Adequate nutritious food in the early stages of life is crucial for ensuring good physical and mental development. Malnutrition has been identified as one of the principal causes limiting India’s global economic potential as it affects the quality of human resources. In the past few years, a series of incidents such as pandemic lockdowns, the Russia-Ukraine war, soaring food prices, higher energy costs, climate disasters and now the Gaza war have impacted the world. These incidents have pushed vulnerable low- and middle-income countries into food crises. The extent to which countries can recover from shocks depends largely on factors such as income inequality, governance, food availability and poverty level.
In India, there has been a rise in the number of undernourished people from 572 million to about 735 million since 2017. According to the Multidimensional Poverty Index (MPI) published by the UN Development Programme and the Oxford Poverty and Human Development Initiative, 25 countries halved their MPI score in four to 12 years, demonstrating that halving poverty within 15 years in line with Sustainable Development Goals is possible. The report says that 415 million Indians moved out of poverty between 2005-06 and 2019-21. The incidence of poverty fell from 55.1 per cent to 16.4 per cent and all indicators of deprivation improved.
But despite the improvement in MPI indicators, one of the major deprivation factors—malnutrition—is still at an alarming level in India. According to NITI Aayog’s MPI report in 2023, 14.9 per cent of Indians are categorised as being poor and nutrition deprivation is the major contributor to this at around 30 per cent. Between 2005-06 and 2019-21 (National Family Health Survey 5 or NFHS 5), the two indicators of malnutrition, stunting and underweight in children below five, registered a considerable decrease by 12 and 11 percentage points respectively. For wasting, the decrease was very marginal, by just 1 per cent. Two other indicators of health, anaemia among children and mothers, also showed a decline by 2.3 and 5.7 percentage points respectively.
Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and nutrients, but let’s briefly discuss the deficiency indicators. Food and feeding behaviours in children are the main factors behind these. Due to low income, many families cannot afford or access sufficient nutritious food such as fresh fruits and vegetables, legumes, nuts, meats and milk. Parents may also lack knowledge about appropriate foods for the child’s age, apart from proper care.
Anaemia is another severe public health problem among women, adolescent girls and young children. The World Health Organization noted in 2017 that with increased morbidity and negative effects on physical well-being, anaemia is related to delayed mental and psychomotor development and an increased risk of maternal mortality. Poor nutrition leads to iron deficiency, the main underlying factor in more than 60 per cent of anaemia cases.
India will have to analyse the performance of states on malnutrition, as this is the foundation of the demographic dividend. A comparison of NFHS 4 and NFHS 5 on the state-wise prevalence of stunting, wasting, underweight and anaemia among children under five and anaemia among women aged 15 to 49 provides better insights into the status of malnourishment. One of the major observations that emerges is inter-year shifts in nutritional status, offering a granular perspective on the experience of states. The other is variations between states and the shocking fact that no state’s malnutrition status is single-digit.
Anaemia can impair cognitive development, stunt growth and increase morbidity from infectious diseases. According to the respected medical journal Lancet, a fifth of maternal mortality can be averted by addressing maternal stunting and iron deficiency. The prevalence of anaemia among children aged six to 59 months has increased in almost all major states except Jharkhand and Haryana. On the incidence of anaemia in pregnant mothers, except Jharkhand, Madhya Pradesh, Maharashtra, Rajasthan and Uttar Pradesh, all other states are showing an increase. The decrease in Rajasthan is negligible.
The burden of malnourishment is still a mammoth task for states. This calls for a proper nutrition mandate at the central policy level and additional focused interventions at the state level. There are several government schemes such as Saksham Anganwadi, Poshan 2.0 and Pradhan Mantri Poshan Shakti Nirman which have been running for long and now have newer components. Still, the average level of nutrition continues to be dire at the micro level.
Considering this, the 15th Finance Commission recommended an additional grant of `7,735 crore to states for nutrition in 2020-21, along with the grants allocated under centrally-sponsored schemes for child nutrition. The finance commission stated that these grants cannot substitute the state or Union shares and are an addition that would be released in two instalments. The second instalment should be released after effective utilisation of the first grant received by a state for the purpose.
Schemes providing direct nutrition interventions are crucial for eliminating malnutrition, but budgetary allocation may vary from year to year. Thus a focused, steady allocation aimed at nutritional outcomes is needed. The Global Nutrition Report 2015 reported that there was a benefit-cost ratio of 16:1 for investments in nutrition in 40 low- and middle-income countries. Therefore, the 16th Finance Commission should reconsider the sectoral grant for nutrition while deciding the kitty for states. This will address the needs of present as well as future generations.
Barna Ganguli
Faculty, Bihar Institute of Public Finance and Policy
Manoj Narayan
Consultant, United Nations