Malnutrition continues to be a major challenge in India 75 years after independence and we need concerted action around it. The UN Food and Agriculture Organization’s (FAO) report on Food Security and Nutrition in the World 2022 puts the number of undernourished people in India in 2019-21 at 224.3 million, i.e., 16% of a 1.4 billion population.
The latest round of the National Family Health Survey 2019-21 (NFHS-5) finds that around a third of India’s children under five years of age are underweight and stunted and 67% children (6-59 months) are anaemic. Among adults, 57% women (15-49 years) are anaemic, as are a quarter of men in the same age group. While we grapple with undernutrition and micronutrient deficiency (hidden hunger), we are also witness to increasing incidence of another side of malnutrition, viz. obesity and an increase in incidence of noncommunicable diseases (NCD). Nearly a quarter of men and women aged 15-49 years are reported to be overweight or obese; and NCDs are reported to account for 65% of deaths in the country.
Malnutrition affects productivity and perpetuates intergenerational inequity. We have public food distribution programmes to ensure access to the poor and vulnerable; these are a legal entitlement under the National Food Security Act. The School Midday Meal and Integrated Child Development Services (ICDS) schemes are among the largest supplementary nutrition initiatives in the world. There is evidence that States where there is more investment in these programmes and their delivery, fare better than others in nutrition outcome indicators. The National Nutrition Mission and Poshan Abhiyaan were launched in 2018 to work for a malnutrition-free India by 2022. With the goal still distant, the government has now released guidelines of an Integrated Nutrition Support Programme — Saksham Anganwadi and Poshan 2.0 — and has proposed a five-year roadmap.
It is imperative that “good nutrition” becomes everyone’s mantra if we are serious about addressing the malnutrition challenge. Political parties should have “malnutrition-free India” as an agenda in their election manifestos, in line with our commitment to the UN Sustainable Development Goals (SDGs). Nutrition surveys in the country have shown that diets largely tend to be cereal-dominated with consumption of all other food groups less than what is recommended. Greater dietary diversity can be the first step to improved nutrition outcomes.
Given India’s size and diversity, the approach has to be decentralised taking into account soil and agro-ecological conditions, food habits and cultural preferences. A top-down approach such as supply of iron-fortified rice through the public distribution system may lead to other problems linked with bioavailability and absorption of food by the body.
Research institutions and the agriculture extension system have to work together for nutrition-sensitive agri-food systems. Integrated crop-livestock-fishery farming systems accompanied by nutrition awareness have demonstrated production diversity contributing to household dietary diversity. The directive to promote nutrition gardens of fruits and vegetables or Poshan Vatikas in schools and anganwadi centres is a welcome initiative and can be extended to district hospitals and primary health centres.
Researchers, policymakers, and government officials at all levels have to be sensitised on the need for nutrition-sensitive food systems. A large section of the population in both rural and urban areas depends on markets for their food. Nutrition-sensitive and affordable agri-food value chains is another ask, as well as greater awareness about healthy and balanced diet among men and women across all income groups. Awareness is also needed regarding the nutrient content in ultra-processed foods and their connection to obesity. Demand for healthy and nutritious food by consumers will make food businesses respond. Digital technology and media, both print and electronic, can play a big role in all this.
Our anganwadi and ASHA workers have been engaging in grassroots health and nutrition message delivery; the effort has to be expanded to include school and college teachers, youth clubs and other local institutions in both rural and urban areas; and community level champions identified and capacitated to be the torchbearers of malnutrition-free villages/panchayats/blocks/districts/towns and cities, leading to a malnutrition-free India.
bhavani9@iitbombay.org
