Republic of Hunger

India’s policy addressing hunger and malnutrition in all age groups has a feast of questions and a famine of answers. India’s hunger, being worse than any sub-Saharan country, needs crisis management and a long term vision. With a new government at the Centre, is the expectation too high, wonders suchayan mandal

The change of guard at the Centre after the general elections has prompted expectations and high hopes from every nook and corner of the country. Manohar Das of Tewri village in Jharkhand, Shib Baksha of Amlasol village in West Bengal and Anita Devi in Maharashtra have no idea about the "Modi Sarkar" at the Centre, yet they hope some government will arrange for two full meals for them a day. India’s overall GDP growth at 4.7 per cent in 2013-14 due to low industrial growth and inflation, is expected to rise thanks to pro- industry steps by the present government. However, election promises for the downtrodden people and development blueprints have a vast difference, which was visible over the last few decades.

 One of the basic needs of the people, be it poor or rich has been food. And India isn’t a country that does not produce sufficient food. Rather, storage of surplus food has always been a problem. Yet, Manohar, Shib and Anita go hungry day after day and Anita’s two sons died of malnutrition before they could be sent to school. 

While development in many sectors is acknowledged, what is less known is that India has also made considerable progress on many social fronts, such as fertility decline, expansion of schooling and bridging the gender gap in education, especially at the primary and lower secondary levels. However, there is one area of human development, where India has not fared particularly well: tackling hunger and malnutrition. 

Child malnutrition rates in India are extraordinarily high ~ among the highest in the world, with nearly one-half of all children under three years of age being either underweight or stunted. Indeed, child malnutrition rates are higher in India than in many countries of sub-Saharan Africa, even though income levels are significantly higher and levels of infant and child mortality are lower in India. 

Pediatric malnutrition 

 Prevalence of child malnutrition in India has remained stubbornly high even after nearly a half-century of respectable agricultural productivity growth and two decades of post-reform economic growth and prosperity in the country. This is puzzling, since rising prosperity appears to have improved other social indicators in India, such as fertility, mortality, schooling and literacy. Adding more support to the view that child malnutrition is weakly correlated with income is the finding that among children of mothers with 10 or more years of schooling as well as mothers from the top income quintile, around one-quarter are underweight. Even in a relatively prosperous and dynamic state like Gujarat, child malnutrition rates have been stagnant over the past decade. 

The National Family Health Survey in 2005-06 showed that almost 50 per cent of Indian children aged six years or below were stunted and more than 40 per cent of children in the same age group were underweight. Moreover, almost 80 per cent of children aged six months to three years were anaemic. 

As India and the world have long known, malnutrition in young children is likely to have long-lasting functional deficits, affecting intelligence and other cognitive abilities, creating a susceptibility to various diseases and even affecting their reproductive health. Ironically, much of this pioneering research was done in India itself. 

The National Family Health Survey (NFHS) found that a significant number of adults in India suffer from malnutrition. Almost 58 per cent of pregnant women aged 15-49 were found to be anaemic. 

This reveals how the nutritional status of young children is being adversely affected from before they are born ~ stunting in children under the age of three years begins with their mothers, who are undernourished or anaemic during pregnancy. The Global Food Security Index also revealed that Indians lack adequate quantities of iron, Vitamin A and protein in their diets. 

 Public health specialist and activist, Dr Binayak Sen said, “Half of the children who die before five years of age have malnutrion as a cause in their pathogenesis. If we look at proportion of weight at birth, 23 per cent of children weigh less than 2.5 kg, which is below normal. This low birth weight has its reason in the womb, which is where they are malnourished already before being born. Low birth weight increases over time and so by the time they are three-years-old, half the children are malnourished. Because of poor sanitation we have widespread faecal oral contamination. Water and food sources have high degrees of contamination and it results in diarrhoea and other gastro intestinal illnesses, which increases the child mortality rate. 

State of famine 

In 1943, three million people died in the infamous Bengal famine. There was no shortage of grain in Bengal at that time, yet people had nothing to eat. Today, there is so much excess grain that the government is hard put to store it yet there are millions in this country staying hungry. In Amlasol, West Bengal, people eat ant eggs, earthworms and snails to stave off hunger. Interpreting the Famine of 1943, Nobel Laureate Amartya Sen suggested that the reason for it was the breakdown of the social arrangement in distributing food. However, a critic of Sen’s opinion, Amrita Rangasami's had written, “The sudden collapse into starvation that has been identified with the famine condition is only the final phase of famine, when the stigmata of starvation become visible, and the victims have collapsed. Famine is not, however, an event marked by the death of the victim. The basic failure in the understanding of famine is the inability to recognise the political, social, and economic determinants that mark the onset of the process. We need, therefore, to redefine famine and identify the various factors ~ political, social, psychological and economic ~ that operate to keep large classes in the population under continuous pressure." 

Nandi Foundation had performed an assessment of children's nutritional status, covering around 44 per cent of all under-five victims of malnutrition. Former prime minister Manmohan Singh had said while releasing the study report that it was a "national shame". Of that there is no doubt ~ but the shame is familiar. Similar data are available from the National Nutrition Monitoring Bureau ~ part of the National Institute of Nutrition (NIN) ~ for many years, and they are also corroborated by the findings of NFHS-III, carried out in 2005-2006. Meanwhile, the NHFS-III tells people that around half of all deaths in the under-five age group were closely associated with their poor nutritional status. The CIA World Fact Book puts India's IMR (infant mortality rate) at 46 ~ 14th highest in the world, higher than that of every South Asian country except Bangladesh, which is at 49. 

 To put the matter in a world context, every three seconds somewhere around the world, a child dies of causes related to avoidable malnutrition. "In those three seconds, the world armaments industry spends 120,000 dollars in order to keep the system responsible safely in place,” Binayak Sen told The Statesman. 

Sen further suggested, “The BMI (body-mass index) is derived by dividing the weight in kilogrammes by the square of the height in metres. The critical value of the BMI is 18.5. Values below 18.5 are indicative of chronic energy deficit ~ hunger. Pednekar from Pune has demonstrated through epidemiological studies that death rates increase as BMI falls below 18.5. If the death rate above 18.5 is taken as unity, then roughly, death rates from 18.5 to 17 are about 1.33, those from 17 to 16 are about 1.5, and BMI values below 16 are associated with a death rate that is double the 'normal' death above 18.5. WHO recommendations are that any community that has more than 40% of its members with a BMI below 18.5 should be regarded as a community in famine. For which, many Indian states should fall in the criteria.” 

Rising food price 

Skyrocketing potato and onion prices spell more woe for the masses, who are already paying "too much" to survive. International Fund for Agricultural Development’s (IFAD) Rural Poverty Report-2011 states, “While international food prices have declined since mid-2008, they are still substantially higher than prior to the price surge, and they are likely to remain at 2010 levels or higher for the next decade.” The report has suggested that about 100 million of world’s rural and urban people have to remain hungry. 

“In India, from 2000 to 2005 food grain prices declined with inflation rate in rural areas coming down from 8.1 per cent in 1993-2000 to 1.90 per cent in 2000-05. In 2007 when the Planning Commission prepared the poverty estimate for the country, the decline in poverty was attributed to low food inflation. But since 2006 food prices have been rising. Food inflation was about 14 per cent in December 2010. Indeed, rise in food prices in the past two years has been higher than in any period since the mid-1970s. From 2005 to 2010, the average wholesale price index for food articles went up by 40.76 per cent,” reads a report in Down to Earth magazine. 

“It will remain high, the era of cheap food is over," asserted Richard Mahapatra, managing editor of Down to Earth. "This is because productivity of agriculture is low and thus impacts production. This is the supply side issue. Also the rainfed areas that contibute a signifcant amount of foodgrain is not getting the policy focus. Even though the new second Green Revolution is aimed at that, it seems to be flawed. Now, the demand side. Demand is increasing but we don't have robust distribution mechanism. So, it creates further price rise. Also, there is huge diversion of agricultural lands to other uses. Combined with low productivity, less lands and absence of distribution mechanism, we are set for high price rise.” 

 According to Mahapatra, because growth per se is meant to reduce hunger, it helps a particular group of people. For the poor and food insecured people we need a different model of growth. But we unilaterally focus on growth model, he added. Due to the PDS and the public wage programmes starvation deaths have definitely come down, he contended. "Often we call cheap foodgrain programmes as populist. They are indeed popular as poor find them useful and their starvation is avoided with this entitlement,” he added. 

Adult malnutrition 

“Malnutrition in children is a horror story and malnutrition in adult is equally horrendous," said Binayak Sen. "Roughly 33-35 per cent of the entire Indian population have a BMI below 18.5, which is indicative of calorie malnutrition.They aren't getting enough food to eat. More than one-third of India is on a chronic basis not getting proper food to eat. Low BMI is also restricting people’s immunity.”  

“Wthout addressing nutritional status, there can be no adequate development. Food Security Act does nothing for betterment of nutritional status of the poeple as such. The Bill is like 'something is better than nothing'. Five kilos of wheat per person per month make two chapattis per day. With two chapatis the nutritional question isn’t answered. This terrible nutritional deficit is yielding polarization in society,” he added. 

Urban malnutrition 

With migration and job prospects, people from the country-side are settling in cities. A complex attitude that makes a farmer hate farmland and dream of industry has also resulted in problem of migration. In villages, people stay in close bond with each other, who can be approached for help in times of crisis. Migrating people in cities start living in slums and ghettos, where they have to live with people unknown and untrustworthy. Moreover, people fight here to make ends meet, which actually leads to self-centric attitude. 

Most of the urban food is really not nourishing and leaves even rich kids under-nourished. Over nourishment or obesity is also hindering growth in urban society. 

Red corridor hunger 

“People who are in chronic situation and stable famine are able to withstand only because of their access to natural resources like land, water and forest," opines Binayak Sen. "Access to this resources was unrestricted. Designating the common properties as commodities that can be owned by corporates is restricting poeple’s right to access and in a way right to live. Any form of resistance is labelled  as insurgency. First they try civil ways and then take recourse in military measures. People have to confront. Application of eminent domain needs to be questioned. Under 5th schedule, govt has to ensure people’s access to natural resources but there is not a single instances of government intervening.” 

According to Mahapatra, over 1.3 million tribals and forest dwellers got rights over the land they had been using for years under the Forest Rights Act. "But six years after the Act was enforced, lives of the forest dwellers have not changed much," he pointed out. "Not one state has initiated concrete steps to officially register the title holders in the state land records. Without this they remain what they used to be ~ officially non-existent.”  

“They have mapped it as red corrridor but poeple’s deprivation hasn't been mapped yet," said Sen. "We need to relook at the arm forces and UAPA laws. Whole discourse in election has become restricted to attitudes to development. Development is about accessing resources. Nobody is saying there are vital issues involved. What is going to happen to the poeple whose right has been denied? State will not be thwarted in its course. There needs to be a contestaion in the level of people. They need to raise the issue.” 

Feast of questions 

So what needs to be done? The conclusion of most studies is that, taken together, these programmes have not made much of a dent in either protein-energy under-nutrition or child malnutrition rates in the country. Richard Mahapatra suggested, “Agriculture contributes around 16 per cent to GDP; it is coming down over the years. But still 60 per cent people depend on this. What does this mean? It is reliable as a source of livelihood or people don't have any other source thus depend on agriculture. In both the cases, shifting people out of agriculture is going to be a tough challenge. Industries or the service sectors have their own limitation and can't absorb such a huge number of people. Strategically, this will be a blunder as we kill out food self-sufficiency.”