Overall, the trend in nutritional outcomes in India during the last fifteen years or so has been positive but modest, manifesting itself mainly in a reduction of the proportion of preschool children who are severely malnourished (through a rightwards shift in the anthropometric distribution). At the same time, however, the household food security situation has hardly changed. This, despite reported reductions in people living below the poverty line, and an increase in the per capita food consumption of the poorest social groups (landless agricultural labourers).
On the agricultural side, there are signs of future problems and constraints as the population growth rate remains high, while the new technologies introduced in the 1970s may now be less effective in catalysing growth in food production. Concern for peoples livelihoods should now be a priority, reflected in agricultural strategies which take account of the fact that an increasing proportion of households are primarily dependent on the demand side of the food market.
In the past 20 years the food production strategy has had built-in biases. While it has been heavily dependent on wheat, the growth in output has been too concentrated in the north western states and in the regions of irrigated rice. Its impact has been relatively disappointing in the densely peopled, poorer eastern states that now contain much of the unutilized potential for irrigation and for higher productivity rainfed rice. The dryland areas of the centre and south were also not sufficiently involved, and despite anticipated linkage effects, the strategy has not yet had a substantial impact on the structural problem of rural poverty. It now appears that the intensification of production has been associated with environmental degradation and pressures on renewable rural energy resources have become even more severe. The focus of planning has hitherto see-sawed between a desire to maximize growth in food production on the one hand and a concern, not so powerfully articulated, for regional equity on the other. Regional equity is now of paramount importance. Easily available means of growth in foodgrains production have now been exhausted and there are probably diminishing marginal returns to the most productive land. This is happening in the face of increasingly serious population pressure on land resources, which highlights the urgency of adopting a more evenly spread, environmentally-sustainable agricultural development strategy; one that considers livelihoods as a more important goal than production per se.
Before such a strategy achieves results, the national food security safety net of the Public Distribution System needs improving. During the 1980s, it was patchy in terms of both coverage and effectiveness (Part II of this report will look in further detail at this intervention).
Despite the levels of governmental expenditure (in both absolute and relative terms) to health, education and social welfare remaining low during the 1980s, there has been a steady improvement in the quality, outreach and utilisation of primary health care facilities. Furthermore, Indias decades of experimentation with nutrition and health interventions since the Applied Nutrition Programmes of the 1950s seems to be beginning to bear fruit, with programmes such as the improved Integrated Child Development Services (ICDS) and the Tamil Nadu Integrated Nutrition Project (TINP). It may be plausible to link these two positive factors with the nutritional improvements seen during this time, although other broader poverty alleviation programmes may also have played a significant role. Part II of this report examines all these interventions in investigating in full the question "why has nutrition improved?" in two South Indian states - Andhra Pradesh and Tamil Nadu.
Regionally, as well as the differences discussed with regard to agriculture, there are also highly significant state-by-state variations in many other nutrition-related variables discussed here, with many factors associated with nutritional problem areas clustering particularly in the states of Rajasthan, Uttar Pradesh, Madhya Pradesh, Bihar and Orissa. Anti-female bias in food provisioning, health care utilization and general care may be particularly severe also in these northern states, and reflected in the regional differences in juvenile sex ratios. By contrast, the one state that ranks highest with respect to many nutrition-related indices is Kerala - where sustained political commitment to human (particularly womens) development through preferential state government support to health, education and welfare sectors, has paid rich dividends.