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Launching a war against malnutrition

LiveMint logoLiveMint 20-05-2014 Livemint

With almost every second child stunted in the country, India is virtually a nutritional basket case. Despite making giant strides in reducing poverty and hunger over the past two decades, India has struggled to combat child under-nutrition. India’s malnutrition burden arises from a long history of flawed policy choices and deep-rooted gender inequality, which the new government must address if it is serious about the fight against malnutrition.

The stasis in India’s nutritional indicators owes to three key factors. First, the double whammy of high population density and unsanitary conditions in India stunts the growth of children, who bear a disproportionate burden of infectious diseases and lose their ability to absorb nutrients. According to research by the health economist Dean Spears, differences in access to sanitation explain almost entirely the gap between stunting rates in India and sub-Saharan Africa.

Second, India’s lopsided food policy has made cereals widely available at the cost of other foods. The so-called green revolution focused on cereals, and met the needs of a hungry nation but the nutrient deficit remained unaddressed. Consumption figures reported by the National Sample Survey Office (NSSO) reflect this. Barely 1% of households reported skipping two square meals a day in the latest NSSO survey. Even the average cereal consumption across income classes is roughly equal. But many families in the lower income deciles are unable to afford pulses, fruits and vegetables. Unfortunately, the National Food Security Act (NFSA) legislated by the previous government perpetuates the damaging legacy of the earlier approach with its focus on cereals at the expense of other nutrient-rich foods. The NFSA is blind to the needs of children, for whom it is the frequency and quality of meals rather than the quantum of food which hold the key to better nutrition.

The third key reason for the high malnutrition burden is the extraordinarily low social status of women in India. Within families, women receive fewer nutrients than men and since a majority of women are anaemic and under-nourished, they bear babies with low birth weights. India has among the highest proportions of low birth-weight babies, who face a nutritional disadvantage right at birth. This problem is a civilizational challenge for the country, and one that is unlikely to be solved by government action alone. Nonetheless, greater attention to maternal health can provide nutritional dividends.

The costs of inaction on the nutrition front are much higher than what many people realize. Malnutrition in early life lowers the cognitive skills of children and makes them susceptible to obesity-related disorders in later life. The productivity losses associated with malnutrition are estimated to be in the range of 5-11% for a country such as India, according to experts.

A growing body of scientific evidence provides clear pointers for policy actions to fight malnutrition in India. We need a radical overhaul of our community outreach programmes to meet the needs of the very young, pay close attention to women’s health, invest in preventive public health services such as clean water and sanitation, provide farm incentives to promote food diversity, and launch an effective nutrition education campaign to ensure that young children are fed adequately. Such a multi-pronged approach will also be far more efficient in tackling under-nutrition than the populist food security law. According to a 2013 estimate by the prestigious medical journal Lancet, it will take $9.6 billion globally to fund effective anti-malnutrition efforts. But India alone will need to spend four times that amount annually to implement the NFSA without getting any significant nutritional return.

Unlike the Congress, the Bharatiya Janata Party had emphasized the importance of nutrition several times in its election manifesto. Its prime ministerial candidate Narendra Modi has promised to improve sanitation standards in the country. It is time for the party and its leader to deliver on those promises by making a clean break from the past, and by focusing on an evidence-based approach to attack malnutrition.

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