Hunger and malnutrition: Why is India in denial?

 

https://healthonair.in/columns/hunger-and-malnourishment-why-is-india-in-denial/

As per the UN’s Sustainable Development Goal (SDG) number two – ‘zero hunger’ – all forms of hunger and malnutrition in the world should end by 2030 so that no one suffers from ill health due to insufficient nutrition. The goal also requires addressing different forms of hunger and malnutrition, such as stunting and wasting among under-5 children, as well as anemia in adolescent girls, pregnant, and lactating women, and older persons, with a strong focus on improving their nutrition levels significantly by 2025. Stunting occurs when a child is too short for their age due to chronic malnutrition while wasting indicates low weight for their height, typically caused by acute malnutrition.

A key tool for measuring progress toward these goals is the Global Hunger Index (GHI) Report. Released recently, it revealed that India has the highest rate of child wasting globally, at 18.7 percent. It ranked India at 111th place out of 125 countries. However, India’s reaction to the report was characterized by denial and indifference. Minister of Women and Child Development of India, Smriti Irani, ridiculed and dismissed the report by calling its methodology “flawed”. What was never discussed by the government, however, was that if there was indeed no hunger or deprivation among people of this country, then why extend the Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY) for a period of five years with effect from 1st January, 2024?

The PMGKAY aims to provide free food to 81.35 crore people, which is more than half of the Indian population. Interestingly, this free provisioning of food for the next five years is not being presented as an acceptance of criticism of the government’s welfare schemes, but as a display of ‘sensitivity’ of the political leadership.

More recently, Minister of State for Health SP Singh Baghel said on the floor of the Parliament that not a single hunger-related death has occurred in the country in the last ten years. On another occasion, a minister from the Hemant Soren-led government in Jharkhand made a statement in the state assembly that there have been no starvation deaths in the state. Just within a matter of a few months of that statement in 2021, the Jharkhand High Court took suo moto cognizance of three alleged starvation deathsin the same family after the media reported the news. Following a court-mandated investigation by the Jharkhand State Legal Services Authority, it was revealed that individuals had to trek eight kilometres to obtain rations, while access to clean water and healthcare services remained scarce and challenging. The HC held up the state government for running welfare services ‘on paper’ and condemned starvation deaths as a matter of shame. Similarly, starvation deaths have recently been reported in various other states such as Odisha, and West Bengal among others.

The Ministry of Health and Family Welfare’s own NFHS-V data also points in the direction of overall poor nutritional indicators. For instance, it shows a dramatic rise in the number of children suffering from anemia when compared to data from NFHS-IV. More specifically, anemia has risen not just in children below six years of age, it has also increased among adolescent girls and boys, among women who are pregnant, and those in the age group of 15-49 years. Almost half of our population is anemic which is a matter of grave concern. Moreover, the prevalence of anemia among adolescent girls (59.1 percent) inevitably contributes to anemia among new mothers. This, in turn, serves as a contributing factor to anemia among newborns, maternal and infant mortality rates, and overall community morbidity due to iron deficiency. Unfortunately, the government will not be collecting data on prevalence of anemia in the sixth round of NFHS. Further, a more careful analysis of the NFHS-V data shows that stunting and severe wasting of under-5 children has actually increased in 11 and 13 out of 17 states respectively. The proportion of children who are underweight has also increased in 11 out of 17 states.

Following the GHI controversy, the Ministry of Women and Child Development issued a press release attributing the poor ranking to ‘malafide intent.’  The release spoke at length about India’s present nutrition-related programs – the Mission Saksham Anganwadi and Poshan 2.0, the Poshan Tracker, Pradhan Mantri Garib Kalyaan Anna Yojana and Antyodaya Anna Yojna etc. – and how India runs the world’s largest food security program and so on.

However, many public health and nutrition experts have already pointed out that irrespective of the size of the Indian food security programme, its basic flaws must be acknowledged and considered seriously if it is going to be implemented effectively and sustainably. First, the PDS system largely covers the poor and vulnerable population based on the outdated 2011 Census so a large number of households has been missed. The number of people who have increased within the existing households is still not officially counted as ‘beneficiaries’ yet. Besides, not all beneficiaries have a ration and/or aadhar card to be able to freely access the PDS. Secondly, our granaries overflow with food grains, they rot, get damaged in transit, and get exported but the intended beneficiaries from the poor and vulnerable sections of the population are unable to access and consume ration from the PDS conveniently, particularly women and girl children due to social and gender inequalities.

Adding nutritionally rich fruits and vegetables to the PDS system is also challenging due to storage issues for instance. Incorporating eggs in to midday meals has been a long-standing point of contention due to concerns about hurting religious sentiments. Only some states have been able to introduce daily eggintake for their high protein and vitamin content.

Moreover, the cereals provided within the PDS are usually wheat and rice, which are heavy on carbohydrate content. Focusing just on increasing and ensuring calorie intake will not make up for the other long-term nutritional deficiencies experienced by people. To cover up for this lacuna, nutritionally rich coarse grains (millets) have also been added to the PDS food basket by some states, and doing that has thrown its own set of challenges. In states where millets are included in the PDS, only a limited number of varieties are promoted for cultivation. This contrasts with the increasing prices of other millet species in urban markets, making them expensive even for city dwellers. Additionally, popular millet types like bajra, jowar, and ragiare being prioritized as major cash crops for export, which further limits their availability for domestic consumption.

The recent claims by Niti Aayog regarding poverty reduction just before elections seem to gloss over the persistent issues of chronic hunger and malnutrition in India. While Niti Aayog asserts significant poverty reduction and promising progress towards meeting SDG goal one (‘no poverty’) before time, experts have raised valid concerns about the accuracy of these claims. To address the persistent issues of hunger and malnutrition – which is SGD goal two, and is closely related with SDG goal one – we need to acknowledge their existence and interlinkages first. Unfortunately, what we often observe instead is a troubling silence and denial regarding these problems.