CAN THE NEXUS BETWEEN INDIA AND

MALNUTRITION BE BROKEN?
SHUBHAM RAJ
___________________________________________________________________________
Abstract
There has been increasing rate of malnutrition in our country which gives a reflection of our
country’s health. The different state of malnutrition can vary from state to state. It depends on
various aspects such as poverty, illiteracy, negligence of health issues by government. If the
country wants to meet sustainable development goals its must pay greater attention to
malnutrition. This paper reflects some of the important cause contributing to malnutrition (like
social group, consumption level, education). There are different Government programs to
eradicate malnutrition but still our country has most number of malnutrition affected people.
Analysis also examines the importance of public distribution system in combating malnutrition
through monitoring of state.
Keywords
Malnutrition, hunger, sign and symptoms, causes, programmes.
___________________________________________________________________________
Introduction
India is among the fastest developing countries both in terms of GDP (Gross Domestic Product)
and population. But every developmental activities comes with a price and one of the price is
malnutrition which is now most common disease in India. Malnutrition is a common disease
among children between zero and five years in India. Not only India but the whole world is
severely affected by child malnutrition. According to WHO the social determinants of the
health are defined as “the conditions in which people are born, grow, live, work and age
including the health system .These conditions are “shaped by distribution of money, power and
resources at global, national and local levels”. There are many definitions of malnutrition
available but the two major organisation , World Health Organisation and United Nations
International Children's Emergency Fund (UNICEF) refers malnutrition as- deficiencies,
excesses or imbalances in a person’s intake of energy and/or nutrients. The term malnutrition
covers two broad groups of conditions. One is ‘undernutrition’—which includes stunting (low
height for age), wasting (low weight for height), underweight (low weight for age) and
micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals). The
other is overweight, obesity and diet-related non-communicable diseases (such as heart disease,
stroke, diabetes and cancer)(Novelo, 2016). According to UNICEF definition of malnutrition,
it is a broad term commonly used as an alternative to undernutrition but technically it also
refers to over nutrition. Individuals are malnourished if their eating regimen does not give
satisfactory calories and protein to development and support or they can't completely use the
sustenance they eat because of sickness (undernutrition). They are additionally malnourished
in the event that they expend an excessive number of calories (over nourishment)(Z Grover &
Ee, 2009).

1|Page
Methodology
The research methodology used in writing this paper is based on existing research available on
this topic. The various data cited are collected from journals, internet, library, government
websites and various international organisation working on malnutrition.
A quick glance of malnutrition in India
India has a “serious” hunger problem and ranks 100th out of 119 countries and score of 31.4
on the Global Hunger Index — behind North Korea, Bangladesh and Iraq (Index, 2017)The
country’s serious hunger level is driven by high child malnutrition and underlines need for
stronger commitment to the social sector, the International Food Policy Research Institute
(IFPRI) said in its report. It is obvious that main cause of malnutrition is poverty, education
and low level of awareness among people. According to the UN report, India is home to 190.7
million undernourished people and 38.4% of children under five in India are stunted. The data
also describe that 51.4% of women in reproductive ages are anaemic. The report defines
stunting as the result of long-term nutritional deprivation which may affect mental
development, school performance and intellectual capacity. Prevalence of child stunting in
India at 38.4% is more when compared with 14.7% in Sri Lanka and 9.4% in China. Children
in India who are stunted fell from 62 million in 2005 to 47.5 million in 2016, the number of
adults who are overweight rose from 14.6 million in 2015 to 29.8 million in 2014(Z Grover &
Ee, 2009)

Hunger and undernourishment lead to severe problems. Children and youth in this state suffer
from numerous nutritional deficiencies which adversely impact their health. In India, data for
2015-16 show the following:
 38 percent of children below five years (urban: 31%, rural: 41%) are stunted (low height
for age);

 21 percent (urban: 20%, rural: 22%) are wasted (low weight for height);
 36 percent (urban: 29%, rural: 38%) are underweight (low weight for age);
 2 percent were overweight in 2006 (above normal weight for height); and
 58 percent of children aged between 6 and 59 months (urban: 56%, rural: 59%) are
anaemic.(AIJAZ, 2017)
Malnutrition in children below five years causes death to approximately 1.3 million deaths.
Data on anaemia shows that 56 percent of young girls and 30 percent of young boys in the age
group of 15-19 years are anaemic.(Bhattacharya, 2017).
Malnutrition in India: States where malnutrition is prominent
i. Uttar Pradesh : Most children here, in India's densest state by population, under the age of 5
are stunted due to malnutrition.
ii. Tamil Nadu: The state, despite high education, has a prominent child malnutrition
problem. A National Family Health Survey reveals that 23% of children here are
underweight, while 25% of Chennai children show moderately stunted growth.

2|Page
iii. Madhya Pradesh: 2015 data reveals that Madhya Pradesh has India's highest number of
malnourished children - 74.1% of them under 6 suffer from anaemia, and 60% have to deal
with malnutrition.
iv. Jharkhand and Bihar: At 56.5%, Jharkhand has India's second highest number of
malnourished children. This is followed by Bihar, at 55.9%.(Faso, 2017)
Nutritional status of a child in India
“India, home to high rate of malnourished children.” This statement has made India won
notoriety despite its prominent growth figures in world’s economy. Although India has
witnessed a significant progress in fighting battle against child malnutrition but its progress
have been quite uneven, and child malnutrition rates remains still high in many states of the
country. The survey of over 6 lakh households conducted in 2015-16 shows that the percentage
of underweight children fell nearly 7 percentage point to 36 percentage while the proportion of
stunted children (those with low height-for-age, a measure of chronic undernourishment)
declined nearly 10 percentage points to 38 percentage. Despite the progress, these rates are still
higher than those of many poorer countries in sub-Saharan Africa. And in some of the worst
affected districts such as Purulia in West Bengal and Nandurbar in Maharashtra, every second
child is undernourished(Faso, 2017). Overall urban child malnutrition rates are lower than that
of rural India.The country’s rural part continues to suffer from worse child malnutrition than
virtually every Sub-Saharan African country with lower per capita income. A prominent
example is The Economist magazine, which stated in an article in its 23 September 2010
edition, “Nearly half of India’s small children are malnourished: one of the highest rates of
underweight children in the world, higher than most countries in sub-Saharan Africa. More
than one-third of the world’s 150million malnourished under-fives live in India.”(Panagariya,
2013).
The consequences of chid malnutrition is the increase in the rate of child morbidity and child
mortality. Each one out of four child in India losses battle against malnutrition. There are two
major types of malnutrition:
Protein-energy malnutrition - resulting from deficiencies in any or all nutrients
Micronutrient deficiency diseases - resulting from a deficiency of specific micronutrients
Protein energy malnutrition (PEM) is a common problem worldwide and occurs in both
developing and industrialized nations. In the developing world, it is frequently a result of
socioeconomic, political, or environmental factors. In contrast, protein energy malnutrition in
the developed world usually occurs in the context of chronic disease. There remains much
variation in the criteria used to define malnutrition, with each method having its own
limitations. Early recognition, prompt management, and robust follow up are critical for best
outcomes in preventing and treating PEM.(Zubin Grover & Ee, 2009). Marasmus
(undernourishment causing a child's weight to be significantly low for their age) and
Kwashiorkor (swelling of body is observed due to retention of fluid) are two main diseases
caused by protein deficiency(Z Grover & Ee, 2009)
Micronutrients deficiency diseases is a lack of dietary minerals, the micronutrients that are
needed for human for proper development. The cause may be a poor diet, impaired uptake of
the minerals that are consumed or a dysfunction in the body to gain from the mineral after it is

3|Page
absorbed. These deficiencies can result in many disorders including anaemia and goitre.
Examples of mineral deficiency include, zinc deficiency, iron deficiency, and magnesium
deficiency.
It is understandable that there is an urgent need to focus on the nutritional needs and overall
development of children. It is thought that malnutrition comes from the development of the
child in the future. Poor fetal growth or growth retardation in the first two years of life leads to
irreparable damage. Insufficient cognitive or social stimulation in the first two years of three
years has a negative impact on the duration of educational performance and psychosocial
functioning.
Malnutrition depends on food we intake which provides energy to our body and energy is
directly proportional to calories we intake. As per the Report of Nutritional Intake in India,
2011-12 published under 68th round of National Sample Survey Office (NSSO), it is observed:
- Among the bottom 5% of rural population ranked by Monthly per Capita Expenditure
(MPCE), 57% of households had calorie intake below 2160 Kcal/consumer unit/day, which
was only 2% for the top 5% wealth fractile of the population.
- Average protein intake per capita per day was seen to rise steadily with MPCE level in
rural India from 43gm for the bottom 5% of population ranked by MPCE to 91gm for the top
5%, and in urban India from 44gm for the bottom 5% to about 87gm for the top 5%.
- Per capita fat intake was about 100g in the top fractile class of the urban sector and about
27gm in the lowest fractile class. In the rural sector the intake of the top fractile class was 92gm
while that of the bottom class was 21gm.
Average dietary energy intake per person per day was 2233 Kcal for rural India and 2206 Kcal
for urban India. At the all-India level protein intake per person per day was 60.7gm in the rural
sector and 60.3gm in the urban. Average fat intake for the country as a whole was about 46gm
per person per day in the rural sector and 58gm in the urban sector.
The undesirable impacts of malnutrition are significant in adults, too. For example, the Body
Mass Index (BMI or the ratio of weight-for height) of a sizeable proportion of women (23
percent) and men (20 percent) in the age group 12 15-49 is found to be falling below the norm.
Evidence exist that people with low BMI are more susceptible to tuberculosis than those who
have normal BMI; thus there is an immediate need to 13 address the problem of undernutrition.
Further, anaemia is prevalent in women (53 percent) and 14 men (23 percent) in the 15-49 age
group, indicating lack of iron, which is among the most prevalent manifestations of lack of
proper nutrition. Meanwhile, about 21 percent of women and 19 percent of men in the same
age group are 15 either overweight or obese. Siddiqui and Donato refer to a dramatic increase
in the prevalence of obesity and its consequent impact on the burden of non-communicable
diseases (NCD) such as 16 diabetes and cardiovascular disease.
Signs and Symptoms of Malnutrition
There is a slight difference between signs and symptoms, signs like any indication of a medical
condition that can be observed objectively (ie, by someone other than the patient), while a
symptom is simply any manifestation of a condition that is apparent to the patient (ie,
something that consciously influences the patient). For example, the rash may be the symptom,

4|Page
but pain is a symptom that only the patient experiences. The signs and symptoms of
malnutrition were classified as follows:
1. lack of appetite or interest in food or drink
2. Tiredness and irritability
3. inability to concentrate
4. always cold
5. loss of fat, muscle mass and body tissue
6. Increased risk of getting sick and having more time to heal
7. Longer healing time for wounds
8. Increased risk of complications after surgery
9. depression
10. Reduction of sexual desire and problems with fertility
In the most serious cases:
1) breathing becomes difficult
2) the skin can become thin, dry, inelastic, pale and cold
3) the cheeks appear empty and the eyes sunken, since the fat disappears from the face
4) the hair becomes dry and sparse, falling easily
Eventually, there may be respiratory failure and heart failure, and the person may stop
responding. Total hunger can be fatal in 8 to 12 weeks.
Children may show a lack of growth and may be tired and irritable. Behavioral and intellectual
development can be slow, which can lead to learning difficulties.
Even with treatment, there may be long-term effects on mental function and digestive problems
may persist. In some cases, these may be for life.
Causes of malnutrition in India
Some of the major causes of malnutrition within our country can be identified as ,
Income – hunger and malnutrition are not due to less availability of food but it due to lack of
the purchasing power of that food. A protein rich food is usually high priced making it away
from the reach of poor. It causes people in poverty, to knowingly opt for malnutrition by going
in for cheaper calorie rich food to satisfy their hunger. Earning of a family play crucial role in
healthcare.in India there is a high income mismatch among the rural population (mainly
agriculture activities related people, labourers) , marginalised peoples and the workforce
related to primary sector . As per the data,2013, provided by World Bank says that about 30
percent (224 million) of India’s population live below international poverty line of less than
$1.90 a day. India’s own methodology to calculate economic status and condition of living is
lacking accuracy and is based on traditional method not scientific method.

5|Page
 Besides income Illiteracy- another major cause when people do not have knowledge and
awareness that healthy food is essential for their health and proper growth they suffer from this
malady. Awareness- some of the rich class people or middle class people due to lack of
awareness stuck into the claw of malnutrition.
Another relevant cause is that the government’s schemes and policies have not been
implemented adequately to overcome the problems of hunger and malnutrition. There has been
extreme inefficiency and ineffectiveness in the implementation of government’s schemes and
policies. For example- States/UTs are entitled to receive food grains(five kg per person per
month of rice, wheat, coarse grains at subsidised prices of INR 3/2/1per kg, respectively) under
the Targeted Public Distribution System (PDS) launched in June1997. Besides ensuring access
to food grains, the Act also provides for monetary maternity benefits, and the establishment of
a grievance redressal mechanism to ensure compliance by State/District government
functionaries. Also the PDS system is engraving corruption, hoarding, black-marketing etc.
Indians pay out around Rs21,068 crore as bribes while availing one of 11public
services.(‘Public Distribution System’, 2005).
Some other factors which also support malnutrition are-inadequate health infrastructure,
technologies and infrastructure. Ignorance of healthy diet, lifestyle of a person.

Government policies and their roles

India's Nutrition Policy of 1993 was shaped on the basis of a detailed understanding of the
factors responsible for the occurrence of 18 malnutrition. The policy called for the adoption of
a multi-sectoral approach and the implementation of a wide range of measures to achieve the
goal of optimum nutrition for all. Subsequently, numerous plans, programmes and missions
were launched on various occasions The policy and programme measures initiated in the health
sector address various aspects of nutrition and are helping to mitigate the problem. This is
evident in the following patterns of decline in some of the country's key health variables: (i)
proportion of under-nourished persons in the total population from 24 percent in 1990-92 to 15
percent in 2014-16; (ii) maternal mortality ratio from 398 in 1997-98 to 167 per 100,000 live
births in 2011-13; (iii) infant mortality rate from 80 in 1991 to 41 per 1,000 live births in 2015-
16;(iv) under-five mortality rate from 115 in 1991 to 50 per 1,000 live births in 2015-16; (v)
percentage of children underweight, stunted, and anaemic .(AIJAZ, 2017).

6|Page
 Direct Policy Measures
• Expand the safety net through ICDS to cover all vulnerable groups (children, adolescent girls,
mothers, expectant women)
• Fortify essential foods with appropriate nutrients (eg., salt with iodine and/or iron)
• Popularise low cost nutritious food
• Control micro-nutrient deficiencies amongst vulnerable groups
Indirect Policy Measures
• Ensure food security through increased production of food grains
• Improve dietary pattern by promoting production and increasing per capita availability of
nutritionally rich food
• Effecting income transfers (improve purchasing power of landless, rural and urban poor;
expand and improve public distribution system)
• Other: Implement land reforms (tenure, ceiling laws) to reduce vulnerability of poor; increase
health and immunisation facilities, and nutrition knowledge; prevent food adulteration; monitor
nutrition programmes and strengthen nutrition surveillance.
Plans ,programme and mission
• Wheat-based Supplementary Nutrition Programme, 1986
• National Plan of Action on Nutrition, 1995
• Public Distribution System, 1997
• National Nutrition Mission, 2003
• National Health Mission, 2013 (subsumes former Rural & Urban Health Missions)
• National Iron+ Initiative, 2013
• Promotion of Infant & Young Child Feeding Practices Guidelines, 2013
• Weekly Iron & Folic Acid Supplementation, 2015
• National Deworming Day, 2015
• Establishment of: Nutritional Rehabilitation Centres; Village Health Sanitation & Nutrition
Committee
• Bi-annual Vitamin-A Supplementation
• Village Health & Nutrition Days (at Anganwadi centres)
• Mid-day Meal Programme, 1962-63
Note: The year mentioned is the above programmes are the year in which programmes the
programmes were launched.
Source: National Nutrition Policy, 1993; Ministry of Health and Family Welfare. Annual
Report 2015-16.
Remedies towards Eradication of Hunger and Malnutrition

Despite economic growth, there has been a problem of malnutrition within the country, which
is a national disgrace. The rules and policies that have been formulated to eradicate this problem
have not been implemented effectively and this is extremely shameful. In this research paper
the remedies that would have contributed to the eradication of hunger and malnutrition were
classified.
1. Universalize and ensure inclusion in all nutrition-related plans and policies with commitment
to universalization and quality for all.

7|Page
2. An impetus should be launched to gain quick access to the poorest people and expand the
Antiodaya scheme; this implies a special supply of standard and cutting-edge nutrition and care
for children suffering from severe malnutrition.
3. Decentralize service delivery, management and response so that the availability of food
through integrated child development services and the public distribution system benefits the
economically disadvantaged sectors of society and farmers.
4. Restructure integrated child development services to include children up to two years and
increase attention to pre-school education.
5. Community ownership of the management and monitoring of programs involving
Panchayati Raj institutions and other village level commissions should be encouraged and
participatory planning promoted.
6. Strengthen the focus on improving nutrition through a leadership and coordination
mechanism with appropriate authorities and responsibilities; this should work from the local to
the national level.
7. A program should be implemented that includes information on national food education and
behavioral change.
8. Women's emphasis should be emphasized, opportunities should be given to promote them;
have access to resources and tackle patriarchal socio-cultural problems affecting women.
9. Awareness of child feeding practices and the ability of voluntary social activists to be
accredited as Community ambassadors of women's rights should be promoted.
10. Attention to the nutritional needs of women and children should be expanded within
existing national programs.
Conclusion
The problem of malnutrition in the country is very serious and is especially frequent
and is present in a high percentage in rural areas than in urban areas. Malnutrition can occur
due to poverty, illiteracy, unemployment, financial problems and diseases. There have been
several signs and symptoms of malnutrition such as illness, infection, depression, apathy, low
weight, overweight, irritability, etc. In this research, emphasis was placed on the malnutrition
problems faced by women and children. Children are the future citizens of the country and the
percentage of undernourished children under three years has increased. The remedies must be
initiated properly to overcome the malnutrition problems within the country; Schemes,
policies, management and responses are essential to formulate to examine the area of
malnutrition. It is mandatory to carry out an investigation and then report the results on the
state of malnutrition in the country between people and their causes.
Since it has been established that malnutrition is prevalent among children and women in rural
areas than in urban areas, it is necessary that rural women are educated about healthy dietary
needs, micronutrients and all basic nutrients, such as proteins, vitamins, calcium, potassium,
carbohydrates, minerals and fats essential for growth and general development. A centre must
also be established to make the food available for free or at a minimal cost to the poorest, most
disadvantaged and economically weaker groups. These must be established in neighbouring

8|Page
places so that these people can easily access them and free themselves from the problem of
malnutrition and hunger.

9|Page
References
AIJAZ, R. (2017). Preventing Hunger and Malnutrition in India. Observer Research
Foundation, (182), 12. Retrieved from http://www.orfonline.org/research/preventing-
hunger-and-malnutrition-in-india/
Bhattacharya, P. (2017). What explains India’s high child malnutrition rates? Livemint.
Retrieved from http://www.livemint.com/Politics/MAbkHJ0jYZ1hu9G0obNXiK/What-
explains-Indias-high-child-malnutrition-rates.html
Faso, B. (2017). Malnutrition in India Statistics State Wise, 1–3.
Grover, Z., & Ee, L. C. (2009). Protein Energy Malnutrition. Pediatric Clinics of North
America, 56(5), 1055–+. https://doi.org/10.1016/j.pcl.2009.07.001
Grover, Z., & Ee, L. C. (2009). Protein Energy Malnutrition. Pediatric Clinics of North
America, 56(5), 1055–1068. https://doi.org/10.1016/j.pcl.2009.07.001
Index, L. H. (2017). Global Hunger Index. Retrieved from
http://www.globalhungerindex.org/pdf/en/2017.pdf
Novelo, G. (2016). What is Malnutrition? World Health Organization, (July).
Panagariya, A. (2013). Does India Really Suffer from Worse Child Malnutrition Than Sub-
Saharan Africa? Economic and Political Weekly, 48(18), 98–111. Retrieved from
http://www.epw.in/special-articles/does-india-really-suffer-worse-child-malnutrition-
sub-saharan-
africa.html%5Cnhttp://www.epw.in/system/files/pdf/2013_48/18/Does_India_Really_S
uffer_from_Worse_Child_Malnutrition_Than_SubSaharan_Africa.pdf
Public Distribution System. (2005), 2005.

10 | P a g e