Even as Gujarat surpasses many Indian states with impressive investments in infrastructure, agriculture, and general economic growth, little is known about how this growth is affecting the state’s social indicators. The recent buzz about the causes of undernutrition in Gujarat raise a number of issues about social and cultural preferences. However, this can be interpreted only in the broader context of what causes undernutrition in India, and indeed, in Gujarat, and through reflection on the extent to which economic growth has the potential to contribute to reducing undernutrition.
First, undernutrition among children is no mystery begging an explanation. The causes of undernutrition globally are well known. They include poor pre-pregnancy nutrition among women, low pregnancy weight gain, poor infant and young child feeding practices, poor hygiene and sanitation, infectious diseases, and underlying social causes such as education, food insecurity, poverty and inequity of every type — against women, against the poor, “lower” castes and against religious minorities. Undernutrition in India is the result of this perfect storm that creates poor conditions for optimal child growth. In India, and in Gujarat, a majority of young women and children under the age of two years (the age group in which it is essential to ensure all inputs are available), are simply not getting all the critical nutritional inputs they need. The NFHS-3 data from 2005-06 showed that no single recommended input was available for more than 70 per cent of the children in Gujarat, and that on most inputs, such as diets of these young children, or sanitation, the situation was abysmally poor. An updated survey in 2009 does not indicate any dramatic change.
Second, the role of social and cultural preferences is recognised in the scientific literature on food and nutrition behaviours. Raising awareness about nutrition and healthy behaviour should be a priority for India, but this has been one of the most neglected areas. There are no robust mass media campaigns on air yet, and behaviour change communications in health and nutrition programmes is known to be poor.
Third, undernutrition can indeed be reduced drastically, but economic growth is not enough. A comprehensive and inclusive approach is essential for success. Brazil took on the task of improving poverty, health, hunger and inequity through comprehensive social programmes and, as a result, almost eliminated childhood stunting. Thailand scaled up essential nutrition actions through community-based programmes, but also ensured that basic health, water-sanitation and poverty reduction actions were in place. Vietnam, Senegal, and Madagascar are all marching on to address undernutrition through similar approaches. We must ask ourselves if India is doing enough on this front.
Gujarat has already embarked on an ambitious programme of infrastructure improvement, agricultural growth and economic growth. The literature indicates that improvements in nutrition can be expected to be, in the best case, only about half the growth rate. Thus, in spite of the high growth rates in Gujarat, the undernutrition situation is likely to need attention for a while, given how poor the situation was in 2005-06. The state is scaling up health and nutrition programmes as well, and this increased spending could yield benefits but will it be enough, and will it yield improvements across the board? Inequity must be recognised as a major contributor to poor nutrition outcomes, and explicit equity-enhancing actions must be taken. Research in India shows that the poorest and socially-excluded groups have benefited the least in terms of nutritional outcomes.
Last, but not least, no one in India has a clue as to where the country stands on the undernutrition statistics today. We can only wonder how much the situation might have improved, who might have benefited from the growth of incredible India, and who might have been left behind. Around us, Nepal, Bangladesh and now Pakistan have updated nutrition indicators in 2011-12, but in India, we are left debating the merits of different types of data collection. In this context, it might well be time for state governments to step in and invest in their own routine health and nutrition surveys. Madhya Pradesh has already done so, and Maharashtra is well on its way to having updated data. An urgent need, especially in times of intense social and economic change, is to establish reliable data systems to capture the impacts of these changes on social and health outcomes.
Data for decision-making and awareness-raising campaigns are among the many smart investments that smart governments around the world are making. This is as good a time as any to make those investments in Gujarat and in as many states across India as possible.
The writer is senior research fellow, International Food Policy Research Institute