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Malnutrition in India: Growing concern
Friday, 05 May, 2023, 08 : 00 AM [IST]
Bhawna Malik & Rekha Chawla
Malnutrition has been a major public health issue in India for decades, affecting a large percentage of the population. Despite India’s rapid economic growth and the country’s efforts to improve nutrition, millions of people in India are still suffering from malnutrition, particularly among children and women.

Malnutrition is a complex issue that results from a combination of factors, including poverty, limited access to healthcare and education, inadequate food supply, and poor sanitation and hygiene practices. According to a report by the Global Hunger Index (GHI) 2022, India ranks 107th out of 121 countries in terms of hunger and malnutrition. This highlights the urgent need for a comprehensive approach to tackle this issue.

According to the World Health Organization (WHO), India is home to the largest number of malnourished children in the world, with approximately 50 per cent of children under the age of five suffering from malnutrition. This high prevalence of malnutrition has significant implications for the health and development of India's population, as malnourished individuals are more susceptible to disease, have lower cognitive function, and are less likely to perform well in school or in the workforce.

There are several different types of malnutrition, including undernutrition, micronutrient deficiencies, and overweight and obesity. Undernutrition refers to a lack of sufficient nutrients, such as protein, vitamins, and minerals, which can lead to stunted growth, and other health problems.

Micronutrient deficiencies, also known as "hidden hunger," occur when individuals do not consume enough essential vitamins and minerals, which can lead to a range of health issues, including anemia, blindness, and impaired cognitive function. Overweight and obesity, on the other hand, result from excessive consumption of calories and can increase the risk of chronic diseases such as diabetes and heart disease.

Overall, malnutrition remains a significant challenge in India, with far-reaching implications for the health and well-being of the country's population. Addressing this issue will require a multifaceted approach that addresses the root causes of malnutrition, improves access to healthcare and education, and promotes healthier behaviours and lifestyles.

Causes of Malnutrition typically in India
The causes of malnutrition in India are complex and multifaceted, resulting from a combination of economic, social, and environmental factors, including poverty, lack of education, inadequate healthcare facilities, inadequate sanitation, and poor dietary practice. In this article, authors have tried pouring light on some of the key causes of malnutrition in India.
  1. Poverty and Income Inequality: Scarcity of money or monetary issues is a major contributing factor to malnutrition in India wherein many families in India struggle to afford nutritious food and often have to rely on low-quality, calorie-dense foods to meet their nutritional needs. High levels of income inequality exacerbate this problem, as the poorest households are often the most food-insecure.
  2. Limited Access to Healthcare and Education: This is another significant cause of malnutrition in India. Children who do not receive proper healthcare and immunizations are more likely to suffer from illnesses that can lead to malnutrition. On top of this, lack of education further contributes to malnutrition, as families may not have the knowledge and resources to provide their children with a balanced diet.
  3. Inadequate Food Supply and Distribution: Food shortages and price spikes, particularly in rural areas are key factors to further worsen this situation. Furthermore, many farmers in India struggle to grow enough crops to meet their needs, and food is often wasted during transportation and storage due to lack of required supply chain and post-harvest managerial issues. This problem is compounded by the lack of access to cold chain and other storage facilities in rural areas.
  4. Poor Sanitation and Hygiene:  Lack of access to clean water and sanitation facilities also has been found to lead to the spread of diseases particularly amongst young children. Children who are frequently sick or immune to diseases are more likely to suffer from malnutrition.
  5. Cultural Beliefs and Practices: This also contribute to malnutrition in India wherein traditional beliefs and carry forward rituals have beliefs system that certain foods are not appropriate for children or pregnant women, leading to restricted diets. Gender discrimination also play a role, as girls and women are often given less food and are more likely to suffer from malnutrition.
Effects of Malnutrition on Health
The effects of malnutrition are severe, especially in children. Children who suffer from malnutrition may experience stunted growth, delayed cognitive development, and weakened immune systems. Malnourished children are more susceptible to illnesses such as diarrhea, pneumonia, and malaria. They may also be more vulnerable to infections and diseases, which can have long-term effects on their overall health. Malnutrition also affects the development of vital organs such as the brain, leading to irreversible damage (Borkent et al., 2023).

Adults who suffer from malnutrition may also experience a range of health problems. For example, they may be more prone to infections, have weakened muscles, and experience fatigue and weakness. Malnutrition can also lead to anemia, which can cause weakness, dizziness, and shortness of breath. In severe cases, malnutrition can lead to organ failure, which can be fatal. In addition, malnutrition during pregnancy can lead to low birth weight, which is a significant risk factor for neonatal and infant mortality (Kumar, 2022).

Another effect of malnutrition is the increased risk of chronic diseases such as heart disease, diabetes, and cancer. This is because malnutrition can lead to an imbalance of nutrients in the body, which can affect the body's ability to regulate blood sugar levels, cholesterol, and blood pressure. Over long periods of time, this can increase the risk of developing these chronic diseases.

This also have psychological effects on an individual leading to depression, anxiety, and other mental health problems. The underlying reason could be production of neurotransmitters in the brain, which can lead to mood disturbances and other psychological symptoms. Henceforth, it is essential to address the underlying causes of malnutrition and provide individuals with access to nutritious foods and proper medical care to prevent and treat malnutrition.

Efforts to Combat Malnutrition in India
To address above-mentioned points, few solutions could help to tackle malnutrition in India.
  1. Address poverty: Addressing poverty through economic growth, employment generation, and social welfare programs can help reduce malnutrition. Another major breakthrough in this could be via skill development program which not only prepares youth for the budding entrepreneurship but also creates job opportunities for others.
  2. Looking at health priorities: Breastfeeding is critical to the health and well-being of children and can help reduce malnutrition. Also, access to clean water and sanitation facilities can lead to the prevention of spread of diseases that contribute to malnutrition. Additionally, improving maternal and child health can help reduce malnutrition by ensuring that mothers and children receive adequate nutrition, care, and support.
  3. Enhance food security: Increasing food security by improving food availability, accessibility, and affordability can help reduce malnutrition. This can be achieved through various measures such as improving agricultural productivity, ensuring food distribution systems, and providing food subsidies to vulnerable groups. Encouraging dietary diversity is another cofactor by promoting the consumption of a wide range of foods which can help address micronutrient deficiencies especially amongst vulnerable strata.
  4. Implementation and follow-ups of nutrition-sensitive programs: Implementing nutrition-sensitive programs such as the provision of fortified foods, nutrition education, and health services can help improve nutrition outcomes. However, this not only stands with a single thought of mere implementation but also stringent follows ups are required to fill the gaps of the programme.  
  5. Strengthen governance and accountability: Strengthening governance and accountability in the health and nutrition sectors can help ensure that policies, programs, and resources are directed towards addressing malnutrition effectively.
Therefore, it is essential to adopt a multi-sectoral approach to tackle malnutrition in India, involving various stakeholders such as government, civil society, private sector, and communities.

To address this issue, the Indian government has implemented various schemes and programs aimed at reducing malnutrition. Some of these schemes include:
  1. Integrated Child Development Services (ICDS): The ICDS is a government program that provides food, healthcare, and education services to children under the age of six and pregnant and lactating mothers. The program also offers growth monitoring and nutritional counselling services to address malnutrition.
  2. Mid-Day Meal Scheme (MDMS): The MDMS is a school feeding program that provides free meals to children in Government schools. The program aims to improve the nutritional status of children and encourage school attendance and retention.
  3. National Health Mission (NHM): The NHM is a government program that aims to improve the availability, accessibility, and quality of healthcare services in India, which was launched in 2018. The mission aims to reduce stunting, underweight, and low birth weight by 2, 2, and 3 % per annum, respectively. It also focuses on strengthening the nutrition-related interventions, converging them for better outcomes, and ensuring an enabling environment for effective service delivery. The program includes initiatives to prevent and treat malnutrition, such as the provision of iron and folic acid supplements and the promotion of exclusive breastfeeding.
  4. Pradhan Mantri Matru Vandana Yojana (PMMVY): The PMMVY is a government program that provides financial assistance to pregnant and lactating women to support their health and nutrition needs. The program aims to reduce maternal and child malnutrition and improve maternal and child health outcomes.
  5. National Nutrition Mission (NNM): The NNM is a government program launched in 2018 to address malnutrition in India. The program aims to reduce stunting, undernutrition, and anaemia in children, adolescents, and pregnant and lactating women through a range of interventions, including community-based monitoring and awareness-raising activities.
Apart from government efforts, non-governmental organizations (NGOs) and civil society organizations (CSOs) are also actively working tirelessly towards addressing malnutrition in India. These organizations work with a mandate to work towards increasing awareness about nutrition and promoting behaviour change, providing nutrition education and counselling, and distributing supplementary nutrition to vulnerable populations.

However, other than these strategies to overcome malnutrition, another method is fortification of food with nutrients. Food fortification is an effective strategy to address malnutrition in India. It involves adding essential vitamins and minerals to commonly consumed foods such as rice, wheat flour, salt, and cooking oil, to increase their nutritional value. This can help ensure that people receive essential nutrients that are lacking in their diets.

Some of the benefits of food fortification include:
  1. Cost-effective: Food fortification is a cost-effective strategy to address malnutrition as it does not require significant changes in food habits, and the cost of fortification is relatively low.
  2. Widely accepted: Fortified foods are widely accepted and consumed by people, making it an easy way to reach a large population.
  3. Improves nutritional status: Food fortification can help improve the nutritional status of vulnerable populations such as pregnant and lactating women, children, and the elderly.
  4. Reduces health risks: Fortifying foods with essential vitamins and minerals can help reducing the risk of various health problems such as anaemia, blindness, and neural tube defects.
  5. Easy to implement: Food fortification is relatively easy to implement as it requires minimal changes in the existing food production and distribution systems.
The following are some examples of fortified foods available in India:
  • Fortified Rice
  • Fortified Wheat Flour
  • Fortified Salt (single or double fortified)
  • Fortified Milk
  • Fortified Cooking Oil
  • Fortified Cereals
In India, the government has launched various initiatives to promote the fortification of foods. For example, the Food Safety and Standards Authority of India (FSSAI), has made it mandatory to fortify salt with iodine, and the government has launched the National Iron Plus Initiative to promote the fortification of foods with iron and folic acid. Thus, fortified foods are a cost-effective and sustainable solution to address malnutrition in India. However, it is essential to ensure that the fortified foods are accessible and affordable to all, especially to vulnerable populations such as children and pregnant women. While food fortification is a promising strategy to address malnutrition, it should be implemented alongside other measures such as improving food security, promoting dietary diversity, and strengthening health and nutrition services to ensure a comprehensive approach to addressing malnutrition.

While progress has been made in recent years, there is still a long way to go to ensure that all Indians have access to the food, healthcare, and support they need to live healthy and productive lives.

Malnutrition remains a significant challenge for India, and concerted efforts are required to address this issue effectively. While the government and other stakeholders have taken several initiatives, there is a need for sustained efforts to ensure that every individual has access to adequate nutrition and health care. Promoting awareness about nutrition and health, providing access to clean water, sanitation, and healthcare facilities, and promoting a balanced and nutritious diet (rainbow diet) are essential for reducing malnutrition in India. With the appropriate interventions and policies, malnutrition can be combatted and wonderful results could be achieved.

(Malik is Ph.D student -Dairy Technology, College of Dairy Science
and Technology Guru Angad Dev Veterinary and
Animal Sciences University; Chawla is assistant professor - Dairy Technology, College of Dairy Science and Technology Guru Angad Dev Veterinary and Animal Sciences University)
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