1. Nourishing a Nation
ReducingMalnutritionin India
Aditya Pratap Singh, Ashishkumar Suryawanshi, Ishwarya
Thyagarajan, Priya Singh and Sethulakshmi Vinayan
Azim Premji University, Bangalore
05 September 2013

2. Malnutrition – a few facts
• UNICEF definition: Malnutrition is a broad term
commonly used as an alternative to undernutrition but
technically it also refers to overnutrition. People are
malnourished if their diet does not provide adequate
calories and protein for growth and maintenance or they
are unable to fully utilize the food they eat due to illness
(undernutrition). They are also malnourished if they
consume too many calories (overnutrition).
• Malnutrition majorly contributes to child mortality.
Stunting, wasting and underweight of children could be
attributed to malnutrition

3. Malnutrition and development
• Malnutrition affects the well being and quality of life of the
nation’s population
• Has a direct impact on development indicators like morbidity,
mortality and literacy levels
• Unhealthy population greatly affects productivity
• The economic growth and potential of the country comes
down
• Heavy infrastructure investment in other domains is required
to compensate these shortcomings

4. Malnutrition in India
• Two-thirds of the 200 million children suffering from
malnourishment live in India. India is currently ranked 65th
among 79 countries in the Global Hunger Index of 2012
• The problem is significantly severe in few states like Bihar,
Uttar Pradesh, Rajasthan, Orissa etc.
• India approximately spends US$2.5 billion for issues relating
to nutrition deficiencies
• There is a productivity loss of close to US$ 10 million because
of malnutrition
• Undernourishment of pregnant women, frequent pregnancies,
lack of hygiene, sanitation and quality healthcare, accessibility
to food, poverty and lack of awareness have been identified
as the main causes for malnutrition

5. Elements other than food intake causing
Malnutrition
• Accessibility to primary health care
• Issues of poor hygiene and sanitary conditions breed
diseases
• Affordability of basic health care
• The food provided under the Public Distribution System
focusses more on meeting the calorific requirements
rather than emphasizing on nutritional value
• Lack of awareness, especially among women regarding
issues like child nutrition, health-hygiene etc.

6. Malnutrition in numbers
0
10
20
30
40
50
60
70
80
1992 1998 1992 1998 1992 1998
Mild Moderate Severe
Underweight Stunting Wasting
Source: Underweight figures calculated directly from NFHS I and NFHS II data; other figures obtained from StatCompiler DHS
(ORC Macro 2004).
Note: Figures are for children under the age of three
India has not made any significant progress in reducing malnutrition over time.
Despite the numbers going down in the recent years, the country has a long
way to go

7. Major Schemes and Policies
The following are the main policies and schemes
introduced by the Indian government to combat
malnutrition:
• Integrated Child Development Scheme (ICDS): 1975;
targeting children below 6 years of age, pregnant and
lactating mothers
• Mid-day meals in schools
• National Children’s Fund: 1979
• National Plan of Action for Children: 2005
• National Rural Health Mission: 2005

8. Major flaws in the policies
(1/2)
Though there are numerous ambitious policies to decrease
malnutrition but some of the challenges these policies
face in terms of implementation are:
• The programmes do not target children below 3 years of
age
• Agendas like preferential treatment for girls, prioritising
poorly performing states have not been met
• The focus is on merely expanding the policies for better
coverage and not improving the service quality

9. Major flaws in the policies
(2/2)
• Lack of judicious funding and resource allocation
• The programmes are vertical in nature and are challenged by
malpractices like corruption and fraud
• There is a very wide gap between policies’ aims and their
implementation
• Despite being designed to be comprehensive and holistic,
results do not reflect this
The recently introduced Food Security Bill aims just at curbing
hunger and reducing poverty and does not cover the nutrition
aspects. States that are already performing well in the
distribution domain face serious challenges with the
introduction of the bill. Food storage and related infrastructure
requires serious revisiting

10. Challenges
• Since the approach followed to address the issue is top-down,
there are many governance loopholes in terms of corruption,
accountability, lack of proper implementation at all levels , etc.
• The quality is mostly compromised to increase the coverage/
quantity. E.g. the recent case of Bihar school children dying
due to bad quality of mid day meal
• PDS has certain loopholes like it is not reaching to the needy
reaching our and serving those really in need of it
• Most of the programs do not look at the long term impact but
rather focus on immediately measurable outcomes
• The policies in place fail to look at factors like gender
differentials within the nutrition framework. E.g. prevalence
of anemia among girls
• Autonomy of the states is constrained by the fiscal incentives
of the Centre

11. Solutions (1/3)
• Though expanding PDS shops as a part of the food security bill might
be helpful, it is also essential to strengthen the existing systems
• Studying the PDS models of states like Tami Nadu where it has been
a success and reviewing possibilities of replication
• Decentralization has to be made stronger with the states being given
more autonomy in decision making and resource utilization
• Efficient monitoring at all levels is needed. Evaluation of small scale
programs is highly essential
• Checks and balances have to designed to keep prevent malpractices.
The community and the local NGOs must be involved to enhance
accountability and transparency
• The ICDS should increase its focus on covering children below 3
years of age and improve the service quality

12. Solutions (2/3)
• Community Participation – awareness regarding health and hygiene
should be promoted. The women Self Help Groups at local level
should be provided with health education in order to generate
health awareness
• Increased involvement of school authorities and community in
keeping a check on mid-day meal schemes
• The policies need to focus on women’s nourishment along with
children’s
• Programmes should be devised such that they look beyond just
calorific value sand should include locally available nutritious food
• Judiciously using the budget allocated for programmes related to
malnourishment
• Focusing more on public health services to improve hygiene and
sanitation. It should not be amalgamated with the medical services

13. Solutions (3/3)
• Expansion and enhancing of the public health services for better
environmental and preventive health care systems
• Integration of the programs with similar agenda for greater,
meaningful impact
• Similar to village health committees, nutrition committees need to
be introduced for designing the dietary plan using local nutritious
food
• In addition to anganwadi workers there should be staff assigned
specifically to work on malnourishment and special training should
be provided to the local level workers like ASHAs and ANMs
• Tackling malnourishment is not just about improving food intake but
also requires efforts in various issues like greater awareness among
both male and female population, improvement in sanitation,
hygiene and health infrastructure etc.

14. Key Solutions - a quick look
Stronger
Decentralization
Strengthening
PDS System
Involving
Community
Strengthening
ICDS
Enhancing
Public Health
System
Holistic,
Comprehensive
Programs
Improving
Health
Education and
Awareness

15. References
HUNGAMA, New Delhi, ‘Fighting Hunger and Malnutrition- Survey Report
2011’ online
World Bank Report on ICDS, 2012
http://siteresources.worldbank.org/SOUTHASIAEXT/Resources/223546-
1147272668285/undernourished_chapter_2.pdf
Mehrotra, S. (2006). Child Malnutrition and Gender Discrimination in South
Asia. Economic and Political Weekly, 41 (10), pp. 912-918
Ghosh, S. (2004). Child Malnutrition. Economic and Political Weekly, 39(40), pp.
4412-4413
Payne, P. & Cutler, P. (1984). Measuring Malnutrition: Technical Problems and
Ideological Perspectives. Economic and Political Weekly, 19(34), pp. 1485-1487
Ramakrishna T. “Tamil Nadu has it covered, but Food Bill poses new challenge,”
The Hindu, 01 September 2013
Sethi Nitin. “Talk about food - The coming battle over beneficiaries,” The Hindu,
01 September 2013
Gupta, M., Shukla, R., Somanathan, T.V. & Datta, K.K (2009). How Might India’s
Public Health Systems Be Strengthened? The World Bank Development
Research Group