Introduction & Overview
Hunger and malnutrition remain critical challenges in India, impacting human development, productivity, and the overall well-being of its population. Despite significant strides in food production and various government interventions, a substantial portion of the population, especially women and children, suffers from various forms of malnutrition.
This module delves into the multifaceted dimensions of hunger and malnutrition, their underlying causes, the comprehensive governmental and global responses, and India's performance on key indices, providing a detailed framework for UPSC examination.
2.2.1: Dimensions of Hunger & Malnutrition
Prelims-Ready Insights
Understanding the fundamental concepts and definitions is crucial for factual recall.
Food Security: The Four Pillars
Conceptually defined by four essential pillars (Source: FAO - Food and Agriculture Organization of the UN):
Availability
Sufficient quantities of food are consistently available, either from domestic production or imports.
Access
Individuals have sufficient resources (economic, physical) to obtain appropriate foods for a nutritious diet.
Utilization
Proper biological use of food, requiring a nutritious diet, safe drinking water, sanitation, and health care to absorb nutrients.
Stability
Ensures continuous availability, access, and utilization of food, even in times of shocks (economic crises, climate disasters).
Types of Malnutrition (Source: WHO, UNICEF)
Undernutrition
Occurs when an individual does not consume enough calories, protein, and micronutrients.
- Wasting (Acute): Low weight-for-height. Severe weight loss.
- MAM: z-score between -2 and -3 SD.
- SAM: z-score below -3 SD (critical).
- Stunting (Chronic): Low height-for-age. Prolonged undernutrition, often irreversible.
- Underweight: Low weight-for-age. Composite indicator.
Micronutrient Deficiencies ("Hidden Hunger")
Lack of essential vitamins and minerals, even if caloric intake is sufficient. Impairs immune function, cognitive deficits.
- Iron Deficiency: Leading to anaemia (common in women and children).
- Iodine Deficiency: Affects cognitive development (cretinism, goiter).
- Vitamin A Deficiency: Leads to night blindness, increased susceptibility to infections.
- Zinc Deficiency: Weakens immune system, affects growth.
Overnutrition
Excessive intake of calories and/or unhealthy nutrients, leading to overweight and obesity.
- Overweight: BMI ≥ 25
- Obesity: BMI ≥ 30
Double Burden of Malnutrition
Coexistence of undernutrition (stunting, wasting, micronutrient deficiencies) and overnutrition (overweight, obesity) within the same individual, household, or population. Often seen in rapidly transitioning economies like India.
Summary: Malnutrition Types
| Type of Malnutrition | Description | Key Indicator(s) | Severity (for Wasting) |
|---|---|---|---|
| Undernutrition | Insufficient calorie/nutrient intake. | - | - |
| Wasting | Low weight for height (acute, recent). | Weight-for-height z-score | MAM (>-3 to -2 SD), SAM (<-3 SD) |
| Stunting | Low height for age (chronic, irreversible after early childhood). | Height-for-age z-score | - |
| Underweight | Low weight for age (composite of wasting/stunting). | Weight-for-age z-score | - |
| Micronutrient Deficiency | Lack of essential vitamins/minerals ("Hidden Hunger"). | Anaemia (iron), goiter (iodine), VAD etc. | - |
| Overnutrition | Excessive calorie intake, leading to overweight/obesity. | BMI (≥ 25 for overweight, ≥ 30 for obesity) | - |
| Double Burden | Coexistence of undernutrition and overnutrition. | Both types present in same population/HH | - |
Mains-Ready Analytical Notes
Complex Nature of Malnutrition
Malnutrition is not solely a food problem but a development challenge. It is an outcome of a complex interplay of food insecurity, poor health, inadequate care practices, and underlying socio-economic and environmental factors. For instance, even with sufficient food availability, poor sanitation (leading to infections) can prevent nutrient absorption, causing undernutrition.
Double Burden of Malnutrition: Growing Concern
- Rising Obesity: As incomes rise, especially in urban areas, there is a shift towards processed foods high in sugar, fat, and salt, coupled with sedentary lifestyles.
- Consequences: Poses a dual public health challenge, increasing the burden of non-communicable diseases (NCDs) like diabetes, heart disease, alongside persistent infectious diseases linked to undernutrition.
- Policy Implications: Requires integrated strategies addressing both undernutrition and overnutrition, promoting healthy diets, and physical activity while ensuring access to nutritious food for the vulnerable.
2.2.2: Causes & Consequences
Mains-Ready Analytical Notes
Critical for understanding the systemic issues and their broad impacts.
Causes of Hunger & Malnutrition
Poverty & Food Inflation
- Poverty: Fundamental root cause, limits access to food, water, healthcare. (Source: Economic Survey)
- Food Inflation: Disproportionately affects poor, reduces purchasing power.
Poor Access to Food
- Physical: Remote areas, poor infrastructure, wastage.
- Economic: High prices, inadequate employment, low wages.
Water, Sanitation & Hygiene
- Lack of Safe Drinking Water & Sanitation: Leads to water-borne diseases, impairing nutrient absorption. (Source: NFHS, UNICEF)
- Poor Hygiene & Health Conditions: Limited healthcare, high incidence of infectious diseases.
Societal Factors
- Illiteracy & Lack of Education: Especially among mothers, linked to poor feeding practices.
- Gender Inequality: Women often eat last and least, perpetuating intergenerational cycle.
- Faulty Feeding Practices: Suboptimal breastfeeding, inadequate complementary feeding.
Climate Change & Post-Harvest Losses
- Climate Change: Extreme weather, crop failures, livelihood loss, food price volatility.
- Post-Harvest Losses: Due to inadequate storage, transportation, processing facilities.
PDS Inadequacies
- Inadequate Public Distribution System (PDS): Issues like leakages, targeting errors, poor quality grains, irregular supply.
Consequences of Hunger & Malnutrition
Impaired Development
Especially in early childhood (first 1000 days), undernutrition leads to stunting, reduced physical growth, and irreversible brain damage, affecting cognitive abilities and learning capacity.
Increased Susceptibility to Disease
Weakened immune systems make malnourished individuals more prone to infectious diseases, creating a vicious cycle of illness and malnutrition.
Reduced Productivity & Economic Burden
Malnourished adults have lower physical and cognitive capacity, leading to reduced productivity in work and lower earning potential. Imposes significant economic burden (lost productivity, increased healthcare costs).
Intergenerational Cycle & Mortality
- Intergenerational Cycle: Malnourished mothers are more likely to give birth to underweight and stunted children, perpetuating the cycle.
- Increased Mortality: Severe forms of malnutrition (SAM) significantly increase the risk of child mortality.
2.2.3: Government Schemes & Initiatives
Prelims-Ready Notes
Key facts, objectives, and components of major schemes.
Key Schemes Overview
National Food Security Act (NFSA), 2013
- Provisions: Legal entitlement to food grains.
- Coverage: 75% rural, 50% urban (approx. 2/3rd population).
- Entitlement: 5 kg food grains/person/month at subsidized rates (Rice @ Rs 3, Wheat @ Rs 2, Coarse grains @ Re 1). AAY households: 35 kg/HH/month.
- Special: Maternity benefit (Rs 6,000), nutritious meals for children (6 months-14 years).
- Operationalizes 'Right to Food'.
Public Distribution System (PDS)
- Evolution: Universal PDS → Targeted PDS (1997) → NFSA → One Nation One Ration Card (ONORC, 2019-20).
- ONORC: Enables portability, biometric authentication (Aadhaar).
- Challenges: Leakages, targeting errors, poor quality.
- Reforms: Digitalization, Aadhaar linkage, e-POS, DBT.
Integrated Child Development Services (ICDS), 1975
- Objectives: Holistic development of children (0-6 years) and pregnant/lactating mothers.
- Components: Supplementary Nutrition (SNP), Immunization, Health Check-ups, Referral Services, Pre-school Non-formal Education, Nutrition & Health Education.
Mid-Day Meal Scheme (PM POSHAN), 1995
- Objectives: Enhance nutritional status, encourage enrolment/attendance.
- Coverage: Class I to VIII in govt/aided schools.
- Renamed PM POSHAN (2021): Expanded scope, "Poshan Vatika," pre-primary children.
POSHAN Abhiyaan (National Nutrition Mission), 2018
- Objectives: Reduce stunting, under-nutrition, anaemia, low birth weight.
- Strategies: Convergence, Technology (ICT-based tools), Behaviour Change Communication (BCC), Community Mobilization.
Food Fortification & Others
- Concept: Adding key vitamins/minerals to staple foods (Iodised Salt, Fortified Rice, Milk, Oil etc.). Monitored by FSSAI.
- Anaemia Mukt Bharat (AMB, 2018): Reduce anaemia (T3 approach, IFA supplementation).
- Eat Right India Movement (FSSAI): Promote safe, healthy, sustainable food habits.
Summary: Major Food Security & Nutrition Schemes
| Scheme Name | Launch Year | Ministry | Key Objective/Components |
|---|---|---|---|
| NFSA | 2013 | Food & Public Dist. | Legal entitlement to food grains; maternity benefits. |
| PDS | (Evolutionary) | Food & Public Dist. | Distribute subsidized food grains; reforms like ONORC & e-POS. |
| ICDS | 1975 | WCD | Holistic child development (0-6 yrs) and maternal health. |
| PM POSHAN (MDMS) | 1995 | Education | Mid-day meals for school children; improve nutrition, attendance. |
| POSHAN Abhiyaan | 2018 | WCD | National Nutrition Mission; reduce stunting, undernutrition, anaemia. |
| Food Fortification | Ongoing | Health & Family Welfare; FSSAI | Adding micronutrients to staple foods. |
| Anaemia Mukt Bharat | 2018 | Health & Family Welfare | Reduce anaemia through IFA supplementation, deworming. |
| Eat Right India | 2018 | FSSAI | Promote safe, healthy, and sustainable food habits. |
Mains-Ready Analytical Notes
Evaluation of Schemes
- NFSA and PDS: Strengths include legal safety net, increased coverage. Challenges remain in targeting errors, quality, pilferage. ONORC enhances portability.
- ICDS & PM POSHAN: Wide reach for early childhood development and school retention. Challenges: Quality of nutrition, infrastructure gaps, burden on frontline workers.
- POSHAN Abhiyaan: Holistic, multi-sectoral approach using technology. Challenges: Ground-level convergence, data quality, sustained funding, capacity building.
Challenges in Delivery and Implementation
- Last-Mile Delivery: Reaching the most vulnerable in remote areas.
- Data Integrity & Monitoring: Real-time, accurate data.
- Behavioral Change: Deep-rooted social norms are difficult to change.
- Capacity Building: Training and motivation of frontline workers.
- Addressing Intersectionality: Malnutrition disproportionately affects specific disadvantaged groups.
Inter-sectoral Convergence
- Crucial for success: Requires coordinated effort from multiple sectors (health, sanitation, education, rural development).
- POSHAN Abhiyaan's role: Designed to facilitate this convergence.
- Challenges: Siloed functioning of ministries, lack of clear accountability.
2.2.4: Global & National Indices
Prelims-Ready Notes
Understand the indicators, sources, and India's recent performance.
Global Hunger Index (GHI)
GHI Indicators (4 components, equally weighted)
- Undernourishment: Proportion of population with insufficient caloric intake.
- Child Wasting: Proportion of children under five years who are wasted (low weight-for-height).
- Child Stunting: Proportion of children under five years who are stunted (low height-for-age).
- Child Mortality: Mortality rate of children under five years of age.
Developed by: Concern Worldwide and Welthungerhilfe
India's GHI 2023 Performance
Rank: 111 out of 125 countries
Score: 28.7 ("Serious" level of hunger)
- Key Concern: India has the highest child wasting rate globally (18.7% in GHI 2023, based on NFHS-5 data).
- Child stunting also high (35.5%).
Government Stance: India has often criticized GHI's methodology, indicators, and data sources, calling it erroneous. Points to NFHS data showing improvements.
National Family Health Survey (NFHS)
Conducted by: International Institute for Population Sciences (IIPS) under the Ministry of Health & Family Welfare.
Key Health & Nutrition Indicators & Trends (NFHS-5, 2019-21 vs NFHS-4)
Trends Summary (NFHS-5 vs NFHS-4): Overall improvement in stunting, wasting, and underweight in children, but a worrying increase in anaemia and overweight/obesity across the population. Exclusive breastfeeding has also shown good improvement.
FAO (Food and Agriculture Organization) Reports
The State of Food Security and Nutrition in the World (SOFI) Report
Annual flagship report by FAO, IFAD, UNICEF, WFP, and WHO. Provides comprehensive global and regional analysis of hunger and food security trends.
Relevance: India often features prominently in SOFI reports concerning the number of undernourished people globally. SOFI 2023 indicated that 735 million people faced chronic hunger in 2022, a rise since 2019, with Asia (including India) having a significant share.
Summary: Major Indices & India's Performance
| Index | Key Indicators | India's Performance (Latest) |
|---|---|---|
| Global Hunger Index (GHI) | Undernourishment, Child Wasting, Child Stunting, Child Mortality. | Rank 111 out of 125 countries (2023). Score 28.7 (Serious). Highest child wasting rate globally (18.7%). |
| National Family Health Survey (NFHS-5, 2019-21) | Stunting, Wasting, Underweight, Anaemia, Exclusive Breastfeeding, Overweight/Obesity. | Stunting: 35.5% (down); Wasting: 19.3% (slight increase); Underweight: 32.1% (down). Anaemia: Children (67.1%), Women (57%) - increased significantly. Overweight/Obesity: Increased. Exclusive Breastfeeding: 63.7% (increased). |
| FAO SOFI Report | Number of undernourished people globally. | Indicates India has a significant share of the global undernourished population, highlighting the scale of the challenge despite progress. |
Mains-Ready Analytical Notes
Analysis of India's Performance
- Positive Trends: Significant reduction in stunting and underweight (NFHS-5), improved sanitation/water access.
- Areas of Concern:
- Persistent High Wasting: Major concern for GHI ranking, indicates acute malnutrition.
- Worrying Rise in Anaemia: Major public health challenge, impacting productivity and cognitive development.
- Double Burden: Simultaneous increase in overweight/obesity points to nutrition transition.
- Critique of GHI: India criticizes GHI for small sample size, over-reliance on child health, and data sources. Despite criticisms, GHI remains a global benchmark.
Reasons for Poor/Improving Indicators
- Improvements attributed to: NFSA, ICDS, MDMS, SBM, JJM, POSHAN Abhiyaan (awareness).
- Poor Indicators (Wasting & Anaemia) due to: Persistent poverty, inadequate maternal nutrition, poor sanitation/hygiene, faulty feeding practices, limited dietary diversity, limited healthcare access.
Policy Implications
- Integrated Approach: Stronger convergence of health, nutrition, sanitation, social protection.
- Focus on First 1000 Days: Critical window for preventing stunting/wasting.
- Addressing Anaemia: Intensifying AMB, diversified diets, fortification, deworming.
- Behavioral Change Communication: Sustained campaigns.
- Addressing Double Burden: Healthy lifestyles, regulating unhealthy food marketing.
- Data-driven interventions: Using NFHS and localized data.
- Strengthening PDS: Further reforms for better targeting and last-mile delivery.
UPSC Previous Year Questions
Prelims MCQs
UPSC CSE 2021: Global Hunger Index (GHI)
Which of the following statements is/are correct regarding the Global Hunger Index (GHI)?
- The GHI is compiled by the Food and Agriculture Organization (FAO).
- The index considers Undernourishment, Child Stunting, Child Wasting, and Child Mortality as its indicators.
- India has consistently ranked among the top 20 countries in the GHI over the last decade.
Select the correct answer using the code given below:
(a) 1 and 2 only
(b) 2 only
(c) 1 and 3 only
(d) 1, 2 and 3
Answer: (b)
Hint: Statement 1 is incorrect (GHI is by Concern Worldwide & Welthungerhilfe). Statement 2 is correct (these are the four indicators). Statement 3 is incorrect (India has consistently ranked low, not among the top 20).
UPSC CSE 2018: Integrated Child Development Services (ICDS) Scheme
With reference to the Integrated Child Development Services (ICDS) Scheme, consider the following statements:
- It is a centrally sponsored scheme implemented by states/UTs.
- It aims to improve the health and nutritional status of children below 6 years and pregnant and lactating women.
- It provides pre-school non-formal education to children aged 3-6 years.
Which of the statements given above are correct?
(a) 1 and 2 only
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2 and 3
Answer: (d)
Hint: All statements accurately describe the ICDS scheme's nature, target group, and core components.
UPSC CSE 2013: National Food Security Act, 2013
The National Food Security Act, 2013 aims to provide food security by
- Providing subsidized food grains to specified categories of households.
- Introducing a uniform Public Distribution System across all states.
- Providing supplementary nutrition to pregnant women and lactating mothers.
Select the correct answer using the code given below:
(a) 1 and 2 only
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2 and 3
Answer: (c)
Hint: Statement 1 and 3 are direct provisions of NFSA. Statement 2 is incorrect; NFSA aims for a legal entitlement framework, not a uniform PDS across states, as states have flexibility in implementation.
Mains Questions
UPSC CSE 2022: Right to Food & Climate Change
Elaborate the scope and significance of the 'Right to Food' in India, particularly in the context of challenges posed by climate change. (150 words)
Direction: Discuss NFSA 2013 as the legal backbone of the Right to Food. Highlight its significance in ensuring food security and dignity. Then, crucially link it to climate change: how climate impacts (droughts, floods, extreme weather) threaten food production, increase prices, and affect livelihoods, making the 'Right to Food' framework even more vital for vulnerable populations as a safety net.
UPSC CSE 2018: Life Expectancy & New Health Challenges
The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? (250 words)
Direction: This relates to the "double burden of malnutrition" and consequences. Discuss challenges like the rise of NCDs (diabetes, heart disease, obesity) linked to overnutrition/lifestyle, mental health issues, geriatric care needs, and the need for a shift from communicable to non-communicable disease management. Steps: focus on preventive healthcare, public health campaigns for healthy lifestyle, strengthening primary healthcare, specialized geriatric care, addressing overnutrition.
UPSC CSE 2017: Panchayati Raj Impediments
What are the impediments to the success of Panchayati Raj in India? (150 words)
Direction: While not directly on hunger/malnutrition, effective Panchayati Raj (73rd/74th amendments) is critical for grassroots implementation and monitoring of schemes like PDS, ICDS, and MDMS. Impediments (lack of funds, functionaries, devolution, bureaucratic control) directly affect local delivery of food security and nutrition programs.
Trend Analysis for UPSC
Prelims Trend
- Focus: Core components/objectives of major schemes (NFSA, ICDS, MDMS, POSHAN Abhiyaan). Indicators and rankings of global indices (GHI, NFHS data). Definitions of malnutrition types.
- Evolution: Questions more specific regarding provisions and data points. Emphasis on current figures (NFHS, GHI) and recent developments (PM POSHAN, ONORC). Shift from basic memorization to nuanced understanding.
Mains Trend
- Focus: Analytical understanding of causes/consequences, critical evaluation of schemes (successes, challenges), policy recommendations.
- Evolution: Shift from descriptive to critical analysis. Questions ask for evaluation, implementation gaps, suggestions.
- Interlinkages: Growing trend to link hunger/malnutrition with poverty, climate change, gender, governance.
- Data-driven arguments: Expect to use NFHS and GHI data to support arguments.
- Holistic solutions: Questions often ask for comprehensive, multi-sectoral strategies.
Original MCQs for Prelims
Original MCQ 1: Child Wasting & Stunting
Which of the following statements regarding 'Child Wasting' and 'Child Stunting' in the context of malnutrition in India are correct?
- Child Wasting is a measure of acute undernutrition, indicating recent and severe weight loss.
- Child Stunting is a measure of chronic undernutrition, often reflecting long-term deprivation.
- As per NFHS-5, India has seen a decrease in both child wasting and child stunting compared to NFHS-4.
Select the correct answer using the code given below:
(a) 1 and 2 only
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2 and 3
Answer: (a)
Explanation:
- Statement 1 is correct. Wasting is low weight-for-height.
- Statement 2 is correct. Stunting is low height-for-age.
- Statement 3 is incorrect. While child stunting decreased (38.4% to 35.5%), child wasting showed a slight increase (21.0% to 19.3% per NFHS-5 data for children under 5, though GHI data might show different specific figures for slightly different age groups/calculations, the NFHS-5 direct comparison shows a slight increase).
Original MCQ 2: PDS Reforms
With reference to the Public Distribution System (PDS) reforms in India, consider the following initiatives:
- One Nation One Ration Card (ONORC) scheme.
- Aadhaar linkage of ration cards and e-POS devices at Fair Price Shops.
- Direct Benefit Transfer (DBT) of food subsidy in lieu of grains.
Which of the initiatives given above are aimed at reducing leakages and improving targeting in PDS?
(a) 1 and 2 only
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2 and 3
Answer: (d)
Explanation: All three initiatives directly aim to improve the efficiency, transparency, and targeting of the PDS: ONORC reduces ghost beneficiaries and allows migrants access. Aadhaar linkage and e-POS verify beneficiaries and track transactions. DBT of subsidy reduces diversion of physical grains.
Original Descriptive Questions for Mains
Original Mains Q1: Malnutrition Paradox
"Despite significant progress in food production and various government interventions, malnutrition remains a persistent and complex challenge in India." Discuss the underlying causes contributing to this paradox and suggest multi-sectoral strategies for ensuring comprehensive nutritional security. (15 marks, 250 words)
Key points/Structure:
- Introduction: Acknowledge India's achievement in food grain production ("food surplus") but highlight persistent malnutrition (refer to NFHS data - anaemia, wasting, double burden). State the paradox.
- Underlying Causes for the Paradox: Access vs. Availability, Utilization Issues (sanitation, health), Dietary Diversity, Behavioural Aspects, Intergenerational Cycle, Double Burden, Climate Change.
- Multi-sectoral Strategies: Strengthening Food Systems (PDS reforms, diversity), Health & Sanitation (JJM, SBM, AMB), Behaviour Change (POSHAN Abhiyaan's BCC), Women's Empowerment, Poverty Alleviation, Data & Monitoring, Research & Development.
- Conclusion: Emphasize holistic, integrated approach beyond just food supply.
Original Mains Q2: PDS Evolution & Challenges
Examine the evolution of the Public Distribution System (PDS) in India. How has the 'One Nation One Ration Card' (ONORC) initiative contributed to enhancing food security, particularly for migrant workers? What challenges still impede the universal effectiveness of PDS? (10 marks, 150 words)
Key points/Structure:
- Evolution: Universal PDS → Targeted PDS (TPDS, 1997) → NFSA, 2013.
- ONORC's Contribution: Portability, crucial for migrant workers, reduces exclusion, reduces leakages.
- Challenges Impeding Effectiveness: Targeting Errors, Quality of Grains, Last-Mile Delivery, FPS dealer issues (corruption), Awareness, Digital Divide.
- Conclusion: ONORC is significant, but further improvements needed.