India needs to double yearly rate of fall in stunting cases to achieve its 2022 target

A new report, ‘Food and Nutrition Security Analysis, India, 2019’, authored by the Government of India and the United Nations World Food Programme, paints a picture of hunger and malnutrition amongst children in large pockets of India. This punctures the image of a nation marching towards prosperity. It raises moral and ethical questions about the nature of a state and society that, after 70 years of independence, still condemns hundreds of millions of its poorest and vulnerable citizens to lives of hunger and desperation. And it once again forces us to ask why despite rapid economic growth, declining levels of poverty, enough food to export, and a multiplicity of government programmes, malnutrition amongst the poorest remains high.

A trap of poverty, malnutrition

The report shows the poorest sections of society caught in a trap of poverty and malnutrition, which is being passed on from generation to generation. Mothers who are hungry and malnourished produce children who are stunted, underweight and unlikely to develop to achieve their full human potential.

The effects of malnourishment in a small child are not merely physical. A developing brain that is deprived of nutrients does not reach its full mental potential. A study in the Lancet notes, “Undernutrition can affect cognitive development by causing direct structural damage to the brain and by impairing infant motor development.” This in turn affects the child’s ability to learn at school, leading to a lifetime of poverty and lack of opportunity.

Another study in the Lancet observes, “These disadvantaged children are likely to do poorly in school and subsequently have low incomes, high fertility, and provide poor care for their children, thus contributing to the intergenerational transmission of poverty.” In other words, today’s poor hungry children are likely to be tomorrow’s hungry, unemployed and undereducated adults.

The findings in the report are not new: many studies over the last five years have exposed the failure of the Indian state to ensure that its most vulnerable citizens are provided adequate nutrition in their early years. India has long been home to the largest number of malnourished children in the world. Some progress has been made in reducing the extent of malnutrition. The proportion of children with chronic malnutrition decreased from 48% percent in 2005-06 to 38.4% in 2015-16. The percentage of underweight children decreased from 42.5% to 35.7% over the same period. Anaemia in young children decreased from 69.5% to 58.5% during this period. But this progress is small.

An ambitious target

The government’s National Nutrition Mission (renamed as Poshan Abhiyaan) aims to reduce stunting (a measure of malnutrition that is defined as height that is significantly below the norm for age) by 2% a year, bringing down the proportion of stunted children in the population to 25% by 2022. But even this modest target will require doubling the current annual rate of reduction in stunting.

The minutes of recent meetings of the Executive Committee of Poshan Abhiyaan do not inspire much confidence about whether this can be achieved. A year after it was launched, State and Union Territory governments have only used 16% of the funds allocated to them. Fortified rice and milk were to be introduced in one district per State by March this year. But the minutes of a March 29 meeting showed that this had not been done, and officials in charge of public distribution had not yet got their act together. Or, as the minutes put it, “The matter is under active consideration of the Ministry of Consumer Affairs, Food and Public Distribution”. Anganwadis are key to the distribution of services to mothers and children. But many States, including Bihar and Odisha, which have large vulnerable populations, are struggling to set up functioning anganwadis, and recruit staff.

The key to ending the tragedy of child nutrition lies with a handful of State governments: the highest levels of stunted and underweight children are found in Jharkand, Bihar, Madhya Pradesh, Gujarat and Maharashtra. Malnutrition is a reflection of age-old patterns of social and economic exclusion. Over 40% of children from Scheduled Tribes and Scheduled Castes are stunted. Close to 40% of children from the Other Backward Classes are stunted. The lack of nutrition in their childhood years can reduce their mental as well as physical development and condemn them to a life in the margins of society.

Stunting and malnourishment starts not with the child, but with the mother. An adolescent girl who is malnourished and anaemic tends to be a mother who is malnourished and anaemic. This in turn increased the chances of her child being stunted.

The problem is access to food

As Amartya Sen noted, famines are caused not by shortages of food, but by inadequate access to food. And for the poor and marginalised, access to food is impeded by social, administrative and economic barriers. In the case of children and their mothers, this could be anything from non-functioning or neglectful governments at the State, district and local levels to entrenched social attitudes that see the poor and marginalised as less than equal citizens who are meant to be an underclass and are undeserving of government efforts to provide them food and lift them out of poverty.

A lot of attention has focussed on the government’s aim of turning India into a $5 trillion economy in the next five years. Whether this will achieved is a matter for debate. But these declarations only serve to obscure a larger reality. There is a large section of society, the poorest two-fifths of the country’s population, that is still largely untouched by the modern economy which the rest of the country inhabits. As one part of the country lives in a 21st century economy, ordering exotic cuisines over apps, another part struggles with the most ancient of realities: finding enough to eat to tide them over till the next day.

Thomas Abraham is a Bengaluru-based writer on social issues. He is the author of ‘Polio: The Odyssey of Eradication’