Nutritional Security in India: Challenges and Solutions | UPSC

Introduction

• • The recently released NSSO’s Household Consumption Expenditure Survey (HCES) 2022-23 offers new insights into the state of nutritional security in India. 
  • The HCES 2022-23 report presents comprehensive data on household consumption patterns for both food and non-food items, along with an analysis of per capita daily calorie intake.

Household Consumption Expenditure Survey (HCES)

• • The Household Consumption Expenditure Survey (HCES) is usually conducted by the National Statistical Office (NSO), Ministry of Statistics & Programme Implementation (MoSPI) every five years.
  • Recently, the NSSO conducted the HCES from August 2022 to July 2023. This survey generates estimates of household Monthly Per Capita Consumption Expenditure (MPCE) and its distribution across rural and urban sectors, States and Union Territories. 
  • This data plays a key role in reviewing critical economic indicators, including the Gross Domestic Product (GDP), poverty levels, and the Consumer Price Inflation (CPI).
  • The recently released Household Consumer Expenditure Survey (HCES) data for 2022-23 by the Ministry of Statistics and Programme implementation points to a shift in the food consumption pattern of Indian households. 
  • The survey covered a sample of 2,61,746 households (1,55,014 rural and 1,06,732 urban) and was spread over 8,723 villages and 6,115 urban blocks.

Report Regarding Nutrition Security in India

Nutritional Insecurity Amongst the 10% Poorest Population:

• • The average daily per capita calorie intake (PCCI) for a healthy life is 2,172 kcal in rural India and 2,135 kcal in urban India.
  • The calorie intake of the poorest 10% of the Indian population falls below this average, with figures ranging between 1,564-1,764 kcal in rural areas and 1,607-1,773 kcal in urban areas.

Variation in Nutritional Insecurity Amongst the 10% Poorest Population:

• • There is significant variation within the 10% poorest population.
  • For the poorest 5% in rural areas, the average PCCI is 1,564 kcal, while for the next 5%, it is 1,764 kcal. In urban areas, the figures are 1,607 kcal and 1,773 kcal respectively.

Proportion of Poor/Deprived Based on Nutritional Requirement:

• • Based on the nutritional threshold of PCCI, 17.1% of the rural population and 14% of the urban population are considered poor.
  • These findings emphasize the need for the Indian government’s policy focus to include nutritional security alongside food security.

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What is Nutritional Security?

• • Definition: According to the FAO (2009), nutritional security entails physical, economic, and social access to a balanced diet, clean drinking water, a safe environment, and healthcare (both preventive and curative) for every individual.

Status of Nutrition Insecurity in India: 

• • High Nutritional Insecurity (Malnutrition): Despite a sharp decline in extreme poverty from 45.9% to 13.4% between 1993 and 2015, India continues to struggle with a high malnutrition burden, as highlighted by the World Bank.
  • Extreme Poverty (World Bank Definition): Defined as living on less than $1.9 per capita per day at the 2011 purchasing power parity rate (PPP).

NHFS-5 Findings on Malnutrition:

• • Over half of Indian women aged 15-49 are anaemic.
  • 35.5% of children under five years are stunted (low height-for-age).
  • 19.3% of children under five years are wasted (low weight-for-height).
  • 32.1% of children are underweight.

Lancet Study  Report: 

• • A Lancet study reports a rise in obesity levels, leading to a ‘double burden of nutritional insecurity,’ where malnutrition and obesity coexist.
  • Obesity in women has spiked in the past three decades — it increased from 1.2% in 1990 to 9.8% in 2022.
  • Obesity in men increased by 4.9 percentage points during the same period, with 26 million men living with obesity in 2022.
  • The study also found that 13.7% of women and 12.5% of men were underweight. 
  • Thinness, a measure of being underweight in children, in Indian girls is the highest in the world, with a prevalence of 20.3%. 

Reasons for Lack of Nutritional Security

Affordability Issues for Poor Households:

• • Nutritious foods like green leafy vegetables and protein-rich diets are often unaffordable for poor households.
  • A study by the Indian Council of Medical Research (ICMR) found that 33% of the Indian population cannot afford a nutritious diet.  
  • For instance, the cost of samosas and pakoras available at roadside shacks is less than fruit and vegetables. While it is not nutritious, it is tastier and is a cause of obesity. 
  • Undernutrition is prevalent in the extremely poor populations in states like Bihar, Jharkhand, or Odisha, where people might be eating just one meal a day

Focus on Staple Crops:

• • Agricultural policies prioritize the production of staple crops like wheat and rice over diverse, nutrient-rich crops, leading to micronutrient deficiencies.
  • The Green Revolution in India emphasized high-yielding varieties of wheat and rice, resulting in a decrease in the cultivation of nutrient-rich crops like millets, pulses, and legumes. This has led to widespread deficiencies in essential micronutrients such as iron, zinc, and vitamin A.

Calories Fundamentalism:

• • The Public Distribution Scheme (PDS) focuses on ensuring food security and calorie intake rather than nutritional development.
  • PDS provides subsidized staples like rice and wheat but often lacks diverse food items needed for a balanced diet. This results in a calorie-sufficient but nutrient-deficient diet for many low-income families.

Feminine Marginalization in Nutrition:

• • Adolescent and young females in poor and lower-middle-income households often receive less attention to their nutritional needs, leading to widespread anemia.
  • According to the National Family Health Survey (NFHS-4), 53% of women aged 15-49 years in India are anemic, largely due to inadequate intake of iron-rich foods and poor dietary practices.

Ineffective Child Care Practices:

• • Poor implementation of child care practices like exclusive breastfeeding and diversified diets post-six months.
  • Only 55% of children in India were exclusively breastfed in 2015-16 (NFHS-4). Additionally, a lack of awareness and support for complementary feeding practices leads to nutrient gaps in infants’ diets.

Growth of Fast-Food and Junk-Food Culture:

• • Increased consumption of cheaper, easily available junk food over nutritious options.
  • The Household Consumption Survey indicates a shift from traditional cereals and pulses to processed foods, beverages, and refreshments. This trend contributes to rising obesity rates and diet-related non-communicable diseases.

Impact of Increased Income and Urbanization:

• • Higher income levels have led to increased consumption of high-fat, high-sugar foods, coupled with low physical activity.
  • A joint study by WHO and ICRIER revealed that India’s ultra-processed food industry grew at a CAGR of 13.37% between 2011 and 2021. Urbanization and lifestyle changes have led to a preference for convenience foods, resulting in higher obesity rates and related health issues.

Negative Effects of Malnutrition

Child Deaths:

• • A Lancet study (2019) attributed 68% of the 1.04 million deaths of children under five years in India to malnutrition.
  •  In 2021, reports from states like Madhya Pradesh and Uttar Pradesh highlighted significant numbers of child deaths due to malnutrition-related complications. In particular, the National Health Mission (NHM) reported that in the tribal areas of Madhya Pradesh, malnutrition was a primary factor in over 1,500 child deaths.

Improper Development of Children:

• • Obesity in children can lead to stunted physical and cognitive development.
  • The Comprehensive National Nutrition Survey (CNNS) 2016-2018 indicated that nearly 10% of school-aged children (5-9 years) in India are obese, affecting their physical growth and academic performance. Additionally, the survey found that over 35% of children under five years are stunted, showing impaired growth and development.

Psychosocial Impact:

• • Malnutrition can cause body image issues and mental health concerns due to societal stigmas.
  • A study conducted in 2020 by the Public Health Foundation of India (PHFI) revealed that malnourished adolescents in urban slums of Delhi reported higher levels of anxiety and depression. The stigma of being underweight or overweight was linked to bullying and social isolation, further impacting their mental health.

Economic Burden:

• • Malnutrition leads to productivity losses and increased absenteeism, imposing an economic burden.
  • According to a 2022 report by NITI Aayog, India loses over $10 billion annually due to malnutrition-related productivity losses. The report highlighted that regions with high malnutrition rates, such as Bihar and Jharkhand, experience significant economic setbacks due to decreased workforce efficiency and increased healthcare costs.

Social Inequality and Disparities:

• • Undernutrition perpetuates health challenges and economic disadvantages among vulnerable sections, exacerbating socio-economic disparities, particularly affecting women.
  • The NFHS-5 (2019-2021) data shows that 59% of women in the reproductive age group (15-49 years) in Jharkhand are anemic, reflecting deep-rooted gender inequalities in nutrition access. The survey also found that rural and tribal women are disproportionately affected, leading to intergenerational cycles of malnutrition and poverty.

Initiatives for Nutritional Security in India

• • National Nutrition Mission (NNM): Also known as POSHAN Abhiyan, aims to reduce stunting, underweight, and low birth weight by 2% per annum and anemia among children, adolescent girls, and women by 3% per annum by 2022.
  • National Nutrition Strategy (2017): Aims to reduce underweight prevalence in children (0-3 years) by three percentage points annually by 2022.
  • National Breastfeeding Promotion Programs: Programs like MAA (Mother’s Absolute Affection) and Vatsalya (Matri Amrit Kosh) focus on regulating breast milk substitutes and improving breastfeeding practices.
  • Integrated Child Development Services (ICDS): Provides nutritional meals, preschool education, primary healthcare, immunization, health check-ups, and referral services to children under 6 years and their mothers.
  • Midday Meal Scheme: Provides cooked meals to children aged six to fourteen years in classes I to VIII who enroll and attend school.

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Way Forward

Change in Policy Focus:

• • The agricultural policies and programs should be leveraged to be more ‘nutrition-sensitive.’ 
  • The focus of food distribution programs needs to shift from ‘calories fundamentalism’ to providing a more diversified food basket, including coarse grains, millets, and pulses to improve the nutritional status of pre-school children and women of reproductive age.

Innovative Approaches:

• • Implement innovative techniques such as bio-fortification, which involves incorporating nutrients into the seeds of major food grains to improve micronutrient intake. 
  • Various food-based safety nets such as PDS and MDM can include bio-fortified staples to provide a more diversified food basket.

Enhanced Focus on WASH Initiatives:

• • Synergy between WASH (Water, Sanitation, and Hygiene) initiatives and nutritional interventions will have a multiplier effect on nutritional outcomes. This will help in improving child nutritional outcomes and are key to the success of nutritional interventions.

Focus on Women’s Education:

• • Targeted programs for improving the educational status of girls, particularly at higher educational levels, need to be promoted. 
  • This will help in better implementation of child care practices like breastfeeding and nutritional needs of children.

Improving Healthcare Services:

• • Improvement of access and utilization of prenatal and postnatal health care services must be prioritized. Comprehensive awareness programs and community participation would play a significant role in curbing undernutrition amongst children.

Learning from Successful International Interventions:

• • India can draw key lessons from countries like Brazil and China, which have successfully tackled food insecurity and malnutrition through agricultural R&D and early childhood development programs.

Investment in Early Childhood Development:

• • Increase investment in the health of children and adolescents, with a focus on early childhood development, care, and education for children aged 0–6 years. The first 1,000 days of life, from pregnancy to a child’s second birthday, are critical for establishing the foundation for lifelong health and development. 
  • Adequate nutrition and care during this period not only impact survival but also the ability to thrive, learn, and break the cycle of poverty.
  • Strengthening the existing 14 lakh Anganwadi Centers and providing adequate training to staff in child development and learning could have a significant impact.

Nationwide School Health Initiative:

• • A nationwide school health initiative can ensure the well-being of 255 million school children and teenagers aged 6-18. 
  • Creating a school environment that encourages health and nutrition through activities such as yoga, physical education, mental health support, counseling, and regular health check-ups should be a top priority.

Transformation of Ayushman Aarogya Mandirs (AAMs):

• • The healthcare system’s foundation is rooted in primary healthcare, essential for achieving desired health outcomes by 2047. The transformation of all Ayushman Aarogya Mandirs must be completed by 2027.
  • Since 2018, the primary healthcare platform has been established with 173,000 AAMs, along with the deployment of community health officers, infrastructure upgrades, telemedicine services, and provision of free drugs and diagnostics.