Even as the Centre and independent experts have criticised the Global Hunger Index for high weightage given to child under-nutrition as a proxy for population-level ‘hunger’ and conflating malnutrition with hunger, the country’s umbrella nutrition programme, the POSHAN Abhiyaan, seems to be lagging.
The dashboard for the programme, which seeks to address under-nutrition among children under 6 years of age, pregnant and lactating women, and adolescent girls, shows that against 98.5 million registered beneficiaries, 181 million hot, cooked meals were delivered in the last 30 days. This means a hot, cooked meal from the government — over the entitlement under the National Food Security Act and the Pradhan Mantri Garib Kalyan Anna Yojana — is not reaching every beneficiary everyday.
“Malnutrition among children needs to be addressed within the first five years. This is where the Integrated Child Development Services programme comes in. Despite several court observations in the landmark right to food case, on ensuring hot, cooked meals to children through ICDS, in many states, dry rations or pre-packaged food continue to substitute the cooked meals on most days, which may not translate into nutritional intake comparable with a hot, cooked meal with nutritional diversity,” says Biraj Patnaik, former principal adviser to the Supreme Court in the right to food case.
“Given that the Centre pays for a large part of the ICDS outgo, it needs to push states to get on ground implementation right,” he adds.
Childhood malnutrition can be an important factor of adult malnutrition, experts say. A multi-country (including India) study published in The Lancet as part of its series on maternal and child under-nutrition shows that childhood under-nutrition plays a role in stunting in adulthood. With maturational delay — which lengthens the period of growth — being typically shorter in low- and low-middle income nations, the likelihood of early-years growth loss getting compensated for in the subsequent few years, even if access to better nutrition improves, is quite low. Early-years under-nutrition also leaves a tell-tale imprint on absorption capability in adulthood, making malnutrition perpetual.
“Several studies show links between low birth-weight/early-years under-nutrition and increased likelihood of diabetes and cardiovascular diseases in later years, leading to lingering nutritional issues,” says Dr K Srinath Reddy, president of the Public Health Foundation of India.
Under-nutrition among women, studies show, have an impact on birth-weight of the babies they bear and feed, leading to a vicious cycle.
Under the centrally-sponsored Pradhan Mantri Poshan Shakti Nirman (PM-Poshan) scheme — the Mid-Day Meal in Schools progamme renamed — the government aims to provide one hot, cooked meal to pre-schoolers along with 118 million children in classes I-VIII in 1.12 million government and government-aided schools.
Even as the government brought down the budget estimate for the programme this fiscal from the FY22 BE, the increase in material costs of meals under for the programme, some experts have argued, is too low to make a difference to the quality of nutrition provided under the scheme.
“The supplemental nutrition vision in India has long focused on quantity over quality — calorie-intake as opposed to a more balanced intake of nutrients, with necessary intake of protein, vitamins and fibre. If we intend to address malnutrition meaningfully, and focus on muscle mass to tackle wasting rather than adiposity, we have to have a more balanced nutritional offering in our schemes,” says Dr Reddy. The criticism of the GHI criteria has also focused on a “Western standards of growth versus Indian reality”, to suggest a genetic predisposition to relative “shortness” (reflected in stunting). However, as a 2013 research published in Oxford Economic Papers shows, the average height of European men aged 21 rose by 11 cm between 1870s and 1980, suggesting improving nutrition and health and decreasing disease as an important determinant of population-wide gains in height. There also needs to be a focus on improving sanitation, given the absorption losses from water-borne diseases. “We can’t expect to see a major change in the malnutrition figures unless we can provide universal sanitation and good quality primary health care. These are key social determinants to crack India’s malnutrition conundrum,” says Patnaik.