It is an accepted fact that nutrition is one of the most important determinants of health and well being of any population. This fact is especially relevant in the Indian context, not only in less developed states, but also in ‘developed’ states characterized by major inequities like Maharashtra. A recent report on Nutritional crisis in Maharashtra has exposed many myths like: Maharashtra is a well off state so most people are well nourished; high economic growth rates translate into better nutritional status of the population; under-nutrition in Maharashtra is a problem only in a few remote tribal pockets; severe malnutrition is the only problem that we need to worry about etc. It has been shown with considerable evidence that despite high ‘growth’ rates, the situation regarding nutrition in Maharashtra may be regarded as a crisis situation. Some key observations are -
- Almost half of the children in Maharashtra are stunted, one fifth are severely stunted. Over one-third (36.2%) of women are undernourished.
- Over one third of all adults in Maharashtra are underweight.
- Nearly half of the women in Maharashtra are anemic. Two thirds of children in Maharashtra are anemic, 40% are having moderate or severe anemia.
- 35 to 40% of new borns are low birth weight, 30% infants are underweight, 46.3% of children below five years are stunted, only 27% of children in age group four to six are able to consume adequate calories and proteins.
In the sphere of undernutrition / malnutrition, the most severely affected segment is that of women and children. When over one-third of women are underweight and half of them are anemic, malnutrition of pregnant women translates into low birth weight babies. Nutritional status in childhood has long term effects on children’s’ lives, on their health status, their ability to think, learn, work, communicate, socialize and perform. Children who are undernourished grow into underweight adults, including underweight mothers, hence the vicious cycle of undernutrition continues.
From 1994 to 2008, while other states like Tamil Nadu have made considerable progress by improving their rank from 12 to 6, Maharashtra is still at 10th rank out of 17 major states for Nutrition index. Maharashtra’s 2008 Hunger Index Score is 22.8, which places it in the category of “alarming hunger,” on par with an economically less developed state like Orissa. This is despite the fact that Maharashtra has among the highest per capita incomes among Indian states, and has enjoyed a higher SDP growth rate than most other Indian states during the last two decades.
In the same period of 1994 to 2008, while Maharashtra’s nutritional status remained nearly stagnant, its per capita income has increased substantially. In fact Maharashtra has a NSDP(Net State Domestic Product) twice as high as that of Orissa, whereas the difference between hunger indexes for both these states is negligible. Thus, it is very clear that Maharashtra’s human development is not corresponding with its economic growth.
The current economic growth process in India is deeply inequitable in nature. As a result, instead of rapidly overcoming historical under-nutrition associated with deprivation, the current growth model, while befitting a relatively small section of the well-off, has perpetuated poverty, deprivation and consequent under-nutrition among a large section of the population. While on one hand it is obvious that poverty is associated with poor nutrition, on the other hand we see hardly any mention of poverty as a key determinant, in the dominant discourse on malnutrition.
Further, if we accept that deeply inequitable growth and persistent poverty prevalent in a large section of society is a fundamental cause of malnutrition, then besides questioning and evolving alternatives to the developmental model, there is an obvious need for large scale redistributive processes and measures. At the core of such processes would be strengthening public systems which need to accessed by majority of the population, particularly for food security, nutrition and health care. Such strengthening would have two major components: ensuring community level accountability for proper delivery of services / entitlements and advocacy for policy change to ensure more equitable, universal and effective provision of entitlements. Both these levels of intervention would need to be guided by a strong rights based approach to public services.