Malnutrition in India – Effects, Causes, Strategies and Government initiatives

This issue falls under the UPSC Main Examination Syllabus of General Studies II –

Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
Issues relating to Poverty and hunger

Article 47 of the Constitution states that it is “duty of the state to raise the level of nutrition and the standard of living and to improve public health”.

Sustainable Development Goals (SDG) Goal 2 aims to “End hunger, achieve food security and improved nutrition, and promote sustainable agriculture.”

With these directives in mind, firstly understand that- Nutrition is the very foundation of human development, it imparts immunity and consequentially reduces morbidity, mortality and disability. Nutrition promotes lifelong learning capacities and enhances productivity.

What is Malnutrition?

Malnutrition refers to the lack of proper nutrition which could be either caused by not consuming the right food with the right nutrients or not consuming adequate amount of food with the adequate nutrients. This leads to lack of essential nutrients in the body.

What is Micro Nutrient Malnutrition (MNM)?

Micronutrient malnutrition is responsible for a range of non-specific physiological impairments, leading to reduced resistance to infections, metabolic disorders, and delayed or impaired physical and psychomotor development. More than 2 billion people in the world suffer from micronutrient deficiencies caused largely by a dietary deficiency of vitamins and minerals. Iodine, iron, vitamin A and zinc deficiencies are among the most serious health risk factors in the world.

Occurance: Micronutrient malnutrition is more frequent and severe among disadvantaged populations, but it is widely observed as a public health problem in some industrialized countries also. For instance, the iodine deficiency in Europe, or iron deficiency, which is currently the most prevalent micronutrient deficiency in the world.

The increased consumption of highly-processed energy-dense but micronutrient-poor foods adversely affects micronutrient intake.

What are the effects of malnutrition?

Malnutrition manifests in the form of stunting, wasting, micronutrient deficiencies and over­weight/obesity. Micronutrient malnutrition acts as a major impediment to socio-economic development contributing to a vicious circle of underdevelopment, to the detriment of already underprivileged groups.

Who all are at risk of Malnutrition?

It has long-ranging effects on health, learning ability and productivity and has high social and public costs leading to reduced work capacity due to high rates of illness and disability.

In children, malnutrition tends to lower IQ and impairs cognitive ability, thus, affecting their school performance and productivity in later life.

Low-birth weight babies have impaired immune function but are at a greater risk of non-communicable diseases during their adulthood also.

The public health implications of micro-nutrient malnutrition are potentially huge and significant when it comes to the prevention and control of diseases such as HIV/AIDS, malaria and tuberculosis, and diet-related chronic diseases.

Global Nutrition Report-2016 by WHO indicated how India still lags behind in tackling malnutrition effectively.

• In terms of stunting, India ranks 114th out of 132 nations (incidence: 38.7%)
• For wasting, India ranks 120th among 130 countries (incidence: 15.1%).
• Anaemia prevalence among women of reproductive ages, India ranks 170th out of 185 countries (incidence: 48.1%).

Governance issue: The lack of co-ordination between health and Women and Child Development (WCD) departments has also been highlighted in the report. It highlighted the need for multi-sectoral missions or agencies, cutting across departments, with clearly defined and measurable targets and monitorable action points for all sectors

What are the causes of Malnutrition in India?

The causes of malnutrition in India can be categorised under the following headings:

• Physio-graphical Causes: Due to geographical diversity and regional imbalance in terms of resources, certain regions in the country lack availability of certain nutrients or food items.

• Historical Causes: The long British rule of exploitation has rendered certain sections of the population and certain regions highly deprived. This translates into lack of nutrition among other outcomes.

• Socio-Economic Causes: Poverty and inadequate coverage of governmental programmes hinders inclusion of various sections of the demography. On the other hand, with increasing level of disposable income among the urban population, there is increasing consumption of junk food and packaged food which is leading to malnutrition in urban areas as well.

• Governance and Policy Failures: Ineffective implementation of policies and failed targets of the five year plans and delayed focus on malnutrition has caused significant harm to the Indian population’s nutritional needs.

• Cultural and Gender Causes: Traditional family’s economic costs incurred with respect to gender roles and cultural links are also responsible for these micronutrient deficiencies.

• Other Causes: The lack of knowledge of appropriate dietary practices and high incidence of infectious diseases are other key factors apart from lack of access to a variety of foods.

Strategies for control of “Hidden Hunger” or micronutritional malnutrition

There is a need to adopt and support a comprehensive approach that addresses the causes of malnutrition and the associated “hidden hunger” caused by poverty and unsustainable livelihoods.  The aim of such a strategy should be to enable all people to obtain from their diet all the energy, macro- and micronutrients they need to enjoy a healthy and productive life.

There are following four approaches to fight malnutrition:

1. Increasing the diversity of foods consumed (dietary diversity) – Focussed at increasing both quantity and range of micronutrients-rich foods consumed. The major impediment is lack of resources for producing and purchasing higher quality foods, especially for poorer populations.
2. Food fortification – Refers to the addition of micronutrients to processed foods as part of a food-based cost-effective approach.
3. Supplementation – Focusses on providing relatively large doses of micronutrients, usually in the form of pills, capsules or syrups. It has the advantage of being capable of supplying an optimal amount of a specific nutrient or nutrients, in the fastest way, in a highly absorbable form. It limitatition arises from a lack of supplies and poor compliance.
4. Public health measures –  Refer to infection control (e.g. immunization, malaria and parasite control), improvement of water and sanitation, high quality of child care and maternal education. This is because micronutrient malnutrition is often associated with poor overall nutritional status and with a high prevalence of infection.

Food Fortification as a remedy for preventing malnutrition

The best way of preventing micronutrient malnutrition is to ensure consumption of a balanced diet, adequate in every nutrient.

Unfortunately, this is far from being achievable everywhere since it requires universal access to adequate food and appropriate dietary habits. Hence, food fortification offers a dual advantage :

1. being able to deliver nutrients to large segments of the population
2. without requiring radical changes in food consumption patterns.

Processed foods are those in which food raw materials have been treated industrially in order to preserve them. Some may be formulated by mixing several different ingredients also.

Steps taken by Indian Government :

In mid-2016, the Group of Secretaries on “Education & Health – Universal Access and Quality”, identified Fortification of food items like salt, edible oil, milk, wheat and rice with iron, folic acid, Vitamin-D and Vitamin-A, with a timeline of 3 years as one of the measures to address the issue of malnutrition in the country.

• The Integrated Child Development Services (ICDS) scheme was launched in 1975. ICDS is one of the world’s largest and most unique outreach programme for early childhood care and development and covers all the districts and blocks in the country.
• Mid- Day Meal Scheme was universalized in 1995.
• The Government is now working on close Monitoring of the Nutrition programmes by digitisation of the Anganwadis. This is expected to turnaround the entire system since it will help in real time monitoring of nutrition status of each child and take up immediate interventions wherever required.
• Under Swatchh Bharat Mission, constructing toilets and providing clean drinking water are being taken up by the Government on a war footing to provide clean living conditions and good health to one and all.
• In 2013, government passed the food security bill entitling 5 kg food grain/person/month at highly subsidised rates. Fortification of food items especially those being distributed through the PDS is also being taken up to address the issue of malnutrition in the country.
• Government has taken steps for rice fortification in all parts of the country to deal with nutritional deficiency among the women and children, with IIT-Kharagpur.

This article discussed the definition of Malnutrition, MicroNutrient Malnutrition, Causes of malnutrition in India, Effects of Micronutrients malnutrition and ways to combat it. We also discussed the important findings of the Global nutrition Report by World health Organisation with respect to India. Government’s interventions in field of nutrition in India have been listed in brief. We hope this comprehensive coverage of several related topics encompassing hunger, nutrition will be useful for UPSC Mains paper 2 preparation specifically and CSE prelims as well. Please share your views with us in comments below.