India has roughly a sixth of the world's under-five population, but a quarter of those under five who are stunted - that is, too short for their age, a leading measure of undernourishment. They make up a massive 44 million who need to be taken care of immediately. (There are only 32 countries, according to a list of 228, whose total population exceeds this.)
Two recent reports - the India Health Report and the Global Nutrition Report - throw a powerful light on the issue of undernourished children in India. However, data problems surface when we pursue them as sources of complementary information. Cross-country comparisons, possible from the global report, become difficult because the country data used by it is not strictly comparable. Its country profiles use data from India's third National Family Health Survey (NFHS-3) of 2006 (48 per cent of children under five are stunted) which casts India in a poor light compared to Bangladesh, Nepal, and Pakistan - whose data is more recent (from 2011-12).
But, take the India Health Report, which uses the Rapid Survey of Children 2014 (does "rapid" mean "quick" and, therefore, "less comprehensive") data, and the same figure is down by a massive nine percentage points to 39 per cent - and India is ahead of the three. The fourth NFHS (2014-15) is due; but, clearly, the average seven-year gap between these national surveys is too large, enough for a large number of children to become disadvantaged for life. It is imperative, says the global report, to decide on a set of core national indicators which impact nutritional health and have data on them collected every two or three years. Otherwise, policy framing suffers.
But the data on hand, current or not so current, indicates that India is at best at the head of a South Asian cluster, behind many poor African countries and way behind Sri Lanka (15 per cent stunted) and China (nine per cent stunted). It is also clear that the way to address the current poor Indian situation is to focus on a bunch of laggard states (nutritional action is largely state government-driven) which bring down the average. Kerala (19.4 per cent) and Tamil Nadu (23.3 per cent) belong to a different league from Uttar Pradesh (50.4 per cent) and Bihar (49.4 per cent).
Nutritional food support can go only a part of the way in fighting stunting. As the health of a child is closely related to the health of the mother and also social practices, it is important to focus on a set of indicators that address the comprehensive picture. So, along with the extent of stunting, we also need to find out how many children have been fully inoculated before they reach age two; how many women of reproductive age are anaemic; how many women got married before 18; how many married women have had at least 10 years' schooling; and what is the extent of open defecation.
Going by these six criteria, the true laggards are mostly a group of Hindi-speaking central Indian states (the cow belt, if you will) which roughly correspond to the old BIMARU configuration - but with important changes at the margin. Chhattisgarh (earlier a part of Madhya Pradesh) is the great exception; it is above the national average in four out of the six criteria listed above. States at the bottom of the pile are Bihar, Jharkhand and Madhya Pradesh, scoring zero; Assam and Orissa come next with a score of one.
In the middle come three states (ahead of the national average in two criteria) which are either trying to get out of their traditional status, like Rajasthan and Uttar Pradesh, or Gujarat whose development model may need questioning. Chhattisgarh and Madhya Pradesh have similar levels of stunting as Gujarat, but have half the net per capita state domestic product as Gujarat!
Of the total nine laggards, four have a nutrition policy. Those that don't (excluding Chhattisgarh, which has virtually arrived) are Bihar, Rajasthan, Assam and Orissa. These are the states which require focused attention.
The India Health Report refers to a study of 63 countries to observe that increases in per capita income translate to improvements in child nutrition status only if accompanied by public and private investments to address dietary issues and disease. Overall, to improve child nutrition it is vitally necessary to improve healthcare services, women's empowerment, social protection and ensure better water supply and sanitation.
On the other hand, pronouncements by policymakers and prominent economists seem fixated on the holy grail of 10 per cent growth. Says the report, "Stunting rates are likely to decline with economic progress, but economic growth cannot, by itself, reduce undernutrition and may contribute to overweight and obesity." And there is a final warning, "India ignores the problem of undernutrition and its impact on child development at it peril and risks large economic, health and social consequences for future generations."