Tuesday, 5 April 2011

MALNUTRITION: India: Many eat poorly. Would a “right to food” help?

March 31st 2011

“LOOK at this muck,” says 35-year-old Pamlesh Yadav, holding up a tin-plate of bilious-yellow grains, a mixture of wheat, rice and mung beans. “It literally sticks in the throat. The children won’t eat it, so we take it home and feed it to the cows.”

Mrs Yadav has brought her children to a state-run nursery in Bhindusi village in rural Rajasthan. The free midday meal is being dished out. Neither she nor anyone else in Bhindusi looks plump enough to turn down such an offer. Stray dogs scamper through the nursery and toddlers are being weighed in the corner while food is passed around. Most are underweight. Mrs Yadav herself is anaemic, like almost all local women; she survives on potato curry and wheat chapatis. Even so, she rejects a free lunch. “The only reason the women come here is because of the creche,” admits Shafia Khan, who is in charge of state nurseries in the district. “The children don’t like the food. And the ones you see here are the lucky ones. Out in the fields, it is terrible. Everyone is listless; they all suffer from vitamin and iron deficiencies.”

The nursery is part of India’s Integrated Child Development Services Scheme (ICDS), the largest child-nutrition programme in the world. Its woes in Rajasthan are part of a larger problem. India is an outlier. Its rate of malnutrition—nearly half the children under three weigh less than they should—is much higher than it should be given India’s level of income. And the burden has shifted more slowly than it ought to have done given Indian growth. Lawrence Haddad, the director of the Institute of Development Studies at Sussex University, reckons that every 3-4% increase in a developing country’s income per head should translate into a 1% fall in rates of underweight children. In India the rate has barely shifted in two decades of growth. Per person, India eats less, and worse, than it used to. Mr Haddad calls the country the world’s Jekyll and Hyde: economic powerhouse, nutritional weakling. Over a third of the world’s malnourished children live there.
When India was poor, its failure to feed itself properly did not seem odd. Poverty was explanation enough. But after one of the most impressive growth spurts in history, the country’s inability to lift the curse of malnutrition has emerged as its greatest failure—and biggest puzzle. Nothing fully accounts for it. True, farming has not shared in the same dazzling success as the rest of the economy, lately rising by only a point or two per person per year. But some African countries have seen farm output per head actually fall—and they have still cut malnutrition more than India.
It is also true that India’s food bureaucracy is a byword for inefficiency and corruption. People steal from the cheap-food shops of the Public Distribution System (PDS) on an industrial scale. Newspapers call a case of theft now under investigation in Uttar Pradesh “the mother of all scams”. At one point, the country’s top investigative agency said it had given up even trying to cope with the 50,000 separate charges. But again, other countries have corrupt bureaucracies, too—or none, which may be as bad.
So the most convincing explanations for India’s nutritional failures probably lie elsewhere. Women are the most important influences upon their children’s health—and the status of women in India is notoriously low. Brides are deemed to join their husband’s family on marriage and are often treated as unpaid skivvies. “The mothers aren’t allowed to look after themselves,” says Mrs Khan. “Their job is simply to have healthy babies.” But if mothers are unhealthy, their children frequently are, too.
India is also riven by caste and tribal divisions. It is no coincidence that states with the most dalits (former untouchables) or tribes (such as Bihar and Orissa) have higher malnutrition rates than those, like Andhra Pradesh and Kerala, with fewer of these excluded groups. So-called scheduled castes and tribes are more likely than other Indians to suffer the ills of poor diet.
But that cannot be the whole story. Astonishingly, a third of the wealthiest 20% of Indian children are malnourished, too, and they are neither poor nor excluded. Bad practice plays some part—notably a reluctance to breastfeed babies. There may also be an element of choice. Long ago, a study in Maharashtra showed that people spend only two-thirds of their extra income on food—and this is true whether they are middle-income or dirt-poor. That may seem perverse. But a mobile phone may be more useful to the poor than better food, since the phone may generate income during the next harvest failure, and good food will not.

Wanted: Bolsa India
These explanations matter because they raise questions about the Indian government’s current attempt to offer a universal “right to food”. Over the past 20 years, the supreme court has said that Indians have various social rights (to work, education and so on) and can sue the government if they are not honoured. The free school-meal programme was an attempt to implement a right to food. Now the government wants to go further. It is talking about giving cheap food to about 90% of country-dwellers and 50% of city folk—three-quarters of all Indians.
Leave aside the budgetary implications, which are awe-inspiring. Such a programme would hugely expand the terminally dysfunctional PDS. It would do little or nothing for neglected castes and tribes. It would not raise the status of women, or encourage breastfeeding and early nutrition. (As Mrs Khan says, “the crucial time is between the ages of nought and three, but we’re not really reaching them.”) Giving cash, rather than food itself, would be better. Better still, India should look to international experience and introduce a conditional cash-transfer scheme, such as Brazil’s Bolsa Família, which pays the mother if her children attend school. India hankers after “universal” benefits that would leave millions malnourished. It should instead learn from schemes that target those who need help—and which actually work.

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