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Hunger, Malnutrition And India’s Dismal Ranking On Global Hunger Index

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Two separate yet connected news reports dominated news space during October. While on the one hand, India hailed the Nobel Prize win of economist Abhijit Banerjee for his work on poverty alleviation, on the other hand, India was ranked a dismal 102nd on the Global Hunger Index, 2019. The paradox and irony of the two different news reports cannot be missed. The irony is that while we celebrate the achievement of a person of Indian origin on the subject of poverty, millions in India, especially children, continue to suffer from debilitating effects of hunger and malnourishment.

Hunger Index Report of the year 2019 was released recently by Welthungerhilfe, a German non-denominational and politically independent non-governmental aid agency. The report has been published since the last ten years in association with the International Food Policy Research Institute (IFPRI) in Washington. Hunger afflicts almost 821.6 million people worldwide as per its estimates, and nearly two billion people suffer from malnutrition worldwide.

Essentially, the Hunger Index measures the nutrition level of children on four parameters:

  1. Undernourishment: share of the population whose caloric intake is insufficient.
  2. Child Wasting: the share of children under the age of five who have low weight for their height, reflecting acute undernutrition.
  3. Child Stunting: the share of children under the age of five who have low height for their age, reflecting chronic undernutrition.
  4. Child Mortality: the mortality rate of children under the age of five (in part, a reflection of the fatal mix of inadequate nutrition and unhealthy environments).

The problem of hunger is complex, and various terms like malnutrition and undernourishment denote the wide variety of manifestation of the problem in different geopolitical settings. While hunger is linked to lack of calorie intake, undernutrition signifies a deficiency of proteins and vital minerals in the diet. Malnutrition is a condition defined by the World Health Organisation as deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.

Millions in India, especially children, continue to suffer from debilitating effects of hunger and malnourishment. Representative image via Getty

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). It is estimated that 2 in every 3 children die due to malnutrition in India. Goal Number Two of the UN Sustainable goals aims for Zero Hunger by 2030. India certainly projects a poor picture in indices and looks nowhere close to achieving the global goal.

What Is Wrong With India’s Report Card?

To understand what is wrong with India’s report card one needs to first ask, which section of the population is denied access to food, and does climate change also has a role to play in keeping people hungry? Simultaneously, it has to be understood what ails the policy decisions at the central and state level in India. The Global Hunger Report of 2019 underlines a crucial development that since the early 1990s, the number of extreme weather-related disasters, such as storms, droughts, fires, and floods has increased manifold. This has resulted in reduced yields of major crops and has contributed to food price hikes and income losses. As per the report finding, these disasters have disproportionately harmed low-income people and reduced their access to food.

The hunger scenario in India has been classified as ‘Serious’ in the Welthungerhilfe report. The tribal population in India continues to be severely experiencing undernutrition. The report identifies marginalization as one of the endemic causes of widespread hunger and lack of nutritional fortification among the poor and marginalized. According to a project finding of Welthungerhilfe, in India, girls, women, indigenous people and members of the lowest caste, so-called ‘untouchables’, are among the weakest in society and enjoy limited access to rights such as the right to food; they attend school less often and have worse access to medical care.

As per the Census report of 2011, India has a total of 104,545,716 scheduled tribes which constitute 8.6% of the total population. Malnutrition plagues a majority of the tribal population due to multiple reasons, but the proliferation of mining projects and erosion of forest and pastoral lands has led to a loss of sustainable ecosystems for tribes. Forests are a storehouse of flora and fauna, and they provide the tribal people with food naturally found and fulfil their nutritional need. Tribes used to and still do forage forest lands and live off on many edible roots, tubers and even insects, but widespread deforestation and climate change and ensuing malnutrition have now put their health at risk.

In India, as many as 303 insect species are consumed by tribal communities in 10 states. Khajuri Poka or Date Palm Worm is a delicacy in Odisha’s Rayagada district, inhabited by Khond and Sora tribes. Food and Agriculture Organization (FAO), a specialised agency of the United Nations notes that insects will play a significant role in providing food security for the ever-increasing population globally, that is slated to reach nine billion in the next three decades.

Several governmental initiatives in the form of Mid-Day Meal Scheme and Poshan Abhiyaan aim to remove dietary inequalities and address nutrition concerns of women and children. Mid Day Meal Scheme (MDM) is one of the single largest food provisioning programmes for school-going children in government schools across India, and it has produced positive results by bolstering child enrollment ratio in schools. Still, it is very much away from the idea of a wholesome meal, as several states deny serving of eggs and fruits, which compensate for lack of vital minerals and proteins due to archaic understanding of nutritional needs of growing children.

A mid-day meal being served at a government school. For representation only. Source: Getty

Sometime back, the High Court of Punjab and Haryana had passed strictures to the state of Punjab to ensure that wholesome food including bananas, eggs and milk should be made a part of mid-day meal. The government website of Education Department (Government of Punjab) informs us that on all school days of the week usually one Dal or seasonal vegetable accompanied with rice or chapatti (flattened bread) is served to children. In addition to this, only one sweetened rice dish (Kheer) is served on one of the days as a sweet dish. This type of menu lacks nutritional fortification as only a bare minimum kind of meal is served.

Angus Deaton, Nobel Laureate in Economic Sciences for the year 2015, has observed in this context that Malnutrition in India is not just related to calorie intake, but India’s dependence on a carbohydrate-based diet with low protein and fat content. Inadequate sanitation also increases in infection-borne deficiencies in nutrients.”

Recently, in West Bengal, an alarming matter came to light. It was reported after the visit of MP (Member of Parliament) Locket Chatterjee, that children in a Hooghly school were only served rice with salt as a mid-day meal. As the matter snowballed into a controversy, the West Bengal government sprung into action and has since revised the menu. The news report generated much debate on the issue of nutrition. The revised mid-day meal menu now includes fish and egg curry besides soybeans.

The problem is that there is variance among states with regard to the menu of a mid-day meal. Mid Day Meal Scheme website under the Ministry of HRD (Ministry of Human Resource Development) of Government of India, informs us that the government is pushing for kitchen gardens, and guidelines exist for keeping the cooking area in a school hygienic and clean. However, with regard to the quality and content of the menu, there is no uniformity.

It may be noted that under the MDM scheme, the centre provides 60% of the cost and the concerned state gives 40% of the cost. According to the available data, the cost of a meal per child in a school is ₹4.48 out of which the centre pays ₹2.69, and the state gives ₹1.79. There is a need to overhaul the mid-day meal entitlements for children by going beyond the watery dal and polished rice routine. Acquisition of new tanks and missiles can wait, and more money should be pumped to fulfill the nutritional needs of children across India.

Addressing Nutritional Deficiencies

The National Food Security Act, 2013, aims to achieve the objective of food security by providing affordable food grains to families living below the poverty line. In this way, the government seeks to achieve food security. The intent of the statute is laudable, but it still doesn’t take the fuller picture of nutritional challenge into account. The policy aim is to ensure the supply of minimum sustenance needs to the maximum number of people. In the process, the broader perspective to address the nutritional requirements, especially of children doesn’t receive the intended legislative push. The immediate concern remains to provide food grains, but only food grains do not satisfy nutritional needs.

The hunger scenario in India has been classified as ‘Serious’ in the Welthungerhilfe report. Image for representation only. Via Getty

Policy challenges, strictly speaking, are non-justiciable (not capable of being decided through the application of rigid legal principles) in courts of law, but the Supreme Court of India has time and again broadened the base of Article 21 of the Constitution of India, 1950. So, when the “Right to Food” was agitated before it, the court passed several interim orders and adopted a unique tool of appointing Court Commissioners to monitor and streamline the Public Distribution System of food grains.

In 2001, starvation deaths took place and victims were tribals and Dalits of Rajasthan, who bore the brunt of the third consecutive drought in the southeastern region of the state. Court-appointed commissioners reported back to court on implementation of its orders in the case of People’s Union of Civil Liberties vs. Union of India and others, (Civil Writ Petition 196 of 2001). The approach of the apex court was widely praised. Lessons from this case need to be replicated.

Civil servants, S.R. Sankaran and N.C. Saxena were appointed as food commissioners in this now-famous case and were tasked to investigate and report a violation of interim measures. Harsh Mander, a noted social activist and ex-bureaucrat took over from Sankaran after his retirement. The case has now ended as the apex court bench headed by Justice Madan B. Lokur observed in the year 2017 that with the passage of the National Food Security Act, 2013, nothing substantial survives in the petition.

On the face of it, this is a scenario where courts seemingly tread into the executive terrain, but the fact remains that when rampant corruption eats away at the Public Distribution System (PDS), the judicial intervention appears to be the only hope. It is a trite law that India in the twenty-first century is well beyond its Marie Antoinette moment—as severe uncontrollable famines or starvation deaths should now be a thing of the past.

A meal should be a complete meal. Our approach should now be not to feed more numbers. A radical shift in policy is required, which gives primacy to nutritional requirements as well. There is a glaring problem of non-implementation of the mandate of the National Food Security Act, 2013. Under Section 4(b) of the Act, a pregnant or lactating woman is entitled to ₹6000 as nutritional support incentive. It has been revealed in many places that these benefits never reach the intended beneficiaries.

The Supreme Court of India recently suggested that community kitchens may be set up to solve the widespread ‘hunger problem’. This venture may be funded by the state or with corporate social responsibility in partnership under the model of  public-private partnership (PPP). But is it enough to have only the bellies filled? The answer is No. Malnutrition is the reason behind 69% of deaths of children in India. The situation is serious and calls for policy changes.

We are running out of time. Queen Marie Antoinette of France, indifferent to the plight of starving millions, had remarked, “Qu’ils mangent de la brioche” (Let them eat cake). Even though basic sustenance is by and large a reality in India, nutritional challenges remain. No government can afford to ignore the real and live issue by only silencing hunger pangs of people; it is obliged to feed people well enough to live a full and dignified life. Food security, in a complete sense, is the need of the hour. Unless a radical shift in policy approach doesn’t come through, we will continue to stare at embarrassing statistical graphs and indices.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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