Views | Malnutrition: A cluttered debate

High malnutrition rates among Indian children evoke a variety of response ranging from dismay to disbelief. The popular debate on India’s malnutrition crisis is often a cluttered one that conflates hunger and malnutrition and tends to focus largely on poverty.

The proportion of malnourished children at 59% is nearly twice the proportion of poor in the country indicating that the reach of malnutrition extends well beyond the poor. Most economists agree that poverty rates have dropped sharply in the past two decades without any significant improvement in malnutrition rates.

India’s malnutrition rates are nearly double that of poorer nations in sub-Saharan Africa that have much higher child mortality rates, and the sharp contrast led the economist Arvind Panagariya to dismiss India’s high malnutrition rates as a ‘myth’ in a recent Times of India opinion piece.

Some would like to claim that our genes are different and find fault in the international growth standards that we use to measure malnutrition, a claim that has been debunked in several studies by the Nutrition Foundation of India and the World Health Organization, which provide evidence that children in well-nourished Indian families grow in line with their peers in the rest of the world.

While malnutrition is probably too important a topic to be left only to experts, it is worthwhile to consider scientific evidence that offer valuable clues to the enigma of high malnutrition in India.

In an influential paper on the topic, written for the Unicef in 1996, Vulimiri Ramalingaswami, a former director of the All India Institute of Medical Sciences in New Delhi, identified inequality among sexes that leads to lower dietary intake by women in South Asia and a high proportion of low birth weight babies in the region, as the key to the enigma. Several subsequent studies have corroborated his thesis.

The low social status of women in South Asia not only skews the distribution of food within the household against women but also leads to a disproportionately higher work load for them, adversely affecting child care. Consequently children and women bear the brunt of malnutrition in India leading to nutritional outcomes that are worse than in any other part of the world. Nearly a fourth of Indian kids are born with low birth weights --- the highest in the world --- as husbands and elders do not pay enough attention to the diet of pregnant women, and one in two Indian women turn anaemic.

Low birth weight is only one half of the story. Many children with normal birth weights falter in growth owing to illnesses that diminish their ability to absorb nutrients. The two main child killers are diarrhoea and acute respiratory infections such as pneumonia --- rampant in India owing to unsafe drinking water and the absence of proper hygiene.

Poverty and the lack of appropriate food do play a major role in causing malnutrition but the causal links are not straightforward, for most of India’s population. Millions of families across India where very young children are malnourished but where adults and older children are well fed stand testimony to the fact that it is not lack of food but the lack of right food at the right time that lies at the root of malnutrition.

A child requires very small amounts of food, several times a day. Poor and lower middle class families are often unable to spend the time and energy involved in arranging for the child’s meals even if they can afford the cost of the food.

Malnutrition in India is a complicated beast with large variations even within India but the first step to tame it is probably to have more clarity on the diagnosis of the problem.

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