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India is the second-most populous country in the world after China. The majority of the population is either middle class or poor. Only handfuls belong to the rich class. At the time of independence, the economic status of the country was very poor from the nutritional point of view. Even after years of the Bengal famine, a significant number of people were still undernourished or malnourished. A majority of such people belonged came from rural areas. The lack of basic human amenities coupled with a literacy rate at 12% added to the existing problem. But, since then India has developed on the social, economic, and global platform. However, there is a lot that is yet to be achieved.
Recently, the World Health Assembly (WHA) released the Global Nutrition Report of 2020. Its findings reveal that India is very far from achieving its 2025 nutrition targets. It further notes that India is severely affected by malnutrition as well as undernutrition.
Over the years, undernutrition has been framed as a health issue (1950-65), a problem of food shortage (1965-75), a multidimensional poverty challenge (1975-97), and a nutrition and food security issue (after 1997). It has always remained as one of the prime subjects of the various five-year plans.
Under the umbrella of the Department of Woman and Child Development, the government adopted the National Nutrition Policy of India in the year 1993. Since then the government has introduced many schemes and programs to recover itself from the clutches of malnutrition, undernutrition, and other such nutrition-related chronic diseases. But, the Global Nutrition Report 2020 shows a different reality.
Where does India stand in it?
The World Health Assembly (WHA) has released its Global Nutrition Report 2020. It predicts that India will miss the global nutrition targets by 2025. In the year 2012, the WHA laid down six nutrition targets for maternal, infant, and young child nutrition. These targets form the basis of deciding nutrition-based policies and goals in nations across the world.
The 2020 Report highlights the progress made by the nations in achieving the global nutrition targets of 2025. These targets include anemia, low birth weight, exclusive breastfeeding, childhood wasting, and childhood overweight, among others. It marks the progress of a total of 194 countries. Of these, India is amongst the 88 countries that are not on track for achieving their 2025 targets. In simple words, India is not likely to achieve any of the four global nutrition goals of 2025.
The report states that India has the highest rate of domestic inequalities in malnutrition. The four targets that India will miss are:
- Stunting among children under the age of five years,
- Anemia amongst women of reproductive age,
- Childhood overweight and obesity
- Exclusive breastfeeding
It has been found that the rate of underweight children has decreased to some extent. But, it is still very high in comparison to the average rates of the whole of Asia. The report also noted that one in two women of reproductive age is anemic, while at the same time the rate of overweight and obesity continues to rise resulting in a lot of severe and chronic health issues. It is seen that the rate of obesity in females is double than that of males.
According to the report, India is among the top three countries along with Nigeria and Indonesia which are severely hit by malnutrition and stunting. One in three children under five years of age suffers from childhood stunting. The highest rates are from Uttar Pradesh with more than 40% stunting. The report also states that one in five children under five years is wasted. The data from rural and urban areas show the existence of inequalities in nutrition amongst the people.
Laws/policies regarding nutrition in India
- National Nutrition Monitoring Bureau, 1972
Under the guidance of the Indian Council of Medical Research, the National Nutrition Monitoring Bureau was established in the year 1972. It aimed to gather an informative dynamic database on the diet and nutritional status of various communities. It also helped in identifying the strengths and weaknesses of the intervention policies of the government. It recommended corrective measures in the Central Nutritional Policies. The Bureau was, however, shut down by the Union Ministry of Health in 2015.
- National Nutrition Policy, 1993
National Nutrition Policy was divided into direct strategies (short term) and indirect strategies (long term). Direct strategies demanded focus on the following:
- Ensuring proper nutrition of the target groups i.e. the vulnerable section of the society (children, adolescent, pregnant and nursing women, etc.)
- Expanding the safety net for children (i.e. expanding the policy to rural slums along with urban slums),
- Food fortification,
- Provisions for low-cost nutrition food, and
- Combating micro-nutrition deficiency in the vulnerable groups
Indirect strategies demanded focus on the following:
- Food security,
- Improving the dietary pattern like providing nutritionally rich food at affordable cost,
- Improving purchasing power,
- Encouraging more of the small and medium enterprise to emerge,
- Prevention of food adulteration,
- Imparting nutrition education through social marketing, communication, etc.,
- Minimum wage administration,
- Equal remuneration for women,
- Monitoring of nutrition programs.
- National Nutrition Mission or POSHAN Abhiyan, 2018
This is the Center’s flagship program aimed at improving the nutritional outcomes for children, pregnant and lactating women. It was launched by Prime Minister Narendra Modi in March 2018. It is a multi-ministerial mission to ensure a malnutrition-free India. Its main focus is on tackling the issue of malnutrition.
- National Food Security Act, 2013
Enacted by the Parliament, this Act came into force in 2013. It aims to provide at least 5 kg of food grains per month at a subsidized price to around 75% of the rural population and 50% of the urban population. This Act also aims to provide nutritional support to pregnant women and lactating mothers along with children aged 6 months to 14 years.
Other major nutrition programs include:
- National Vitamin A Prophylaxis Programme, 1970: In 1970, the National Prophylaxis Program against Nutritional Blindness was launched. It is a Centre sponsored plan under which covered all children between the ages of one and three years. This plan sought to administer about 2,00,000 IU of vitamin A to such children every six months.
- Special Nutrition Programme, 1970: Launched in 1970, this program provides a gives supplementary feeding of around 300 calories and 10 grams of protein to preschool children. It also covers nursing mothers and feeds them with 500 calories and 25 grams of protein. It takes place for six days in a week.
- Balwadi Nutrition Programme, 1970: The Balwadi Nutrition Program was also launched in 1970. It is a program that focuses both on healthcare as well as education. Under this program, the Government of India seeks to supply food supplements to the Balwadis. It is meant for children who belong to the age group 3–6 years. It focuses on children of the rural areas and was launched under the aegis of the Department of Social Welfare.
- Integrated Child Development Services (ICDS), 1975: It is a program initiated by the Central Government in India. It is more of a package of integrated services. It provides food, preschool education, primary healthcare, immunization, health check-up, and referral services to children under 6 years of age and their mothers. This program sees implementation at the grass-root levels through Anganwadi workers.
- National Iodine Deficiency Disorder Control Programme, 1992: This program started as the National Goiter Control Programme (NGCP). It was later renamed to National Iodine Deficiency Disorders Control Programme (NIDDCP) in August 1992. This was to broaden the spectrum of iodine deficiency disorders like mental and physical retardation, deaf-mutism, cretinism, stillbirths, etc.
Mid-Day Meal Scheme, 1995: It is a school meal program launched by the Government of India. It was formulated to ensure better nutrition amongst the school-going children. It covered all the children of primary schools run by the government or aided by the government. It allowed such children to receive a fully prepared mid-day meal.
Scope of improvement
The government follows the archaic system of PDS (public distribution system) wherein the food rich in calories is provided to a specific section of the society. The government must look beyond calories and should start providing grains such as millets and pulses. This way the nation will be able to help the undernourished and malnourished sections of the society. Chhattisgarh government established its own Food Security Act that provides pulses and iodized salt along with wheat and rice. This step of Chhattisgarh is a step towards fighting off nutrition-related diseases.
The agrarian approach should move toward a “crop-neutral” focal point. It must not boost staple crops over other harvests. The Global Nutrition Report 2020 also proposes that such a change of focus would permit farmers to react. They will understand the signal and work towards meeting the demand for non-staple crops like vegetables, fruits, meat, and fish.
Better connectivity of smallholders with the high-value markets for nutrient-rich non-staple crops, meat, and fish will help the government achieve many objects. Diversifying agricultural production will help in fighting poverty. It will have a positive impact on dietary diversity as well.
Nutritional wellbeing can be achieved through the allocation of adequate financial, technical, and in-kind resources. The government should ensure adequate allocation of resources for implementing necessary policies and programs.
Support public-private partnerships with the food industry and other major non-food businesses (e.g. private health and life insurance, and self-insured corporations) for research and development on healthier products, effective behavior change, and other similar common aims. This must include the development of clear and transparent policies to identify and minimize conflicts of interest.
Over the last few years, there has been a rise in dynamic discussions on nutrition. From recognizing micro-nutrient deficiency in the National Health Policy after 15 difficult years to the as of late drafted Food Fortification Regulations, 2018, many positive advances have been made by the Government of India. The most relevant one being the National Nutrition Mission (NNM) propelled in 2018. NNM has been hailed as a comprehensive approach towards raising the nutrition level in the country on a war footing. The seriousness is evident from the budgetary allocation of over Rs 9,000 crore towards this mission. It is a multi-ministerial mission to ensure a malnutrition-free India.
However, the focus is still on staple crops and ignores other nutrient-rich crops. Such behavior has received criticism by the Opposition. It could be seen as one of the tactics for saving the vote bank. But, there is something wrong with India’s approach as shown by the findings in the Global Health Report, 2020.
NNM and NFSA are now seen as nothing more than fiscal mismanagement and as an opportunity to serve vote bank politics. Considering India’s federal structure of government, the Centre does not bear the sole responsibility. The State Governments must work together under the guidelines from the Center to ensure that nobody is left behind and that nutrition reaches all. There is also a need to co-opt the overall ecosystem comprising of corporate, academia, think tanks, health experts, and non-governmental organizations (NGOs).
Like any other government program, nutritional policies also suffer from underutilization of allocated funds. Alok Kumar, Advisor, Health, NITI Aayog said that “[…] before we achieve what we want to, we have to work on various issues ranging from sustainability and utilization of funds, and ground-level work. The sustenance of the program will depend on political will and investment in nutrition. Since states will handle the program, accountability becomes a problem”.
Introducing new policies mindlessly is not the solution that the nation needs now. COVID-19 has rendered the already vulnerable sections of society to be more vulnerable. Ever since the 70s, the governments have been trying to take the problem of poor nutrition head-on. Success was seen too. But, it has never been enough. If India wishes to make use of the potential of its huge population, then, it must ensure that the population is healthy. It needs to map the inequalities in nutrition within the domestic sphere. The need of the hour is not to introduce yet another nutrition policy but a policy that marks a tremendous shift in focus as well as attitudes. The next big problem then would remain of implementation. Without proper implementation, no policy can survive.
Hidden hunger (micro-nutrient deficiency) keeps on being a significant public health issue. Today, India has more than 190 million undernourished individuals. About 47.5 million Indian children under 5 years of age suffer from stunting. The writing is rather clear on the wall. Lack of proper nutrition is an enormous issue. It leads to malnutrition, undernutrition, stunting, and other nutrition-related chronic diseases. The time has come to get India nutrition ready, if we need to reap the benefits of our demographic dividend. There’s a lot more to be done. The Global Nutrition Report 2020 shows the holes in India’s nutrition policies and approaches towards tackling nutrition issues. As per the report, almost 4% of India’s GDP was lost due to malnutrition.
There is a basic need to make a pool of specialist approved data on nourishment that is open to all. This can help mothers to give the correct nourishment to youngsters, yet additionally, help recover from malnutrition. Fortification can be another economical, practical, and adaptable approach to guarantee faster growth. It is time that the central and state governments join hands with each other and include people in the planning for their well-being. If India needs to survive the dreading impact of malnutrition and other such diseases, it needs a tremendous shift in its vision and approach.
Author: Rishita Saxena from Bharati Vidyapeeth University, New Law College Pune.
Editor: Shalu Bhati from Campus Law Centre, Faculty of Law, University of Delhi.