The Global Hunger Index (2017) ranks India 100th out of 119 countries with a low overall score of 31.4. According to the State of Food Security and Nutrition in the World 2017 report, India is home to 190.7 million undernourished people- a 14.5% prevalence of hunger vis-à-vis the country’s total population. According to NHFS4, 38% of children below 5 years are stunted, 21% are wasted and 36% are underweight. Anaemia is prevalent in 53% women and 23% men in the 15-49 age groups
21% of women and 19% of men in the same age group are either overweight or obese. The dramatic increase in the prevalence of obesity has a consequent impact on the burden of non-communicable diseases such as diabetes and cardiovascular disease.

• Stunting– low height for age,
• Wasting– low weight compared to height,
• Underweight- low weight for age.
• Malnutrition includes both under and over nutrition.

Despite being one of the fastest growing economies in the world, India has been ranked at 103 out of 119 countries, with hunger levels categorised as “serious”, in the Global Hunger Index 2018. Recently, three girls died of starvation resulting from prolonged malnutrition in the national capital Delhi, which has a high per capita income.

India’s child malnourishment level is not only the highest in the world but varies considerably across States. It is a well-known fact that the foundation of a healthy life is laid in the first six years. At least one in five Indian children under the age of five are wasted, which means they have extremely low weight for their height, reflecting acute under-nutrition, according to the Global Hunger Index 2018. The only country with a higher prevalence of child wasting is the war-torn nation of South Sudan, says the report.

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. As per the National Family Health Survey-2016, the proportion of stunted (low height for age) children under five is significantly higher (38.4%) than global (22.9%) averages. The underweight (low weight for age) children rate (35.7%) is a lot higher than the global average (13.5%) too. It is a country that fares poorly on many nutrition indicators. There are 19.8 million children in India, under the age of 6, who are undernourished.

Challenges :- 

Faster economic growth has enormous benefits, but it is by no means sufficient and sustainable if millions of children remain undernourished, as it not only impacts early childhood health and imposes disease burden but also affects education, wages and productivity when they grow up, which will impact India’s growth.

Worryingly, malnutrition in some of its agriculturally-developed districts (Karnal, Panipat, Sonipat, Rohtak as well as in Gurugram) is even higher than the average of Odisha. Recently, Madhya Pradesh has registered double-digit growth in food grain production making it one of the wheat granaries of India, but acute malnutrition is still critical in most of its districts with a high proportion of underweight (42.8%) and stunted children (41.9%).

Challenges with data: -  Lack of credible data on a year-year basis. For example, there has been a 10-year gap between NFHS 3 and NFHS 4.
Further, there is confusion and inability to cope with measurement procedures among poorly trained Anganwadi workers and thus data on malnutrition may not be accurate.
Lack of adequate access to food: Due to ineffective functioning (corruption and leakages) of the public distribution system (PDS), access to food is a major problem. Loss of food grains in warehouses (due to rotting and theft) further aggravates the problem.
Issues with ICDS: - Major issues with ICDS are the supply of quality food and its uniform distribution. Also, Anganwadi workers are unable to play an effective role in attending to the problem of malnutrition because of low wages and inadequate training.
Cereal-based Diet: - A major reason for micronutrient deficiency in India is because of a cereal-based diet. However, even the National Food Security Act does not address the issue of nutritional deficiency adequately. Further, food fortification has also been inadequate.
Social-economic and Cultural challenges:-  Major challenges in implementing nutritional programmes are socio-cultural factors such as caste. For example, Hausla Poshan Yojana, a plan to provide nutritious food to pregnant women and malnourished children in Uttar Pradesh failed to even start because some women beneficiaries allegedly refused to consume the food prepared by Anganwadi workers belonging to the SC community.
Illiteracy among women and gender biases is also a challenge
Lack of nutritional and health awareness: - Lack of awareness, ignorance of healthy diets, unhealthy feeding and caring practices, poor breastfeeding practice are major challenges in reducing malnutrition
Sanitation and hygiene:-  Lack of sanitation is also an important challenge in reducing malnutrition. Poor sanitary conditions caused by open-defecation and other issues lead to the incidence of diarrhoeal diseases which make children susceptible to stunting.
Financial Constraints: - Budgetary allocations of many schemes have decreased over time. Further, the money allocated has remained unspent in many states.

Economic Growth vs Mal nutrition :- 

One problem lies with the current thinking of growth-oriented development. No doubt, the low income and Empowered-Action-Group (EAG) States face major challenges to improve malnutrition, but, two EAG States, 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 and 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. These groups are also affected in poorer States of U.P., Bihar, Jharkhand and Madhya Pradesh. Around two-thirds of stunted/underweight children are from 200 districts of both less developed and developed States.

Another prominent idea is the need to link agriculture and nutrition, as agriculture provides answers to most nutrition problems. Our estimates, however, show malnutrition continues to be high in agricultural surplus States like Haryana (34% stunting and 29.5% underweight). To understand the contradiction between agrarian plenty and malnutrition, let us take the example of diversified food. With the increase in diversity in food intake, measured through Food Intake Index using 19 food items in all 640 districts, 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.

Diversity Food Intake :- 

A majority of children across districts in Tamil Nadu consume a reasonably highly diversified food, leading to lower percentage of stunted/underweight children across districts. Children in a majority of districts in West Bengal, Odisha, Kerala and Karnataka consume mediocre level of food items and malnutrition is relatively lower than in Rajasthan, U.P., Jharkhand, M.P., Gujarat, Bihar and Haryana (children in many of their districts consume less diversified food). The diversified food intake is very low in a majority of Indian districts; just 28% of children consumed over five items of the total 19 food items.

Way Ahead :- 

• To address the problem of child under-nutrition, and disease there should be early life-cycle interventions targeting the first 1,000 days of a child’s life.
• ICDS, Mid day Meal and PDS should be re-worked upon for greater effectiveness. Public-Private partnership in this domain should be encouraged. This would ensure that leakages, space and other constraints of lack of hygiene, delay in supply of food etc do not hinder delivering nutritious food.
• It is important to extend the food fortification of staples. public-private partnerships can help leverage the appropriate technology for scaling up food fortification interventions. Further, the focus should be on incorporating nutritious food and diversify the diet.
• It is important to target multiple contributing factors, for example, water, sanitation and hygiene (WASH). The focus should not only be on building toilets but bringing about a behavioural change among people
• Agricultural policy should be aligned with nutrition policy with incentives provided for encouraging the production of nutrient-rich and local crops for self-consumption.
• It is important to have sufficient information and reliable, updated data for effective interventions. It is thus necessary to collect and maintain real-time data on various nutrition indicators