Box 2.1

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India has lagged behind in improving its GHI score despite strong economic growth. After a small increase between 1996 and 2001, India’s GHI score fell only slightly, and the latest GHI returned to about the 1996 level, as the above graph shows. This stagnation in GHI scores occurred during a period when India’s gross national income (GNI) per capita almost doubled, rising from about 1,460 to 2,850 constant 2005 international dollars between 1995–97 and 2008–10 (World Bank 2012).

When comparing GHI scores with GNI per capita, it must be emphasized that India’s latest GHI score is based partly on outdated data: although it includes relatively recent child mortality data from 2010, FAO’s most recent data on undernourishment are for 2006–08, and India’s latest available nationally representative data on child underweight were collected in 2005–06. Given that the Government of India has failed to monitor national trends in child undernutrition for more than six years, any recent pro­gress in the fight against child undernutrition cannot be taken into account by the 2012 GHI.

Nonetheless, even bearing in mind that possible recent advances in the fight against child undernutrition are not yet visible in the latest GHI, India’s track record is disappointing. Generally, higher incomes are associated with less hunger. This pattern is shown by the black line, which was predicted from a regression of the GHI on GNI per capita for 117 countries with available data. India’s data points fall consistently above the predicted line. This result means that given India’s per capita income, it has higher GHI scores than would be expected. Between 1990 and 1996, India’s trend line moved in parallel with the predicted line, indicating that its GHI score was falling commensurate with economic growth. After 1996, however, the disparity between economic development and progress in the fight against hunger widened, and India moved further away from the predicted line.1

In two other South Asian countries—Bang­ladesh and Sri Lanka—GHI scores were also higher than expected but decreased almost proportionally with GNI per capita growth (that is, largely in parallel with the predicted line). Compared with countries at a similar level of economic development, Sri Lanka achieved impressively high literacy and life expectancy through welfare-oriented policies, investment in public healthcare and education systems, and a commitment to gender equality (Samarage 2006). Bang­ladesh has benefited from broad-based social progress, and its vibrant NGO sector and public transfer programs helped reduce child undernutrition among the poorest. Bangladesh has also closed the gender gap in education through targeted public interventions and has overtaken India on a range of social indicators, including the level and rate of reduction of child mortality (UNICEF 2012b; World Bank 2005; Drèze 2004). The country is also committed to regular monitoring of children’s nutritional status.

China has lower GHI scores than predicted from its level of economic development. It lowered its levels of hunger and undernutrition through a strong commitment to poverty reduction, nutrition and health interventions, and improved access to safe water, sanitation, and education. Brazil successfully implemented targeted social programs (von Braun, Ruel, and Gulati 2008). Since 1992, Mozambique has been recovering from a long-lasting civil war and has witnessed economic growth and poverty reduction (van den Boom 2011), coupled with hunger reduction: all three components of the GHI improved since 1990.

In India, 43.5 percent of children under five are underweight (WHO 2012, based on the 2005–06 National Family Health Survey [IIPS and Macro International 2007]): this rate accounts for almost two-thirds of the country’s alarmingly high GHI score. According to the latest data on child undernutrition, from 2005–10, India ranked second to last on child underweight out of 129 countries—below Ethiopia, Niger, Nepal, and Bangladesh. Only Timor-Leste had a higher rate of underweight children. By comparison, only 23 percent of children are underweight in Sub-Saharan Africa (although India has a lower proportion of undernourished in the population than Sub-Saharan Africa2 ).

It must be emphasized that child undernutrition is not simply the outcome of a lack of food in the household. There are many other potential causes, such as lack of essential vitamins and minerals in the diet, improper caring and feeding practices, or frequent infections, which often result from inadequate health services or unsanitary environments. Women’s low status in India and ­other parts of South Asia contributes to children’s poor nutritional outcomes in the region because children’s development and mothers’ well-being are closely linked: women’s poor nutritional status, low education, and low social status undermine their ability to give birth to well-nourished babies and to adequately feed and care for their children (von Grebmer et al. 2010). According to surveys during 2000–06, 36 percent of Indian women of childbearing age were underweight, compared with only 16 percent in 23 Sub-Saharan African countries (Deaton and Drèze 2009).3

Research has shown that early nutritional deprivation causes lasting damage to children’s physical and cognitive development, schooling outcomes, and economic productivity in later life (Victora et al. 2008). These findings underline the urgent need to address the issue of child undernutrition effectively, focusing particularly on the thousand days from conception to a child’s second birthday. Whereas increases in food production and improved distribution of food may be necessary to reduce child undernutrition, these measures alone are usually insufficient. The findings of a recent IFPRI study imply that in the absence of concurrent improvements in health and education, only modest impacts on child undernutrition in India are to be expected from income growth (Bhagowalia, Headey, and Kadiyala 2012). A multisectoral, well-coordinated approach is needed to successfully fight child undernutrition in India and elsewhere (Headey, Chiu, and Kadiyala 2011; von Braun, Ruel, and Gulati 2008; Bhutta et al. 2008).

India has moved on a number of fronts to improve food security and nutrition in past years and has recognized the need for multisectoral action (Kadiyala and Menon 2012). The government operates several large-scale, nutrition-relevant social programs, but poor design, low coverage, and insufficient monitoring are continual challenges. In the absence of up-to-date information on nutrition outcomes, program effectiveness remains uncertain. Home to the majority of the world’s undernourished children, India is in dire need of monitoring systems for child undernutrition and related indicators that produce data at regular intervals, in order to improve program performance and scale up impact (Kadiyala et al. 2012).

1. Unless child underweight was almost halved in India between 2005–06 and 2008–2010—which is extremely unlikely—this statement holds even if progress in reducing child underweight has recently accelerated. Recognizing the dearth of up-to-date information on child undernutrition in India, an alliance of civil society organizations conducted a nutrition survey in selected districts in 2011. The findings, while not nationally representative, indicate some improvement: child underweight fell from 53 to 42 percent in high-burden districts between 2002–04 and 2011, and the rate of reduction was lower in better-off districts (Naandi Foundation 2011). [Back]
2. In 2006–08, 19 percent of the population was undernourished in India, and 27 percent in Sub-Saharan Africa (FAO 2011a). [Back]
3. This number is the population-weighted average for all these countries, which comprise roughly two-thirds of Sub-Saharan Africa’s population.[Back]