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Health and Wellness

India's Hunger

India has programmes to alleviate hunger but not the will to enforce them

The Global Hunger Index ranks India a poor 97 among 118 countries.

The many government schemes to feed India's poor and hungry do not seem to be doing much. The International Food Policy Research Institute in Washington has ranked India 97 among 118 countries on the Global Hunger Index. India fared worse than all its neighbours – China, Myanmar, Sri Lanka and Bangladesh – except Pakistan, which is ranked 107.

The Global Hunger Index report also predicts that India will fail to achieve its Sustainable Development Goal target of ending hunger by 2030. This despite the midday meal schemes for school children, anganwadis systems to provide nutritious food and rations to pregnant and lactating mothers and subsidised grains at five kilograms per person below the poverty line every month through the public distribution system. But how much improvement can be expected in a country where social spending on health and education is lower than sub-Saharan Africa?

Economist Reetika Khera who works on food security, health and nutrition policies blames the government’s lackadaisical approach towards hunger. The National Food Security Act which was passed in 2013 includes three schemes that can help with improving nutrition. The schemes are implemented by different departments of the government, each working in isolation from the other. “At the moment, the problem is that no department is doing enough,” she said.

Improvement, but not enough

If India’s Global Hunger Index scores for 1992, 2000, and 2008 were put it in the "alarming" category as per the report's classification, then the 2016 score is pushes it up to "serious". There has been improvement said Jill Bernstein, one of the authors of the Global Hunger Index report. The other categories according to rank are " extremely alarming" and "moderate".

“However, the starting point [the 1992 score] was very high and the progress has not been sufficient to bring India into the low or even moderate category,” said Bernstein.

In 1992, India’s Global Hunger Index Score was 46.4 units which dropped to 28.5 in 2016 – an improvement of 17.9 units. Now compare this to neighbouring Nepal which according to the 2016 report is also classified under the "serious" category with India. Nepal’s score was 43.1 in 1992 which dropped to 21.9 in 2016, which is 21.2 units better.

More than 45 countries on the Global Hunger Index including India, Pakistan and Afghanistan will still have “moderate” to “alarming” hunger scores in the year 2030 if they continue to reduce hunger at the same rate since 1992.

Bernstein also pointed out India has been inconsistent in its improvement.

"In the case of India, the nutrition situation of children must be a high priority," she said. "Children are the most sensitive to periods of poor nutrition because their bodies and brains are developing so rapidly.”

Lack of coordination

“We need a convergent approach,” said Vanessa D'Souza, CEO of SNEHA, a non-profit working for undernourished children in urban areas. “You can’t approach the issue of hunger in urban areas as you do in rural areas. The challenges are different.”

For instance, in urban areas the anganwadis under the Integrated Child Development Scheme provide nutrition but the municipalities are responsible for meeting the child and pregnant woman’s healthcare needs. Members of the civil societies regularly find that the two institutions work independent of each other.

“The anganwadi worker should be able to refer the child to the health facility with ease and a health workers should refer the child to anganwadi in case he is malnourished," said a social worker from Mumbai. "This is not happening.”

Activists working on food security believe that India’s policies for tackling hunger have largely remained focused on rural regions. “In urban areas, we have a problem of awareness,"said D'Souza. "The mother does not know what to feed her child. We come across malnourished children [eating] junk food.”

Bernstein said that the government can help to ensure that mothers and children have access to healthy and diverse foods and that parents understand what constitutes a healthy diet for their children. “Issues such as women’s empowerment and education are also part of the big picture, and contribute to the nutrition situation of the family,” she said. “We know that the nutrition of mothers during pregnancy and proper nutrition for children during the first two years of their lives are vitally important and have long-lasting consequences.”

Bernstein also stressed the role of hygiene and sanitation averting diseases like diarrhoea that rob the body of nutrition.

Unclear data 

The Global Hunger Index report states that 15.2% of the Indian population is undernourished. At present there are no specific government interventions to address the issue of adult undernourishment. “When pregnant women are undernourished it leads to neonatal death and to the birth of smaller, sicker babies,” said Diane Coffey, a visiting researcher at the Indian Statistical Institute in Delhi.

The Global Hunger Index is a multi-dimensional scale derived on the basis of undernourished population of the country, the proportion of wasting and stunting in children and mortality in children below five years. The Global Hunger Index scores are calculated on the basis of these parameters by studying the existing data available in the country. The authors of the report have looked at India's National Family Health Survey data to measure the country's efforts in addressing hunger.

But government data from which the Global Hunger Index has been constructed has not been released publicly for researchers to study relationships between variables. “Individual level data helps researchers understand the nature of the nutrition problem much better than the very simple factsheets that have been released,” said Coffey.

Need healthcare, employment

D'Souza who works on malnutrition in urban areas said that a stable employment would help improve the well-being of both undernourished mother and her child. In rural areas too, scarcity of jobs has led to migration which makes families including children more vulnerable to hunger.

A senior health official from Maharashtra, a state which recently received a notice from the National Human Right Commission for malnutrition deaths in Palghar district, said migration was the main cause for malnutrition in the state. “The couple takes the child away to a neighbouring state where they are not registered with the system and don’t receive the necessary care," he said. "When they come back, the child’s health has deteriorated and when we start improving the child’s health, they again disappear.”

Another problem is the lack of access to healthcare facilities. Most rural areas don’t have a child-specialist to treat children with severe and moderate malnutrition. Purnima Upadhyay, an activist working with the non-profit organisation Khoj, found that many health centres in Melghat district do not have basic drugs. “There was a stock-out of paracetamol,” said Upadhay. “It is only when the media reports and the courts order that the government starts functioning. Otherwise it is a complete systemic failure.”

Upadhyay frequently comes across cases where women are unable to take benefits of monetary government schemes. “Mothers are entitled money after they give birth," she said. "Most don’t end up getting it as the banks are too far. This money could have helped them to care for the child.”

Economist Khera said that under the universal maternity entitlement scheme, Rs 6,000 is given per child to a mother. “However, the government has done nothing to operationalise maternity entitlements, and efforts of strengthen the Integrated Child Development Scheme and Midday Meal Programmes.” In fact she pointed out that instead of including nutritious food items such as eggs on the menu various state governments are stalling it.

In order to achieve its zero hunger target of Zero Hunger set by the United Nations may need to stop drafting new schemes but instead consider implementing them effectively.

Corrections and clarifications: This story has been edited to correct the statistics relating to the Global Hunger Index scores of India and Nepal.

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