India - An Undernourished Nation?

The prevalence of underweight among children in India is amongst the highest in the world, and nearly double that of Sub-Saharan Africa. In 1998/99, 47% of children under three were underweight or severely underweight, and a further 26% were mildly underweight such that, in total, underweight afflicted almost three-quarters of Indian children. Levels of malnutrition have declined modestly, with the prevalence of underweight among children under three falling by 11% between 1992/93 and 1998/99. However, this lags far behind that achieved by countries with similar economic growth rates. Undernutrition, both protein-energy malnutrition and micronutrient deficiencies, directly affects many aspects of children’s development. In particular, it retards their physical and cognitive growth and increases susceptibility to infection, further increasing the probability of malnutrition. Child malnutrition is responsible for 22% of India’s burden of disease. Undernutrition also undermines educational attainment, and productivity, with adverse implications for income and economic growth. Most growth retardation occurs by the age of two, and is largely irreversible. Underweight prevalence is higher in rural areas (50%) than in urban areas (38%); higher among girls (48.9%) than among boys (45.5%); higher among scheduled castes (53.2%) and scheduled tribes (56.2%) than among other castes (44.1%); and, although underweight is pervasive throughout the wealth distribution, the prevalence of underweight reaches as high as 60% in the lowest wealth quintile. Moreover, during the 1990s, urban-rural, inter-caste, male-female and inter-quintile inequalities in nutritional status widened. There is also large inter-state variation in the patterns and trends in underweight. In six states, at least one in two children are underweight, namely Maharashtra, Orissa, Bihar, Madhya Pradesh, Uttar Pradesh, and Rajasthan. The four latter states account for more than 43% of all underweight children in India. Moreover, the prevalence in underweight is falling more slowly in the high prevalence states. Finally, the demographic and socioeconomic patterns at the state level do not necessarily mirror those at the national level and nutrition policy should take cognizance of these variations. Undernutrition is concentrated in a relatively small number of districts and villages with a mere 10% of villages and districts accounting for 27-28% of all underweight children, and a quarter of districts and villages accounting for more than half of all underweight children. Micronutrient deficiencies are also widespread in India. More than 75% of preschool children suffer from iron deficiency anemia (IDA) and 57% of preschool children have sub-clinical Vitamin A deficiency (VAD). Iodine deficiency is endemic in 85% of districts. Progress in reducing the prevalence of micronutrient deficiencies in India has been slow. As with underweight, the prevalence of different micronutrient deficiencies varies widely across states. In general, in lowincome agricultural Asian countries, the physical impairment associated with malnutrition is estimated to cost more than 2-3% of GDP per annum - even without considering the long-term productivity losses associated with developmental and cognitive impairment. Iron deficiency in adults has been estimated to decrease productivity by 5-17%, depending on the nature of the work performed. Other data from ten developing countries have shown that the median loss in reduced work capacity associated with anemia during adulthood is equivalent to 0.6% of GDP, while an additional 3.4% of GDP is lost due to the effects on cognitive development attributable to anemia during childhood. Micronutrient deficiencies alone may cost India US$2.5 billion annually, and that the productivity losses (manual work only) from stunting, iodine deficiency and iron deficiency together are responsible for a total productivity loss of almost 3% of GDP. Whether undernutrition is measured as the prevalence of underweight, stunting or wasting, it is clear that the nutritional situation in India is amongst the worst in the world. India’s prevalence of underweight (47%) compares to Bangladesh (48%) and Nepal (48%), but is much higher than all other countries within South Asia and far higher than the averages for other regions of the world. High prevalence combined with India’s large population means that of the 150 million malnourished children aged under five in the world, more than a third live in India. The decline of the prevalence of underweight during the 1990s has also been less rapid than in most other countries with similar socioeconomic or geographical characteristics. Despite an average annual increase in per capita GDP of 5.3%, the average annual prevalence of underweight in India fell at a rate of only 1.5%. In some other countries, underweight prevalence fell by more than 5%, even though annual growth in per capita GDP was around 2% or less. In China, the prevalence of child underweight fell at an annual rate of more than 8%, backed by a 12% annual growth rate. In Bangladesh, despite economic growth that lagged behind that of India, the prevalence of underweight declined at a higher rate (3.5%). Thanks The World Bank, HNP, August 2005.