Two reports released on Thursday, The Global Nutrition Report (GNR) and India Health Report on Nutrition, 2015 (IHR), offer a critical analysis of the state of nutrition in India.
The first report, the India Health Report: Nutrition 2015(IHR), provides easy-to-understand, State-wise data dashboards that give a comprehensive view of nutrition and its determinants. It looks at disparities in these outcomes and their multiple determinants across geographical regions, socio-economic classes, and demographic groups to help identify strategic choices for policy-making at the State level.
Two other things, both related to inequality, stand out as well in the data. First, the data point to tremendous variability across States in delivering what should be universal, rights-based and already mandated health and nutrition services. For example, sample this for intra-State disparity. Food provided by the Integrated Child Development Services reaches barely 1 in 5 children in Uttar Pradesh but over 90 per cent in Odisha. Less than 33 per cent of children in Nagaland are fully immunised; in Goa, it is more than 90 per cent. Close to 80 per cent defecate in the open in Odisha; barely 2 per cent do so in Kerala. Why?
These are disparities across States that operate in the same national framework, and there is, let’s face it, no good reason for this other than an inability or an unwillingness to invest in changing ground realities, for everyone and everywhere.
This is not an insurmountable challenge and it’s certainly an area where States can, if they want it, make dramatic change in short timeframes. Examples abound from within India. The data in the reports show that, clearly, the imperative for introspection, and looking within for solutions was never clearer. No child should go without basic health care, food security and things like water and a toilet. Indeed, no adult should either. No society should condone such inequalities in the basics. And no society has progressed without addressing these basics.
As with all statistics, the devil is in the detail. The most telling part is that the condition of girls and women, without any intra-State variability, is a depressing reality across the country. More than half of women are anaemic. Levels of attained education are low for most Indian women, with only a few States doing well enough to have more than 50 per cent of their women with 10 years of schooling. This is barely the level of education that would enable them to participate in meaningful employment and be a part of India’s growth story. Even worse, in 2014, the proportion of young women (20-24 years) married before they were 18, is as high as 1 in 2 in some States and 1 in 3 in many other States, including parts of the South.
The relationship between age at marriage of mothers, and undernutrition among their children is clean and clear. Early marriage is a clear predictor for poor nutritional outcomes. What incites families to to give their daughters away in marriage at an age when they should be invested in, to build their skills, and strengthen their bodies and minds to engage with an emerging economy? What prevents societal investment in the well-being of girls when it is so clear that this is an investment in the future of society?
When Professor Ramalingaswami and colleagues wrote about the Asian Enigma in nutrition in India back in the early 1990s, they pointed to the same issues; that the status of women in Indian society is a major driver of differences in nutritional outcomes in comparison to other regions of the world. Sadly, little has changed in some of the worst places in the world and in which to be born a girl. Our analyses and insights lead to the same conclusions. The real question, therefore, is this: will it take another 20 years for the penny to drop? How long will society have to wait? And, how many children’s lives will be stunted because we keep forgetting to shore up investments in girls?
There is but one solution to this conundrum of girls and women at this point in time. Invest in our girls. Everywhere. Across India. They deserve it. Their children deserve it. And, India’s economy does too.
(Purnima Menon is senior research fellow, International Food Policy Research Institute, and Neha Raykar is lead economist, Public Health Foundation of India.)