Food and Nutrition Security Analysis

The Ministry of Statistics and Programme Implementation (MoSPI) and World Food Programme have jointly released the Food and Nutrition Security Analysis, India, 2019 report that analyses the available food and nutrition security information in India.

Foodgrains availability in India

Production: Over the last 20 years, total food grain production in India increased from 198 million tonnes to 269 million tonnes. Wheat and rice are the staple foods of Indians and are a major portion of food grain production, constituting around 75 percent of the total food grain production and thus serving as a Food and Nutrition Security Analysis, India major source of income and employment to millions of people. The state of Uttar Pradesh leads in the production of wheat, cereals and Foodgrains, closely followed by Punjab and Madhya Pradesh. West Bengal is the ‘rice bowl’ of India, followed by Uttar Pradesh, Punjab and Bihar.

Net Availability: Since 1996, the per capita net availability of foodgrains has increased from 475 to 484 gm/day in 2018, while per capita availability of pulses has increased from 33 to 55 gm/capita/day. Although there has been a huge increase in production of rice, wheat and other cereals, their per capita net availability has not increased at the same level, due to population growth, food wastage and losses, and exports.

Production Trends: Between 1996-99 and 2015-18, the annual growth rate for food grains was 1.6 percent. The growth rate is highest for maize (5.9 percent) followed by pulses (2.4 percent), wheat (1.8 percent), cereals (1.6 percent), rice (1.4 percent) and bajra (0.9 percent) during 1996-99 to 16-18. Conversely, the annual growth rates have declined for jowar (-2.26 percent), small milllets (-1.71 percent) and ragi (-1.21 percent).

Farm Productivity: Though yields in food grains have increased by 33 percent in last two decades, it has been far less than desired. As per the SDG India baseline report (2018) by Niti Aayog, a target has been set for India to achieve yields of 5,018 kg/ hectare for rice, wheat and coarse grains by 2030, compared to the present combined yield of 2,509 kg/ hectare. While no state or Union Territory (UT) in India has achieved this target yet, the UT of Chandigarh is nearing the targeted productivity with current levels at 4,600 kg/ hectare, followed by yields of 4,297 kg/ hectare in Punjab.

Access to Nutritious Food

Food Expenditure: According to Engel's law, the share of income spent on food decreases, even as total food expenditure rises. A higher share of total monthly expenditure for food shows lower purchasing power and is related to food access, so it is a relative measure of food insecurity. On average, people of India allocate about 49 percent of their monthly expenditure on food in rural areas and 39 percent in urban areas. The share of food expenditure is highest among the poorest (lowest 30 percent) expenditure group. In rural and urban areas, the poorest 30 percent spend as much as 60 percent and 55 percent respectively, on food.

Food Expenditure Trends: Between 1972- 73 and 2011-12, the share of expenditure on food has decreased around 33 percent in rural areas and 40 percent in urban areas whereas non-food expenditure have increased during the same period. Between 2004-05 to 2011-12, among the poorest, the share of expenditure on food has declined by 9 percent in rural and 8 percent in urban areas of India. Declining trends suggest that incomes have increased in both rural and urban areas and that food is no longer the only predominant expenditure head for the people.

Food Consumption Pattern: In the food basket, it turns out that in both urban and rural areas, the share of expenditure on cereal and cereal substitutes has declined between 1972-73 and 2011-12, from 57 percent to 25 percent in in rural areas and from 36 percent to 19 percent in urban areas. For the same period, the relative importance of some items especially beverages, ‘milk and milk products’ and ‘fruits and nuts’ has shown a remarkable increase, indicating an increased diversity in consumption in the country. In the food basket, the energy and protein intake from cereals has decreased in both rural and urban India, largely because of increased consumption of other food items such as milk and dairy products, oils and fat and the foods evolved due to changing food pattern such as fast food, processed food, and sugary beverages.

Notably, the consumption of unhealthy energy and protein sources is much higher in urban areas. This has most likely contributed to the emerging problem of obesity in India.

Nutritional Intake: Between 1983 to 2011- 12, the average daily per capita consumption of both energy and protein decreased in rural India while in urban areas, there was no consistent trend. This decline has happened despite the increase in household income. For energy consumption alone, the trend suggests that despite increases since 1983, the overall energy intake is marginally lower than the minimum requirement. For protein intake, despite the declining trends, per capita consumption in both rural and urban areas is higher than the minimum daily requirement. However fat intake has increased steadily since 1983 and is much higher than the minimum daily requirement.

Nutritional Intake Among the Poor: Among the lowest 30 percent of the expenditure/ income class, the average per capita consumption of energy in rural area is 1811 kcal/day which is much lower than the Indian Council of Medical Research (ICMR) norm of 2,155 kcal/day. For protein, it is 47.5 grams/ day compared to 48 grams/day norm while for fat it is 28 grams/day which is the same as the ICMR norm for rural India. For urban areas, per capita intake of energy is 1,745 kcal/day compared to 2,090/day norm from ICMR.

For protein it is 47 grams/day compared to a norm of 50 grams/day and for fat it is 35 grams/day compared to the norm of 26 grams/day. The current intake level of nutrients such as the energy and protein were lower than the all-India average and the daily minimum consumption requirement.

Only fat intake in rural and urban areas was at par or more than the daily minimum consumption requirement.

Public Distribution Public Distribution System (PDS) and Nutritional Intake: The Targeted Public Distribution System (TPDS) has provided a critical nutritional supplement to the people across all states in India. During 2011-12, the average per capita supplementation of energy from PDS was 453 kcal/day in rural areas and 159 kcal/day in urban India. In terms of protein, the supplementation through PDS has averaged 7.2 grams/day in rural areas and 3.8 grams/day in urban areas. The PDS supplementation to the poorest 30 percent population has been around 339 kcal/day. It has been seen that poorest 30 percent of households had lower capacity to access food, and as a result, despite the PDS support, they were not able to reach the Recommended Dietary Energy (RDA) levels of energy and protein intakes.

Utilization

National Malnutrition Decadal Trends: The prevalence of malnutrition in children 6-59 months in India has declined between 2005-06 to 2015-16 with chronic malnutrition, or stunting, decreasing from 48.0 percent in 2005-06 to 38.4 percent in 2015-16 and underweight decreasing from 42.5 percent in 2005-06 to 35.7 percent in 2015-16. The prevalence of acute malnutrition, or wasting, has marginally increased during the same period, from 19.8 percent to 21.0 percent. The prevalence of anaemia in young children has also decreased from 69.5 percent in 2005-06 to 58.5 percent in 2015-16.

Stunting Trajectories: Stunting has declined by one fifth during last decade with an annual decline of around one percent. The prevalence of stunting is above 30 percent across all states in India, except Kerala. The trajectory to reduce stunting in India reveals that the POSHAN Abhiyan target to decline stunting to 25 percent by 2022, will accelerate the rate of reduction from existing 1 percent to 1.9 percent per annum. The Government of India has envisaged a challenging target for itself through National Nutrition Mission (NNM) with the target to reduce stunting by at least 2 percent per annum to reach 25 percent by 2022. Goa and Kerala have already achieved this level in NFHS-4 (2015-16). Four other states (Daman and Diu, Andaman and Nicobar, Puducherry and Tripura) have already accomplished mission 25 and Punjab (25.7 percent) is close to achieving it (NFHS-4).

Inter and Intra State Variations in Malnutrition: The prevalence of stunting in children under five is the highest in Bihar (48 percent), Uttar Pradesh (46 percent), Jharkhand (45 percent), and Meghalaya (44 percent) and lowest in Kerala and Goa (20 percent each). Jharkhand also has the highest prevalence of underweight (48 percent) and wasting (29 percent). District level mapping of malnutrition shows considerable intrastate variations. However, very few districts in Northern and North-Eastern states have shown ‘Low’ level of wasting (2.5-4.9 percent) and underweight (less than 10 percent).

Vulnerable Pockets and Sections in India: As mentioned, the highest levels of stunting and underweight are found in Jharkhand, 6 Bihar, Uttar Pradesh, Madhya Pradesh, Gujarat and Maharashtra. Few states have a very high burden of malnutrition. The poorest quintile of the population is the most vulnerable in terms of stunting. In addition to the earlier mentioned states, the two poorest quintile groups in Haryana, Meghalaya, Karnataka, Rajasthan and Punjab have high levels of stunting. At the national level, among social groups, the prevalence of stunting is highest amongst children from the Scheduled Tribes (43.6 percent), followed by Scheduled Casts (42.5 percent) and Other Backwards Casts (38.6 percent). The prevalence of stunting in children from Scheduled Tribes in Rajasthan, Odisha and Meghalaya is high while stunting in children from both Scheduled Tribes and Scheduled Castes is high in Maharashtra, Chhattisgarh and Karnataka.

Prevalence of Multiple Types of Malnutrition among Children: Multiple burden of malnutrition is the coexistence of any two or all three measures of malnutrition: stunting, wasting and underweight. The analysis of NFHS-4 reveals 6.5 percent of children under five are both stunted and wasted and also are underweight, while 18.4 percent of children are both stunted and underweight and 8.2 percent of children are both wasted and underweight. This analysis helps in identifying the most vulnerable section where children are suffering from multiple forms of malnutrition

Micronutrient Malnutrition: Vitamin A, iron and iodine deficiency disorders are the most common forms of micronutrient malnutrition in the world. Supplementation and fortification are the main ways to deal with these deficiencies at a large scale. In India, 60 percent of children aged 9-59 months received Vitamin-A supplements in 2015-16, and 13 out of 36 states are lagging behind the national average including some larger states and the north-eastern states. In terms of fortification, around 93 percent of households were using iodized salt in 2015-16 which is very positive.

Anaemia Prevalence: In the last decade, anaemia among women of reproductive age decreased by 2.3 percentage points; an annual decline of 0.4 percent. In 2015- 16, the prevalence of anaemia is much higher among women (53.1 percent) than men (23.3 percent). In 2015- 16, only 58.5 percent children aged 6-59 months were anaemic compared to 69.5 percent in 2005- 06. The prevalence of anaemia is highest among children in Haryana (71.7 percent), followed by Jharkhand (69.9 percent) and Madhya Pradesh (68.9 percent). Several union territories have even higher prevalence of anaemia: Dadra and Nagar Haveli (84.6 percent), Daman & Diu (73.8), and Chandigarh (73.1 percent). Mizoram was the only state in 2015-16 having ‘mild’ level of anaemia prevalence according to WHO thresholds (WHO, UNICEF and WB, 2018), followed by Manipur. A district level analysis shows that almost all the districts fall in to the ‘severe’ (more than 40 percent) category, very few in ‘moderate’ (20-39.9) category and around 10 districts in ‘mild’ (5- 19.9) category.

Double Burden of Malnutrition: For several decades India was dealing with only one form of malnutrition- undernutrition. However, in the last decade, the double burden which includes both over- and undernutrition, is becoming more prominent and poses a new challenge for India. From 2005 to 2016, prevalence of low (< 18.5 kg/m²) body mass index (BMI) in Indian women decreased from 36 percent to 23 percent and from 34 percent to 20 percent among Indian men. However, during the same period, the prevalence of overweight/obesity (BMI > 30 kg/m²) increased from 13 percent to 21 percent among women and from 9 percent to 19 percent. Children born to women with low BMI are more likely to be stunted, wasted, and underweight compared to children born to women with normal or high BMI.

Socio-Economic Determinants of Malnutrition among Children: Just over half the children born to mothers with no schooling are stunted, compared with 24 percent of children born to mothers with 12 or more years of schooling. The prevalence of underweight in children with uneducated mothers is 47 percent compared to 22 percent for those whose mothers have some education. By wealth quintile, the prevalence of malnutrition decreases steadily with increased wealth. Malnutrition is relatively more prevalent among Scheduled Tribes than Scheduled Castes at national level, while considerable variation exists between states. There is a strong negative correlation between stunting and improved sanitation.

Recommendations

Recommendations are grouped by the three pillars of food security: availability, access and utilisation.

Recommendations to improve availability

• Agricultural Diversification: Farmers should be encouraged and incentivised to increase production of micronutrient-rich grains such as millets, as well as other nutritious foods such as soyabeans, vegetables and fruits. This may entail various support measures to the farmers such as establishing policies on price guarantees, subsidies and trade restrictions.
• Sustainability of Food Productivity: Additionally, use of innovative and low- cost farming technologies, increase in the irrigation coverage and enhancing knowledge of farmers in areas such as appropriate use of land and water have high potential to improve the sustainability of food productivity. Further, there is also a need to encourage establishment of agro-processing units and improved supply chains. On the demand side, awareness campaigns about balanced diets should be implemented while more nutritious grains such as millets may also be introduced to poor families through several welfare schemes.
• Policy Support: There is a need for promotion of farming, marketing and demand generation of traditional coarse cereals like maize, which are produced in abundance and are good source of energy. Enhanced coverage of Soil Health Card and Research and Development (R&D) extension to small holder farmers (especially women) and protection of farmers against price fluctuations and losses can be critical steps towards improving agricultural produce of such traditional crops in the country.
• Improve Storage Capacity: Seasonal price fluctuations of food commodities are common. As agricultural production is seasonal, poor farmers are forced to sell their produce immediately after harvest as a due to lack of storage and other socio-economic constraints. Fruits, vegetables, and pulses apparently show high price volatility among all agricultural products which indicates that the availability of nutritious food items throughout the year, especially among the poor, is a challenge which could be addressed by increasing the storage capacity and preventing post-harvest losses.

Recommendations to Improve Access

Strengthened Safety Nets Programmes: Among the poorest population, the daily per capita consumption of energy is below RDA norms across almost all states. Therefore, it is imperative to improve the targeting efficiency 8 of all food safety nets, especially that of the Targeted Public Distribution System (TPDS), to ensure that the poorest are included. In addition, fortification of government approved commodities within the social safety net programmes can improve nutritional outcomes, such as the introduction of fortified rice which is a cost-effective way of increasing micronutrient intake of low-income families. It is encouraging that a rice fortification pilot programme is ongoing. In rural areas, there is evidence that suggests that a well implemented Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) has provided significantly higher market wages. Therefore, for vulnerable landless labourer households, the best short-term policy option is to strengthen the MGNREGS.

Recommendations to Improve Utilisation

• Improve Child Feeding Practices: In 2015- 16, only 9.6 percent children 6-23 months were consuming a minimum acceptable diet in India despite 94 percent children receiving breast milk, milk or milk products. 22 percent children have minimum dietary diversity and 36 percent have minimum meal frequency in India (NFHS-4). The highest percentage of children receiving adequate diet were in Puducherry (31 percent) and Tamil Nadu (31 percent). There is therefore, a need for improving child feeding practices in the country, especially at the critical ages when solid foods are introduced to the diet. In fact, fortification, diversification and supplementation may be used as simultaneous strategies to address micro and macro nutrient deficiencies.
• Food Supplementation Programmes: The Take-Home Rations (THR) under the Supplementary Nutrition Programme (SNP) and which are provided through Anganwadi to children under three years of age and pregnant and lactating mothers should be adapted to the local food habits in each state. Locally acceptable innovations to develop complementary foods should be prioritized. Opportunities to fortify the key commodities in THR should be explored to address micronutrient deficiencies amongst the beneficiaries. Key messages on nutrition and feeding should delivered at the time of distribution of THR to every mother.
• Mother and Child Care: According to NFHS-4 data, 62 percent children of age 12- 23 months are fully immunized. Seven states out of 36 have more than 80 percent of children fully immunized. In 2015-16, only 30 percent of pregnant women had consumed IFA for at least 100 days and 21 percent had received full ANC during their pregnancies. Better performance in all these areas has a far-reaching potential to improve the nutritional status of the entire society.
• Prioritise Maternal Anaemia: The distribution (78 percent) and consumption (30 percent) of IFA tablets remains suboptimal all over the country, even in states where access to prenatal care has improved dramatically. This is an area of concern that needs to be addressed with utmost priority. Focus on addressing the Increase in Wasting Prevalence: Further works needs to be undertaken to identify factors associated with these increases with special focus on the states with the highest burden as well as Scheduled Tribes and Castes.
• Improvement in Water, Sanitation and Hygiene Practices: Achieving India SDG target (NITI Aayog, 2018) for WASH by 2030 looks promising, with targeted efforts by the Government of India through various programmes such as the Poshan Abhiyan and Swachh Bharat Mission. In 2015-16, while about 90 percent households had access to improved drinking water, and 40 percent had access to improved sanitation (NFHS-4). However, the access to sanitation has also shown significant improvement in the past four years.

Other Recommendations

• Monitoring Progress on SDG 2: While several steps are being taken by the government and other organizations on matters of food and nutrition security, methods and indicators to track and monitor progress are still not adequate to give a clear picture on the progress towards meeting SDG 2 targets in the country. This report is one such attempt to understand the current status of food and nutrition security in India and states. However, this may not be achieved unless more disaggregated data with higher frequency is available. The SDG Index published by NITI is a step in the right direction. However, there’s also a need for more robust measures that can take cognizance of all aspects of SDG 2.
• Addressing Gender Issues: Women and children have been the target population for various welfare schemes, yet, they remain vulnerable due to various inequalities that exist in terms of opportunities, access to resources and having an equal voice in the decisions that shape their households and communities. To address such inequalities, all the major programmes would need to be gender sensitive. The programme designs will also have to delve into matters such as the involvement of men in child care and feeding practices, and intra-household food insecurity. It has been observed in this study that evidence on such areas has been relatively less explored. Accordingly, the data collection should also aim at obtaining gender disaggregated data at various levels.
• Knowledge on Consumption Patterns and Behaviours: A more targeted approach based on identified food consumption patterns and mapping at state level of the locally available nutritious food commodities is an area that has not been explored enough. Such knowledge can be further used to encourage balanced diets among vulnerable households.
• Greater Use Of Technology: Use of technology at all levels can improve the flow 10 of information at all levels for the various pillars of food and nutrition security. At the production stage: Increased use of Information Technology to better inform farmer in terms of crops, rainfall and soil health, especially through customized mobile apps and tools in local languages. This could also improve synergies between Kisan Call Centres, Krishi Mitras and mKisan Portal. Similarly, empowering local Self-Help Groups and Panchayats to make use of mobile apps will help them to provide regular feedback on the functioning of food-based safety nets schemes. Further, the use of technology has potential to encourage greater policy coherence and coordination across the food systems, agriculture and nutrition.

Source: Food and Nutrition Security Analysis, India, 2019