Malnutrition is a complex issue for India. It is an example of how India is a nation of extremes. Many among the population live in poverty and are not able to obtain as much food as they need. This is contrasted by the ever expanding number of people within the country suffering from obesity.
Worth noting is that those suffering from obesity often still fall within the diagnosis of malnourished. This is due to poor diets consisting of fast food and sugary products causing obesity while not providing the necessary nutrient intake the body needs. Due to this, many suffering from obesity will find themselves with some of the same health issues as those who are chronically underweight.
About a third of Indians are believed to be malnourished and over forty percent of children receive less food than they should. The government of India is increasing food subsidies to address this situation, but the rapidly rising population and increasing proportion of the population living in urban areas are causing continuing issues.
Although great improvements to malnutrition rates have been made within the past few years, though there still remains a great number of malnutrition related illnesses that are still present in the county. The National Family Health Survey (NFHS), conducted across 2005-2006 found that 42.5 percent of children under five years old were underweight.
After much controversy the results of the 2015 report concerning malnutrition in India was released. The government was accused of covering the report up due to its damning implications of the continuing problem of malnourishment. Though the number of malnourished children under five had fallen, it was still a prevalent problem, affecting close to a third of India’s children.
The Rapid Survey on Children (RSoC), a survey performed between the year 2013 and 2014 also noted a reduction in malnourishment figures. A civile collective have demanded that malnutrition should be included as a medical emergency in hopes to further decrease the number of malnourished children in India.
The RSoC reports that:
- 38.7 percent of children under five are considered stunted (low height for age)
- 29.4 percent are considered underweight (low weight for age)
- 15 percent are considered wasted (low weight for height)
Economic situation and obesity are likely intertwined
Economic growth coincides with decreased rates of stunting and wasting – but may also bring with it increased rates of obesity. This is according to a recent study published in The Lancet Diabetes & Endocrinology which analyses how the burden of malnutrition changes as countries undergo economic development.
In India this situation is complex, as despite the GDP rise of the country in recent years, untold numbers still live in abject poverty. This creates a dual burden of obesity among the wealthier individuals, as well as vast swathes of the population suffering from poverty related malnutrition.
Malnutrition in childhood often results in poverty — and therefore further malnutrition — during adulthood. Stunting during infancy is linked to a range of poor health indicators in later life, including poor educational performance. This may account for the statistic that 66 percent of working Indians experience lower wages because of stunting. Workers who were stunted as children earn, on average, thirteen percent less than they should.
Micronutrient Malnutrition in India
With over one sixth of the global population residing in India, one third of about two billion people suffering from vitamin and micronutrient deficiency are in India. Micronutrients are required in small quantities and responsible for vital functions of the human body.
Studies conducted a decade ago estimate that India loses around one percent of its GDP due to conditions resulting from micronutrient malnutrition. Despite plans put forward by the government preceding this study, the issues presented within it continue to blight India to the current day, with very few campaigns specifically targeting nutrient intake.
This situation may become worse in the future — potentially due to an unexpected result of climate change. A study projects that, by 2050, CO2 concentration will reach 550 parts per million (ppm). In those conditions, concentrations of nutrients such as protein, iron and zinc in crops could drop by between three and seventeen percent. This is due to photosynthesis rates being increased, resulting in more rapid plant growth and higher calorie content, at the expense of a lower nutritional density.
State governments have programmes in place attempting to combat malnutrition in children by providing free meals.
In Maharashtra more than 500,000 women and 6.1 million children under six years old receive free meals and nutritional supplements through the state’s 97,287 anganwadis. Anganwadis are mother and child centres established by the Indian government in 1985 as part of its Integrated Child Development Services.
Beneficiaries will now have to provide an Aadhaar number if they wish to receive these free meals. If they do not have one, officials are responsible for ensuring they follow the procedure to obtain one.
Global Nutrition Report 2017
Despite government attempts at intervention, 38 percent of children are suffering from stunting and 21 percent are affected by wasting. Stunting permanently reduces a child’s capacity for growth. Even more detrimental to the child, it also affects brain development. This can prevent a child from achieving a proper education, it can also contribute to mental health problems.
Scientists say there are at least fifty brain chemicals or neurotransmitters that are affected by the intake of food and micronutrients by the child in his or her first 1,000 days. The impact of inadequate nutrition during this golden period is lasting and irreversible, with effects beyond physical health to affect the child’s cognitive development.
“A well-nourished child is one-third more likely to escape poverty, learn better in school, be healthier and grow into productive contributors to their economies,” says Jessica Fanzo, Professor of Global Food and Agriculture Policy and Ethics at John Hopkins University.
These figures imply that the situation in India regarding malnutrition remains unaddressed. Figures for stunting remain the same as they did in 2015, while those considered to be affected by wasting have risen from fifteen percent to 21 percent. While figures may vary depending on how the survey was conducted, this still implies little progress has been made.
Obesity in Indian adults is rising, and appears to disproportionately affect women, with 22 percent of women found to be obese compared to sixteen percent of men. This may be accounted for by traditional Indian values, in which men work and the women remain at home.
Malnutrition as a risk factor for disease
Besides increasing the risk of infant mortality and causing stunting in children, malnutrition can be a causative factor for numerous health conditions.
Anaemia is a common condition that can result from a lack of iron intake. The condition leads to feelings of weakness and fatigue. When combined with other conditions it can potentially result in mortality.
Malnutrition heightens the risk of contracting numerous infections, as well as delays recovery time. In its most severe forms it can cause muscle wasting. All of these things can reduce the capacity of the individual to work, which, as malnutrition disproportionately affects those in poverty, can lead to worsening financial situations.
Madhya Pradesh and low birth weight
In Madhya Pradesh, 24 million people, or roughly a third of the population, live under the poverty line. In regions where poverty is abundant, diets may be lacking and malnutrition may be common.
Authors of the Million Death Study suggest low birth weight is the leading cause of neonatal death, which drives up the under-five mortality rate. Low birth weight can be caused by many factors. Foremost among these are poor diet during pregnancy, as well as a lack of healthcare before and during the birth.
Nations within a nation
Due to food aid programmes often running on a state by state basis, the amount of assistance in maintaining a healthy diet a citizen can expect varies wildly by state.
‘Nations Within a Nation’, a study published in The Lancet was touted as ‘the first comprehensive analysis of health in India’. It shows that the ‘substantial gains in healthcare’ made by India in recent years have not been evenly distributed across its 29 states and seven union territories.
The study identifies child and maternal malnutrition as ‘still [the] leading risk factor for premature death and poor health’. This is particularly true in states at a lower income states such as Assam, Bihar and Uttar Pradesh.
Further work such as the nutrition atlas continues to highlight these issues. The first of its kind, the nutrition atlas provides online maps analysing nutrition trends across India at both a national and state level. The atlas includes among its resources various interactive maps, graphs and statistics. These are drawn from various national and international sources. They offer valuable insight into issues as stunting, wasting, anaemia, tuberculosis and obesity.
The atlas provided a mean to address the huge disparities between states, with obesity levels shown to be higher in richer and urban states, and malnutrition higher in rural, poorer states. This development could lead to more efficient state programmes, or even national programmes with specific state by state goals.
Food safety, not a priority?
Only one percent of food approved for sale in India has been tested for pesticides according to a new government report.
A lack of adequate equipment and mass shortages of staff at the Food Safety Standards Authority of India (FSSAI) have led to lapsed standards and little oversight in the testing of food quality, according to an audit by the Comptroller and Auditor General (CAG) of India that. These lapses could foster situations during food production and packaging that allow for diseases such as salmonella and E.coli to contaminate products, posing a significant risk to public health.
Contaminated food, particularly in a situation where a large portion of the population is undernourished, poses a huge risk to public health. Contaminants within the food can contribute to diarrhoeal diseases, which, in those that are already malnourished, carries a far greater risk of mortality.
FSSAI programmes to improve dietary health
FSSAI has responded to the rising tide of NCDs (of which bad dietary habits are a major risk factor) by launching the Eat Right Movement. This has been influenced by the India State-level Disease Burden report, which noted “dietary risks, which include diets low in fruit, vegetables and whole grains, but high in salt and fat, were India’s third leading risk factor for health loss in 2016”.
The programme aims to encourage reductions in “western-style” diets and to promote the consumption of fresh fruits and vegetables. Such a change could have a notable positive impact on the rates of NCDs, as it would reduce a major risk factor.
India: Undernourished children, a call for reform and action
In a report published by the World Bank it was claimed that India’s Integrated Child Development Services (ICDS) needs to undergo significant changes to address the current malnutrition crisis in India. The prevalence of underweight children in India is among the highest in the world, and is nearly double that of Sub-Saharan Africa, the report says. It also observes that malnutrition in India is a concentrated phenomenon.
Reform is vital if India wishes to address a problem which is a significant causative factor of infant mortality, as well as a host of other health conditions.