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12:00 pm IST I Aug 21, 2013
By Shailey Hingorani and Allison Hutchings
At a conference in April, India’s Food Minister K.V. Thomas said the country would be known the world over for taking an important step toward eradicating hunger, malnutrition and poverty. He was referring to the National Food Security Bill, which aims to provide very cheap grains to around 70% of the population.
Despite the unprecedented scale of the bill’s agenda, it feels stale.
It is an amalgamation and continuation of previous nutrition and food distribution programs in India, including the Integrated Child Development Services, which was launched in 1974 to provide supplementary nutrition to children up to the age of six. There is also the midday meal program, which came into the spotlight in June when 23 schoolchildren in Bihar died after eating a contaminated lunch.
By focusing on food intake alone, these programs have failed to adequately address malnutrition in India. They do little to address children’s different nutritional needs, which vary according to age and gender. Malnutrition is a complex condition with many drivers. Malnourished children need a holistic set of solutions, not just more food.
Nutrition indicators for Indian children under five are dismal. Nearly 43% are underweight, 70% are anemic, and 57% are vitamin A deficient, the World Bank says. These deficits at the start of life continue through adolescence and ultimately compromise health and productivity throughout an individual’s lifetime.
The Food Security Bill, which has been passed by the ruling Congress party as an ordinance and is due to be voted into law during the ongoing session of Parliament, ignores new approaches to tackling malnutrition and instead relies too heavily on the ICDS to meet all the nutritional requirements of children up to the age of six.
The ICDS provides free, age-appropriate meals to children through its anganwadi centers across the country. The World Health Organization says malnutrition encompasses poor feeding practices like inadequate breastfeeding, and persistent infections like diarrhea, which rob children of nutrients. But the ICDS works on the assumption that lack of adequate food intake is the primary driver of malnutrition.
Marginalized groups such as street children and child laborers, who tend to be the most malnourished, are also largely excluded from the ICDS because of its poor targeting of the most vulnerable. The Food Security Bill doesn’t address where this group will source its main nutrition from or how access to healthcare facilities will improve.
Simply distributing food doesn’t ensure that it will get to those who need it most, nor does it ward off infections that preclude children from absorbing the food’s nutrients.
The ICDS also hasn’t been universalized. A Planning Commission report on the ICDS in 2011 found that only half of the children eligible for the program were enrolled in anganwadi centers. The ICDS hasn’t covered as many children as intended.
Instead of addressing shortcomings in existing programs or incorporating successful initiatives like Community Management of Acute Malnutrition, the Food Security Bill uncritically adopts the ICDS and tasks it with eradicating hunger and malnutrition.
CMAM uses community health workers to identify and treat malnourished children. It is a low-cost initiative endorsed both by Unicef and the WHO in 2007. Save the Children tests in Bangladesh in 2010 found that more than 90% of children suffering from severe acute malnutrition in a treatment group recovered as a result of being correctly diagnosed and treated by community health workers.
Establishing a relationship between communities and health workers, creating watch lists of sick children, detecting illness early and using cost-effective high quality care are important policy insights to be drawn from this experience.
The ICDS shouldn’t be the primary vehicle through which malnutrition is addressed in India. But the government, eager to get support as the general election approaches, is trying to push through a populist legislation. It is unlikely to change the status quo.
Solely focusing on increasing food intake has done little to improve the nutritional status of children in India. In its current state, the Food Security Bill will be a whole lot of grain without a whole lot of gain.
Shailey Hingorani is a Fulbright scholar at the Harvard Kennedy School of Government and can be followed on Twitter @burntcognac. Allison Hutchings is a Boston-based social policy researcher. This post reflects their personal views.