The Global Hunger Index report of 2022, published in mid October, shows India’s place to have fallen to 107 from the previous year’s 101, out of 121 countries. Once again, the Government of India has questioned the survey’s methodology and sample size and accused the authors, Concern Worldwide and Welthungerhilfe, of bias. In a statement almost identical to that of last year, the Women and Child Development Ministry alleged that a consistent effort was on to tarnish India’s image.
GHI calculations are based on four indicators: undernourishment in adult and child populations, under-five mortality, stunting (low height for age) and wasting. Undernourishment, measured against adequacy of food access, was used as a lead indicator of international hunger eradication targets, including the Sustainable Development Goal number 2. Child stunting and wasting went beyond adequate calorie availability and were used as indicators for child nutrition. Child mortality reflected the most serious consequence of hunger. Critics of the report argued that there was no concrete evidence to establish the connection between hunger and these four indicators.
For the 2022 report, data from 136 countries were analysed. There were sufficient data from 121 countries to calculate GHI scores and rank them. India was ranked 107 with a GHI score of 29.1, considered as “serious”. In South Asia, India was ahead of only Afghanistan (109).
The Food and Agriculture Organization (FAO) describes undernourishment as the consumption of fewer calories than what an individual needs for a healthy and productive life. Taken together, the four parameters—undernourishment, child mortality, stunting and wasting—reflect inadequate consumption of calories and micronutrient deficiencies. According to the authors of the report, the hunger index is meant to raise awareness and understanding of the problem and find ways to address it.
Biased, says government
According to the Union government stunting, wasting and under-five mortality are related to the health of children rather than that of the entire population. It also alleges that prevalence of undernourishment (PoU) is calculated on the basis of an opinion poll with a very small sample size of 3,000.
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The FAO estimates PoU on the basis of the Food Insecurity Experience Scale (FIES) Survey Module. The Women and Child Development Ministry says that given India’s size, the minuscule sample size used by the FIES is unacceptable and shows bias. The other three indicators, it says, are outcomes of complex interactions of factors apart from hunger—drinking water, sanitation, genetics, environment and utilisation of food intake. Calculating hunger on the basis of indicators relating to the health of children is neither scientific nor rational, the Ministry says.
Primary school students collect midday meals inside the Similipal Tiger Biosphere Reserve in Odisha; a 2018 photograph. NFHS-5 shows stunting, undernourishment and anaemia continue to affect a large percentage of Indian children. | Photo Credit: BISWARANJAN ROUT
The Ministry found the report disconnected from reality and unmindful of the government’s efforts to ensure food security during the pandemic. The statement included a long list of food security interventions by the Narendra Modi government.
No other country has objected to the methodology (see interview) in the survey. The report does not deny that hunger is multi-dimensional and in fact the authors point out that inadequate calorie intake is one dimension of the problem.
What government data show
Government data from the National Family Health Surveys, including the latest round (2020-21), show that while stunting has decreased, wasting is more or less stagnant. In India’s most populous State, Uttar Pradesh, only 6.1 per cent of the children in the 6-23 months age group receive an adequate diet, according to NFHS-5. Stunting in the State has decreased from 46.3 per cent (NFHS-4) to 39.7 in the latest round; there is no improvement in the wasting rates and severe wasting has risen. Nearly 32.1 per cent of (6-23 months) children are underweight and 66.4 per cent children are anaemic.
At the all-India level, things are not significantly better. A Press Information Bureau release in December 2021 stated that nationally “anaemia among women and children continues to be a cause of concern”. Close to 50.4 per cent of women in the 15-49 age group are anemic. Child nutrition indicators, however, have shown a slight improvement nationally. Stunting has declined from 38 to 36 per cent, wasting from 21 to 19 per cent.
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Clearly, the government’s own data made correlations between nutrition and indicators of stunting, wasting and underweight children. There was also a correlation between maternal health and nutrition and child health and nutrition. There were, undeniably, other determinants but they were not as significant as adequate nutrition in determining rates of stunting, wasting, low body weight and mortality.
Frontline reached out to Laura Reiner, head of the GHI project. She said well-recognised studies showed that child malnutrition and mortality data were extremely sensitive indicators of the nutrition of the whole population (interview).
About the GHI methodology, she said: “These are internationally recognized standards for measuring hunger. We pull all of our GHI data from internationally recognised organisations that use the highest scientific practices to collect data. Of course, we can only work with what governments feed in or what is collected by the United Nations. And we apply the same standards everywhere.”
Stunting in children, she said, was associated with impaired motor and cognitive development. “India has made significant progress in the fight against hunger since 2000, but the regression or stagnation that has occurred in child wasting cannot be denied and must be acknowledged,” she said.
The global picture
The report says global progress against hunger has stagnated in recent years and the problem has worsened in many countries. In 44 countries hunger levels are “serious” or “alarming” and in 22 others the GHI scores have plummeted since 2014. PoU had declined between 2000 and 2017, after which it increased sharply. Stunting and under-five mortality has decreased, but wasting levels are stagnating.
There are inter-country variations. Low and middle income countries (LMICs) took a major hit during the pandemic as fuel prices rose, supply chains got disrupted and inflation became the norm. Two-thirds of survey respondents from 18 LMICs reported that their household food quantity had diminished and over half reported that their food quality had declined.
A baby rests while his parents work in a brick manufacturing unit in Thrissur district, Kerala; a file photograph. Nutrition for children of working class families continues to be a concern. | Photo Credit: K.K. MUSTAFAH
According to the Food Price Index of the FAO, in February 2022 global food prices reached the highest levels since the first FPI in 1990. High food prices were found to disproportionately affect poorer households because they had to spend more on food. Region-wise, hunger levels in South Asia and Africa were labelled as “serious”.
The report says that child wasting is an outcome of low birth weight of babies and insufficient weight gain of mothers during pregnancy. India, Pakistan and Afghanistan had child stunting rates between 35 to 38 per cent.
While conflict is the likely reason for food insecurity south of the Sahara, in East Africa it is extended drought on account of climate change. In West Asia, North Africa, Latin America and the Caribbean, hunger levels are not serious but the trends are troubling. East and South Asia are doing better, but there are countries where one or the other indicator shows worrying trends. Europe and Central Asia have the lowest GHI score for any region, but in five Central Asian countries hunger levels range from alarming to serious.
Since 2014, hunger has increased in 20 countries with moderate, serious or alarming GHI scores for 2022. Not all countries have high values for all indicators. For instance, Timor Leste with a GHI score considered “serious” has the highest levels of stunting in the world; India has the highest rates of wasting at 19.3 per cent, while Haiti and the Democratic People’s Republic of Korea have high undernourishment rates. Nigeria has the second highest child mortality rate after Somalia. Thirteen of 32 countries that showed improvement are in Europe and Central Asia and five in Latin America and the Caribbean.
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Some countries with favourable GHI scores have wide intra-country disparities in nutritional status. This came to light after the assessment of county and district scores within countries. For instance, in Ethiopia, there were wide variations in stunting levels, with higher rates in the north of the country. In India, Chhattisgarh, Gujarat, Odisha and Tamil Nadu showed a decline in stunting between 2000 and 2016.
In India there are gaps in the data made available by the government. The findings of the National Consumption Expenditure Survey 2017-18 have not been released. The survey by the NSSO would have been a good barometer of what India was actually spending on, including food. The GHI and similar reports are occasions to introspect, more so when the findings correspond with India’s own health and nutrition data from national health surveys.
The Crux
- India slips to 107th position among 121 countries in Global Hunger Index report of 2022.
- Government of India alleges bias and finds fault with methodology.
- The GHI uses four parameters to measure hunger: undernourishment, stunting, wasting and child mortality.
- India says three of these are related to the health of children and do not concern the entire population.
- GHI project head Laura Reiner says health of children is crucial in guaging food distress levels of a population.
- She also says the same methodology is applied to all countries in the survey and no other country has objected.
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