THE Global Hunger Index 2016 puts India at 97 out of 118 countries. The release of these numbers is great news. For those of us who have been concerned about the neglect of hunger and nutrition issues in India, the numbers have created the “news peg” that will allow the media to turn its attention to this important issue.
To illustrate the neglect of people’s issues by the mainstream media, see the accompanying graphic where, using Google Trends data on searches between 2011 and 2016, I compared “iphone” with “food security”. The graphic presents a comparison of searches for three categories: (a) People and Society (b) Law and Government and (c) News. The result is remarkable—among “people and society”, food security dominates the search for iphone (left most panel, red line); in “law and government”, food security begins to trail iphones; in the “news” category, the food security line barely leaves the X-axis! The only time it does so—somewhere in the middle of the five-year time range under consideration—is around July 2013 when the National Food Security Act was enacted by Parliament. It is also worth pointing out that much of the coverage at that time was against the enactment of the law. This suggests that not only the government but the media, too, are completely failing to reflect the concerns of the people and society.
Undernutrition—Multi-headed beast Not only is undernutrition a complex issue, it is also an intergenerational problem. Nutrition is not a problem of just inadequate food or nutrients. The fight against it requires not just adequate food inputs but also appropriate health interventions (such as facilities for safe births and immunisation), safe drinking water, public sanitation and hygiene, and so on. An undernourished mother is likely to give birth to an underweight, anaemic, stunted child. It is not a problem that can be dealt with as easily as, say, hunger.
This has two important implications for policy: the battle against undernutrition requires comprehensive inputs (including health, education, food and sanitation) and a sustained effort over a long period. Looking for quick fixes such as fortified foods will only take us so far.
PDS benefits Yet, the National Food Security Act (NFSA), 2013, has four components that can help in the making of a small dent in the scale of the problem of hunger and undernutrition. First, the public distribution system (PDS) entitles two-thirds of the population to subsidised grain (5 kilograms a month) at Rs.2 a kg for wheat and Rs.3 a kg for rice. While it is true that leakage from the PDS was a serious problem for much of the decade of the 2000s, it is also true that many States have made progress in fighting corruption.
According to estimates for 2011-12 (the latest year for which representative data are available), leakage rates were down to 10 per cent in Chhattisgarh (from 50 per cent in 2004-05), and 20 per cent in Odisha (from 75 per cent) and Bihar (from 90 per cent). The Bihar story is quite remarkable. According to independent surveys by researchers at the Delhi School of Economics (2013-2015), people were getting between 75 and 80 per cent of their entitlements. A World Bank survey in 50 gram panchayats (2014-15) found that households received between 68 and 100 per cent of their entitlements.
Since then, the NFSA has been implemented in more States, and in some cases this seems to have contributed to improving the PDS. In a survey of six States conducted in June 2016, we found that leakage rates in Madhya Pradesh and West Bengal had also come down dramatically (see table: NFSA Survey 2016: Selected Findings). In Madhya Pradesh, one factor that helped tremendously was the phasing out of the grain allocated to the State under the “APL quota”. In West Bengal (as in Bihar), the prospect of the State elections made the PDS a political priority. It remains to be seen whether, post-elections, States are able to sustain this improved performance.
Programmes for children Second, the NFSA, 2013, includes two programmes for children: the Integrated Child Development Services (ICDS) Scheme for children under six and the Mid-Day Meal (MDM) scheme for schoolgoing children.
Medical and nutrition research shows that the most important time for making nutrition interventions are the first 1,000 days of a child’s life, including the time spent in the womb. If a child cannot be protected from undernutrition in the first few years, the probability of later interventions succeeding is small.
In the light of these findings, it is important to focus on the strengthening of the ICDS and the MDM scheme. The ICDS is especially important because it reaches children in the most vulnerable age group and is a comprehensive intervention: it includes immunisation, growth monitoring and supplementary nutrition.
Height and weight are considered important indicators of nutrition. The impact of the ICDS on reducing stunting has been documented by various economists: Monica Jain (2015) uses 2005-06 data from the National Family Health Survey and finds that girls who received supplementary feeding at anganwadis are taller. The data pertain to a time when the ICDS was not very comprehensively implemented in many—not all—parts of the country. The past decade has seen some shaking off of policy inertia as far as this scheme is concerned.
Indeed, Nitya Mittal and J.V. Meenakshi of the Delhi School of Economics analyse data (in 2015) from three poor and poor-performing States—Bihar, Jharkhand and Odisha— from 2012. They find that access to ICDS services reduces the prevalence of underweight children by 13 percentage points.
There is an immediate need to ensure that children are provided nutritious food in these programmes. Successful state initiatives (in Odisha and Tamil Nadu) such as giving eggs or black gram to children under the ICDS should be promoted in other States. Eggs are important because they contain all nutrients (except vitamin C) and since they are nutrient-dense, they are especially suited for children’s small stomachs. With their long shelf lives, eggs are also better options than other nutritious items such as milk in rural areas. It was a disappointing blow when a proposal to introduce eggs for children under the ICDS and the MDM scheme was shot down in several States last year.
Instead of building on the small gains in the past decade (as reflected in reduced rates of stunting and underweight children), what we have seen are attempts to cut budgets (later reversed owing to public pressure), repeated news leaks and ministerial announcements that take-home rations for children in the 0-3 year age group may be replaced with pre-packed food or cash. Indications are that the political commitment to these programmes, low to begin with, has suffered in the past two or three years. Third, and most importantly, the NFSA, 2013, recognised the principle of universal maternity entitlements. The idea behind maternity entitlements is to recognise (and compensate for) the value of child birth and child care. Apart from being a right that ought to be recognised, there is a lot of evidence of the varied benefits of cash support to mothers. Ideally, women should be given the equivalent of six months’ wages, but the NFSA makes a provision of only Rs.6,000 for every child. This is insultingly low, but even this has not been implemented so far.
A pilot in 50-odd districts which started before the Act was passed continues as before. Only two States have initiated the scheme from their own budgets: Odisha provides Rs.5,000 per child and Tamil Nadu Rs.12,000 per child. The experience of these States has been encouraging. For instance, a survey of Odisha’s Mamata scheme in December 2014 showed that out of 1,500 eligible mothers, more than one thousand had received the benefit, over 70 per cent got all four instalments and, on average, mothers reported receiving Rs.4,722 out of Rs.5,000. Most of them used it to meet food and health needs; one-third of the respondents saved the money, while less than one-tenth used it for celebrations.
The media lauded the passage of the Maternity Benefits Amendment Act, which increased maternity leave for women. Yet, hardly anyone commented on the fact that it will benefit only those working in the organised sector, which employs only around 10 per cent of the workforce. A large majority of women enjoy no protection at all. During our field surveys, we often come across women who go back to hard manual labour within days of giving birth. This harms them as well as their children (infants need frequent feeding and if the mother undertakes wage work in places with no child care facilities, she is forced to compromise on the child’s needs). For such women, a cash compensation can go a long way in meeting their own requirements and their children’s.
It is sometimes argued that the cash incentive will lead to greater fertility among poor women. There is no evidence of this. Interestingly, this argument is never made when it comes to advocating greater maternity entitlements for women in the organised sector. These are just some examples of the ways in which elected representatives and the media ignore issues that affect the vast majority.
Political priority Readers may recall that the opposition blocked the last few parliamentary sessions under the second United Progressive Alliance government, and hardly any business could be conducted. At that time, the Bharatiya Janata Party (BJP), then in the opposition, criticised the government’s food security law as being too weak and achieving too little.
The BJP stalwart Murli Manohar Joshi moved an amendment to increase the per person entitlement of grain to 10 kg, and “two and a half kilograms of pulses and nine hundred grams of cooking oil per person per month”. Sushma Swaraj opposed the clause that allowed the government to give cash in case of a failure to provide grain. She said that “if cash is given in place of grain it will go straight to a liquor shop and if the government tells us that the woman will be recognised as the head of the household and that the cash will go to her, then her troubles will be double—the money will be snatched from her, she will be beaten and she will starve”.
When the National Food Security Ordinance was brought, Narendra Modi, as the Chief Minister of Gujarat, wrote an open letter to Prime Minister Manmohan Singh to express his “deep concern” and stated that it did “not address even calorific security, not to talk about nutritional security which is the main objective”.
Now, as the ruling party the BJP is going all out to further weaken the food security legislation. Within the first year, the Shanta Kumar Committee recommended a reduction in the population covered by the legislation and replacement of food with cash. The introduction of nutritious food items is being blocked on dubious grounds; nobody is talking about implementing maternity entitlements; and attempts have been made to cut Central funding for these schemes.
The PDS, which was just beginning to make progress in its battle against corruption, is now being saddled with Aadhaar. (All the improvements in the PDS described above predate the introduction of Aadhaar.) This is leading to exclusion and disruption and is opening the door to corruption again.
The PDS, the ICDS and the MDM scheme constitute lifelines to a vast majority of the population. Maternity entitlements need to be seen both as a right for women and as instruments in the battle against undernutrition. A government that ignores or undermines them does so at its own peril.
Reetika Khera is Associate Professor of Economics at the Indian Institute of Technology Delhi.
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