Improve nutrition delivery and not bristle at low rank

In general, the GHI score over the years are not comparable, because the data on which the index is constructed is being revised and improved by the United Nations all the time. Hence, within-year comparisons between countries are valid but not across years. However, the 2023 scores have been constructed so that they can be compared to three earlier years—2000, 2008 and 2015—to examine how a country has fared over time. The total score is on a scale of 0 to 100. Anything more than 50 is considered to be extremely alarming, while a score of 35 to 49 is alarming. Between 20 to 34 is called serious and below that is moderate or low. India’s score is 28.7 and has shown only a small progress of 0.5 points in GHI since 2015. There are 43 countries for whom the scores are in alarming or serious category, and India is in that grouping. India’s global rank is 111 out of 125 countries, and is below all its South Asian neighbours.

This has raised the hackles among various quarters. The ministry of women and child development (MWCD) has raised objections and called the GHI a flawed measure of hunger. Their point is not wholly semantic, for placing India very low in the “hunger” index globally implies widespread starvation and a crisis of food security in the country. That certainly is not the case, and even as early as in the late 1990s, the National Sample Survey (NSS) had documented the adequacy of food availability.

Nearly 30 years ago, the NSS questionnaire had one query to the sample respondent: “Did you have at least one square meal in a day”, to which about 95% gave an answer in the affirmative. However, the GHI actually captures both hunger (lack of calories) and malnutrition (lack of micronutrients), so the point is not to quibble about the title given to the index. The index has four components, with one third weight each for undernourishment and child mortality, and the remaining one third weight equally divided between child stunting and wasting. The data on child wasting (18.7%) and stunting (35.5%) are taken from India’s own fifth National Family Health Survey, which covered the years from 2019 to 2021.

This data puts India among the worst 15 countries. But this data has been rebutted by data from another source, the MCWD’s Poshan (nutrition) tracker, which shows stunting at only 7%. So, the government’s own two sources have contradictory indicators, or perhaps there has been a steep improvement in the last few years. That is unlikely, and this data discrepancy needs to be sorted out. One big, but unreasonable objection is that three of the four components refer to child nutrition or hunger, so how can one extrapolate to the whole population. In a young country, the status of children’s well-being deserves a high weightage.

Rather than bristle at the global ranking and India’s poor show, it is better to take stock of what is the underlying insight, and what can be done to make the situation better. For it can be nobody’s case that India’s hunger and nutrition adequacy is all hunky-dory. We have been running a free food grain distribution for 810 million people for more than four years, surely necessitated by concerns about food security. At the micro level too, the anecdotal evidence is not exactly satisfactory. Take child mortality, which is an important component of the GHI. Indeed, if there is just one indicator that should be used to capture the well-being of society at large, it should be the infant mortality rate (IMR), not at age zero, but at age 1.

To measure IMR at age 1, the data gathering machinery must track the sample of 1,000 births all the way till the babies have their first birthday. Unlike IMR at age zero, which is a simple statistic of how many live child-births per 1,000 births have taken place, IMR-1 tracks each baby in the chosen sample. Unfortunately, India does not properly track IMR-1, even though it is an important indicator and highly correlated with most development indicators. A reduction in IMR-1 should be pursued, much like the pursuit of Project Tiger in mission mode.

India’s reported (and imperfect) IMR-1 is around 33, although there is very wide variation across different states. Many developed countries even measure IMR at age 5, so the babies are tracked till their fifth birthday. In 2018, an estimated 882,000 children under five died in India, the highest in the world. More recently, a government hospital in Maharashtra’s Nanded reported deaths of more than a dozen babies within a short span of 24 hours. These are not isolated instances. The causative factors may be many and point to poor quality of primary care, ante and post-natal care as well as a severe shortage of medical and para-medical staff. Hence, it is not surprising that even babies that survive exhibit undernourishment and high nutritional deficiency.

The GHI ranking has raised the hackles among government folks and others who are pointing to mala fide intentions and a global conspiracy to malign India. We would do well to give up the quibbling on the ranking, and focus instead on reducing IMR-1 and the rates of stunting as well as wasting among India’s large children population.

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Updated: 18 Oct 2023, 08:29 PM IST