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Diet Diversity is a must for India’s nutrition security

By Ravneet Kaur
on November 4, 2020

The Global Hunger Index (2020) recently ranked India 94th out of 107 countries, despite a declining undernourished population. Some of the stats speak volumes: the National Family Health Survey-4 (2015-16) found 35.7% children aged less than five years were underweight, and 38.4% were stunted. The need to address malnutrition is thus more urgent than ever. In this article, we will look more specifically at the concept of ‘diet diversity’ and the various policies in place to address malnutrition in India which, by and large, don’t include diet diversity so far.

To some extent, the COVID-19 has brought the much required focus on public health in India. Nutrition isn’t being discussed much, however, as a public health issue in the Indian public policy space. Diet diversity, an important component of healthy nutrition, is even less discussed. Diet diversity can be defined as a sufficiently different amount of food or food groups in one’s diet. Various studies have highlighted the benefits of a varied diet, particularly one including fruits and vegetables, in increasing longevity and reducing the rates of chronic degenerative diseases and in improving nutritional quality and child growth in developing countries.

According to the (2015-2016) National Family Health Survey-4, only 9.6 percent of children were fed a minimum acceptable diet.  That figure declined to 6.4 percent of children as per the Comprehensive National Nutritional Survey (2016-18), a few years later. Minimum acceptable diet is an indicator which combines standards of dietary diversity and feeding frequency by breastfeeding status. Amartya Sen and Dreze (1990) have noted that shortage of staple foods like wheat and rice leads to hunger and starvation. In order to reduce under-nutrition, governments started providing staple foods at subsidized prices, including in India.

In order to target severe acute malnutrition, a medical intervention in the form of highly dense packed food was also introduced but didn’t really convince the policy sphere. Ready-to-use therapeutic food (RUTF), is a packaged paste of peanuts, oil, sugar, vitamins, milk powder and mineral supplements, which contains 520-550 kilocalories of energy per 100 g. Such intervention, however, by being a temporary solution, is unsustainable and reversible in nature.  Existing food policies, such as the Public Distribution System (PDS) and Mid-day Meal (MDM) catalyse mono diets with a lopsided focus on starchy carbohydrates like rice and wheat, and have left the population devoid of other nutrients. These have resulted in distorted food patterns especially in economically backward communities as poor families are dependent on subsidized food grains for food security. While perhaps food secure, they are left nutritionally insecure. Their diets are predominantly based on starchy staples and often include little or no animal products and few fresh fruits and vegetables, as noted by Ruel (2002).

Similar trends have been noticed during the author’s fieldwork experiences. As part of a public policy degree, I conducted fieldwork in Rajasthan at Kasturba Gandhi Balika Vidyalayas (KGBV) on child development issues. KGBV are residential schools set up in educationally backward blocks at the upper primary level for girls belonging predominantly to the Scheduled Castes, Scheduled Tribes, Other Backward Classes and minority communities. The menu at KGBVs has been designed to provide a balanced diet to adolescent girls, but that usually doesn’t materialize, as the girls end up eating 5-6 rotis per day along with rice. Other fieldwork at Aurepalle, Telangana, where children under the Mid-day meal scheme are being provided rice and dal along with an egg, showed that quite a few children ended up skipping the eggs. Also, their diet was traditionally based on locally grown sorghum but the consumption pattern has changed by now due to existing schemes, and so the focus has shifted to rice or wheat. A study by Gupta and Mishra (2014) discussed caste, class, gender and religion as important shaping factors of dietary consumption and thus diet diversity. Despite heterogeneous dietary patterns across social groups, we have relatively homogenous food policies, however, which shows serious lacunas in our existing policies.

The National Nutrition Strategy (2017) by NITI Aayog realises the importance of diet diversity in addressing malnutrition. However, almost all the policies lack focus on causal factors to improve diet diversity, which depends upon the accessibility, affordability and acceptability of food items other than rice and wheat. In addition to this, PDS, MDM and Minimum Support Price form an important cluster of schemes which contribute to the nutritional status of the country. However, neither of the policies can be worked on in silos since each is interrelated. The fight against malnourishment cannot be won with wheat and paddies only. Food security in India is incomplete without discussing agricultural security. Successful multi-sectoral linkages will be key on the journey towards a health secure nation. In addition, inclusion of nutri-cereals in mainstream food policies should be considered. It’s not only about their production but their accessibility and affordability as well. A one-size-fits-all approach has failed to lead to a nutritionally secure India. Sustained efforts with targeted interventions are required for successful convergence in policy objectives and outcomes, in addition to multi-sectoral policies.

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