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India’s Slip on Global Hunger Index

Neetu Choudhary (choudharyneetu@gmail.com)is with the A N Sinha Institute of Social Studies, Patna.

After witnessing an improvement from 2008 to 2014, India’s rank on Global Hunger Index slipped in 2016. This slip is attributed to reformulation of GHI to encompass the multidimensional character of malnutrition, wherein underweight was replaced by stunting and wasting. While GHI scores of several other countries witnessed a decline, India fared worse. This is explained through a stickiness in child stunting levels in India attributed to gendered norms, poor sanitation, and high regional concentration.

The Global Hunger Index (GHI) 2016 reinstates India’s abysmal status on malnutrition. India ranks 97 out of 118 countries on GHI 2016, indicating serious levels of nutritional deprivation among its children. There has been a slip in India’s rank with respect to GHI 2014 as well as GHI 2008 that were at 55 and 66 (out of 120 countries) respectively. This slip in India’s ranking corresponds to GHI scores of 23.7, 17.8, and 28.5 in 2008, 2014, and 2016, respectively. Does it imply that the incidence of hunger in India that went down from 2008 to 2014 has further resurged between 2014 and 2016? It might not necessarily be so, although it does indicate the “stickiness” in certain types or forms of malnutrition in the country.

Reformulation of GHI

The central reason for this slip is the reformulation of GHI starting 2015, in which India’s score was 29. In 2015, the formula for calculation of GHI score was expanded to encompass the multidimensional character of malnutrition and the indicator of the underweight among children was replaced by those of the stunted and the wasted among the children. As a result, the GHI scores of several countries, including India, have deteriorated. This is corroborated from Table 1, where the GHI scores of several countries of the global South have deteriorated in Global Nutrition Report 2016, wherein Brazil is the exception, while for China the deterioration is not significant.

These countries are India’s counterparts1 which register economic growth rates no better than India but are much better off on their population nutrition status. If observed carefully, it is India’s disappointing performance on child stunting and wasting that particularly accounts for its higher GHI score. While India is worse than its counterparts on all components of GHI, it is the distance between the levels of stunting and wasting amongst them that is the most striking.

With underweight as the malnutrition component in GHI, India witnessed some improvement in its ranking on GHI between 2008 and 2014, as the country considerably reduced its proportion of children who were underweight. However, the incidence of stunting (and even wasting) among children has witnessed relatively much smaller decline during the last decade. As seen from Figure 1, the level of stunting among children in India declined by approximately 19% during 2005–06 and 2013–14, whereas the level of underweight and wasting declined by around 31% and 24% respectively. That is, still more than 38% of children in India are stunted, whereas 29% and 15% of them are underweight and wasted, respectively. The scenario is more or less similar at the state level in India, with the exception of few states that could combat stunting effectively.

Given that malnutrition is a multidimensional phenomenon (UNICEF 1994), the revised GHI formula is able to depict a relatively truer state of hunger in countries across the globe. Inclusion of stunting ensures consideration of rigid cultural factors, while that of wasting represents aspects of diet quality as well. Also, stunting is an indicator of long-term growth failure, and therefore, must be accounted for in any analysis of potential threat a given level of child malnutrition poses for a country. This is one of the key reasons the sustainable development agenda of the United Nations associate bodies display primary concern towards stunting.

The Role of Gender

The downward rigidity in child stunting as compared to underweight in India, is no longer a conundrum, yet this relentlessness is piercing. There is a plethora of work today that explains the multi-faceted dynamics underlying stunting in general, and in the context of India in particular. Gender is recognised as a crucial link in malnutrition (stunting and wasting in particular) outcomes (Vir 2016; Mukhopandhyay 2015; UNICEF 2011; Haddad 2015, 1999; Haddad et al 1996; Smith et al 2003). In fact, greater incidence of child malnutrition in India is largely attributed in the literature to rigid gendered norms and low status of women (Haddad 2015; Haddad et al 1996; Smith et al 2003). However, on gendered indicators, India continues to fare much behind its counterparts (Table 2).

The incidence of low birth weight at 28% over 2008–12 in India is significantly high as compared to its counterparts. This does not only indicate the potential threat to child nutrition but also the neglect maternal health continues to face. Adult female literacy as a percentage of male literacy in India is 67.5%, while countries with improved nutrition scenario have 95% of their adult women as literates (Table 2). Youth literacy rate for females at 74.4% is not as dismal, yet considerably behind what has been attained by the listed countries.

If gender is considered as the central node in dealing with child malnutrition, then it is difficult to abate stunting in the near future. With increased level of awareness associated with female education, immediate improvement in factors like dietary practices underlying the incidence of wasting may be witnessed. But social norms pertaining to gender are unlikely to relent in near future, thus challenging any effort to tackle stunting, unless aggressive public interventions are undertaken. Is the Indian government doing enough?

Need for Political Commitment

Malnutrition is not an apolitical issue; tackling it requires a consideration of the political economy and creation of an enabling environment (Gillespie et al 2013). Thus, political commitment to abate the crisis of malnutrition would reflect partly in resources mobilised toward this end, and partly in inter-sectoral and intergovernmental coordination and partnership. Public expenditure on issues identified as crucial for nutrition is one of the macro indicators reflecting political commitment and policy priority. Figure 2 compares India with selected countries on the basis of spending on education and health (as a percentage of gross domestic product or GDP).

Public expenditure on issues critical for nutrition, particularly expenditure on health, is much lower in India as compared to listed developing countries. Much of this expenditure on health is cornered by targeted programmes, while structural issues such as gender or social ways of living such as sanitation have failed to receive adequate attention. Sanitation is found to be a critical determinant of child malnutrition, particularly stunting (Dobe 2015; Schmidt 2014). But India’s performance in this regard is abysmal. Although the current government through its Swachh Bharat campaign has begun to lay emphasis on this aspect, the desired change is likely to take time since more than 626 million people in India (nearly half the population) routinely defecate on the ground outdoors (WHO 2014). This has been considered as an important reason for India’s stunting epidemic (Spears 2013).

Child nutrition has of late become central to the agenda of international development, as reflected through a series of dedicated research and development initiatives, including the Lancet series and the Global Alliance for Improved Nutrition (GAIN), among others. However, in India, nutrition is yet to figure as a national mission.

Regional Concentration

Although many states have been able to curb their levels of child malnutrition, six states in India still have more than 40% of their children as stunted (RSOC 2013–14). Three of these states, namely Uttar Pradesh, Bihar, and Jharkhand are at an alarming state of child malnutrition with a little less than half of their children being stunted. Six states account for approximately 41% of Indian population and as explicable from Figure 3, these states make disproportionately higher contribution to India’s stunted child population. The contribution of Uttar Pradesh and Bihar to India’s stunted children is particularly striking at around 21.5% and 11% as against their share in population at around 16.5% and 8.6% respectively.

In other words, to reduce stunting in India, the six states, particularly, Uttar Pradesh and Bihar, deserve special attention. The performance of these states on the underlying determinants of stunting is also dismal. Further, with the exception of Gujarat, these states are also among the relatively poorer states in India and may be at a disadvantage as far as their ability to spend on nutrition interventions is concerned.

The author’s recent visit to the district of Purnea in Bihar revealed lack of financial resource with the state government as one of the central factors responsible for below optimal performance of the Integrated Child Development Services (ICDS) in the district. An inconsistency in disbursement of monthly allocations to ICDS centres in villages was reported during the visit, due to which both quantity and quality of daily dietary guidelines were compromised. Presently, the ICDS is run with both centre and state contributions and its coverage is not universal. It has been observed earlier that the poorer states receive least coverage and funding (Lokshin et al 2005). The cost sharing formula may be altered at least for these critical states, and the number of ICDS centres for a given population should be increased so that eligible beneficiaries are not filtered out, as was reported to be the case in Purnea.

Moreover, if the downward rigidity in India’s child stunting level is to be fathomed, as of now it can be explained in terms of three critical factors—gender, sanitation, and regional concentration—wherein high stunting states are poorer as well as backward for the indicators of gender and sanitation. It is time that child malnutrition is addressed at war-footing level in India. All surrounding social sector interventions need to be aligned with the nutrition question and policy processes must be made nutrition sensitive. As far as gender norms are concerned, experience with the role of female education confirms that there is no alternative to radicalism. Even women in Kerala—Indian milestone on indicators of female literacy—suffer from significant levels of gender discrimination despite their better educational and health performances (Miller and Rodgers 2009; Rondinone 2007). It is high time that this be addressed with seriousness in policy spaces.

Note

1 It is particularly worthwhile to compare India with Brazil, Russia, China and South Africa; together they make the BRICS and represent the strength of the global South.

References

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Gillespie, S et al (2013): “The Politics of Reducing Malnutrition: Building Commitment and Accelerating Progress,” Lancet, Vol 382, No 9891, pp 552–69.

Haddad, Lawrence (1999): “Women’s Status—Levels, Determinants, Consequences for Malnutrition, Interventions and Policy,” Asian Development Review, Vol 17, Nos 1–2, pp 96–131.

— (2015): “Is Gender Inequality the Main Roadblock to Achieving Nutrition Targets? The Global Nutrition Report on Gender Equality,” Agriculture for Nutrition and Health, 9 March, http://a4nh.cgiar.org/2015/03/09/is-gender-inequality-the-main-roadblock....

Haddad, Lawrence et al (1996): “Food Security and Nutrition Implications of Intra-household Bias: A Review of Literature,” Food Consumption and Nutrition Division Discussion Paper No 19, International Food Policy Research Institute.

Lokshin, Michael et al (2005): “Improving Child Nutrition? The Integrated Child Development Services in India,” Development and Change, Vol 36, No 4, pp 613–40.

Miller, Jane E and V Yana Rodgers (2009): “Mother’s Education and Children’s Nutritional Status: New Evidence from Cambodia,” Asian Development Review, Vol 26, No 1, pp 131−65.

Mukhopadhyay, Simantini (2015): “The Intersection of Gender, Caste and Class Inequalities in Child Nutrition in Rural India,” Asian Population Studies, Vol 11, No 1, pp 17–31.

Rondinone, Antonella (2007): “Reconsidering the Status of Women in Kerala (India), A Geographical Analysis Based on Recent Data on Emigration, Sex Ratio and Social Status,” Rivista Geografica Italiana, Vol 114, No 2, pp 179–205.

RSOC (2013–14): “Rapid Survey on Children, 2013–14,” Ministry of Women and Child Development, Government of India.

Schmidt, Charles W (2014): “Beyond Malnutrition: The Role of Sanitation in Stunted Growth,” Environment Health Perspective, Vol 122, No 11.

Smith, Lisa C et al (2003): “The Importance of Women’s Status for Child Nutrition in Developing Countries, Research Report No 131, International Food Policy Research Institute, http://www.ifpri.org/sites/default/files/publications/rr131.pdf.

Spears, Dean (2013): “The Nutritional Value of Toilets: How Much International Variation in Child Height Can Sanitation Explain?,” Research Institute for Compassionate Economics (RICE), http://riceinstitute.org/wordpress/wp-content/uploads/downloads/2013/07/...

UNICEF (1994): “The Urban Poor and Household Food Security: Policy and Project Lessons of How Governments and the Urban Poor Attempt to Deal with Household Food Insecurity,” United Nations Children’s Fund, New York.

— (2011): “Gender Influences on Child Survival, Health and Nutrition: A Narrative Review,” United Nations Children’s Fund, New York.

— (2012): Country Statistics, United Nations Children’s Fund, http://www.unicef.org/statistics/index_countrystats.html.

Vir, Sheila C (2016): “Improving Women’s Nutrition Imperative for Rapid Reduction of Childhood Stunting in South Asia: Coupling of Nutrition Specific Interventions with Nutrition Sensitive Measures Essential,” Maternal & Child Nutrition, Vol 12, pp 72–90, http://onlinelibrary.wiley.com/doi/10.1111/mcn.12255/pdf.

WHO (2014): “Water Sanitation Health: Fast Facts,” World Health Organization, Geneva, http://www.who.int/water_sanitation_heal​th/monitoring/jmp2012/fast_facts/en/.

Updated On : 23rd Aug, 2017

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