Despite being one of the fastest growing economies in the world, India has been ranked at 103 out of 119 countries in the Global Hunger Index 2018.
India is home to over 53.3 million stunted, 49.6 million underweight and 29.2 million wasted (low weight for height) children under five

Reasons why economic development or increase in food production has not reduced malnutrition:-

Economic development :- Faster economic growth has enormous benefits, but it is by no means sufficient and sustainable if millions of children remain undernourished.

Experiences with Indian states:-

• Some of the low income and Empowered-Action-Group (EAG) States like Chhattisgarh and Odisha, have performed better on this front compared to Gujarat and Maharashtra where per capita income is almost double.
• The development path prevalent in Gujarat is more about growth, development, investment, which, however, has not been able to translate as better nutritional status in the State.
• Odisha, which is a low income State, has a better network of Integrated Child Development Services (ICDS), public health facility/workforce per lakh population and educational attainment among women, which have translated into a better nutritional status when compared with Gujarat.
• Further, tribals, rural, poor and illiterate mothers children are badly off in so-called developed States of Haryana, Gujarat and Punjab.

Mother’s health:-

• Scientists say the initial 1,000 days of an individual’s lifespan, from the day of conception till he or she turns two, is crucial for physical and cognitive development. But more than half the women of childbearing age are anaemic and 33 per cent are undernourished, according to NFHS 2006. A malnourished mother is more likely to give birth to malnourished children.

Social inequality:-
For example, girl children are more likely to be malnourished than boys, and low-caste children than upper-caste children.

Sanitation:-

• Most children in rural areas and urban slums still lack sanitation. This makes them vulnerable to the kinds of chronic intestinal diseases that prevent bodies from making good use of nutrients in food, and they become malnourished.
• Lack of sanitation and clean drinking water are the reasons high levels of malnutrition persists in India despite improvement in food availability.

Lack of diversified food:-
With the increase in diversity in food intake malnutrition (stunted/underweight) status declines. Only 12% of children are likely to be stunted and underweight in areas where diversity in food intake is high, while around 50% children are stunted if they consume less than three food items.

Lack of food security:-

• The dismal health of Indian women and children is primarily due to lack of food security.
• Nearly one-third of adults in the country have a body mass index (BMI) below normal just because they do not have enough food to eat.

Failure of government approaches:-

• India already has two robust national programmes addressing malnutrition the Integrated Child Development Service (ICDS) and the National Health Mission but these do not yet reach enough people.
• The delivery system is also inadequate and plagued by inefficiency and corruption. Some analysts estimate that 40 per cent of the subsidised food never reaches the intended recipients

Disease spread:-
Most child deaths in India occur from treatable diseases like pneumonia, diarrhea, malaria and complications at birth. The child may eventually die of a disease, but that disease becomes lethal because the child is malnourished and unable to put up resistance to it.

Poverty:-

• The staff of ICDS places part of the blame of malnutrition on parents being inattentive to the needs of their children, but crushing poverty forces most women to leave their young children at home and work in the fields during the agricultural seasons.
• Regional disparities in the availability of food and varying food habits lead to the differential status of undernutrition which is substantially higher in rural than in urban areas. This demands a region-specific action plan with significant investments in human resources with critical health investments at the local levels.

Lack of nutrition:-

• Significant cause of malnutrition is also the deliberate failure of malnourished people to choose nutritious food.
• An international study found that the poor in developing countries had enough money to increase their food spending by as much as 30 per cent but that this money was spent on alcohol, tobacco and festivals instead.

Way forward:-

Package of basic measures like including programmess to encourage mothers to exclusively breastfeed their children for up to six months, fortifying basic foods with essential minerals and vitamins, and increased cash transfers with payments targeted at the poorest families can turn the tide.

Some other recommendations are for universal access to infant and young childcare, including ICDS and crèches, provisions to provide biannual critical nutrient supplements and programmes aimed at deworming children.

In the area of maternal care, the strategy proposes that the government provide nutritional support in particular, the adequate consumption of iodised salt to mothers during pregnancy and lactation.

India is facing a double-burden of malnutrition: Over-nutrition and under-nutrition existing simultaneously, there is a pressing need for a multi-sectoral approach along with nutrition-sensitive and nutrition-specific interventions to address the problems holistically.

For this, there is a need to reiterate the priorities which may include, spreading of knowledge and awareness regarding safe food, diversifying food baskets, putting women and children at the centre of any nutritional intervention and leverage on modern technologies to impart nutrition-linked messages and sustainable agricultural practices.

Strengthen and restructure ICDS and leverage PDS :-
ICDS needs to be in mission mode, with a sanction of adequate financial resources (from the central government) and decision-making authority.

Extend coverage of food fortification of staples:-

• Currently, fortification of staples is limited to the mandatory iodisation of salt. However, the Food Safety and Standards Authority of India (FSSAI) is in the process of formulating draft standards for the fortification of foodgrains which will add to the nutrient value.
• This would help in providing sufficient calories and micronutrients to a large number of children under-five.

Target multiple contributing factors, for example, WASH – The underlying drivers for India’s ‘hidden hunger’ challenges are complex and go beyond direct nutritional inputs. The push for toilet construction must be combined with a strategy for behavioural change.

Align agricultural policy with national nutritional objectives – Agriculture policy must be brought in tune with nutritional policy, with incentives provided for encouraging the production of nutrient-rich and local crops for self-consumption.

An inclusive and holistic approach, including controlling/regulating food price, income support policies for making food cheaper are other important steps that need to be considered.