Abstract
In 2015–16 some 38% of preschool children in India were stunted, 21% wasted, and more than half of Indian mothers and young children were anemic. Though widely studied, surprisingly little research on malnutrition in India explores the role of diets, particularly the affordability of nutritious diets given low wages and the significant structural problems facing India’s agricultural sector. To explore this we used nationally representative rural price and wage data to estimate the least cost means of satisfying India’s national dietary guidelines, referred to as the Cost of a Recommended Diet (CoRD), and assessed the affordability of this diet relative to male and female wages for unskilled laborers. Although we find that dietary costs have increased substantially for both men and women, rural wage rates increased more rapidly, implying that nutritious diets became substantially more affordable over time. However, in absolute terms nutritious diets in 2011 were still expensive relative to unskilled wages, constituting approximately 80–90% of female and 50–60% of male daily wages. Overall, we estimate that 63–76% of the rural poor could not afford a recommended diet in 2011. Achieving nutritional security in India requires a much more holistic focus on improving the affordability of the full range of nutritious food groups (not just cereals), a reappraisal of social protection schemes in light of the cost of more complete nutrition, ensuring that economic growth results in sustained income growth for the poor, and more timely and transparent monitoring of food prices, incomes and dietary costs.
Highlights
India performs exceptionally poorly on a wide range of undernutrition indicators, exhibiting high rates of stunting (38%), wasting (21%) and anemia (58%) among preschoolers, and underweight (23%) and anemia (53%) among adult women (IIPS, 2015)
While some research has explored the importance of child feeding practices in reducing morbidity and improving nutrition outcomes (Dewey, 2016; Menon, Headey, Avula, & Nguyen, 2018; Paintal & Aguayo, 2016), few have focused on the broader importance of diet quality, especially for women’s nutrition, and even fewer have discussed the cost of nutritious diets
Since national-level numbers hide a lot of variation in a country as large and diverse as India, we investigate trends in the rate of growth of state-level averages of Cost of a Recommended Diet (CoRD)/unskilled wage ratios for men and women over 2001-2011, the first and last years in our data (Figures 3 and A.2, Table A.3)
Summary
India performs exceptionally poorly on a wide range of undernutrition indicators, exhibiting high rates of stunting (38%), wasting (21%) and anemia (58%) among preschoolers, and underweight (23%) and anemia (53%) among adult women (IIPS, 2015). High prevalence rates combined with a large population mean that India is the single largest contributor to maternal and child undernutrition world-wide. In recognition of these problems, the current Indian government has invested considerable resources in a national nutrition strategy, including the 2019 launch of the multi-ministry flagship initiative called the Poshan Abhiyaan (which roughly translates to ‘nutrition mission’), the official stated goal of which is a malnutrition-free India by 2022. A complex set of factors affect nutritional status (UNICEF, 1990) These range from ‘basic’ causes (such as resource availability, political climate) to ‘underlying’ causes (inadequate access to food, care and health services, and an unhealthy environment), to ‘immediate’ causes (inadequate dietary intake and morbidity or disease). Explanations have tended to focus more on ‘underlying’ and ‘basic’ causes such as poor sanitation and hygiene, household income or socioeconomic status, household shocks or disaster events, and low levels of women’s education and empowerment, among others (Aguayo, Nair, Badgaiyan, & Krishna, 2016; Bhagowalia, Kadiyala, & Headey, 2012; Cavatorta, Shankar, & Flores-Martinez, 2015; Chambers & Medeazza, 2013; Coffey, Deaton, Drèze, Spears, & Tarozzi, 2013; Corsi, Mejía-Guevara, & Subramanian, 2016; Datar, Liu, Linnemayr, & Stecher, 2014; Fenske, Burns, Hothorn, & Rehfuess, 2013; Headey, Hoddinott, & Park, 2016; Joe, Rajaram, & Subramanian, 2016; Vir, 2016)
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