India's malnutrition plight: The effects are more dire than we think

by Siddharth Chatterjee / IFRC | @sidchat1 | International Federation of Red Cross and Red Crescent Societies (IFRC) - Switzerland
Monday, 19 November 2012 11:19 GMT

* Any views expressed in this article are those of the author and not of Thomson Reuters Foundation.

(Corrects paragraph 8 to say macro-nutrient not micro-nutrient).

Siddharth Chatterjee is chief diplomat and head of strategic partnerships and international relations at the International Federation of the Red Cross and Red Crescent Societies. Email: Twitter: sidchat1

Today, Indian President Pranab Mukherjee and Bollywood actor and social activist Aamir Khan launch a massive media campaign to highlight the country's depressing record on malnutrition and its consequences. 

It is well known that India has higher rates of malnourished children than sub-Saharan Africa, but what is less known is that this insidious challenge could debilitate India’s future prospects, undermine its human capital and jeopardise its economic growth.

Malnutrition remains an enormously pervasive issue in India. A recently released Global Food Security Index (GFSI) shows that in 2012, almost 20 percent of all Indians – more than 200 million people – are undernourished.  

The National Family Health Survey in 2005-06 showed that almost 50 percent of Indian children aged six years or below were stunted and more than 40 percent of children in the same age group were underweight. Moreover, almost 80 percent of children aged six months to three years were anaemic.

As India and the world have long known, malnutrition in young children is likely to have long-lasting functional deficits, affecting intelligence and other cognitive abilities, creating a susceptibility to various diseases and even affecting their reproductive health. Ironically, much of this pioneering research was done in India itself.

The National Family Health Survey found that a significant number of adults in India suffer from malnutrition. Almost 58 percent of pregnant women aged 15-49 were found to be anaemic.

This reveals how the nutritional status of young children is being adversely affected from before they are born – stunting in children under the age of three years begins with their mothers who are undernourished or anaemic during pregnancy. The Global Food Security Index also revealed that Indians lack adequate quantities of iron, vitamin A and protein in their diets. 

The programmes that have been successful in the past are the ones that address macro-nutrient malnutrition through monthly weighing, actionable and pertinent education on nutrition, selective supplementation of children under 18 months who do not gain adequate weight and referral in the case of infections.

For micro-nutrient malnutrition, programmes that leverage public-private-partnerships have helped. The local government in India's southern state of Tamil Nadu and the neighbouring union territory of Pondicherry have partnered with the Britannia company’s Nutrition Foundation to provide iron-fortified biscuits to school children as part of the Midday Meal Scheme in public schools.

In terms of existing public sector programmes, India is refurbishing its flagship Integrated Child Development Scheme to target 200 of the most vulnerable districts in the country with regard to maternal and child nutrition. It is also increasing the scheme’s budget by 58 percent between 2011/12 and 2012/13.

Authorities have also introduced the Rajiv Gandhi Scheme for Empowerment of Adolescent Girls, or SABLA, to improve, among other things, the nutritional status of young girls aged 11-18

In order to create a sizeable and effective intervention, it is important to consider this issue from the right perspective: malnutrition is an outcome and not a disease. 

It is an outcome of the failure of the system to reach those in most need at the right time. The first 1000 days (270 days of pregnancy plus 730 days until the child reaches two years old) is when an intervention is most likely to be effective. This 1000-day focus can be achieved by capitalising on existing infrastructure to create tangible results. 

For example, India’s growing network of Accredited Social Health Activists (ASHAs) are community health workers (mostly women) who travel through their villages providing relevant health information. The government can achieve faster results by using these workers to target specific populations – especially young mothers – to inform them about the need for better nutrition and ways to achieve this for themselves and their young children. Programmes that target young women can also be used to educate girls about the value of nutrition.

The direct cash transfers being considered by the government, which will be enabled by its unique identification number programme, Aadhar, are also likely to be effective. Under this scheme, instead of receiving subsidised rations under India’s Public Distribution Scheme, poor families will receive cash transfers directly into their bank accounts, allowing them to spend the money on the food they deem necessary.

Pilot programmes and early results have shown an increase in the nutrition levels of the beneficiaries. Non-governmental organisations can help by creating and disseminating awareness programmes targeting those not reached by private sector or government programmes, especially children who are not enrolled in school and who live in remote parts of the country.

In the coming years, it is imperative for India that its nutrition crisis, especially amongst young children, be curbed as soon as possible. Human capital is at the heart of a nation’s wellbeing and prosperity. The young children stunted today by under-nourishment are the workers, managers, innovators and leaders of tomorrow. 

As India enters the next stage of its growth, it cannot afford for this group to be stymied in any way.