The Hindu Business Line : Nutrition security under increasing threat

Despite rapid economic growth, the nutritional status of our population appears to be worsening according to some important indicators. In this edition of Macroscan, C.P. Chandrasekhar and Jayati Ghosh examine the evidence on nutrition from the latest National Family Health Survey.

The National Family Health Surveys (NFHS) are extremely useful indicators of many basic conditions of life and health among our population. Two such surveys were conducted in the previous decade, in 1996-97 and 1998-99. The latest survey, hereafter NFHS-3, was conducted over 2005-06 and covered all 29 States.

The good, bad news

The results of these surveys give important insights into the health and nutrition conditions in the States. These provide both good and bad news. The good news is that fertility rates continue to decline, and the mean age at marriage for women continues to increase, albeit slowly (it is currently 19.4 years). More couples use modern family planning methods. Infant mortality rates also continue to fall, and the rural-urban gap in infant mortality is also coming down.

However, there are other areas that reveal major problems, in both public health and nutrition. One striking failure of public health systems comes out in the evidence on immunisation. The percentage of children in the age group 12-23 months who have been fully immunised (by receiving vaccines for BCG, measles, and three doses each of polio/DPT) has gone up very slightly, and is still only 43.5 per cent. That means more than half of our children still do not receive full immunisation and are therefore prey to completely eradicable diseases.

What is even more shocking is that is some States, including the more “developed” ones of Maharashtra, Gujarat and Punjab, the immunisation coverage rate has actually fallen since the previous Survey!

In both Punjab and Maharashtra the decline has been quite sharp, from 78 and 72 per cent to around 60 per cent. In some other more backward States too, the rate of immunisation has declined, suggesting a worsening of the most basic public health provision rather than an improvement.

Nutritional status

However, the real concerns arising out of this latest NFHS report come from the information on trends in nutritional status. Remember that this period is supposed to be one of economic boom, the period when the Indian economy (and therefore presumably Indians) have never had it so good.

Aggregate GDP growth rates have been around 8 per cent on average and per capita GDP has increased by around 6 per cent per year. In this “take-off phase” it would be normal to expect that calorie consumption and nutritional indicators would show some improvements, even if not dramatic improvements, at least substantial.

But already the data from the National Sample Survey Rounds on consumption expenditure had told us that per capita calorie consumption, far from rising, has actually decreased, even for the poorest groups. Per capita foodgrains consumption declined from 476 gm per day in 1990 to only 418 gm in 2001, and even aggregate calorific consumption per capita declined from just over 2200 calories per day in 1987-88 to around 2150 in 1999-2000. The latest NSS survey suggests further declines in calorie consumption.

This cannot be entirely a sign of people moving towards different (and qualitatively better) consumption patterns through different food choices, as some analysts have argued. Instead, it is more likely to reflect shifts in wage incomes, relative prices and increasing costs of health and other essentials, that have reduced the ability of households to spend more on food.

The worst aspect is that this is happening in a context of already very poor standards of nutrition on average. The NFHS-3 provides some depressing reminders of the low and, in some cases, worsening nutrition status of most of our citizens, especially the young.

Take the proportion of children below three years of age who are underweight. Chart 1 shows that this indicator shows very little improvement, especially when compared to the 1996-97 survey. And in any case, the proportion of underweight children remains appallingly high at 46 per cent for the country as a whole.

It is predictably higher in the more economically backward States, such as Madhya Pradesh with 60 per cent, Bihar with 58 per cent, Jharkhand with 59 per cent and Chhattisgarh with 52 per cent. What is worth noting is that in several of these States, the proportion of children actually increased between 1996-97 and 2005-06. In Bihar it went up from 54 to 58 per cent; in Jharkhand the increase was from 54 to 59 per cent.

However, such a degeneration was not confined to the poorer and more backward States, from where we have got inured to hearing bad news. It happened also in some of the more prosperous States. Thus, in Gujarat, which is one of the richest States and has shown one of the highest rates of economic growth over this period, the proportion of underweight children also increased slightly even between NFHS-2 and NFHS-3, from 45 to 47 per cent.

Anaemia alarming

The statistics on anaemia are even worse, as Chart 2 indicates. Not only are the data on the prevalence of anaemia alarmingly high, but they have actually got significantly worse since the mid-1990s. In the latest survey, nearly four out of five children in the age group 6-35 months had anaemia, while nearly three out of every five ever-married women and pregnant women also were anaemic. The prevalence of severe anaemia also remains high.

Data on anaemia provide some evidence of the quality of nutrition, and therefore address the point that some analysts try to make about calorie consumption or even weight for age/height not being correct indicators. If even anaemia is on the increase in the country as a whole, especially among vulnerable categories such as children and pregnant women, we must have serious concerns about the inadequate nutrition we are providing our citizens.

There is an evident gender gap in operation here as well: for adults, while anaemia is high among both sexes, it is very high among women, with the prevalence of anaemia among women more than double that among men in almost all States. Once again, the States with the highest levels of anaemia among the population have also shown more increases in this indicator. For example, in Bihar, child anaemia has increased from 71 per cent to 83 per cent, and that among ever-married women from 49 per cent to 58 per cent. In Uttar Pradesh, it has increased from 74 per cent to 85 per cent.

However, some States such as Jharkhand, West Bengal and others do show a decline in this indicator.

Except in some States such as Punjab, the share of underweight women is also very high, with the national average at 33 per cent. In rural areas this proportion increases to 39 per cent.

It has been evident for some time now that concerns about food security are not relics of the past, but unfortunately only too contemporary.

Such a concern should now be extended to cover nutrition security, which seems to be even more under threat. The results of the latest NFHS should certainly cause alarm bells on the state of public nutrition to ring very loudly in the corridors of power.