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India can eliminate malnutrition in next 15 years

Lawrence Haddad and Ramanan Laxminarayan, December 19, 2015 0:27 IST
India is on the move. Its economic growth rate is now faster than China’s. Health is also improving and the number of children under the age of five who die each year will soon be lower than a million. A large number to be sure but much fewer than the two million children under five who died each year just a decade ago.

But averting child deaths is not sufficient. It is also important to ensure that they are healthy and well nourished. Numerous studies have shown that poor health and undernutrition in early childhood can have long-term effects on the child’s height (which is a marker for how well the child will do in later life), school attendance, educational attainment and wages as an adult.

Fortunately, nutrition is also on the move. Child undernutrition rates have been declining, first at a slow rate between 1992 and 2006, and at an accelerated pace since 2006. The rate of reduction of the most stubborn type of malnutrition –low height for children under 5 (also known as stunting)—is now 50 per cent faster.

While this represents a step change in the fight against malnutrition, the rate of progress is neither fast enough to meet the World Health Assembly’s 2025 goals nor the new Sustainable Development Goal ambition of ending malnutrition by 2030.

Child undernutrition rates in India are among the highest in the world, with nearly one-half of all children under 3 years of age being either underweight or stunted. India is still home to over 40 million stunted children and 17 million wasted children under five.

The 2015 India Health Report and the 2015 Global Nutrition Report, both released in Delhi this week, note that while India is making solid progress on combating some forms of malnutrition such as under 5 stunting and wasting, and is doing very well on increasing exclusive breastfeeding rates, it is only on track to meet two of the 8 global nutrition goals: under 5 overweight rates and exclusive breastfeeding rates.

Can India meet these global targets that it has signed up to? Absolutely. Faster economic growth will help enormously, but it is by no means sufficient. So what does India need to do to accelerate malnutrition reduction? The Indian Health Report and the Global Nutrition Report make several recommendations.

First, expand the coverage of high-impact nutrition interventions. Though these interventions are offered universally, the quality is highly variable and the uptake is low, either because people do not know about their entitlements, or they are too inconvenient to use.

In a recent study, we showed that children in India who were part of the government’s ICDS programme were 7.8 per cent more likely to be enrolled in school and completed 0.84 more grades of schooling at the time of adolescence than equivalent children who were not part of the progra-mme. ICDS could be a national asset and should be both deepened and expanded.

Second, because malnutrition is the result of low performance in many sectors, it requires improvements in all sectors to get rid of any weak links in the chain of nutrition production. Agriculture needs to produce high-quality food that people can afford to purchase. Food price and income support policies need to focus on empowering women and making healthy food cheaper.

Water and sanitation programmes should be designed to keep germs out of the mouths of infants and young children. Schools should be seen as an opportunity to teach children, especially adolescent girls, about healthy diets and caring for infants.

Finally, stakeholders must show intent to eliminate malnutrition. Malnutrition reduction must be led by state governments—this is their duty of care to their citizens—but everyone has to play their part: civil society, businesses, and researchers.

Varied performance

The lesson of the last decade is that performance on nutrition is highly varied with Tamil Nadu, Goa and Kerala doing extremely well and states like Uttar Pradesh, Bihar and Jharkhand being left behind. Politicians have to be held accountable on how well they perform on this key investment, which more than any other, will determine economic prosperity for the future generations.

Action on nutrition requires work but is worth the investment for a few reasons. First, eliminating malnutrition would eliminate 45 per cent of all under 5 mortality. That is, about 3,000 children who will not die each day because of poor nourishment and associated disease. Second, it will help slow emissions of greenhouse gases because the foods in healthier diets tend to have lower emissions.

Finally, the economic arguments are powerful. Children who are not stunted do better in school, earn higher wages as adults. The Global Nutrition Report estimates the benefit-cost ratio for India of investing in high-impact nutrition programmes to be 34:1. This is equivalent to a compound rate of interest of 12 per cent over a 30-year period. What a fantastic rate of return. Investing in improved nutrition will power and sustain economic growth over the next two decades and will allow India to fully reap its demographic dividend.

India’s malnutrition rates are declining faster than ever. But this rate can decline even faster. We know what to do. Many co-untries such as Brazil, Ghana and Vietnam have halved their malnutrition rates within 10 years. What an incredible legacy it would be for the current government to match and even surpass this. This would finally dispel the “curse” of malnutrition in India.

China astounded the world in the last 15 years by bringing down poverty rate. India can astound the world during the next 15 years doing the same to malnutrition rate, a truly “Made in India” accomplishment.

(Haddad is senior research fellow, IFPRI and co-chair, GNR IEG, and Laxminarayan is distinguished professor, PHFI, New Delhi)

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