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Hidden Hunger, Burdened Women

Challenges for Food and Nutrition Security Interventions

Sohini Sengupta (sohini.sengupta@tiss.edu) teaches at the Tata Institute of Social Sciences, Mumbai. 

Reminiscent of poverty debates, serious undernutrition in India risks becoming a measurement quibble, unless we talk about unequal development gains and the answerability of governments towards less empowered citizens. Based on the simple counting of food consumed by 240 households and conversations with women, this article explores the contrast between local knowledge of what constitutes a “good diet” and the deficient meals consumed by people in Odisha, a state in eastern India. Effective interventions need to look beyond “maternal responsibility” and address entitlement uncertainties and gender inequality, in order to ensure essential nutrition and good health of vulnerable groups such as women and children.

The author would like to thank the anonymous reviewer/s for their insightful suggestions on an early draft that has contributed to the present version of the article. This article derives from a study conducted on behalf of the civil society organisation South Orissa Voluntary Action (SOVA), Koraput, Odisha, in 2015–16. The author would like to acknowledge the commitment and contribution of the experienced team members of SOVA, especially Ramprasad Patnaik, Gourishankar Rao, Suprabha Nisanka, Pramila Sahu, Sanjukta Das and Leon Takri for help with data collection and Sanjit Patnaik and Bubu Saha for overall support. The original study was sponsored by the Voluntary Service Overseas (VSO), India. The views expressed in this article are of the author’s and do not necessarily represent the views of SOVA or VSO, India.

 

It was a bright spring morning in Dharapadar village as we sat talking to a group of women about their diets and health. From the cemented seating area under a banyan tree, agricultural fields rose upwards into the hills, dotted with flaming silk cotton trees. Low-lying (bil) fields of that village had been submerged by the upper Kolab reservoir. Most people cultivated hill plots during the rain months for a crop of rice or mandia (ragi/finger millets), but a majority were dependent on non-farm labour. Several children roamed freely. One young boy, of around 12 years, carried his infant sister. On being asked why he was not in school, he said that he must look after his sister, as his parents were away for two months, in a distant village, threshing mandia. They were left in the care of his infirm grandmother and had not had a morning meal.

Older children, who cared for younger siblings when their parents went for wage work, were often out of school and missed the mid-day meal. Here, boys and girls entered wage labour early and dropped out of school. In the second village, we saw a small girl eating a meal of boiled rice with two pieces of cauliflower. She had fetched it herself and stood outside her house eating it. An infant cried loudly while being cradled by her grandmother in a third village. Though old enough to eat solid food, she was, according to the old woman, crying for breast milk. The child’s mother, who was in her third trimester of pregnancy, had gone to harvest mandia. In the previous year, she had lost a child soon after birth.

This description provides a starting point for a discussion about the observed quality of diets of a group of rural households in the predominantly tribal district of Koraput, infamous for high levels of child undernutrition (IIPS 2017; United Nations Standing Committee on Nutrition 2011). The aim of this article is to highlight the contrast between local knowledge about what constitutes a “good diet” and the actual meals consumed by people, as documented by a household survey. The article begins with a brief review of debates in food security scholarship. This is followed by a discussion about field setting and methodology. Findings from the household survey on dietary diversity are presented, followed by a section on women’s experiences and attitudes towards maternal diets, based on focus group discussions (FGDS). The article concludes with some suggestions about interventions around food, nutrition and gender, in the context of rural, tribal communities.

Undernutrition Paradox

Reducing child undernutrition constitutes a key development agenda; the second sustainable development goal is “zero hunger” (Lancet 2013; Smith and Haddad 2014; UNGA 2017). Controversy over the “rank” obtained by India in the Global Hunger Index (GHI) reveals the politically contentious nature of food and nutrition security (IFPRI 2017a). As significant improvements in child nutrition have been achieved by India in recent years, the lower than previous GHI rank raised a political storm (Mokkapati 2017; Lele 2017). The International Food Policy Research Institute (IFPRI) clarified that the GHI scores were a “snapshot” for the reference period and not comparable across years, due to changes in the calculation methodology (IFPRI 2017b). Reminiscent of the poverty line debates (Deaton and Kozel 2005), the GHI controversy is more than a measurement quibble, indicating inequalities in development gains and a need for the accountability of governments towards less empowered citizens, in the context of “serious” hunger.

That the robust economic growth of the past decades in India has not reduced undernutrition is well established. Some commentators describe this as the “Indian enigma,” where high levels of undernutrition persist despite reasonable economic growth (Sridhar 2008; Gillespie et al 2012; Balagamwala and Gazdar 2013). Observed trends include people consuming fewer calories, cutting back protein calories and increasing consumption of fats (Deaton and Drèze 2009; Gaiha et al 2013; Das 2014). Undernutrition is concentrated among the poorest socio-economic groups, Scheduled Castes (SCs), Scheduled Tribes (STs) and the rural poor (Gillespie et al 2012; NNMB 2009 cited in Albert 2017). Food and nutrition insecurity of vulnerable social groups is compounded through the remoteness of settlements, dire poverty and dysfunctional food security programmes (Drèze 2004, 2015; Khera 2011; UNICEF 2014; Albert 2017) and “food budget squeeze” through rising expenditure, low incomes and reduced public services (Basu and Basole 2013).

Food Access and Nutrition Security

Worldwide, the poor have less diverse and monotonous cereal-based diets that are deficient in essential minerals and vitamins (Arimond et al 2010). The inability to access food through sources such as own-production, purchase, social protection or private charity causes food insecurity (Cohen 2017: 648). Rising food prices compel the poor to cut back on non-staples or reduce food expenditure (Smyth and Sweetman 2010; Ramachandran 2013; Basu and Basole 2013, 2017). Inadequate diets are associated with the “delocalization of food supply” and disruptions in food systems, as people lose access to farms, forests and commons (Kuhnlein and Receveur 1996; Pimbert 2009; Vira et al 2015). Literature on agriculture and nutrition finds a positive correlation between cultivating food crops and nutrition security (Gillespie et al 2012; Hossain et al 2016; Viswanathan et al 2015). Landless and subsistence farming rural poor suffer from chronic food insecurity (Gillespie et al 2012).

Dietary inadequacies indicate a widespread deficit in achieving a host of social and economic rights. The right to food constitutes the claims of individuals on society and state and it is dependent on other socio-economic rights such as education, information, work and health (Drèze 2004). The right to food spells out the government’s responsibility “to respect, protect, facilitate and fulfil the rights of the individual to secure adequate food and nutrition,” and enables citizens to make demands and allows the state to fulfil its obligation (Geissler 2017: 685). In India, the National Food Security Act, 2013 (NFSA) informs and empowers public policy measures that can contribute towards adequate diets.

A targeted public distribution system (PDS) takes care of the household needs of staple cereals, allowing poorer households to reallocate limited incomes towards other essentials. Eggs provided in schools and anganwadis under the mid-day meal and Integrated Child Development Services (ICDS), are ways in which diets of poor women and children are being augmented (Drèze 2015). Other rights-based measures, such as the public works programme Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS), support livelihoods and incomes. While income from the MGNREGS is linked to increasing household expenditure on milk, meat and fish among poorer rural households (Bose 2013: 18), recent incidents of starvation deaths in rural and tribal areas have been attributed to the poor implementation of the NFSA (Aijaz 2017).

Gender and Nutrition Interventions

Gender inequality is linked to the prevalence of undernutrition and low birth weight in South Asia (Osmani and Sen 2003). The increasing price of food has a gendered impact, as women cut back on their own consumption to preserve “the intake of children and men” (Smyth and Sweetman 2010: 367). Women, due to their role as mothers and caregivers of children and families, occupy a central place in nutrition policy and intervention (van den Bold et al 2013), but an early marriage means that they are not empowered to take decisions about childbirth and care (Sethuraman 2008).

Moreover, high labour burden on rural women in agriculture, domestic work, manual labour and other services keeps them away from appropriate care practices (Gillespie et al 2012: 14). Nutrition interventions have been criticised for their “biomedical” and neoconservative attitude, that equate empowerment with the counselling of “ignorant mothers” to change their behaviour (Heikens 2009). Thus, narrowly conceived strategies focused on “maternal responsibility” fail to consider the structural underpinnings of rural poverty, such as mobility of rural labour, cost of food, absent carers, discriminatory societal norms and the engagement of women in arduous farm, non-farm and domestic work.

Informed by the insights from the above debates in food and nutrition security scholarship, this article presents the findings from a small study conducted in Koraput district of Odisha. The study was undertaken to explore the quality of diets among communities, where local non-governmental organisations have been engaged in maternal and child health interventions. Mapping food practices provides an important insight into the uncertain food entitlements of the rural community. Poor quality diets reflect societal inequalities and household food insecurity, and thus, nutrition interventions need to go beyond biomedical approaches to incorporate broader livelihood, social protection and gender frameworks, to address the crisis of “hidden hunger,” among the rural poor and tribal households.

Study Site and Methodology

Koraput is the southernmost district of Odisha, with high poverty levels and poor development indicators. District-level data from the National Family Health Survey 4 (NFHS-4) reveal poorer attainment for Koraput as compared to the state. Among the under-five children, 44% were stunted, 29% were wasted and 46% were underweight and 73% of children in the age group of 6–59 months, 67.6% of women and 44.3% of men were anaemic (IIPS 2016). For the present study, 241 households with a population of 1,158, from 17 villages spread over three administrative blocks—Kundra, Koraput and Jeypore—were interviewed using a dietary diversity questionnaire during the household survey. Households were purposively selected to include women with children in the age group of 0–23 months.

Using a standardised tool developed by the Food and Agriculture Organization (FAO) and the Food and Nutrition Technical Assistance (FANTA) project, the female household head was asked to recall the different food items consumed by the household, in the last 24 hours (Swindale and Bilinsky 2006). To assess the frequency of consumption of specific food items over a longer period, household members were asked to recall the frequency of consumption of food items, in terms of the number of days when it was consumed over seven days (WFP 2008). In addition to the survey, FGDs were undertaken with girls, pregnant and lactating women, elderly women and accredited social health activist (ASHA) community workers, to understand the nutrition and food beliefs and practices among the community. The surveys and discussions took place from February to June 2015. Tools were translated into Oriya and experienced ­community workers, fluent in the tribal dialects, including Desiya, were trained to use the household dietary diversity score (HDDS) and Food Consumption Score (FCS) tools.

Profile of the Households

Among the interviewed households, 43% were ST, 44% were SC and 13% were from Other Backward Classes (OBC). The educational attainment of adult men and women was low: 85% women and 66% men were non-literate. Seventy-seven percent were dependent on tube wells and 13% on wells as a source of drinking water and only 3% had access to sanitation. Though pathways from agriculture to household nutrition are complex, agriculture may lead to more diverse diets. High dependence on unskilled manual work, uncertain agricultural output due to rain dependence and absence of landownership are established factors influencing diets in rural poor households (see Figures 1, 2 and 3). The term “housework” concealed women’s labour in family farms and fuelwood and forest produce collection. The present study finds some correlations between landownership, kharif paddy cultivation and diets.

 

 

Quality of Diets: Dietary Diversity

Household dietary diversity is defined as the number of unique foods consumed by the household members over a given period (Swindale and Bilinsky 2006). The purpose of assessing dietary diversity is to understand whether people are consuming mono­tonous starchy diets, characteristic of food insecure contexts, or diverse diets associated with micronutrient sufficiency. To calculate the HDDS, food items consumed by the household during the previous day were grouped into different types of food, based on the chart provided by the FAO. A score of one was given for each type of food consumed and the counts were added. Compared to the maximum attainable HDDS (12), the average HDDS was found to be 3.95 and came down to 3.33, if tea and alcohol were ­excluded. The diets of landless households and those who did not cultivate kharif paddy, were poorer than landowning households (Table 1). Variation in diets was observed across the administrative blocks, with Koraput having the lowest score (Table 2).

Several food groups necessary for dietary sufficiency were missing from the household diets. While all households consumed rice and mandia, close to half did not consume any pulses and more than a quarter did not consume any vegetables. The consumption of animal protein in the form of eggs, fish, dry fish or meat was also very low. Most households did not consume any fruit, with the exception of green papaya that was used as a vegetable, and tamarind used for flavouring curry. None consumed milk and milk products and food items made with sugar, while more than a quarter of the households consumed purchased fried food during breakfast or as a snack (Figure 4).

Food Consumption Score

Since nutritional benefits of all food types are not equal, data was also collected to calculate the FCS. FCS is a composite score based on dietary diversity, food frequency and relative nutritional importance of different food groups (WFP 2008). Interviewed households were asked to recall the number of days during which they had eaten different types of food for all meals, in the previous week. Collected data of consumed food items were grouped into eight food groups (staples, pulses, vegetables, fruit, meat/fish, milk, sugar and oil). The consumption frequency of each food group was multiplied by an assigned weight based on its nutrient density as follows: main staples: two, pulses: three, vegetables: one, fruit: one, meat and fish: four, milk: four, sugar: 0.5 and oil: 0.5 (WFP 2008: 20). These values were added to obtain the FCS for each household (WFP 2008: 9).

Household FCS was then grouped in terms of the “typical threshold” provided by the World Food Programme manual, to construct a dietary profile of the household. An FCS below 21 is considered as a poor diet, which indicates that the households are likely to be not consuming staples or vegetables on a daily basis. Scores between 21 and 35 suggest borderline diets and scores of 35 or above are assumed to have an adequate diet. Various dietary combinations can give rise to the threshold FCS (WFP 2008: 21). A point of concern is that households consuming oil and sugar every day, but missing on other nutritious food groups, can also attain an acceptable score. Based on FCS data, close to half the interviewed households had borderline diets (Figure 5). The highest proportion of households with borderline FCS was found in Koraput block and more landless and SC households had borderline diets (Tables 3 and 4). Consumption frequencies of different food items show very low consumption of pulses, vegetables, dairy and animal protein (Figure 5).

 

The above discussion indicates that the quality of diets of households in the study area was poor. This finding is of some concern, as the household data was collected in the post-harvest and not the lean season. Most households followed a predominantly starch-based diet, with inadequate diversity across food groups. An important finding (pointed out in other reports), is the low consumption of pulses (Aijaz 2017), as even the poorest diets in India are assumed to consist of staples and pulses (Gopaldas 2006). Agricultural dependence, landownership and caste affect dietary diversity. The highest proportion of households with borderline diets were the landless households. Landlessness was highest among the SC households as compared to other social groups, and these households also had poorer dietary scores. This suggests that chronic hunger may be entrenched in landless households.

The women who participated in the FGDs during the course of this study seemed to be aware of the ill effects of poor nutrition on both the mother and the child. According to them, ­undernourished mothers gave birth to low birthweight children, who were considered “weak” and who frequently suffered from ailments such as cold and cough. Lack of proper ­nutrition was also believed to be problematic and sometimes life-threatening for the women giving birth, causing weakness, anaemia and death. Despite these understandings, they exp­ressed their inability to influence factors that shaped their poor diets and low nutritional status. Some of the key themes that emerged from open-ended conversations with the girls, women and ASHAs in the study area are discussed ahead.

Cost and Availability

Cost and seasonality are important factors in maternal diets, as the preferred food items were not always affordable or available. Households generally consumed boiled rice or millets (mandia/ragi and suan), but the rice supplied by the PDS sufficed for only 15–20 days in a month, for a family of five. Mandia, wherever consumed, was cultivated by the household. Rice or mandia/ragi was accompanied by a sour stew, amat, prepared with a few pieces of green vegetables and thickened with rice powder. Most households consumed meat, eggs, fish and dry fish whenever they could purchase them.

While wild pig, bat and rats were mentioned by the ASHAs, these were rare and infrequently consumed food items in most villages. Dried bananas, tamarind, mandia and chillies were mainly eaten in the scarcity periods. Some families could afford only mandia and rice peja (water in which rice or mandia has been boiled) twice a day, and thus could not provide extra food for pregnant women. In better off households, an extra meal of hot cooked rice with vegetables was provided to ­women who had given birth.

Some women mentioned that the decline in home gardens had reduced the availability of seasonal vegetables for consumption. In villages where these were cultivated, more people consumed vegetables. Travelling to purchase vegetables was considered an additional expense. In Kundra block, where a greater variety of crops were cultivated, women also reported consuming more vegetables. Among gathered food that was a part of local diets, mushrooms (chotti) and bamboo shoots (kordi), were seasonal, found only during months of the rainy season in the hill forests. In winter, vegetables were cheaper and the high cost of vegetables in summer meant that the households did without them. In some villages, vegetables like pumpkin were sliced, sun-dried and stored for later consumption. Leftover food was also dried in the sun and cooked later as a new meal, as we saw in a village. Local health workers were extremely concerned about the contamination of dried leftovers, and did their best to dissuade people from consuming leftovers.

Utilisation of Supplementary Nutrition

During one of our visits, we found that several households in a village had stopped consuming meat and fish because they were observing the festival of Shivratri. A woman who was four months pregnant had remarked that she was observing a fast for the past month because of Shivratri. An interesting problem had thus emerged around the eggs provided by the anganwadi centre for pregnant women. Since women would not eat eggs in that month, they were cooking and feeding them to their children and other family members. The issue of sharing take-home nutritional supplements provided exclusively for pregnant and lactating women was widespread, even outside festival months.

When pregnant and lactating women were provided with uncooked eggs, they tended to take them home, and shared the eggs with family members. The nutritional supplement provided by the ICDS was also shared, cooked and consumed. The problem of utilisation was not restricted to in-kind transfers. The cash component from social schemes such as Mamata was utilised for household needs, and not for purchasing nutritious food for pregnant or lactating women. Women expressed reservations about individual entitlements and viewed all ­resources as meant for collective sharing among household members. An older woman told us that it was unthinkable that women would eat the eggs by themselves, while there were men and children in the house (personal interview 2015).

Compounding the problem of utilisation, supplementary nutrition was not supplied regularly. For example, 15 villages of the Lima gram panchayat did not have access to any anganwadi service at all. In several other villages, the service was irregular and the quantities provided were less than the entitlements. In almost all the villages, pregnant women reported receiving four rather than eight eggs per month. Women and ASHAs in some panchayats reported that in the previous two months, women had received only the supplementary nutrition powder (chatua).

Sometimes the supplementary powder provided by the ICDS was of poor quality. In such situations, the chatua was fed to domestic cattle or chicken. Local civil society workers referred to recent incidents of adulteration of the supplementary nutrition powder, and how groundnuts were being replaced by plain flour. The ASHAs also mentioned that pregnant and lactating women visited their natal homes or gave birth in their natal villages, and lost out on supplementary nutrition and eggs, nutritional counselling and health referral services, as they were registered for receiving these only in their marital villages.

Traditional Beliefs around Maternal Diets

Traditional beliefs around birth and pregnancy have a bearing on women and children’s health. On asking whether pregnant and nursing women ate special foods or were prohibited from eating certain types of food, most said that the women ate whatever was prepared at home, and that there were no special foods or extra quantities for them, though some said that Amritbhanda (Oriya term for papaya) was given to nursing mothers, as it increased “their milk.” Younger women said that they consumed less food during pregnancy because they felt nauseous. Older women felt that if pregnant women ate more, they would get suffocated and hence they should eat less.

The ASHAs echoed the common belief that women who consumed “high protein” food would have a difficult time during birth because the child would become “more healthy.” Heavier or bigger babies, according to them, would result in complications during birth. This finding suggests that the ASHAs need to be better trained and informed about some problematic aspects of traditional beliefs relating to pregnancy and child birth, to be able to convince their clients about the need for pregnant women to have nutritious diets.

Many of the traditional beliefs around diets of pregnant or nursing women were about various forms of restriction. Based on the FGD with older women, it was found that pregnant women were restricted from consuming all kinds of nuts, including coconuts and sweets with sesame seeds, because they were believed to trigger a life-threatening condition called anasi in the child. Fruits such as papaya and jackfruit and vegetables such as drumsticks, mushrooms, dried bamboo shoots and mutton were res­tricted because these were considered hard to digest and might cause amri in the child. Amri and anasi are local terms for ailments in newborn and infants, attributed to the maternal diet.

Different types of yams such as saru (elephant’s foot yam) and semili-konda (wild yam) were forbidden, because they were believed to cause rashes and bleeding in newborn children. Women were also restricted from consuming meat and spicy food for 12 days after birth, because it was believed that this would cause constipation in the breast-fed infant. During this time the consumption of lentils, papaya and rice water was recommended. Restrictions also extended to nutritional supplements provided by the ICDS, such as iron tablets. Older women said that just as vegetables grown with fertilisers were neither nutritious nor of good quality, consuming iron tablets before giving birth would have harmful effects on the child.

Women’s Work Burden

Pregnant women’s work burdens were high, since most women were expected to continue labouring till the last week of pregnancy, with some rest permitted at the end of the third trimester. But even this was contingent on the availability of other members of the family to perform the work. In families with lesser number of working hands, women were expected to perform all the household work, including agricultural labour and arduous tasks such as fetching fuelwood, till the day of birth. The women who went out for work during the day carried small quantities of food with them to their workplace and returned home in the evening. This contributed to their deficient food intake.

Women said that they were told since their youth that the more they worked till the date of childbirth, the easier it would be to give birth. Through interviews with the ASHAs, it was found that women going out for work, soon after giving birth, led to the deterioration of the health of the infants, due to a lack of adequate care and inappropriate weaning food. The ASHAs complained that the mothers were unable to comply with their advice of taking the malnourished infants to the NRC (Nutrition Resource Centre) at Koraput district town. The fact that they would have to stay at the NRC for two weeks usually deterred the mothers from following this course of action.

Decision-making Power

Younger women were not empowered to take key decisions in their households, including those regarding childbirth. Senior women played an important role and monitored the behaviour of younger women. In all our discussions with young women, several older women would always be present. We asked one of the younger women who had a month-old child and another two-year-old daughter, whether she planned to have more children. While the younger woman did not voice her opinion, her mother in-law said: “Why would anyone wish ‘to cut a fruiting tree’?” (personal interview 2015) She also said that she herself had only two children and thus did not have too many “own people” (personal interview 2015).

On asking why she had only two children, she mentioned that many had been born, but only two had survived. From her perspective, “now that children were born and lived, what was the reason to not have them?” (personal interview 2015) Other older women present had nodded their heads and agreed. All the younger women mentioned giving birth at the “medical” (meaning at a hospital) and receiving cash benefits under the Odisha government’s Mamata scheme. While the government cash transfer programme appears to have been effective in promoting institutional birth, decision-making about reproduction indicates a great influence of older women. This indicates not only that older women must be included in health and nutrition education that usually tends to be maternal-focused, but also that younger women’s empowerment would have positive effects on their health. 

The relatively lower social status of women is a cause of concern. Young women experienced domination by male partners and elder relatives. They were not only expected to contribute economically to the household, but also perform physically arduous labour throughout their pregnancy. Health workers advi­sed younger and pregnant women about the importance of consuming nutritious food and iron tablets and educated them about the correct procedure for consuming the supplementary powder. Older family members primarily told the same women about the different food items that they were restricted from consuming.

Elderly women’s opinions about household resource allocation prevailed, and they exercised control over younger women’s decisions about childbearing, childcare and food practices. The relatively early age of marriage and fewer years in school help to perpetuate this unequal relationship. In many cases, older women’s advice around diets and childbirth and care might contradict the information given by government health workers, leading to partial or absence of compliance with government programmes. While women are a focus of nutrition policy and intervention, a narrow focus on “maternity” and insufficient attention to gender inequalities and household poverty may limit the effectiveness of maternal and child health strategies.

Conclusions

Koraput district in Odisha is home to some of the poorest people in the country. Extreme poverty is manifested as chronic food scarcity, insecure livelihoods and low attainments in maternal and child health. This article finds that food insecurity is widespread, based on the average HDDS. Most households are consuming a predominantly starch-based diet, with inadequate diversity across food groups, even during the post-harvest season. Based on the food frequency data collected during this study, close to half the interviewed households and a higher proportion of the landless and SC households were found to have borderline diets. A worrying observation was the low consumption of pulses.

Unequal social relations, household poverty and the inability to access nutritious food create formidable challenges towards attaining nutritional goals for women and children. A shift away from agricultural livelihoods, dependence on market purchase and rising costs of food add to household food insecurity. Some of these issues emerged during the FGDs with women. Having adequate knowledge of balanced diets in contexts where the households are unable to purchase a range of basic food items, would not lead to better diets. Local livelihood interventions to strengthen cultivation and home gardens can provide a long-term solution to reducing food deficit. Coupled with such initiatives, the implementation of the NFSA and expanding its provision to include dried pulses/legumes and millets, in addition to subsidised rice and wheat, would contribute substantially towards better diets.

Working with younger and older women in the community could provide a useful entry point to gradually influence community beliefs about maternal and child health practices. This may also serve to increase the effectiveness of government social programmes. In addition to improving the utilisation of supplements and improving the quality of government-provided take-home rations for women, individual diet quality can be improved through participatory initiatives around cultivating, preparing and consuming locally available nutritious food items. Interventions around girls’ formal education, women’s age of marriage and high levels of work burden need to be designed to address the nutrition security of women and children.

References

Aijaz, Rumi (2017): “Preventing Hunger and Malnutrition in India,” Observer Research Foundation, http://www.orfonline.org/research/preventing-hunger-and-malnutrition-in-india/.

Albert, Sandra (2017): “Indigenous Peoples, Food and the Environment in Northeast India,” The Routledge Handbook of Food Ethics, Part III, Mary Rawlinson and Caleb Ward (eds), London: Routledge, pp 113–25.

Arimond, Mary, Doris Wiesmann, Elodie Becquey, Alicia Carriquiry, Melissa C Daniels, Megan Deitchler, Nadia Fanou-Fogny, Maria L Joseph, Gina Kennedy, Yves Martin-Prevel and Liv Elin Torheim (2010): “Simple Food Group Diversity Indicators Predict Micronutrient Adequacy of Women’s Diets in 5 Diverse, Resource-Poor Settings,” The Journal of Nutrition, Vol 140, No 11, pp 2059S–069S.

Balagamwala, Mysbah and Haris Gazdar (2013): “Agriculture and Nutrition in Pakistan: Pathways and Disconnects,” IDS Bulletin, Vol 44, No 3,
pp 66–74.

Basu, Deepankar and Amit Basole (2013): “The Calorie Consumption Puzzle in India: An Empirical Investigation,” Working Paper Series No 285, Amherst: Political Economy Research Institute, University of Massachusetts, https://www.peri.umass.edu/fileadmin/pdf/working_papers/working_papers_251-300/WP285.pdf.

—    (2017): “The Mystery Is Solved: Why Is India’s Calorie Intake Falling even though It Is Getting Richer?,” Scroll.in, 4 May, https://scroll.in/article/
723897/the-mystery-is-solved-why-is-indias-calorie-intake-falling-even-though-it-is-getting-richer
.

Bose, Nayana (2013): “Raising Employment through India’s National Rural Employment Guarantee Scheme,” Vanderbilt University, http://webcache.googleusercontent.com/search?q=cache:-kTvyhLAuk8J:https://my.vanderbilt.edu/nayanabose/files/2013/11/Job-Market-Paper_Nayana-Bose.pdf%2Bhttps://my.vanderbilt.edu/nayanabose/files/2013/11/Job-Market-Paper_Nayana-Bose.pdf&hl=en-IN&gbv=1&ct=clnk.

Cohen, Marc (2017): “Food Supply: Factors Affecting Production, Trade and Access,” Human Nutrition, Catherine Geissler and Hilary Powers (eds), 13th ed, Oxford: Oxford University Press, pp 647–65.

Das, M (2014): “Measures, Spatial Profile and Determinants of Dietary Diversity: Evidence from India,” Indira Gandhi Institute of Development Research, Mumbai, http://www.igidr.ac.in/pdf/publication/WP-2014-045.pdf.

Deaton, Angus and Jean Drèze (2009): “Food and Nutrition in India: Facts and Interpretations,” Economic & Political Weekly, Vol 44, No 7, pp 42–65.

Deaton, Angus and Valerie Kozel (2005): “The Great Indian Poverty Debate,” The World Bank Research Observer, Vol 20, No 2, pp 177–99.

Drèze, Jean (2004): “Democracy and Right to Food,” Economic & Political Weekly, Vol 39, No 17, pp 1723–31.

—    (2015): “Caste, Class and Eggs,” Times of India, 9 June, https://blogs.timesofindia.indiatimes.com/toi-edit-page/caste-class-and-....

Geissler, Catherine (2017): “Global Nutrition, Policies and Interventions,” Human Nutrition, Catherine Geissler and Hilary Powers (eds), 13th ed, Oxford: Oxford University Press, pp 665–93.

Gaiha, Raghav, Nidhi Kaicker, Katsushi Imai, Vani S Kulkarni and Ganesh Thapa (2013): “Has Dietary Transition Slowed in India? An Analysis Based on the 50th, 61st and 62nd Rounds of the National Sample Survey,” Occasional Papers, Rome: International Fund for Agricultural Development, https://core.ac.uk/download/pdf/10029981.pdf.

Gopaldas, Tara (2006): “Hidden Hunger: The Problems and Possible Interventions,” Economic & Political Weekly, Vol 41, No 34, pp 3671–74.

Gillespie, Stuart, Jody Harris and Suneetha Kadiyala (2012): “The Agriculture-Nutrition Disconnect in India: What Do We Know?,” IFPRI Discussion Paper 1187, International Food Policy Research Institute, Washington, DC, http://ebrary.ifpri.org/cdm/ref/collection/p15738coll2/id/126958.

Heikens, Geert (2009): “Rethinking the Role of World Bank in the Battle against Hunger,” Lancet, Vol 374, No 9686, pp 281–82.

Hossain, Mahabub, Nusrat Jimi and Md Aminul Islam (2016): “Does Agriculture Promote Diet Diversity? A Bangladesh Study,” LANSA Working Paper Series 11, Brighton: Leveraging Agriculture for Nutrition in South Asia, https://opendocs.ids.ac.uk/opendocs/bitstream/handle/123456789/
12884/BRAC%20study%20Hossain%20et%20al%20GG.pdf?sequence=1&isAllowed=y
.

IIPS (2016): “National Family Health Survey 4, State Fact-sheet, Odisha,” International Institute of Population Sciences, Mumbai, http://rchiips.org/NFHS/pdf/NFHS4/OR_FactSheet.pdf.

—    (2017): “National Family Health Survey (NFHS-4) 2015–16 India: Odisha,” International Institute of Population Sciences, Mumbai, http://rchiips.org/nfhs/NFHS-4Reports/Odisha.pdf.

IFPRI (2017a): “Global Hunger Index: The Inequalities of Hunger: Synopsis,” International Food Policy Research Institute, Washington DC, https://www.ifpri.org/publication/2017-global-hunger-index-inequalities-hunger-synopsis.

—    (2017b): “Interpreting India’s Performance on the Global Hunger Index,” International Food Policy Research Institute, Washington, DC, https://www.ifpri.org/news-release/interpreting-indias-performance-global-hunger-index.

Khera, Reetika (2011): “Revival of the Public Distribution System: Evidence and Explanations,” Economic & Political Weekly, Nos 44 & 45, pp 36–50.

Kuhnlein, Harriet V and Olivier Receveur (1996): “Dietary Changes and Traditional Food Systems of Indigenous People,” Annual Review of Nutrition, Vol 16, No 1, pp 417–22.

Lancet (2013): “Executive Summary of the Lancet Maternal and Child Nutrition Series,” Vol 6, No 9890, pp 1–12, https://www.thelancet.co­m/pb/assets/raw/Lancet/stories/series/nutrition-eng.pdf.

Lele, Uma (2017): “Feeding India: Discussions on IFPRI’s Hunger Index Illustrate the Complexity of India’s Malnutrition Problem,” Indian Express, 3 November, http://indianexpress.com/article/opinion/columns/global-hunger-index-india-ranking-child-mortality-ifpri-national-health-mission-4919888/.

Mokkapati, Sathya Raghu V (2017): “Hunger Index: The Devil in the Detail,” Hindu Business Line, 26 October, http://www.thehindubusinessline.com/opinion/global-hunger-index-india-ranking-analysis-wrong/article9926427.ece.

National Nutrition Monitoring Bureau (NNMB) (2009): “Diet and Nutritional Status of Tribal Population and Prevalence of Hypertension among Adults. Report on Second Repeat Survey,” National Institute of Nutrition, Indian Council of Medical Research, Hyderabad.

Osmani, Siddiq and Amartya Sen (2003): “The Hidden Penalties of Gender Inequality: Fetal Origins of Ill-health,” Economics and Human Biology, Vol 1, No 1, pp 105–21.

Pimbert, Michel (2009): “Towards Food Sovereignty: Reclaiming Autonomous Food Systems,” International Institute for Environment and Development, London, https://www.iied.org/towards-food-sovereignty-reclaiming-autonomous-food-systems.

Ramachandran, P (2013): “Food and Nutrition Security: Challenges in the New Millennium,” Indian Journal of Medical Research, Vol 138, No 3, pp 373–82.

Sethuraman, Kavita (2008): “The Role of Women’s Empowerment and Domestic Violence in Child Growth and Undernutrition in a Tribal and Rural Community in South India,” Research Paper No 2008/15, United Nations University-World Institute for Development Economics Research, https://www.wider.unu.edu/sites/default/files/rp2008-15.pdf.

Sridhar, Devi (2008): The Battle against Hunger: Choice, Circumstance and the World Bank, New York: Oxford University Press.

Smith, Lisa and Lawrence Haddad (2014): “Reducing Child Undernutrition: Past Drivers and Priorities for the Post-MDG Era,” Working Paper No 441, Institute of Development Studies, Brighton, https://www.ids.ac.uk/publication/reducing-child-undernutrition-past-drivers-and-priorities-for-the-post-mdg-era.

Smyth, Ines and Caroline Sweetman (2010): “Introduction,” Gender and Development, Vol 18, No 3, pp 363–72.

Swindale, Anne and Paula Bilinsky (2006): Household Dietary Diversity Score for Measurement of Household Food Access: Indicator Guide, Version 2, Washington DC: Food and Nutrition Technical Assistance, https://www.fantaproject.org/sites/default/files/resources/HDDS_v2_Sep06_0.pdf.

UNGA (2017): Report of the Secretary-General, Progress towards the Sustainable Development Goals, E/2017/66, New York: United Nations General Assembly, https://unstats.un.org/sdgs/report/2018.

UNICEF (2014): Nourishing India’s Tribal Children: The Nutrition Situation of Children of India’s Scheduled Tribes, New York: United Nations International Children’s Emergency Fund, http://unicef.in/Uploads/Resources/Tribal-low-res-for-view.pdf.

United Nations Standing Committee on Nutrition (2011): “The HUNGaMA Survey Report,” Hydera­bad: Naandi Foundation, http://www.hungamaforchange.org/HungamaBKDec11LR.pdf.

van den Bold, Mara, Agnes Quisumbing and Stuart Gillespie (2013): “Women’s Empowerment and Nutrition: An Evidence Review,” IFPRI Discussion Papers 1294, International Food Policy Research Institute, London, http://fsnnetwork.org/sites/default/files/ifpridp01294.pdf.

Vira, Bhaskar, Christoph Wildburger and Stephanie Mansourian (eds) (2015): “Forests, Trees and Landscapes for Food Security and Nutrition. A Global Assessment Report,” IUFRO World Series, Policy Brief, International Union of Forest Research Organizations, Cambridge: Open Book Publishers.

Viswanathan, Brinda, Getsie David, Swarna Vepa and Bhavani R V (2015): “Dietary Diversity and Women’s BMI among Farm Households in Rural India,” LANSA Working Paper, Series 3, Brighton: Leveraging Agriculture for Nutrition in South Asia, https://opendocs.ids.ac.uk/opendocs/handle/123456789/12161.

WFP (2008): “Food Consumption Analysis: Calculation and Use of the Food Consumption Score in Food Security Analysis,” World Food Programme, Rome, http://documents.wfp.org/stellent/gro­ups/public/documents/manual_guide_pro­c­e­­d/wfp197216.pdf?_ga=2.138569715.1363523­­­­­20­6­.­­­­1511852998-561245921.1511852998.

Updated On : 13th May, 2019

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