (micronutrients) that in turn lead to nutritional deficiencies. It stunts intellectual growth, reduces productivity, and perpetuates poverty. India is a leading contributor of undernourished people in the world with nearly 194.4 million people not receiving adequate nutrition, which amounts to 14.37 per cent of the population.

In India, there has been a 1.5 per cent increase in the number of undernourished individuals from 2014 to 2022. India accounts for one-third of the world’s undernourished children since nearly 36 per cent of children under five years are stunted, 19 per cent are wasted, 32 per cent are underweight and 3 per cent are overweight, according to NFHS-5 data. 

Geographically, Maharashtra followed by Bihar and Gujarat has the worst levels of malnourishment in children in the country. Madhya Pradesh, Andhra Pradesh, and Jharkhand have very high rates of undernutrition, which incidentally happen to be the regions with the highest population of children and the highest poverty rates.

Even states with the lowest percentage of undernutrition, such as Mizoram, Sikkim, and Manipur have much higher malnutrition rates than developed nations. 

Issues related to Accessibility and Awareness

Accessibility to nutritious food is a leading cause of undernourishment among the Indian population which is directly proportional to poverty levels and the financial capability of people.

According to a joint report released by the FAO, the IFAD, UNICEF, the WFP, and the WHO, nearly 42 per cent of the global population is unable to afford healthy food, however, this number is significantly higher in India and amounts to 74.1 per cent of the Indian population.

The Right to Protein Campaign introduced the Nutrition Awareness Index 2023, a state-wide index to asses awareness, affordability, and accessibility of nutrition in India as perceived by end consumers, which showed that nearly 53 per cent of young Indians find nutrition access challenging while 50 per cent believed that they ate a nutritious diet, despite failing to recognize nutrition sources correctly.

Easy accessibility to nutritious food is extremely pertinent. India has fostered easy accessibility to nutritious food by assisting vulnerable groups through programs such as the Public Distribution system that targets around 800 million individuals, the PM Poshan School Lunch Program for 118 million students, and the Integrated Child Development Services for 110 million recipients, to enhance nutrition via food fortification.

Government Schemes and Changing Parameters: Navigating the Nutrition Challenge 

The cornerstone of India's efforts to combat child undernutrition includes programmes like Poshan Abhiyaan (the National Nutrition Mission) and the ICDS, one of the world's largest early childhood development schemes. These schemes aim to provide supplementary nutrition to children and support expecting and lactating mothers.

Additionally, the National Food Security Act (NFSA) mandates the provision of five kilograms of wheat/rice/coarse cereals to over 80 crore identified deprived individuals, addressing general undernutrition. However, the impact of these programs has raised questions.

The National Family Health Survey (NFHS) data reveals that approximately one-third of Indian children under the age of five are stunted, and around one-fifth suffer from wasting. Alarmingly, these figures have remained largely unchanged over the years, despite significant government investments in public health and nutrition programs. 

Unawareness about such initiatives renders government interventions ineffective, thereby underscoring the importance of raising awareness to ensure access, which would effectively convey the goal, objectives, and vision of service policies to both consumers and stakeholders.

The pandemic and subsequent lockdown have also had a significant impact on the implementation of nutrition schemes in India.  In 2019, nutrition supplementation under the ICDS scheme benefitted 8.74 crore mothers and children. By 2021, it had fallen by more than 14 per cent, owing to the pandemic. This was despite an increase in the allocation of funds for the ICDS.  

The declining rates are attributable to several factors, including the closure of Anganwadi centres- which are the frontline service delivery points of the ICDS scheme, the decline in attendance of beneficiaries, and the lack of transportation for Anganwadi workers. The quality of services provided under the ICDS scheme has also declined. 

Conclusion

India faces a critical challenge in combating malnutrition, as evidenced by its low global rankings on hunger and nutrition indices. Despite the presence of various policy frameworks and programmes, the country continues to grapple with this multifaceted issue. To effectively address this pressing problem and fulfill its nutritional goals, India must place nutrition as a top priority on its development agenda.

This entails not only increasing budgetary allocations but also establishing robust regulatory frameworks to promote healthier diets, implementing bio-fortification initiatives, and revitalizing essential programmes like mid-day meals.

While the path to ending hunger and improving nutrition is complex, India can make significant strides with the right policies and investments, ultimately advancing its SDG commitments and safeguarding the well-being of its population. 

The focus must lay on the timely planning, execution, and delivery of fiscally sponsored governmental initiatives to target different facets of mal-nutrition and public health that merit swift, and long-term support and fiscal intervention. We discuss more on this in the next part of this series. 

[Deepanshu Mohan is Professor of Economics and Director, Centre for New Economics Studies (CNES), Jindal School of Liberal Arts and Humanities, O.P Jindal Global University. He is currently a Research Fellow with Birkbeck College, University of London. Samragnee Chakraborty and Hima Trisha M are Senior Research Assistants (CNES), and Aditi Desai, Amisha Singh, and Nitya Arora are Research Assistants (CNES). Authors would also like to thank public health experts, Dr Sunil Kaul, co-founder of the ANT, Dr Indranil Mukhopadhyay, Professor at O.P Jindal Global University, and Mr Murari Mohan Goswami, Senior Development Consultant for their continuous support and guidance. This is an opinion article and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for them.]