India is a nation of 901 million inhabitants as of 1993, the second most populous in the world. Population is growing at 2.1% per annum. With a per capita GNP of U.S.$290 in 1993, it is one of world's poorest countries and accounts for about one-third of the world's absolute poor. Nutritional and related data up to around 1990 were given in the ACC/SCN's Second Report on the World Nutrition Situation (vol.II, p9-15, 1993).
Recent Trends in Nutrition
Nutrition surveys were conducted in eight states in 1991/92 by the National Nutrition Monitoring Bureau (NNMB, Hyderabad) and they provide the most recent estimates of the nutrition situation. Sampling techniques varied between the 1991/92 estimates and those done previously in 1988-90. In interpreting trend data, it is also important to keep in mind that nutritional levels are sensitive to short-run shocks (e.g. a bumper crop was harvested in 1989).
Most commentators feel that in view of the uncertainties, it is probably reasonable to conclude only that the average trend from 1975 through to 1992 is likely to be of improvement. The national and state-wise trends cannot be accurately updated for 1988-90 to 1991-92. Thus the most recent definite estimate remains as shown in the Second Report on the World Nutrition Situation, Volume II, p. 13 (ACC/SCN, 1993). New data from a national survey carried out in 1993, in collaboration with DHS, are expected soon, which may allow further state-wide comparisons over time. With this in mind, some qualitative implications are as follows.
The tentative results from comparing 1988-90 with 1991-92 suggest some possible deterioration in the nutritional status of children (1-5 years old) in three states, Karnataka, Maharashtra, and Gujarat, and static situations in Kerala, Tamil Nadu, Andhra Pradesh, and Orissa. This deterioration in Karnataka and Maharashtra could be judged statistically significant, but this was not the case for Gujarat. Seven states had information from both the earlier survey (1988-90) and the later survey (1991-92). Combining the trends of the seven states, weighted by their population, indicates that the average prevalence of underweight children (<75% of NCHS standard) increased from 53.3% to 56.6%. This trend would reverse some of the gains made in the previous decade, particularly those in Maharashtra and Karnataka.
Factors Affecting Trends in Nutrition
Economic Growth. While the most recent economic data show positive trends, the period around the time that the latest nutrition survey data were available (1991-92) was a period of economic crisis in India. The crisis, starting in 1990, reached its peak in the summer of 1991 when foreign currency reserves had declined to almost $1 billion, inflation had risen to an annual rate of 17%, industrial production was falling, and overall economic growth had declined to 1.1% in 1991/92. By comparison, the economic growth rate in the 1988-90 period was estimated at 5.4%.
The programme of stabilization and the economic reform measures put in place in 1991/92 helped restore economic growth to 4% in 1992/93, brought down the inflation to 7%, restored the foreign currency reserves to $6.4 billion and stimulated a strong recovery in exports towards the end of the financial year. FY92/93 marked the first full year of the sweeping adjustment program undertaken in India-aimed at restoration of macroeconomic stability and broad based liberalization of the economy. With the revival of the economy in 1992/93, it is expected that the nutritional status of the population should improve.
Food Security. India's agricultural sector contributes about 30% of GDP. Large public investments in irrigation infrastructure and research, coupled with land reform that would give ownership of land to the landless, the introduction of high-yielding seed varieties, and expanded use of fertilizer, have resulted in some notable achievements - including self-sufficiency in rice, wheat, coarse grains, sugar, and edible oils. But while these longer term gains in agricultural output continue (see food production index), year to year highs and lows are still dependent on the weather conditions for most of the country. The vagaries of the monsoon cause large fluctuations in agricultural production from one year to another. And since agriculture remains as the backbone of the economy, the annual changes in this sector affect the domestic product from year to year.
For example, agricultural production data for the 1990-91 period indicate low gains due to low rainfall, particularly in Karnataka and Maharashtra. Total foodgrain production in Karnataka declined from 7.1 million MT in 1989/90 to 6.3 million in 1990-91 before recovering to about 8.4 million in 1992-93. Since two-thirds of the population is still dependent on agriculture for their livelihood, the low agricultural output could have contributed to any deterioration in nutritional status of children.
The production of foodgrains during 1992/93 reached a record level of 180 million MT, which was higher by about 7% over the previous year. This was mainly due to a quantum jump in the production of coarse cereals, which was higher by 11 million MT over 1991/92. The production of wheat also increased to 56.8 million MT in 1992/93, a 2% increase over the previous year output. The food production per caput index (with 1979-81 as base=100), indicates an increase from 110 in 1986 to 123 in 1993.
Household Food Security. Changes in agricultural output can explain the overall food availability situation in the country, but not necessarily of the food security situation at the household level. Changes in incomes, poverty, and food prices affect the ability of households to acquire food. The NNMB surveys include food consumption indicators. The data for 1991/92 show that it was indeed a bad year for household food intakes in most of the eight States that it surveyed. Compared to 1988/89, average calorie intakes declined in six of the seven States, with the deepest deterioration occurring in Karnataka and Gujarat. These trends are consistent with the anthropometric data cited earlier.
In India, alleviation of poverty and unemployment continue to be the long run objectives of economic and social development in India. The Indian Planning Commission estimated in 1987/88 that 29.9% of population lived below the poverty line with 33.4% in rural areas and 20.1% in urban areas. The Expert Group of the Indian Planning Commission found a steady decline in the proportion of population living below the poverty line. Essential commodities such as rice, wheat, edible oils, and kerosene are distributed through the PDS (Public Distribution System) at prices generally lower than the market price, through an elaborate network of fair price shops (FPS). Wheat and rice, the two primary staple foods consumed in India, are the two main cereals distributed through the PDS. As of March 31, 1993 there were more than 400,000 FPSs in the country; 313,000 in rural areas and 96,000 in urban areas. On an average, one fair price shop is required to cover a population of 2000. Even though the supply of PDS items is supplementary in nature, it has helped in protecting the real purchasing power of some of the vulnerable sections of the population.
Nutrition and Social Programmes. The adjustment programs that started in 1992 adopted a new outlook with respect to many of the socially-oriented programs in the country. The government recognized that social sector support is a high priority needed to protect disadvantaged groups during the adjustment period. The new initiatives sought to improve the quality of human resource programs, such as the Integrated Child Development Services (ICDS), and improve its efficiency in reaching the poor.
The most recent data indicate that while about half of India's 5,300 district blocks are now reached by the ICDS program, its effectiveness in dealing with the problems have been hampered by a number of implementation weaknesses that are being remedied by some institutional and policy changes. While improvements were seen in nutrition in the 1980s, it was evident that gains were made especially in the wealthier States (with the notable exception of Kerala).
A number of reforms in the ICDS program implementation were sought during the adjustment transition period. One shortcoming in the program is the poor targeting of program allocations from the central government. Second, while the central government bears most of the cost of the ICDS program, a number of the States fail to allocate sufficient funds for food supplements required under the program. Furthermore, a review by the World Bank on the monitoring of the ICDS indicates that it focuses more on the inputs (such as number of feeding days) rather than outputs (such as number of children who are brought out of malnutrition). Moreover, difficulties are experienced in focussing on the most vulnerable age-group, those children under three years of age.
In the adjustment transition period beginning in 1992, the government has instituted reforms by increasing the level of effort of ICDS in 180 most-in-need districts where infant and maternal mortality rates are highest. There are plans to include adolescents in the program coverage, and to provide iron and food supplements.
Conclusions
The indications are that nutrition improvement in India may have faced reversal in the early 1990s, related to economic problems and other factors. With economic growth reviving, nutrition should improve also. However, the underlying rate of improvement is slow, probably around 0.5 percentage points per year, at a level of about 65% prevalence of underweight.
Accelerating this rate would likely benefit from more priority to health education and poverty alleviation, and more effective nutrition interventions, e.g. through the ICDS.
INDIA
(Estimates in 1993)
|
Population |
: 901 million |
|
Population Density |
: 264 per sq. km. |
|
Population Growth Rate |
: 2.1% per annum |
|
Urban Population |
: 27% |
|
IMR |
: 83 |
|
GNP US$ (Per Capita) |
: 290 |
|
PPP estimates of GDP |
: 1150 |
Underweight preschool children (Percent below -2 s.d. weight for age)
Infant mortality rate (Per 1,000 live births)
ECONOMICS
GDP per capita (1987 Mkt. prices, Rupee / capita)
Debt service ratio (Debt service/exports)
FOOD
Food production index (Per caput, 1979-81=100)
Dietary energy supply (Kcals/caput/day)
Consumer price index (1980=100)
FPI/CPI ratio (1980=100)
HEALTH
Immunization coverage (Percent)
Access to local health care (Percent)
PUBLIC EXPENDITURES
Education and health expenditures (US $ per capita)
Education and health expenditures (Percent of government expenditures)
