The tough road to nutritional security

Over the past month, there has been much debate about what resulted in India’s improved ranking in the Global Hunger Index (GHI). There is little clarity in terms of data and policies about how India achieved significant improvements in child nutrition over the past decade.

The GHI report by the International Food Policy Research Institute did not give a clear answer as to what has contributed to improved nutrition even though it did point to some factors that distinctly increase micro-nutrient availability.

But a new report by the Institute of Development Studies (UK) and United Nations Children’s Fund (Unicef) has studied the Health and Nutrition Mission by the Maharashtra state government since 2005 and details some important lessons for the rest of the country. To be sure, despite the professed improvements, India still has serious levels of malnutrition with one in three children under the age of five being underweight.

Between 2006 data from the National Family Health Survey and the 2012 data from the Maharashtra Comprehensive Nutrition Survey, the IDS-Unicef report found dramatic reduction in child stunting in the state—both in the national and global context. Stunting rates for children under two years of age, for instance, fell from 39% to 24%. That is a decline of 3 percentage points per year. “This is faster than any country level trend. Bangladesh comes close with declines of 2 percentage points over a similar period,” states the report. This is even more remarkable given that the state’s performance in reducing stunting between 1992 and 2006 was below the national average. As such, lessons from Maharashtra may be useful for the rest of the country.

One insight from the report is that nutritional improvements require clear policies and their proper implementation. Among all goals that economic growth hopes to achieve such as reduction in hunger and poverty, there is none more difficult to achieve than reducing malnutrition. The reason being that improving nutritional outcomes requires a combination of factors such as the timely availability of appropriate food for infants, overall sanitation etc. Without these enabling conditions better nutritional outcomes are not possible.

To begin with, since 2000 Maharashtra picked up on economic growth and as a result, between 2004 and 2012 poverty declined from 38% to 17.4%. Another component is the quality of governance. While Maharashtra was average in overall governance, yet thanks to the Nutrition Mission—the first state in the country to have such a mission—declared the state’s commitment to nutrition and became a rallying point for all stakeholders. This resulted in improvements such as an increase in budget allocation, and credible improvements in filling up frontline health worker vacancies which in turn made programmes such as the Integrated Child Development Services better run.

The state also improved on another factor—the overall status of women. Increased female literacy rates, better maternal health, higher age of first pregnancy, etc., meant that women were in a better position to make decisions. This translated to better infant and child nutrition.

Of course, a lot more can be done, especially in the field of overall governance, sanitation and agricultural productivity where the state lags behind others. But the fact that Maharashtra could carry out improvements despite limitations shows the results could be replicated in other states if governments there have a more focused approach on nutritional matters. But this is a very big if.

The good news is that at least someone is listening. The government of Uttar Pradesh, infamous for its callous treatment of women, shoddy governance and widespread poverty and malnutrition has launched a nutrition mission like Maharashtra’s.

Is nutritional security for all as quixotic as food security for everyone? Tell us at views@livemint.com

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