Hunger and Nutrition: Time to Act*

On 15 February, 2013, Dogra Hall of IIT Delhi was brimming with an enthusiastic crowd, comprising mostly young students and teachers, to listen to India’s foremost thinker on hunger and malnutrition—Prof. Amartya Sen. A panel discussion entitled Hunger and Nutrition: Time to Act was organized there by Department of Humanities and Social Sciences (IIT-D).

In her introduction, Dr. Reetika Khera (IIT Delhi) informed that the Government is thinking of enacting the National Food Security legislation. Life cycle approach to food security has been considered under the new bill. (Nutrition during childhood and adolescence influence a woman’s pre-conceptional nutritional status, which subsequently influences the outcome of pregnancy and the health of her child). Initially, in-kind transfers like PDS, MDMS and ICDS were considered under the National Food Security Bill (NFSB) (Please check: Standing Committee Report on National Food Security Bill, 2011, Twenty Seventh Report (January, 2013), Fifteenth Lok Sabha).  Now under the same bill there is provision for cash transfers.

Reetika explained that the PDS is known for two reasons nowadays—a. It is corrupt and leaky; and b. PDS suffers from inclusion and exclusion errors. However, PDS coverage is less than what is required. In a survey of 9 states done during 2011, it was found that in Himachal Pradesh, Tamil Nadu and Kerala, the PDS has been functioning well. PDS revival could be seen in Himachal Pradesh and Odisha. PDS leakages in Chhattisgarh have been brought down from 50 percent to 10 percent. (For more on this, please check: Revival of the Public Distribution System: Evidence and Explanations -Reetika Khera (November, 2011), Economic and Political Weekly, Vol. XLVI, No. 44 & 45, Nov 5). She said that the Standing Committee on NFSB has recommended provisioning of only 5kg of foodgrains per person, which is about half of what is required on an average in a month according to the ICMR norms. She asked that it needs to be seen whether individual entitlements are better than household entitlements. Reetika asked whether the principle of monthly entitlements of 5kg of foodgrains per person to only 67 per cent of the population (75 per cent in rural areas and 50 per cent in urban areas) be followed uniformly across all the states and UTs irrespective of their urban-rural population compositions.

Shyama Singh (grassroots worker at NREGA Sahayata Kendra, Jharkhand) informed that 90 percent population in her state is poor. Out of 12 months in a year, beneficiaries are not provided ration in 4 months. There exists low purchase-to-entitlement ratio. Gram Sabha meetings are now regularly held to monitor the working of NREGS and PDS. A lot of struggle took place in the past for transparency in the NREGS due to which Lalit Mehta (2008) and Niyamat Ansari (2010) lost their lives. These two social workers lost their lives since they tried to expose corruption in the job scheme. Muster rolls are now regularly presented before the Gram Sabha. There was a time when mates were employed on behalf of contractors. But they have now been replaced following the Panchayati Raj elections. Maintaining attendance sheet in NREGS work is a crucial task for mates. Mates are now selected by the people and not from contractors’ side.

Shyama Singh said that wells are now being constructed in Palamu and Latehar districts, which are benefitting the small farmers and irrigation. Due to dearth of technical expertise, wells collapsed at many places earlier. But that problem has been overcome. .         

Shyama was positive about the Right to Food legislation. In Jharkhand, people want ration instead of cash transfers. This is because: a. Banking infrastructure is poor; b. Banks are remotely situated; c. Poor people often have to stand in long queues to avail banking services; and d. Cash transfer has not been linked to rate of inflation. She suggested that godowns for storing foodgrains should be brought under the ambit of panchayats. There should be social auditing of local PDS and ICDS by an independent agency.

Referring to the NFSB, Shantha Sinha (Chairperson National Commission for the Protection of Child Rights) said that the Parliamentary Standing Committee has diluted the bill by replacing children's entitlement with an additional allocation of 5 kg of food grains per month for pregnant women under the PDS. In India, 46 percent of children are malnourished. Nearly 48 percent of Indian children are stunted. Slums of Delhi and Mumbai show the pathetic situation of children. Children die due to malnutrition and hunger. At many places migrant labourers have asked for anganwadi centres and access to food under the ICDS. People want their children to be healthy. It is a welcome step that the Standing Committee on NFSB has suggested that MDMS will be extended to children aged 16 years. The Supreme Court orders on Right to Food and the states that followed those orders led to the growth of anganwadi centres in the country. (ICDS is implemented through 12.41 lakh centres known as anganwadi centres (AWCs), each located in a habitation of 400-800 population). The NFSB has, however, bypassed the ICDS and anganwadi centres. The Standing Committee has also suggested restricting maternity benefits to the first two children to ensure population stabilization. By denying food to children, family planning measure is pushed through. The Committee is silent on support for breastfeeding. Shantha Sinha emphasized that a legal framework on Right to Food is a commitment from the State. A vibrant and inclusive NFSB will deepen democracy. As opposed to Montek S Ahluwalia she said that ICDS is functioning well and exclusive breastfeeding is practiced everywhere.

(For a critique of Standing Committee’s recommendations on the NFSB, please go to: Why the Parliament should reject the standing committee’s recommendations on the Food Security Bill: RTFC).     

Montek S Ahluwalia (Deputy Chairperson, Planning Commission) said that some of the things as facts should be accepted. But given that the data on malnutrition dates back to 2005-06 (NFHS-3), he estimated malnutrition prevalence in the country to be one-third of India’s child population rather than 46 percent as stated by Shantha Sinha. (Please check my blog post: India’s nutrition and hunger data is too old). Government policies have been sensitized to the issue of malnutrition. The rate of decline in malnutrition has been slower than the rate of decline in poverty, he said. Civil society has helped in taking up the issue of malnutrition. The criticism of the Supreme Court is valid. However, universalization without quality (U without Q) will not work. The ICDS is not working well may be because it is under-funded, under-manned or maybe there are other factors. There is a need to resolve the issue that how ICDS is affecting malnutrition. But inadequacy of data is a problem. He said that there are too many low birth weight children taking birth in India. Early marriage (due to social prejudice) when female body is not prepared to give birth is the main reason behind low birth weight. (Nearly 47 percent Indian girls get married before age 18). Exclusive breast feeding should be done in the first 6 months but a statute cannot guarantee this. In many Indian families, early breast feeding is not considered clean. Instead of ICDS, IEC-information, education and communication promoting good child rearing is essential. Unfortunately exclusive breastfeeding is not practiced in India. [Percentage of children receiving exclusive breastfeeding in the first 6 months of life is 46 percent (as per latest available data during 2006-2010)]. Poor people emulate things, which are not healthy practices. Since most damage is done to a child during the first 3 years since its birth, the ICDS should concentrate on children below 3 years instead of children between 3 years and 6 years.

Montek S Ahluwalia informed that immunization rate in India is worse than that in Bangladesh and China. [Vaccine coverage in the case of DTP3 (third dose of diphtheria and tetanus toxoid and pertussis vaccine) is 72 percent and in the case of measles is 74 percent in 2011]. Conditional cash transfer for child immunization could be suggested. He said that family income has a role in ensuring food security.

Montek S Ahluwalia said that the Government is committed to provide foodgrains to 67 percent of its population in India. Institutional arrangement for the supply of foodgrains require: a. Centre to transfer foodgrains to the states; and b. Centre to transfer subsidy to the states. States vary in efficiency with which they run PDS. Naming and shaming the poor performing states through monitoring and evaluation is difficult due to the political nature of PDS. Fiscal deficit issue should not be raised in the case of NFSB and an additional allocation of Rs. 20000-Rs. 30000 crore can be made. (Presently India spends Rs. 70000 crore on food subsidy). Subsidies on diesel, which is presently at Rs. 91000 crore has to be done away with.  

Amartya Sen (Professor of Economics and Philosophy at Harvard University) said that those who oppose custom duties on gold imports or taxes on fuel are organized but children are unorganized. One needs to see whether the political parties are taking up the right issues. Political parties should be sympathetic to issues of food security and nutrition. He said that the extent of healthcare and nutrition policies in India is appalling in India. Although India’s economic growth is quite close to that of China, India has comparatively higher proportion of malnourished children. India (Gini coefficient of 0.37) is less unequal than China (Gini coefficient 0.474) [A Gini of zero denotes absolute equality, while a value of 1 (or 100 on the percentile scale) means absolute inequality]. One third of Indian families don’t have electricity connections. (Census 2011 finds that for 67.2 percent of Indian households the chief source of lighting is electricity). Half the Indian families don’t have any toilet. (Census 2011 finds that for 53.1 percent of Indian households there is no latrine within the premises). In China, the corresponding figure for no latrine is only 1 percent and in Bangladesh it is only 6 percent. On the basis of nature of inequality in India, the nature of development can be determined. The development model adopted by the country has not gone well beyond a certain extent.

Amartya Sen informed that the Asian growth model pioneered by Japan after the Meiji restoration in the 19th century and that was followed by South Korea, Taiwan, Singapore and finally China emphasized on enhancing human capabilities. All these countries placed immense faith on education and health. A multi-party system is also essential for freedom of expression. Apart from liberty what is important are equality and basic capabilities. Public reasoning has been considered important by John Stuart Mill.

Amartya Sen said that there is need for courage and reasoning and then the need to integrate the two. He said that it is difficult to assess what is affecting malnutrition. But on the basis of evidence, there is a need to see what modifications can be made in the NFSB. Reason instead of passion should be used to decide whether cash or in-kind transfer should be made. Food in kind has a greater impact on malnutrition reduction rather than cash. If cash is given to women, it is difficult to assess whether the money has been spent on children or something else. If there are problems associated with identification even after Aadhaar enrollment, then there is no basic difference between cash and in-kind transfers. He said that public reasoning cannot be done without data or statistics. Since there is no updated malnutrition related data, the principle of Urban-50% and Rural-75% cannot be applied.

Amartya Sen informed that China has done better in reducing child malnutrition. In China, minimum wages have increased by 7 folds as compared to India. In Tamil Nadu the ICDS has done well. The moral objective to be informed is essential.

Speaking on the NFSB, Amartya said that the bill has watered down the directives of the Supreme Court pertaining to food security and nutrition. The Standing Committee has further weakened the bill by removing the entitlement under the ICDS. Gujarat’s growth story has been overplayed since states like Maharashtra, Uttarakhand and Bihar too displayed higher economic growth. For sustaining growth in the long-run, there is need for an effective strategy in health, nutrition and educational fronts. For India, it would be difficult to sustain economic growth with such high levels of poverty and undernutrition. Jamshed ji Tata developed Jamshedpur as a municipality and invested in education and health. He understood the importance of these two factors in economic growth like in the Asian growth model. Amartya Sen mentioned about the Bhore Committee Report on health (1946). Imitating Chinese growth path without knowing how China invested in enhancing human capabilities is not a good idea, added Sen.

On the advantages of a universal PDS over a targeted one, Amartya Sen said a. Universal schemes help to avoid corruption; b. Presence of powerful and influential people who have a stake in such programmes make such programmes relatively efficient; and c. Exclusion is absent and citizens' right is ensured.

* While utmost care has been taken in good faith to summarize the main speakers’ views, these may not be exact quotes. Please check with the speakers for verbatim quotes.