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Hidden hunger can be addressed by ensuring that households (and women and children within households) have access to diverse diets
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Minister for women and child development Maneka Gandhi recently announced that her ministry would urgently put together a comprehensive, time-bound action plan to tackle malnutrition. This is a welcome step and hopefully this time around, such a plan will be more than superficial statements of intent and actually make a difference on the ground.
Researchers and activists have, for many years now, been demanding a set of measures to tackle undernutrition in the country. This includes universalization with quality of the integrated child development services (ICDS) scheme, ensuring prevention and treatment of childhood diseases, providing maternity entitlements, making available crèche and daycare services for children of working mothers and so on. Along with these measures aimed at addressing child malnutrition, a universal public distribution system (PDS) that includes pulses and oils along with cereals, social security pensions and a robust employment guarantee, can go a long way in contributing to household food and nutrition security.
In the last 10 years, there has been a lot of improvement in these government schemes. There has been a massive expansion in ICDS and PDS is being expanded under the National Food Security Act (NFSA). In many states, pulses and cooking oil have been included in the PDS food basket. However, there is a lot left to be done. For example, the quality of the supplementary nutrition provided under ICDS is still very poor. Although universal maternity entitlements have been promised under NFSA, there is no sign of these being actually implemented.
One serious gap in the efforts towards tackling malnutrition in India is the lack of recent data. The latest available nationally representative data is from 2005-06 (National Family Health Survey-3, or NFHS-3). The good news in the Global Hunger Index (GHI) report released on Monday, along with the fact that there is an improvement in India’s ranking based on the GHI, is that there seems to be new data on child malnutrition. This data shows that there has been an improvement in underweight prevalence among children under five from 43.5%, as shown by the NFHS, to 30.7% according to the recent data. One hopes that the ministry of women and child development will soon make the findings of this survey public, allowing more research and analysis.
As rightly pointed out by the GHI report, the challenge of malnutrition is not just one of lack of food (hunger) but of micro-nutrient deficiencies (hidden hunger) as well. But these two are not completely unrelated. Further, hunger as in not having enough food is also still prevalent. Data from the National Nutrition Monitoring Bureau (NNMB) for 2012 shows that diets in rural India, especially of young children, are woefully inadequate in terms of even calorie and protein intake. Among children aged 1-3 years, only 49% were seen to have a dietary adequacy of both proteins and calories. This figure is about 60% for 4-6 year olds. This data also shows that although there has been a slight improvement in the consumption of different food items rich in micronutrients such as vegetables, milk and meat, the absolute quantities consumed are still very low. Field visits to rural areas in most parts of the country continue to show how diets are predominantly cereal-based, with very little else being available in the household. Even though one might not witness the kind of hunger and starvation that was seen earlier, in terms of quantity and quality and diversity, diets are very poor.
Hidden hunger can be addressed by ensuring that households (and women and children within households) have access to diverse diets. This would require a range of interventions, including ensuring access to livelihoods and local natural resources such as land, water and forests. Addressing behaviour change issues such as complementary feeding practices, hygiene and sanitation would also be important. It is often seen that these can be achieved not just by counselling and IEC (information, education and communication) alone, but by also providing the enabling environment for practising such desirable behaviour by taking care of access and availability issues. Underlying factors such as gender inequality within the household also need to be addressed through girls’ education, etc.
For the deficiencies that cannot be addressed through diverse diets or those that are widely prevalent (for example, more than 50% children and women are anaemic) there are supplementation programmes. India does have, at least on paper, universal supplementation programmes for iron (for anaemia) and vitamin A. There are, of course, huge gaps in implementation of these programmes—for example, there is a massive shortage of paediatric iron syrups for children in most states—which need to be corrected.
There is a tendency to look for magic bullet solutions to complex problems like malnutrition; for instance, through the provision of centrally produced and packaged foods. It has been seen that commercial interests also try to take advantage of such a context. Therefore, in India, we have repeatedly seen attempts by profit-making interests to take over food distribution programmes, such as the school midday meals scheme or the ICDS programme. While these are prone to corruption and take control away from local communities, strategies based on locally available foods can contribute to building local livelihoods as well. Similarly, agriculture-based strategies also need to take care to ensure that farming communities are not made to be dependent on large corporations or that there are no long term environmental damages.
Dipa Sinha works as Fellow, Centre for Equity Studies, New Delhi. The views expressed here are personal.
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