Tata Trusts: Why We Work On Nutrition

India has witnessed unprecedented economic growth in the last two decades and is the world's fastest growing large economy, today. While in the last 60 years, life expectancy has doubled, literacy rates have more than quadrupled, and health conditions have improved, malnutrition remains a major public health challenge. Women and children form a large percentage of those affected, with approximately 40 per cent of children in India being undernourished, and 70 per cent of Indian women being anaemic. With a growing level of obesity in urban areas, and India now recording the highest number of obese people in the country, we are also slowly facing a double burden of malnutrition.

We know that not only does the right nutrition have a profound impact on a child's ability to grow and learn, and lead a productive life, we also know that it is good economics to invest in nutrition. With intergenerational consequences and a long term impact on cognition and productivity, nutrition affects the quality of life and working potential of individuals.

Improving nutrition also forms part of the global Sustainable Development Goals (SDGs) adopted by countries to be achieved by 2030. In addition, as a World Health Organization (WHO) Member State, India has also endorsed global targets for improving maternal, infant and young child nutrition and is committed to monitoring progress. These World Health Assembly (WHA) targets are to be achieved by 2025 include: 40 per cent reduction in child stunting, 50 per cent reduction in anemia in women, 30 per cent reduction in low birth weight. No increase in child overweight, Increase rate of exclusive breastfeeding to at least 50 per cent and Reduce and maintain childhood stunting to less than 5 per cent.

As the government finalises measurable indicators within the 17 Sustainable Development Goals (SDGs) and the attendant 169 targets, addressing malnutrition needs to be prioritized in the indicator-setting process of the SDGs. SDG 2 (End hunger, achieve food security and improved nutrition and promote sustainable agriculture) within its five targets and three Means of Implementation targets seems skewed in its emphasis on agricultural productivity growth and sustainable food production with just one target speaking to the malaise of malnutrition. The target focuses on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons. The WHA targets mentioned above also need to be taken into consideration within the SDG indicator setting.

The Indian government's target, as part of the Sustainable Development Goals (SDGs), more specifically SDG 2, is to reach a figure of 12 per cent of stunting for the country by 2022, which is a reduction of 3 per cent per year. With 38.7 per cent children in the country suffering from stunting, India ranks 114 in the list of 132 countries surveyed. The percentage is much higher than the global prevalence of stunting at 23.8 per cent, as per the latest Global Nutrition Report (GNR). While stunting has reduced in the last decade, this has been at about 1 per cent per year, which necessitates rapid acceleration in progress; accurate and timely availability of data and a high level, cross sectoral mechanism to monitor the progress and keep it on track.

Despite some progress made nationally, we find significant disparities in the targets for malnutrition reduction. Most states have yet to set time-bound targets for under-5 overweight or low birth weight. Only six states have set up nutrition missions; of these, only Uttar Pradesh and Odisha have time-bound targets. Maharashtra, Karnataka, Gujarat and Madhya Pradesh do not have time-bound targets.

Similarly, while there has been a decline in childhood stunting in almost all states, there still exists a wide gap between states. Therefore, while 28 per cent of children in Telangana and 27 per cent in Tamil Nadu have a low height for age, the corresponding figures for Bihar and Madhya Pradesh are 48 per cent and 42 per cent. The Global Nutrition Report 2015 finds that Bihar, Jharkhand, and Uttar Pradesh have high initial rates of stunting and yet the subsequent declines in stunting in these states are lower than most other states. Even though these states did see a considerable decline in stunting since the last survey, at this rate it will take a long time for them to catch up.

At the Tata Trusts, we believe that nutrition goes beyond food, and addressing undernutrition and stunting of children necessitates a multi sectoral approach, encompassing many other aspects like maternal health, basic healthcare, education, gender empowerment and sanitation. For instance, the links between WASH and stunting remain critical. One of the top priorities of the Union government is the Swachh Bharat Mission (SBM), a flagship of the PM with his own personal commitment to making India open-defecation free by 2019. In this regard, it would be important to find a mechanism to track progress together, especially at the District level.

While the government has to be in the driver's seat in our fight against malnutrition, philanthropic organisations, NGOs, multilateral and bilateral bodies, corporates and businesses also have a role to play. Furthermore, the focus must be at the district level given that most schemes are implemented at the districts and there is also a need to map specific contextual constraints unique to states and districts. A statement of high level political commitment, along with a clear roadmap and monitoring plan, clearer delineation of responsibilities among different line Ministries / state departments, adequate budgetary allocations, focusing on women, children and the most marginalized is needed, in order for us to achieve the SDGs and targets on nutrition.