Being ranked 100th of 119 countries in the Global Hunger Index (GHI) is a matter of deep shame for India. GHI, apart from adequacy of calorific intake, works in child wasting (low weight for height), stunting (lower height than typical for age) and under-5 mortality into its definition of hunger. India has recorded good progress in tackling lack of access to foof—largely through ICDS, the Food Security Act, and mid-day meals, though better targeting and value-delivery can be done through direct benefit transfers. It has also seen a decline in stunting and a sharp fall in under-5 mortality in the last 25 years. The trouble is child wasting has inched up since 1998-2002 and prevalence of stunting still remains a high 38% despite having fallen from 62% in the early 1990s.
So, if India isn’t going “hungry” as far as calorific intake goes, why are the physiological outcomes such as height, weight so poor? Household access to improved sanitation—one of the factors that GHI also points out—is chiefly to blame. Water-borne diseases like diarrhoea have not only been historically responsible for most of the under-5 deaths, they also cause poor absorption of nutrients. So, effectively, if a child or her caregiver is not trained to follow hygienic practices, or consumes contaminated food/water, no matter how well the child is fed, absorption and physical growth will be sub-par. In 2013, Dean Spears, a Princeton University researcher, showed that the ill-effects of open defecation and the contamination of water extended beyond those who have no access to proper sanitation. Spears found that even the richest 2.5% of children in his India study—from urban households with educated mothers and indoor toilets—were shorter than the age-appropriate height. These children lived in areas that neighboured other areas where open defecation was common, and they, as per Spears, were almost exactly as short as children in other countries exposed to similar levels of nearby open defecation. To better its GHI rank, India must focus on improving sanitation and fighting related infections. While India made the rotavirus vaccine, against diarrhoea, a part of its public immunisation initiative just last year, the sanitation story is getting better too. Over 5.1crore rural households now have sanitary toilets—that leaves just over 30% of such households to be covered—and 1,325 cities have been declared open-defecation free.