Despite Green Revolution success, rate of malnutrition in India remains stubbornly high

Published on: June 28, 2019
Excerpts from “Food and Nutrition Security Analysis, India, 2019”, jointly prepared by the Ministry of Statistics and Programme Implementation & The World Food Programme:
The Green Revolution in India which took place in the 1960’s was responsible for increasing agricultural productivity and overall food production in the country. As a result, India had a surplus stock of cereals for the first time ever with a national focus on calorie support to all people, especially for those from lower income groups. In the following decades, as the economy continued to grow, the country experienced a significant decline in poverty levels. Despite this remarkable feat, the rate of malnutrition in India remains stubbornly high.

percapita food
Per capita net availability of foodgrains (gm/day), India, 1996-2018

Foodgrains Availability in India
Production: Over the last 20 years, total food grain production in India increased from 198 million tonnes to 269 million tonnes. Wheat and rice are the staple foods of Indians and are a major portion of food grain production, constituting around 75 percent of the total food grain production and thus serving as a major source of income and employment to millions of people. The state of Uttar Pradesh leads in the production of wheat, cereals and Foodgrains, closely followed by Punjab and Madhya Pradesh. West Bengal is the ‘rice bowl’ of India, followed by Uttar Pradesh, Punjab and Bihar.

Net Availability: Since 1996, the per capita net availability of foodgrains has increased from 475 to 484 gm/capita/day in 2018, while per capita availability of pulses has increased from 33 to 55 gm/capita/day. Although there has been a huge increase in production of rice, wheat and other cereals, their per capita net availability has not increased at the same level, due to population growth, food wastage and losses, and exports.

Production Trends: Between 1996-99 and 2015-18, the annual growth rate for food grains was 1.6 percent. Production growth for other major crops are: 2.4 percent for pulses, 1.8 percent for wheat, 1.6 percent for other cereals, 1.4 percent for rice, and 0.9 percent for bajra. Maize had the highest growth, at 5.9 percent. Conversely, other crops had declines in annual growth rates such as: jowar (-2.26 percent), small millets (-1.71 percent) and ragi (-1.21 percent).

Farm Productivity: Though yields in food grains have increased by 33 percent in last two decades, it has been far less than desired. For instance, India has set a target of achieving yields of 5,018 kgs/hectare for rice, wheat and coarse grains by 2030, compared to the present combined yield of 2,509 kgs/hectare. While no state or Union Territory (UT) in India has achieved this target yet, the UT of Chandigarh is nearing the targeted productivity with current levels at 4,600 kgs/hectare, followed by yields of 4,297 kgs/hectare in Punjab.

Changes in the Total Foodgrains Production and Percentage Share of Various Food grains in Food Grain Production Basket in India, 1996-99 and 2015-18

Access to Nutritious Food
Food Expenditure: According to Engel’s law, the share of income spent on food decreases, even as total food expenditure rises. A higher share of total monthly expenditure for food shows lower purchasing power and is related to food access, so it is a relative measure of food insecurity. On average, people of India allocate about 49 percent of their monthly expenditure on food in rural areas and 39 percent in urban areas. The share of food expenditure is highest among the poorest (lowest 30 percent) expenditure group. In rural and urban areas, the poorest 30 percent spend as much as 60 percent and 55 percent respectively, on food.

Food Expenditure Trends: Between 1972- 73 and 2011-12, the share of expenditure on food has decreased around 33 percent in rural areas and 40 percent in urban areas whereas non-food expenditure and consequently, nonfood expenditures have increased during the same period. Between 2004-05 to 2011-12, among the poorest, the share of expenditure on food has declined by 9 percent in rural and 8 percent in urban areas of India. Declining trends suggest that incomes have increased in both rural and urban areas and that food is no longer the only predominant expenditure head for the people.

Food Consumption Pattern: In the food basket, it turns out that in both urban and rural areas, the share of expenditure on cereal and cereal substitutes has declined between 1972-73 and 2011-12, from 57 percent to 25 percent in in rural areas and from 36 percent to 19 percent in urban areas. For the same period, the relative importance of some items especially beverages, milk and milk products and fruits and nuts has shown a remarkable increase, indicating an increased diversity in consumption in the country. In the food basket, the energy and protein intake from cereals has decreased in both rural and urban India, largely because of increased consumption of other food items such as milk and dairy products, oils and fat and relatively unhealthy food such as fast food, processed food, and sugary beverages. Notably, the consumption of unhealthy energy and protein sources is much higher in urban areas. This has likely contributed to the emerging problem of obesity in India.

Nutritional Intake: Between 1993-94 to 2011- 12, the average daily per capita consumption of both energy and protein decreased in rural India while in urban areas, there was no consistent trend. This decline has happened despite the increase in household income. For energy consumption alone, the trend suggests that despite increases since 1983, the overall energy intake is marginally lower than the minimum requirement. For protein intake, despite the declining trends, per capita consumption in both rural and urban areas is higher than the minimum daily requirement. However fat intake has increased steadily since 1983 and is much higher than the minimum daily requirement.

Nutritional Intake Among the Poor: Among the lowest 30 percent of the expenditure/ income class, the average per capita consumption of energy is 1811 kcal/day which is much lower than the Indian Council of Medical Research (ICMR) norm of 2,155 kcal/day. For protein, it is 47.5 grams/day compared to 48 grams/day norm while for fat it is 28 grams/day which is the same as the ICMR norm for rural India. For urban areas, per capita intake of energy is 1,745 kcal/day compared to 2,090/day norm from ICMR. For protein it is 47 grams/day compared to a norm of 50 grams/day and for fat it is 35 grams/day compared to the norm of 26 grams/day. The current intake level of nutrients such as the energy and protein were lower than the all-India average and the daily minimum consumption requirement. Only fat intake in rural and urban areas was at par or more than the daily minimum consumption requirement.

Public Distribution System (PDS) and Nutritional Intake: The Targeted Public Distribution System (TPDS) has provided a critical nutritional supplement to the people across all states in India. During 2011-12, the average per capita supplementation of energy from TPDS was 453 kcal/day in rural areas and 159 kcal/day in urban India. In terms of protein, the supplementation through PDS has averaged 7.2 grams/day in rural areas and 3.8 grams/day in urban areas. The PDS supplementation to the poorest 30 percent population has been around 339 kcal/day. It has been seen that poorest 30 percent of households had lower capacity to access food, and as a result, despite the PDS support, they were not able to reach the Recommended Dietary Energy (RDA) levels of energy and protein intakes.
Trends of Production and Requirement of Cereals and Pulses in India, 2000-2018

National Malnutrition Decadal Trends: The prevalence of malnutrition in children 6-59 months in India has declined between 2005-06 to 2015-16 with chronic malnutrition, or stunting, decreasing from 48.0 percent in 2005-06 to 38.4 percent in 2015-16 and underweight decreasing from 42.5 percent in 2005-06 to 35.7 percent in 2015-16. The prevalence of acute malnutrition, or wasting, has marginally increased during the same period, from 19.8 percent to 21.0 percent. The prevalence of anaemia in young children has also decreased from 69.5 percent in 2005-06 to 58.5 percent in 2015-16.
Stunting Trajectories: Stunting has declined by one fifth during last decade with an annual decline of around one percent. The prevalence of stunting is > 30 percent across all states in India, except Kerala. The trajectories to reduce stunting in India highlight that, with the present rate of reduction in stunting (1 percent per year), by 2022, 31.4 percent children will be stunted. The Government of India has envisaged a challenging target for itself through National Nutrition Mission (NNM)with the target to reduce stunting by at least 2 percent per annum to reach 25 percent by 2022. Goa and Kerala have already achieved this level in NFHS-4 (2015-16). Four other states (Daman and Diu, Andaman and Nicobar, Puducherry and Tripura) have already accomplished mission 25 and Punjab (25.7 percent) is close to achieving it (NFHS-4).

Inter and Intra State Variations in Malnutrition: The prevalence of stunting in children under five is the highest in Bihar (48 percent), Uttar Pradesh (46 percent), Jharkhand (45 percent), and Meghalaya (44 percent) and lowest in Kerala and Goa (20 percent each). Jharkhand also has the highest prevalence of underweight (48 percent) and wasting (29 percent). District level mapping of malnutrition shows considerable intrastate variations. However, very few districts in Northern and North-Eastern states have shown ‘Low’ level of wasting (2.5-4.9 percent) and underweight (less than 10 percent).

Vulnerable Pockets and Sections in India: As mentioned, the highest levels of stunting and underweight are found in Jharkhand, Bihar, Uttar Pradesh, Madhya Pradesh, Gujarat and Maharashtra. Few states have a very high burden of malnutrition. The poorest quintile of the population is the most vulnerable in terms of stunting. In addition to the earlier mentioned states, the two poorest quintile groups in Haryana, Meghalaya, Karnataka, Rajasthan and Punjab have high levels of stunting. At the national level, among social groups, the prevalence of stunting is highest amongst children from the Scheduled Tribes (43.6 percent), followed by Scheduled Casts (42.5 percent) and Other Backwards Casts (38.6 percent). The prevalence of stunting in children from Scheduled Tribes in Rajasthan, Odisha and Meghalaya is high while stunting in children from both Scheduled Tribes and Scheduled Castes is high in Maharashtra, Chhattisgarh and Karnataka.

Prevalence of Multiple Types of Malnutrition among Children: Multiple burden of malnutrition is the coexistence of any two or all three measures of malnutrition: stunting, wasting and underweight. The analysis of NFHS-4 reveals 6.4 percent of children under five are both stunted and wasted and also are underweight, while 18.1 percent of children are both stunted and underweight and 7.9 percent of children are both wasted and underweight. This analysis helps in identifying the most vulnerable section where children are suffering from multiple forms of macronutrient malnutrition.

Micronutrient Malnutrition:
Vitamin A, iron and iodine deficiency disorders are the most common forms of micronutrient malnutrition in the world. Supplementation and fortification are the main ways to deal with these deficiencies at a large scale. In India, only 60 percent of children aged 9-59 months received Vitamin-A supplements in 2015-16, and 13 out of 36 states are lagging behind the national average including some larger states and the north-eastern states. In terms of fortification, around 93 percent of households were using iodized salt in 2015-16 which is very positive.

Anaemia Prevalence: Iron deficiency anaemia remains a major public health concern in India where half of women 15- 49 years of age are anaemic, regardless of age, residence or pregnancy status. In the last decade, anaemia among women of reproductive age decreased by only 2.3 percentage points; an annual decline of 0.4 percent. In 2015-16, the prevalence of anaemia is much higher among women (53.1 percent) than men (23.3 percent). In 2015- 16, 58.5 percent children aged 6-59 months were anaemic compared to 69.5 percent in 2005-06. The prevalence of anaemia is highest among children in Haryana (71.7 percent), followed by Jharkhand (69.9 percent) and Madhya Pradesh (68.9 percent). Several union territories have even higher prevalence of anaemia: Dadra and Nagar Haveli (84.6 percent), Daman & Diu (73.8), and Chandigarh (73.1 percent). Mizoram was the only state in 2015-16 having ‘mild’ level of anaemia prevalence according to WHO thresholds, followed by Manipur. A district level analysis shows that almost all the districts fall in to the ‘severe’ (more than 40 percent) category, very few in ‘moderate’ (20-39.9) category and around 10 districts in ‘mild’ (5-19.9) category.

Double Burden of Malnutrition: For several decades India was dealing with only one form of malnutrition- undernutrition. However, in the last decade, the double burden which includes both over- and undernutrition, is becoming more prominent and poses a new challenge for India. From 2005 to 2016, prevalence of low (< 18.5 kg/m2) body mass index (BMI) in Indian women decreased from 36 percent to 23 percent and from 34 percent to 20 percent among Indian men. However, during the same period, the prevalence of overweight/obesity (BMI > 30 kg/m2) increased from 13 percent to 21 percent among women and from 9 percent to 19 percent. Children born to women with low BMI are more likely to be stunted, wasted, and underweight compared to children born to women with normal or high BMI.

Socio-Economic Determinants of Malnutrition among Children: Just over half the children born to mothers with no schooling are stunted, compared with 24 percent of children born to mothers with 12 or more years of schooling. The prevalence of underweight in children with uneducated mothers is 47 percent compared to 22 percent for those whose mothers have some education. By wealth quintile, the prevalence of malnutrition decreases steadily with increased wealth. Malnutrition is relatively more prevalent among Scheduled Tribes than Scheduled Castes at national level, while considerable variation exists between states. There is a strong negative correlation between stunting and improved sanitation.

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