The article analyses the problem of malnutrition in India and suggests the pathways to achieve the malnutrition free India by 2030.

Severity of the nourishment problem in India

• There were  189.2 million undernourished people (28 per cent of the world) in India in 2017-19, as per the combined report of FAO, IFAD, UNICEF, WFP and WHO (FAO, et.al. 2020) on “The state of Food Security and Nutrition in the World”.
•  India accounts for 28 per cent (40.3 million) of the world’s stunted children (low height-for-age) under five years of age, and 43 per cent (20.1 million) of the world’s wasted children (low weight-for-height) in 2019.
• In India, the problem has been more severe amongst children below the age of five years.
• As per the National Family Health Survey (NFHS, 2015-16), the proportion of underweight and stunted children was as high as 35.8 per cent and 38.4 per cent respectively.
• In several districts of Bihar, Jharkhand, Uttar Pradesh, Madhya Pradesh, Rajasthan and even Gujarat, the proportion of underweight children was more than 40 per cent.

Aims of the National Nutrition Mission (NNM)

• Ending all forms of malnutrition by 2030 is also the target of Sustainable Development Goal (SDG-2) of Zero Hunger.
• Towards this end, NNM aims to reduce stunting, underweight and low birth weight each by 2 per cent per annum.
• It aims to reduce anaemia among children, adolescent girls and women, each by 3 per cent per annum by 2022.
• However, the Global Burden of Disease Study 1990–2017 has estimated that if the current trend continues, India cannot achieve these targets under NNM by 2022.

Understanding the key determinants and deciding policy response

1) Mothers’ education

• Mothers’ education, particularly higher education, has the strongest inverse association with under-nutrition.
• Women’s education has a multiplier effect not only on household food security but also on the child’s feeding practice and the sanitation facility.
• Despite India’s considerable improvement in female literacy, only 13.7 per cent of women have received higher education (NFHS, 2015-16).
• Therefore, programmes that promote women’s higher education such as liberal scholarships for women need to be accorded a much higher priority.

2) Sanitation and access to safe drinking water

• The second key determinant of child under-nutrition is the wealth index, which subsumes access to sanitation facilities and safe drinking water.
• WASH initiatives, that is, safe drinking water, sanitation and hygiene, are critical for improving child nutritional outcomes.
• In this context, the Swachh Bharat Abhiyan aims to eliminate open defecation and bring about behavioural changes in hygiene and sanitation practices.
• In five years of the Abhiyan, as per government records, rural sanitation coverage has gone from 38.7 per cent in 2014 to 100 per cent in 2019, while the sanitation coverage in urban cites has gone up to 99 per cent by September 2020.
• This remarkable achievement of the Swachh Bharat Abhiyan, subject to third-party evaluations, is expected to have a multiplier effect on nutritional outcomes.

3) Leveraging agricultural policies

• We should leverage agricultural policies and programmes to be more “nutrition-sensitive” and reinforcing diet diversification towards a nutrient-rich diet.
• Food-based safety nets in India are biased in favour of staples: rice and wheat.
• They need to provide a more diversified food basket, including coarse grains, millets, pulses and bio-fortified staples.
• Bio-fortification is very cost-effective in improving the diet of households and the nutritional status of children.
• The Harvest-Plus programme of CGIAR can work with the Indian Council of Agricultural Research (ICAR) to grow new varieties of nutrient-rich staple food crops.

4) Promotion of exclusive breastfeeding, complementary foods, diversified diet

• The promotion of exclusive breastfeeding and the introduction of complementary foods and a diversified diet after the first six months is essential to meet the nutritional needs of infants and ensure appropriate growth and cognitive development of children.

5) Access to prenatal and postnatal care

• Access and utilisation of prenatal and postnatal health care services also play a significant role in curbing undernutrition among children.
• Aanganwadi workers and community participation can bring significant improvements in child-caring practices.

Consider the question “Assess the severity the problem of malnutrition in India and suggest the measure to achieve the goal of malnutrition free India by 2030”

Conclusion

To contribute towards the holistic nourishment of children and a malnutrition free India by 2030, the government needs to address the multi-dimensional determinants of malnutrition on an urgent basis.

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