India's Nutrition situation has worsened during Covid; needs due attention

In the 75th year of Independence, India has a lot to rejoice about and a lot to reflect on. Of all the problems confronting the youth, nutritional insecurity is the worst, holding the power to cripple the future of an entire generation. Recent UNICEF report stated that nearly 12 lakh children could die in low-income countries in the next six months due to a decrease in routine health services and an increase in wasting, including three lakh children from India (nearly as much as the countrywide death toll from Covid-19). If this challenge has to be mitigated, India must use the pandemic as an opportunity to come up with long-term multi-stakeholder solutions to the problem of nutrition in the country.

Recently released National Family Health Survey (NFHS 5) indicates that since the onset of the pandemic, acute undernourishment in children below the age of five has worsened, with one in every three children below the age of five suffering from chronic malnourishment. According to the latest NFHS data, 38% of children under five are stunted (less height), and 21% are wasted (too thin for height). This is much higher than in other developing countries where, on average, 25% of children suffer from stunting and 9% are wasted. Inadequate dietary intake is the most direct cause of undernutrition.

Global Nutrition Report 2020 by GAIN (Global Alliance for Improved Nutrition) has identified India as the Global capital of anaemia and stunting as depicted below:

The report further states that in India, one in two women of reproductive age is anaemic, one in three children under five years of age is stunted, and one in five children under five years is wasted. Inequalities are evident for stunting, with stunting prevalence being 10.1% higher in rural vs urban areas. Rates of overweight or obesity reach 20.7% in adult women and 18.9% in adult men. With this coexistence of undernutrition and overweight or obesity, India faces the double burden of malnutrition.

There is a disconnect between agricultural policy and contemporary nutritional challenges. Agricultural policy has been slow to respond to the persistent problem of micronutrient malnutrition and child stunting, as well as the emerging challenges of overweight and obesity. Agricultural policy is heavily biased towards improving staple-grain productivity, especially for the major staples of rice, wheat and maize, while dietary diversity needs are not adequately addressed.

For consumers to be able to purchase and consume healthy foods that are available within the food environment, such foods need to be affordable. For the most vulnerable groups of the population, nutrient-rich foods such as animal-source foods, fruits and vegetables are not affordable. Both price levels and volatility affect household purchasing power, welfare and food security, and nutrition.

Recent research published in Global Food Security Journal by Soumya Gupta et al quantified the divergence in the cost of current diets as compared to EAT Lancet recommendations at sub-national level in India observed that actual dietary intake is valued at US$ 1 per person per day as against recommended diet costing around US $ 5 per person per day:

Global Nutrition Report further identified actual usage of different food groups against recommended usages for adult Indians as detailed below:

The differences are very stark and telling on the state of nutrition in the country:

1. Our diet is heavy in cereals (whole grains) and occupies centre-stage, with consumption higher than global average.
2. In terms of positives, Indian diet is high in legumes, vegetables & Fibres while being much lesser in red & processed meats.
3. However, it is much lesser in terms of fruits, nuts, milk & Poly-unsaturated fats.
4. Further, it is high in sugars, sodium & trans-fats indicating much higher usage of salt & vegetable oil.

What is required to be done?

As a society, we need to focus on following 5 A's:

1. Awareness on Quality of Nutrition: Therefore, what is required is, shift from coarse grains to higher value-added food like nuts, fruits & milk; shift from vegetable oils to better quality fats like Butter, Ghee, nut-oils, etc. and moderation in usage of sugar & salt.

2. Availability: Increase availability of right nutritious food by changing agriculture policies and incentivising production of more fruits, lentils and oil-seeds as against cereals and sugar; Pushing more of these products under mid-day meals and PDS. 

3. Affordability: Making food groups as above affordable by increasing productivity, rationalising taxes and including high value-added food products in PDS.

4. Aspirational Infrastructure: Creating infrastructure for harvesting, storage, preservation, transportation & marketing of above nutritional foods to make it available & affordable to masses.

5. Agro-climatic protections: Creating an eco-system for protecting both farmers as well as consumers against agro-climatic vulnerabilities and hence fluctuations in availability as well as price.