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Malnutrition remains one of the biggest challenges facing India. In the last large survey, the National Family Health Survey of 2005-06, about 42 per cent children under the age of five were underweight. Economic growth has failed to redress this problem. Recently released estimates from the District Level Health Survey for selected states continue to paint a dismal picture.
In the best performing states, like Karnataka and Himachal Pradesh, the proportion of children who are underweight declined by 7 to 8 percentage points between 2005-06 and 2012; in the worst — Maharashtra and West Bengal — there is virtually no improvement. At this rate, it is unlikely that we can achieve the Millennium Development Goal of 28 per cent children being underweight by 2015. Not only is this a blow to India’s core values, it has vast economic consequences.
According to a study by the international non-profit, Save the Children, this cost is expected to be between 1 to 2.5 per cent of the GDP per annum by 2030. In spite of the urgency of the problem, the only solution at hand, the National Food Security Act (NFSA), 2013, appears inadequate to the task of addressing the problem for a number of reasons.
First, the primary focus of the NFSA is to expand access to cheap cereals, although dietary composition is as relevant to Indian malnutrition as hunger or caloric deficiency. The NFSA’s focus on hunger is bolstered by the observation that successive rounds of the National Sample Survey (NSS) and the National Nutrition Monitoring Bureau surveys document declining caloric consumption among the Indian population. However, as Jean Dreze and Angus Deaton note, most of this decline is observed among upper-income groups, particularly in rural areas. These groups are increasingly moving away from manual labour and hence may need fewer calories.
But malnutrition is not limited to the poor. The National Family Health Survey shows that although 57 per cent of the children in the households with the lowest levels of wealth are underweight, even among the top 40 per cent of households, about 30 per cent of the children are underweight. So it is not simply a question of income or access to food grains, but rather of the composition of food and dietary diversity. The India Human Development Survey (IHDS), organised by the National Council of Applied Economic Research (NCAER) and the University of Maryland, documents that when households consume a diet of cereals, coarse grains, pulses, milk, vegetable, fruits and fat, the percentage of children who are underweight goes down by about 5 percentage points, even when compared to other children from families similar in socio-economic background but with lower dietary diversity.
Second, the NFSA does not take into account the unanticipated effects of the expansion of the public distribution system (PDS), which may well result in a reduction in nutritional quality due to its emphasis on cereals. While the proportion of families obtaining food from ration shops has grown from 25 per cent to over 50 per cent between 2004-05 and continued…