|Hunger in India: Facts and challenges|
Chronic hunger and undernutrition is the worst tribulation of the poverty that still plagues millions of households in India and the plight of children is of special concern. Undernutrition in childhood is one of the reasons behind the high child mortality rate and is also highly detrimental for the future for those who survive (Pelletier 1994). Chronic undernutrition in childhood is linked to slower cognitive development and serious health impairments later in life that reduce the quality of life and also the economic productivity of people (Scrimshaw 1996). Undernutrition is hence not only a consequence of poverty but also a cause.
The extent of undernutrition in India is widespread but the exact magnitude — both in absolute terms and in international comparison — varies co
al situation in India to other parts of the world, based on two main methods for characterising undernutrition. A further objective is to investigate to what extent undernutrition in India has declined over time and how the inter-state differences have evolved. A third objective is to challenge the "conventional wisdom" that female children are more frequently undernourished than male children.
The Nutritional Status of Indians in Comparison
There are only two sets of measurements that can be used to compare the incidence of undernutrition in various parts of the world. The first is the food supply-based estimates emanating from the FAO. The second is the anthropometric data on children from the WHO (2001a) and the Demographic and Health Surveys (DHS) providing information on body weights of adult women (ACC/SCN 2000; Nubé 2001). We shall start out by making a comparison between India, South Asia in general and Sub-Saharan Africa using the two sets of indicators. The choice of Sub-Saharan Africa (simply Africa in the following) for comparison is that both sets of estimates find this region and South Asia to have the highest incidence of chronic undernutrition. The two data sets lead, however, to different conclusions regarding which of these two regions is the most afflicted.
4Estimates of nutrition based on food supply (FAO)
The UN agency for food and agriculture, the FAO, provides estimates of the prevalence of chronic undernutrition at the level of households for most developing countries and globally. These estimates are routinely cited in the media worldwide and have become the dominant view of the problem. The estimates from the FAO also formed the statistical basis for the chief resolution to halve the number of undernourished people by the year 2015, taken by 186 government representatives at the World Food Summit in 1996.
The FAO calculations of undernutrition are based on the estimated per capita availability of food (converted into calories) in individual countries (own production and net imports). The distribution of the available calories across households is estimated from household food surveys. Subsequently, the FAO establishes a norm for the minimum per-person calorie requirement of an average household in the individual countries. This minimum norm is set so as to allow household members to maintain health-consistent body weights and to conduct some light physical activity (work). The share of the households in the distribution that has an availability of calories below the norm is classified as undernourished.
In its latest report, presented a few months ago, the FAO (2001) asserts that 777 million people in the developing countries were undernourished in 1997-99 and that the number had dropped by some 40 million only since the early 1990s. FAO hence conjectures that the objective of reducing the number of undernourished by half before the year 2015 will be missed by a large margin. According to its assessment, there has been a minuscule decline (by 1-2 percentage points) in the share of undernourished households in both Africa and South Asia. The incidence of undernutrition in 1997-1999 was about 40 per cent higher in Africa (at 35 per cent) than in India and South Asia (at 25 per cent).
In absolute numbers, however, the FAO assessment suggests an increase by some 40 million undernourished people in the two regions combined (Table 1). That is, in the two regions where undernutrition was the most prevalent in the early 1990s, the number of undernourished people has increased rather than decreased, in sharp contradiction of the chief objective of the World Food Summit in 1996. This means that while the number of undernourished people in the developing countries in other regions declined by some 80 million, the increase in Africa and South Asia by 40 million reduced the net decline worldwide to 39 million only.
4Undernutrition by anthropometric factors
The main alternative method for estimating the prevalence of undernutrition in Africa and South Asia is through observations of what shares of the population in these regions show direct symptoms of undernutrition. These are people who are abnormally short for their age and have body weights below what is consistent with health. The shares of pre-school age children and women of fertile age — the two categories examined the most frequently — who are stunted and underweight are considerably higher in South Asia than in Sub-Saharan Africa. This is quite the opposite of what is reported by the FAO (Table 2).
4Are the FAO estimates to be trusted?
There are several reasons to mistrust the FAO estimates of undernutrition, especially for Africa. The main reason is that the FAO has underestimated the per-capita "availability" of food in this region where very primitive methods are used to enumerate acreage and yields for major crops. Moreover, much of the food produced in this region is for subsistence, which tends to be under-recorded (Heston 1994).
Another reason why the FAO has overstated the prevalence of undernutrition in developing countries in general is that its norm for minimum calorie requirement is based on at least two misconceptions. One is that the FAO has failed to recognise that the nutritionists have revised downward the basal metabolic rate (BMR), i.e. the number of calories that a person needs to maintain basic body functions (Hayter and Henry 1994; Shetty et al. 1996). The other is that FAO’s norm does not take into account the fact that households have different per capita calorie requirements because they differ in terms of age and sex composition. The FAO has hence ignored the fact that households with many young children have lower calorie requirements per person than the "average" household (Svedberg 2001a).
That its estimates of prevalence of undernutrition in Africa as compared to South Asia have been flawed has been acknowledged by the FAO in an indirect way. In 1996, in connection with the World Food Summit, the FAO purported that chronic undernutrition in the 1990-92 period was affecting twice as large a proportion of the population in Africa (43 per cent) as compared to South Asia (22 per cent) and India (20 per cent). Subsequently, these numbers have been revised downward for Africa and upward for South Asia (Table 1). The difference between the two regions for 1990-92 has hence been reduced by half, from 21 percentage points according to the 1996 assessment to 10 percentage points in the most recent assessment (2001). The FAO is silent on what has motivated the revision, but further revisions in the same directions are probably to be expected. The FAO will find it increasingly difficult to gain trust in its estimates when the anthropometric evidence becomes richer and shows little resemblance to the ‘map’ of undernutrition it produces.
4Are the anthropometric measurements reliable?
To obtain anthropometric measurements is uncomplicated, relatively inexpensive and the estimates contain small measurement errors and biases (Marks et al. 1989). That the FAO’s estimates of undernutrition for almost all major developing regions are considerably above the shares of children and adult women who are stunted and wasted, therefore, indicate that they are overestimates (Svedberg 2001a). The only exception is South Asia, where the shares of stunted children and wasted women by far exceeds the FAO estimate (cf. Tables 1 and 2).
One possible explanation for the exceptionally low anthropometric status of people in South Asia that has been ventured is that the population here has a genetic potential for growth in stature that is lower than in other parts of the world. When it comes to young children, this seems not to be the case. Gopalan (1992) found that children from well-to-do urban households in India have the same average height and weight for age as their Caucasian cousins (the norms used by the WHO). It has also been observed that children of Indian stock living in the UK have norm-consistent heights on average (Eveleth and Tanner, 1990; also see Svedberg 2000). This suggests that the anthropometric failure among Indian children below the age of five is phenotypic rather than genotypic; that is, the growth faltering is caused by factors other than a genetic predisposition for low growth in stature and small body frames. To my knowledge, no scientific study has been made of the genetic potential for final growth in stature of adult women in South Asia.
The most commonly advanced explanation for the shortness and thinness of South Asian women is their "discriminated position" vis-à-vis men, which is passed on from generation to generation (Ramalingaswami et al. 1996; Osmani 1997; Ramakrishnan et al. 1999). While their shortness may in part be due to genetic factors, this cannot explain the observation that almost half the adult women in India and South Asia have a body mass index (BMI) below 18.5 — while only 11 per cent in Africa (Table 2 and note a). The high incidence of wasting in India must be explained by undernutrition and inadequate health status.
When it comes to healthcare, we have the further puzzling observation that the anthropometric status of children and adult women in Africa is far better than in South Asia while the mortality rates (even before the HIV/AIDS pandemic) are much higher in Africa. The likely explanation is that the share of the population (especially in rural areas) with access to primary health care and basic sanitation is considerably lower in Africa than in South Asia (Svedberg 1999; WHO 2001b).
A common belief is that young children and women of fertile age, the two categories that have been examined in most countries, are the main victims of undernutrition. This may well be so, but we do not know for certain since the equivalent information on the height and weight of school-age children, teenagers, adult men and elderly people is simply not available. In the section on Gender Differentials below, however, we will address the question of whether the anthropometric evidence corroborates the conventional notion that female children in India are "discriminated against" vis-à-vis males in terms of nutrition and health.
Peter Svedberg is Professor of Development Economics at the Institute for International Economic Studies, Stockholm University. He is the author of Poverty and Undernutrition: Theory, Measurement and Policy (Clarendon Press, Oxford, 2000, to be published by OUP India soon), a definitive study of undernutrition in Sub-Saharan Africa and South Asia. He lives in Stockholm