For the past few years, the annual publication of the Global Hunger Index (GHI) has grabbed headlines in India for the country’s poor ranking on food and nutrition. The 2021 edition of this report ranks India at 101 out of 116 countries, with the hunger situation in the country categorised as ‘serious’.
Worryingly, this rank places India even below the extremely poor and politically unstable nations in Sub-Saharan Africa such as Cameroon and Tanzania, as well as its poorer South Asian neighbours of Bangladesh, Nepal and Pakistan.
Media attention, however, focuses narrowly on this ranking, and there is little serious discussion on the nutritional crisis that India faces. Worse still, in recent times, the government response to this report has been outright denial of GHI on account of its methodology. GHI methodology is not without flaws. GHI is a composite measure that uses three interlinked dimensions of hunger, including proportion of population consuming inadequate calorie intake, proportion of undernourished children (which includes two indicators of ‘stunted’ and ‘wasted’ children below the age of 5 years), and under-5 mortality rates. These three dimensions are assigned one-third weight each. The one-third weight of child undernutrition component is shared equally between the two indicators of child nutrition.
For dietary energy intake, the GHI uses Food and Agriculture Organisation’s Prevalence of Undernourishment data which is more a measure of food supply than actual consumption. Despite this shortcoming, the fact remains that the nutritional situation in India is worse than in many other countries that are poorer in per capita income. India fares particularly badly on child undernutrition, which has had a significant impact on the country’s consistently low GHI ranking. Child undernutrition in India remains stubbornly high.
Recent data from India’s National Family Health Survey-5 (2019-21) shows that one-third of all children under five years of age are stunted (35.5%) and underweight (32.1%), and child nutrition levels barely improved from the last round of this survey done in 2015-16. In fact, the proportion of underweight and stunted children has increased in some states, including economically advanced states of Maharashtra and Kerala. Indeed, in the global food security discourse India is described as an ‘enigma’ where child undernutrition is higher than many countries in Sub-Saharan Africa.
Moreover, high economic growth in India for over a quarter of a century has contributed too to improve child nutrition. Cross-country evidence shows that economic growth and consequent rise in average incomes reduce child undernutrition, and decline in prevalence of child underweight tends to be nearly half the rate of growth of per capita Gross Domestic Product. As per World Bank data, between 1990 and 2015, the average per capita GDP in India grew at an average annual rate of 4.5 per cent. This income growth should have provided a potent force to address the problem of childhood undernutrition;
and if the observed relationship between GDP per capita and undernutrition held perfectly in India, this would have eliminated childhood undernutrition during this 25-year period. Yet, India’s progress on this front has been sluggish.
There are several possible explanations for this enigma. First, the failure of economic growth to make a significant dent to childhood undernutrition lies in exclusionary nature of India’s growth that has benefitted a small section of country’s populace, while leaving behind a majority. In particular, the prevalence of undernutrition is higher among children of historically marginalised communities of Scheduled Castes/Tribes who continue to witness starvation deaths.
Second, the low status of women and widespread gender discrimination contributes to high rates of childhood undernutrition. The gender differentials in treatment favouring boys over girls in food and health care, results in higher undernourishment among girls which in turn manifests into women bearing below normal weight babies, leading to intergenerational cycle of undernourishment. India has among the highest proportion of low-weight babies which means the problem of undernutrition starts in the womb, which is rooted in low status of women.
Third, the generally poor hygiene and sanitation conditions that lead to disease, often mean that even
when there is enough food to go around, food consumed is inadequately absorbed in the body for it to achieve optimal development. Finally, socio-cultural norms around breastfeeding also inhibit child growth, and 40% of Indian children under the age of six months are not exclusively breastfed, against the recommended guidelines.
We need to acknowledge the nutritional crisis that stares at us and start a serious public discussion on this issue. There is a moral imperative to address childhood undernutrition in India. And good nutrition at an early age generally improves children’s educational and employment outcomes later in life, and economic gains for India are likely to be substantial too.
Chetan Choithani
PhD, Assistant Professor, Inequality and Human Development Programme, School of Social Sciences, National Institute of Advanced Studies, Bengaluru