The famous Kubler-Ross theory suggests five stages of grief. It starts from denial and arrives at acceptance through anger, bargaining and depression. That’s for individuals. What happens to a nation that is grieving hunger, as is apparent from the recently released Global Hunger Index 2021 in which India has slipped to the 101st position among 116 countries, placed behind Pakistan, Bangladesh and Nepal. The index places India at the “serious” level of hunger. This has been a consistent trend in recent years. India was ranked 102nd among 117 countries by the same index in 2019 and 94th out of 107 countries in 2020. The government seems to be in denial mode, questioning the methodology of such indexing. However, other indicators, internal and external, do show the state of hunger and its worsening situation in our country in recent years.
India produced 291.95 million tonnes of food grains in 2019-20, yet 69% of deaths of children under the age of five has been attributed to malnutrition by UNICEF in its State of the World’s Children report. The UNICEF study found that 8.8 lakh children in India below the age of five died prematurely in 2018. Of those, 69% died of malnutrition. Nearly 690 million people are undernourished, 144 million children suffer from stunting – a sign of chronic undernutrition. About 47 million children suffered from wasting in 2018, a sign of acute undernutrition, and 5.3 million children died before their fifth birthday, in many cases as a result of undernutrition. The Right to Food Campaign documented over 100 hunger related deaths from across the country between 2015 and 2019 based on media reports and fact-finding investigations. An October 2020 survey across 11 states conducted by Hunger Watch found that people are worse off in terms of quantity and quality of food consumed, compared to February 2020.
The fifth round of the National Family Health Survey (NFHS), though not yet out for all the states and Union Territories (UTs), tells a similar gloomy story. NFHS-5 factsheets for 22 states/ UTs show chronic undernutrition has increased in 13 states/UTs, whereas underweight has increased in 16 states/UTs. Around 51.4% of women in the reproductive age group (15-49 years) were anaemic, according to NFHS-4 (2015-16) data. This figure has not improved during NFHS-5, based on the data available for many states and UTs.
The NITI Aayog report card on sustainable development, where eradication of hunger is one of the prime goals, has a similar story to tell. Released in June 2021, the report highlighted the fact that 11 states, including the most populous ones, scored less than 50 out of 100 in reaching zero hunger.
The pandemic has threatened India’s food security landscape across all four indicators, viz. availability, access, utilisation and stability. It has in turn further intensified the existing problem of malnutrition among women and children. A group of volunteers maintained a database of deaths, unrelated to the virus, reported in the media for the period March-July 2020. The number of news reports are more than 700, listing more than 1,000 deaths across the country. The reasons include exhaustion, starvation, hunger, distress suicide, and so on. Several migrant labourers lost their lives on the road while walking back to their hometowns on empty stomachs during the first and very hastily implemented nation-wide lockdown. These incidents were well-documented in the media. In May 2020, a 60-year-old migrant died due to starvation and exhaustion after travelling from Maharashtra to Uttar Pradesh by foot. Later that month, a 40-year-old agricultural labourer starved to death while walking from Pune to his village in Parbhani district in Maharashtra. In Agra, a 5-year-old girl died due to starvation in August 2020. Belonging to the Jatavs community, she had not consumed any food except biscuits and water for days before she died.
The second wave of the pandemic and the resulting burdens of health expenditure as well as localised lockdowns have once again risked the livelihoods of many. Data from the Centre for Monitoring Indian Economy shows that nearly 17 million daily wage labourers and small traders, such as street vendors, lost employment in the month of May 2021 alone.
The current state of affairs in this context raises several questions. Even after 74 years of Independence why do the people of the country deserve to die of starvation or face the atrocities and the inhuman behaviour meted to them? Isn’t this the dreaded symbol of an eroding democracy?
Domestic or global, government or private, all credible sources of data show the precarious situation and poor performance of India in dealing with the problem of acute malnutrition. The UN’s State of Food Security and Nutrition in the World report shows that not only does India have the highest number of malnourished people at 189.2 million during 2017-19, but the rate of decline is rather slow. A sad irony given that India is the second largest food producer in the world.
Acute malnutrition is a complex socio-cultural problem that lies at the interplay of inequitable access to nutritious foods and health services, sub-optimal infant and young child feeding practices including breastfeeding, low maternal education, poor access to clean water and sanitation, poor hygiene practices, food insecurity and unpreparedness for emergencies. Analysis shows that global and national patterns hide inequalities within countries and communities, with vulnerable groups being most affected. Most people cannot access or afford a healthy diet for a productive life. Apart from indirect interventions, there is a need to directly focus on nutritional deficiencies and address them in a timely manner. A paradigm shift in food and nutrition security from the existing caloric consumption method to consumption of micronutrient and protein-rich food is an urgent need. At the same time, strengthening the four pillars, namely availability, access, utilisation and stability, through direct and indirect modes is crucial.
Once we go beyond denial and blame games, perhaps we can start thinking positively on how to work towards a hunger-free society. Existing institutions in the form of the Integrated Child Development Services (ICDS), which caters to children below the age of 6 as well as adolescent girls, lactating and pregnant mothers; the midday meal programmes in schools; the Public Distribution System (PDS); subsidised food canteens across states; and job guarantee schemes are rightly positioned to address hunger, and food and nutrition security. It is high time we bring nutrition focus to food instead of going by calorific terms.
A second hurdle in the form of food choice politics needs to be addressed where states seem to have more say. Vitamin B12, a vital nutrient, is found in eggs, fish, milk, yogurt, which are affordable and accessible. Eggs have already been introduced in many states; Odisha has piloted the inclusion of dried small fish in its ICDS programme. If the success of the white revolution across the states cannot be translated into provisioning of its products to where it is most needed, a welfare state needs to rethink its development strategy.
The rural job guarantee scheme is already in place to facilitate food access through employment and income, albeit the budget provisioning needs to be based on demand as provisioned in the Mahatma Gandhi National Rural Employment Guarantee Act. Hence, in most cases the existing institutions will suffice to address hunger and malnutrition. These institutions need expansion, refocus on nutrition and delivery. A focus on nutrition requires addition of numerous food items beyond carbohydrates. The employment and income guarantee programme can be further strengthened by increasing the number of working days and expansion to urban areas. Some states have already initiated subsidised food programmes in urban areas. These programmes need expansion and nutrition focus, and avoid possible positioning and stigmatisation of as only for the ‘poor’. This will address hunger needs not only for low-income groups but welcome anyone who is hungry. A large number of students, informal and gig workers, among others, can benefit from such programmes. All these provisions need to be assessed based on ‘quality of public service’ instead of just providing services.
While there are institutions, programmes and policies in place to address the acute problems of hunger and malnutrition, an intent to act on these issues is missing. Perhaps once we reach the state of acceptance, the already existing institutions and pathways will help achieve a hunger-free nation.
Amalendu Jyotishi is a Professor at the School of Development, Azim Premji University. He can be reached by e-mail: amalendu.jyotishi@apu.edu.in
Gummadi Sridevi is an Associate Professor at the School of Economics, University of Hyderabad. She can be reached by e-mail: gummadi645@gmail.com
Views expressed are the authors’ own.