High undernourishment, gender disparity: India’s nutrition trends align with hunger index findings

The Global Hunger Index for the year released in October ranked India at 111 out 125 countries. The report showed that India scored 28.7 on a scale of 100 with 0 the best and 100 the worst. Concern Worldwide and Welt Hunger Hilfe, the nonprofit that publishes the index, categorised India’s hunger severity as “serious”.

For the third year in a row, the Indian government dismissed the findings of the index and questioned its methodology. In a video available on social medium Union Minister Smriti Irani, who heads the Women and Child Development Ministry that is responsible for the nutrition of women and children, says that there are indices “which do not project the India story and deliberately so”.

“Three thousand people in a country of 140 crore get a phone call from Gallup and they are asked: ‘Are you hungry?’” Irani says in the video.

The government claims that the index uses three indicators that measure the health of children and thus “cannot be representative of the entire population”. The fourth indicator, it alleges, is based on a survey conducted by Gallup World Poll that has a small sample size.

Irani adds that after traveling for several hours that day she was able to eat only at 10pm. “If you’ve called me at any time of the day today from Gallup and asked, ‘Are you hungry’, I’ll say, ‘Oh yes, I am’,” the minister says.

The minister’s comments only served to undermine a widespread problem of poor nutrition across India. In fact, on November 5, Prime Minister Narendra Modi announced that the government’s free foodgrain scheme that has an estimated 80 crore beneficiaries will be extended by five years till December 2028.

The InfoSphere team at the Centre for New Economics Studies, in an analysis of nutrition data from the National Family Health Survey and the World Bank, found that India’s nutrition trends are consistent with some of the findings of the hunger index.

What the hunger index says

According to the Global Hunger Index 2023 report, global hunger is a serious concern due to the “combined effects of overlapping crises”: the Covid-19 pandemic, the Russia-Ukraine conflict, economic stagnation, the consequences of climate change and unrest in several countries.

The Global Hunger Index score is calculated based on four indicators: undernourishment, child stunting, child wasting, and child death. The index relies heavily on indicators of child malnutrition because it is a principal development marker on interpreting the state of nutrition-access across each state in India.

Development indices have also relied on other public health metrics – such as maternal health, neo-natal healthcare among others – to measure nutritional intake/malnutrition and understand its relationship with reproductive health.

According to the index, child stunting refers to the share of children under the age of five with low height for their age, while child wasting measures refers to children with low weight for their height, both reflecting undernutrition. Child mortality refers to the share of children who die before their fifth birthday.

India improved its overall score on the index from 38.4 in 2000 to 35.5 in 2008 and 29.2 in 2015. But since then the country has registered a minor change improving to just 28.7.

Undernourishment

A major finding of the index is that undernourishment among the population has increased from 14% in 2015 to 16.6% in 2023.

Undernourishment, as defined by the Food and Agriculture Organization of the United Nations, refers to a persistent or chronic lack of sufficient food consumption, resulting in inadequate energy intake for the body. Those suffering from undernourishment struggle to fulfil their basic energy needs and may also have a deficit of vital nutrients.

In India, undernourishment is the result of multiple factors such as poverty and volatile agricultural productivity. There are distributional issues as well, which the Public Distribution System that provides free ration is aimed at addressing.

An analysis of data on undernourishment in India, from the social indicators datasets of the World Bank, found that from 2014 to 2018 there was a decrease in the number of people suffering from undernourishment. But from 2018, there is an increase in malnourished individuals.

In 2020, this pattern took an ominous trajectory as Covid-19 lockdown measures were implemented. The number of undernourished individuals increased by 24% from 2017 to 2021 – from 17.63 crore to 22.43 crore. This is likely the result of multiple factors such as economic volatility, external disruptions like the pandemic, climate change effects and societal challenges, including food availability and distribution.

For instance, in November 2016, old Rs 500 and Rs 1,000 notes were demonetised overnight, dealing a blow to the economy and months later in July 2017, the Goods and Services Tax regime was implemented.

The lack of frequent data collection makes it difficult to ascertain the volume of rise in malnourishment. However, ethnographic studies by the Centre for New Economic Studies in two cities over the course of January and February 2021 of around 200 workers found that daily wage workers indicated cutting down to one meal a day.

Rural-urban dichotomy

Considering the nourishment of men and women in rural and urban India side by side, a disparity becomes evident. The data below is extrapolated from the fourth and fifth National Family Health Surveys.

The nutritional status from fourth and fifth National Health and Family Surveys from 2015-’16 and 2019-’21 point to a noticeable discrepancy in nutrition levels, particularly between rural and urban areas. The nutritional status indicators calculate, for adults between the age of 15-49, body mass index or BMI, overweight and obesity among respondents and high risk waist to hip ratio. The data indicates that undernourishment is more prevalent in rural areas than in metropolitan areas.

In the fourth survey, a total of 20.7% women and 18.6% men had poor nutrition with these numbers declining to 18.7% of women and 16.2% of men in the fifth survey. Overall, poor nutrition was far more widespread among those residing in rural areas higher for men and women in the fourth and fifth surveys.

India’s trend of higher poor nutrition among women, rural or urban, when compared to men, remains consistent: the fourth survey found at least 31.3% women in rural India suffered from poor nutrition when compared to 26.3% men. These figures declined to 21.2% of women compared to 17.8% men in the fifth survey. In urban areas, too, more women suffered from poor nutrition at 15% compared to 14.3% men in the fourth survey and 13.2% women compared to 13% men in the fifth survey.

Feminist scholarship has long demonstrated that women often put the nutritional needs of their children and other family members over their own.

In the case of young girls too, their nutritional requirements take second place over the food needs of other male family members. This exacerbates the malnutrition levels and concerns of anaemia amongst reproductive women in the country. The Global Hunger Index report, too, notes that “women and girls make up about 60 percent of severely hungry people”.

An analysis of the number of deaths of children under the age of five was conducted to examine the trend from 2014 to 2021, using datasets from the World Bank. The graph shows a decline in India’s child mortality rate from 11 lakh in 2014, to 7 lakh in 2021, a significant decrease of around 39%.

Child mortality is a key indicator of poor reproductive healthcare access, in the absence of which adequate nutrition also worsens. It is a crucial indicator of malnutrition because malnourished children are more vulnerable to illnesses and have weak immune systems that can lead to higher mortality rates.

The declining trend indicates the favorable influence of policies, interventions and investments in the domain of healthcare. Yet, the overall decline in access to basic nutrition among rural populations, especially children and women, reflect that there is a long way to go towards progressive realisation of nutritional security in India.

Deepanshu Mohan is Professor of Economics and Director of Centre for New Economics Studies, OP Jindal Global University. Aryan Govindakrishnan and Jheel Doshi are Research Assistants with CNES and members of the InfoSphere team.

This is the first part of a two-part series by CNES InfoSphere team analysing India’s macro-nutritional landscape drawn from different metrics to cross-validate and test the findings of the recent Global Hunger Index report, ranking India at 111 out of 125 nations. To view InfoSphere’s work, please see its website here.