CHAPTER -- V

CHAPTER V

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 CHAPTER-V
STATUS OF NUTRITION IN INDIA: AN INTER-STATE ANALYSIS

5.1 Introduction
Malnutrition is a major cause of millions of deaths each year across the
globe. Approximately one billion people are undernourished worldwide and
majority of them are living in developing countries. Young children and pregnant
and lactating women are the most vulnerable groups and the most likely to be
affected. Under-nutrition is the underlying cause of child deaths and of one-third of
child diseases. Lack of access to nutritiously adequate food and health care
undermines countries' development potential and threatens public health and
security. However, developing nations has been facing the challenge of lower
nutritional levels, both quantitatively and qualitatively. Again, the nutritional
requirements, necessary for keeping good health, are known to vary across
individuals and over time for a variety of reasons, generally unknown to us
(Ravallion, 1992). Many factors such as age, purchasing power, culture etc. play
important role in deciding the diet of a human being. But all the human being is not
able to meet the dietary requirements for sustaining a healthy and active life. It is
necessary to monitor the nutritional intake of the people, particularly in developing
countries like India that include a sizable group of economically deprived people.
Under nutrition or malnutrition in India has been a major issue for long time
now. Under nutrition in India is among the highest in the world. This always puts
the health of our country in a state of emergency. A significant proportion of the
world's poor live in India and so as a significant proportion of the world's
malnourished children. The magnitude of malnutrition is generally assessed by
comparing the food energy intake of persons with proposed norms. Poverty and
under-nutrition coexist, and poor dietary quality is associated with poor childhood
growth, as well as significant micronutrient deficiencies. There is strong relationship
exist between poverty and nutrition, while poverty restricts access to food required
to meet daily requirements and thus leads to malnutrition, malnutrition can adversely
affect educational and economic attainments and hence perpetuating poverty.
Micronutrients are one of the most fundamental components of a healthy and a well-
nourished society and must become a central pillar of our efforts. Hence, deficiency
in micronutrients such as vitamin A, iodine, iron etc. prevents people to maintain a
healthy life in India.

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5.2 Definition of Malnutrition
Availability of adequate nutritional levels that is required for meeting the
energy and micronutrients requirements for humans is one of the major criteria
while evaluating success of development policies of a nation. Scientifically
definition of malnutrition is the condition that develops when the body does not get
the right amount of the vitamins, minerals, and other nutrients it needs to maintain
healthy tissues and organ function. Technically malnutrition includes both over-
nutrition and under- nutrition. According to World Food Programme (WFP)
programs and assessments, malnutrition refers to under-nutrition unless otherwise
specified. WFP defines malnutrition as “a state in which the physical function of an
individual is impaired to the point where he or she can no longer maintain adequate
bodily performance process such as growth, pregnancy, lactation, physical work and
resisting and recovering from disease. By the year 2010, nearly half of India's small
children are malnourished: one of the highest rates of underweight children in the
world, higher than most countries in sub-Saharan Africa. More than one-third of the
world's 150m malnourished under-fives live in India.
Poor nutrition starts before birth and continues into adolescence and adult life
and may also span generations. An undernourished and anemic mother gives birth to
a low birth weight baby, more susceptible to infections and more likely to failure of
growth. This may lead to undernourished and anemic child and adult. It also spans
generations. Even if the adolescent catches up on some lost growth, the effects of
early childhood malnutrition on cognitive development and behaviour may not be
fully corrected. “A stunted girl is thus most likely to become a stunted adolescent
and later a stunted woman. Apart from direct effects on health and productivity,
adult stunting and underweight increase the chance that her children will be born
with low birthweight. And so the cycle continues” [ACC/SCN 1992].
The major cause of malnutrition is lack of macronutrients (carbohydrates,
protein and fat), micronutrients (vitamins and minerals), or both. Macronutrient
deficiencies occur when the body adapts to a reduction in macronutrient intake by a
corresponding decrease inactivity and an increased use of reserves of energy
(muscle and fat), or decreased growth. The most common micronutrient deficiencies
are iron (anaemia), vitamin-A (xerophthalmia, blindness), and iodine (goiter and
cretinism). Others, such as vitamin C (scurvy), niacin (pellagra), and thiamine or

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vitamin B1 (beriberi), also can occur during acute or prolonged emergencies when
population are dependent on a limited, unvaried food source.
5.3 Nutrition Policy of India
During the 1970s and 1980s nutritionists were intensely engaged in
understanding the nature of under-nutrition in India. The major problem with the
policy makers was to control the malnutrition by determining the causes and
measurement. By the mid-1980s, however, with the decline in severe forms of
malnutrition such as kwashiorkor, marasmus, pellagra and beriberi, the direction of
nutrition research shifted towards the ascendancy of nutrition related diseases such
as diabetes, hypertension, coronary heart disease, micronutrients and obesity. Policy
makers focused on programmes related to nutrition supplements rather than nutrition
policy as a whole and social planning engaged to implement it.
5.3.1. Nutrition Policy, 1993
The nutrition policy document of 1993 did talk of intervention programmes, but
not in isolation. It identified key areas of action like increasing foodgrain
production, the public distribution system to ensure food security, land reforms,
health, information system, child and women development and education. Its goal
was to reduce further chronic energy deficiency (CED), low birth weight, anaemia
of pregnancy, to achieve production targets of 250 MT by 2020, to have a strategy
for horticulture to promote protective foods and evolve an inter-sectoral approach to
nutrition planning. In contrast, the Tenth Five-Year Plan proposes a paradigm shift,
with four basic thrust areas:
 Shift from household food security and freedom from hunger to nutrition
security for the family and individuals.
 Shift from untargeted food supplementation to screening of all persons from
vulnerable groups for identification of those with various grades of under-
nutrition and appropriate management.
 Shift from lack of focused intervention on the prevention of over-nutrition to
strategies of prevention, control and management of obesity.
5.3.2. National Plan of Action on Nutrition, 1995
The national Plan of Action on nutrition 1995 laid down a systematic
framework for collaboration among national government agencies, state
governments, NGOs, the private sector and the international community. It is a
multi-sectoral framework for implementation of the national nutrition goals to be
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reached by the year 2000. This plan states the objectives and tasks of 14 different
sectors namely Agriculture, food, civil supplies and public distribution system,
education, forestry, maternal and child health care, food processing industries,
health, information and broadcasting, labour, rural and urban development, and
women and child development and welfare. To ensure the proper implementation of
the policy, specific strategies have been laid down and each organisation involved in
implementation has been made responsible for the right outcome. Integrated child
development services (ICDS) scheme is one of the major interventions policies of
government for addressing the nutrition challenge in the country. An assessment of
ICDS showed that 81 per cent of children less than 6 year of age were living in an
area served by Anganwadi centre (AWC) but still there were problems of access.
Few other intervention policies are National Rural Health Mission (NHRM) and
other health sector intervention, total sanitation campaign, Mid-Day Meal Scheme
(MDMS), Target Public Distribution System (TPDS), National Horticulture mission,
Mahatma Gandhi National Rural Employment Guarantee scheme (MGNREGS), etc.
5.3.3. Recent Policy on Nutrition
To combat malnutrition in the country, new plan of action has been initiated
over the 12th five plan period under the chairman ship of prime minister. The major
focus area will be.
 Strengthening and restructuring ICDS with special focus on pregnant and
lactating mothers and children under three.
 Brining various programmes together through various strong institutional
and programmatic convergences at the district, block and village level to
monitor the programme implementation.
 Strengthening information and education system to create awareness about
various programmes on nutrition.
The objective of the policy will be to reduce 25 percentage points in
underweight amongst children under three and five, reduction in the prevalence of
the moderate and severe anaemia in children, pregnant women and adolescent by 50
per cent of the current level, improvement of breast feeding and complementary
feeding, and 100 per cent consumption of adequately iodated salt at the household
level.
5.4 Nutrition Intake in India

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 Along with the increase in GDP, real per capita consumption has also grown
rapidly, at 2.2 percent a year in the 1980s, at 2.5 percent a year in the 1990s, and at
3.9 percent a year from 2000 to 2005. Although the household survey data show
much slower rates of per capita consumption growth than do these national accounts
estimates, even these slower growth rates are associated with a substantial decrease
in poverty since the early 1980s, Deaton and Drèze (2002), Himanshu (2007). But,
per capita calorie intake has been declining, so as the intake of many other nutrients.
The fat is the only major nutrient group whose per capita consumption is
continuously increasing. More than three quarters of the population live in
households, whose per capita calorie consumption is less than 2,100 in urban areas
and 2,400 in rural areas, a numbers that are often considered as “minimum calorie
requirements” in India. Economic growth is necessary for sustaining progress in
efforts to reduce poverty, hunger and malnutrition. But it is not sufficient. Inclusive
growth, growth that provides opportunities for those with meagre assets, skills and
opportunities, improves the incomes and livelihoods of the poor, and is effective in
the fight against hunger and malnutrition.
Table-5.1: Worldwide prevalence of Under-Nourishment
Undernourished Population
(millions) Proportion in Total Population
Country 1990– 2000– 2005– 2010– 2014– 1990– 2000 2005 2010– 2014–
92 02 07 12 16 92 –02 –07 12 16
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)
Bangladesh 36.0 27.7 24.3 26.5 26.3 32.8 20.6 16.8 17.3 16.4
India 210.1 185.5 233.8 189.9 194.6 23.7 17.5 20.5 15.6 15.2
Myanmar 26.8 24.3 17.0 9.4 7.7 62.6 49.6 33.7 18.0 14.2
ASIA 741.9 636.5 665.5 546.9 511.7 23.6 17.6 17.3 13.5 12.1
Viet Nam 32.1 20.7 15.9 12.2 10.3 45.6 25.4 18.5 13.6 11.0
China 289.0 211.2 207.3 163.2 133.8 23.9 16.0 15.3 11.7 9.3
Nepal 4.2 5.2 4.1 2.5 2.2 22.8 21.9 15.8 9.2 7.8
Indonesia 35.9 38.3 42.7 26.9 19.4 19.7 18.1 18.8 11.1 7.6
Thailand 19.8 11.6 7.7 6.0 5.0 34.6 18.4 11.7 8.9 7.4
Source: The State of Food Insecurity in the World, 2015
The undernourished population is declined in India over the period of 1990–
92 to 2014–16. But in terms f absolute population, India still has the second-highest

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estimated number of undernourished people in the world. China and India alone
account for 81 percent of the total reduction of the number of undernourished people
in the developing regions between 1990–92 and 2014–16, and China alone accounts
for almost two-thirds. The proportion of undernourished population in China has
significantly declined during the above period from 15.3 per cent in 1990-92 to 9.3
per cent in 2014-16. The proportion of undernourished people is still higher than any
other Asian countries except Bangladesh even higher than the average Asian number
(Table-5.1). Indian policy makers need to look for more inclusive growth to meet
the millennium development goal.
According to a report “The State of Food Insecurity in the World” published
by Food and Agriculture Organization in the year 2015, the proportion of total
population undernourished in India has decreased from 1990-92 to 2010-12 from
23.7 per cent to 15.6 percent respectively (Table-5.2). The organisation is expecting
that the percentage may further decline in 2016 to 15.2 per cent. That is definitely a
good symbol to India policy makers to meet the millennium development goal.
Table-5.2: Prevalence of Under-Nourishment in India
Year Undernourished Population (millions) Proportion in Total
Population
1990–92 210.1 23.7
2000–02 185.5 17.5
2005–07 233.8 20.5
2010–12 189.9 15.6
2014–16 194.6 15.2
Note: the data for 2014-16 is estimated and taken from FAO stat-2015
Source: The State of Food Insecurity in the World-2015
The calorie intake from cereals has been declining from 1993-94 to 2009-10
for both rural and urban sector by nearly 7 percentage point in the rural sector and
by about 3.5 percentage point in urban sector. The share of oils and fats has risen by
3 percentage points in both rural and urban sectors. The share of milk and milk
products has grown by about 1.4 percentage points in the urban sector but only 0.6
percentage points in the rural.

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Table-5.3: Calorie Consumption over Nine Food Groups: 1993-94 to 2009-10
Percentage of share of calorie intake from food group
Cereals roots & Sugar& Pulses, veg.& meat, milk& Oils & misc.
Year honey nuts& fruits eggs&fish milk fats food, etc
tubers
oil seeds products
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
Rural
1993-94 71.03 2.65 4.80 4.92 2.02 0.68 6.15 5.34 2.41
1999-
67.55 3.25 5.14 5.46 1.97 0.77 6.17 7.37 2.32
2000
2004-05 67.54 2.95 4.78 4.98 2.23 0.76 6.42 7.36 2.98
2009-10 64.16 2.78 4.61 4.54 1.84 0.72 6.79 8.53 6.04
Urban
1993-94 58.53 2.54 6.21 6.05 3.26 1.02 8.00 8.79 5.60
1999-
55.05 2.90 6.15 6.86 2.94 1.12 8.23 11.24 5.52
2000
2004-05 56.08 2.82 5.69 6.68 3.17 1.05 8.61 10.58 5.32
2009-10 55.01 2.59 5.66 5.94 2.62 1.00 9.37 11.92 5.87
th
Source: Nutritional Intake in India, NSS 66 Round, Report No. 540, January 2012
The share of vegetables and fruits, as well as sugar and honey are declining
over the period which is notable especially in urban India. Table-5.3 shows the
percentage break-up of calorie intake over nine food groups – cereals, roots and
tubers, sugar and honey, pulses, nuts and oilseeds, vegetables and fruits, meat, eggs
and fish, milk and milk products, oils and fats, and miscellaneous food, food
products and beverages – for rural and urban India for four years spanning the
period 1993- 94 to 2009-10. The Contribution of other items such as meat, eggs and
fish shows a slight rise followed by a fall (Table-5.3).
Table-5.4: Percentage Break-Up of Protein Intake by Food G roup: 1993-94 to
2009-10
Percentage of share of protein intake coming from
Milk& milk Egg, Other
Year Cereals Pulses All
products fish& meat foods
(1) (2) (3) (4) (5) (6) (7)
Rural
1993-94 69.42 9.76 8.81 3.66 8.35 100
1999-2000 67.43 10.91 9.19 4.04 8.43 100
2004-05 66.37 9.47 9.28 3.98 10.84 100
2009-10 64.87 9.06 10.02 4.04 12.01 100
Urban
1993-94 59.41 11.54 11.66 5.29 12.10 100
1999-2000 57.03 13.10 12.43 5.98 11.46 100
2004-05 56.16 11.00 12.33 5.47 14.98 100
2009-10 56.39 11.31 13.75 5.59 12.96 100

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Source: Nutritional Intake in India, NSS 66th Round, Report No. 540, January 2012
The contribution of cereals to protein intake has fallen by about 4.5
percentage points in rural India and by 3 percentage points in urban India. Table-5.4
shows percentage break-up of protein intake by food group for India as a whole over
the period 1993-94 to 2009-10. The table depicts that the contribution of pulses
have undergone a slight fall in both rural and urban sectors. The fall in the
contribution of cereals has been balanced, in the rural sector, mainly by a rise of
about 3.5 percentage points in the contribution of the “other food” category, and also
by a rise of 1 percentage point in the contribution of “milk and milk products”. In
the urban sector, “milk and milk products” has seen a rise in share of 2 percentage
points and “other food”, a rise of less than one percentage point (Table-5.4).
5.5 Inter-state Variation in Nutrition Intake of India
The average per capita intake of both calorie and protein in rural India
witnessed a decline over the period from 1972-73 to 2009-10. Table-5.5 and Table-
5.6 depicts the trend of average per capita intake of calorie, protein and fat for both
rural and urban areas of major states of India. At the all-India level calorie intake has
fallen from 2266kcal to 2020 kcal per person in the rural sector over the period
1972-73 to 2009-10. At the level of individual States also there is a gradual decline
in calorie consumption with the notable exception of Kerala and West Bengal,
where there appears to have been an increase up to 2004-05, and a decline thereafter.
In case of Punjab and Haryana, the estimates are unusually high for 1972-73 but
otherwise gradually declined. The decline has sharpest in rural areas of Haryana and
Punjab, where intake has fallen around 1000 kcal. Kerala shows a rise in calorie
intake from 1559 kcal in 1972-73 to 2014 in 2004-05 and declined thereafter. Other
states appear to have undergone little change in calories intake levels over the period
(Table-5.5).
At the all-India level protein intake has fallen from 62.2g to 55.0g per person
in the rural sector over the period 1972-73 to 2009-10. The decline has taken place
in most major States but has been sharpest in rural areas of Rajasthan, Haryana,
Uttar Pradesh and Punjab, where intake has fallen by 13-19g. Kerala is only major
state shows a rise in protein intake from 38g in 1972-73 to 55.4g in 2004-05 and
then declined to 52.7g in 2009-10. Orissa, Maharashtra, West Bengal, Andhra
Pradesh and Tamil Nadu appear to have undergone little change in protein intake

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levels over the period. The protein consumption other major states has declined
gradually during this period.
There is a rising trend in the mean consumption of fat during the period at all
India level with every major State showing a rise. The rise has been from 24 gm in
1972-73 to 38 gm in the year 2009-10, a rise of 14g during this period, at all India
level for rural population. In the rural sector, Kerala, Madhya Pradesh, Maharashtra,
Orissa and Tamil Nadu witnessed a significant rise in fat consumption during this
period. These states have risen almost double in terms of fat consumption during this
period.
In urban India, the average per capita intake of both calorie and protein in
rural India declined gradually during the period under consideration. Table-5.6
depicts the trend of average per capita intake of calorie, protein and fat for urban
areas of major states of India. At all-India level calorie intake for urban sector has
fallen from 2107kcal to 1946 kcal per person over the period 1972-73 to 2009-10.
At the level of individual States there is not much variation in calorie consumption
across the states. In case of Punjab and Haryana, the estimates are unusually high for
1972-73 but otherwise declined gradually.
Protein intake has been consistence in at all-India level of urban area over
the period of 1972-73 and 2009-10. Few States has witnessed a sharpest decline in
urban areas of Punjab, Rajasthan and West Bengal, where intake has fallen by 10g.
The Protein intake in Kerala, Karnataka and Tamil Nadu has risen while rest of the
states undergone little change in protein intake levels over the period. There is a
rising trend in the mean consumption of fat during the period at all India level
continued in urban sector also with every major State showing a rise (Table-5.6).
The overall decline is substantially greater for rural than for urban India.
The decline appears to have been sharper in the latter half of the period (i.e., after
1993-94), especially in the urban sector. In terms of average calorie intake during
last two rounds of survey Karnataka, Kerala, Madhya Pradesh, Maharashtra and
Tamil Nadu are below the all India level average calorie consumption. In terms of
average protein intake during last two rounds of survey Karnataka, Maharashtra,
Orissa, Tamil Nadu and West Bengal are below the all India level average protein
consumption. In terms of average fat intake during last two rounds of survey Assam,
Chhattisgarh, Kerala, Tamil Nadu, Uttar Pradesh and West Bengal are below the all

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India level average fat consumption. The fat consumption in Orissa is significantly
lower than the average fat consumption at all India level (Table-5.5 and Table-5.6).

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126
 Of all the food groups, cereals make the largest contribution to calorie intake
contributing about 60 per cent for rural India as a whole and about 50 per cent for
urban India. The contribution of cereals varies across the major States. The calorie
intake from cereals is also significant. The calorie intake from cereals is accounting
for over 50 per cent for many States, especially in rural areas (Table-5.7 and Table-
5.8).
The pattern of calorie intake from non-cereal food was similar in rural and
urban areas. “Oils and fats” accounted for 9 per cent of such calorie intake in rural
areas and 12 per cent in urban areas. The contribution of milk and milk products and
“miscellaneous food” (“misc. food, etc.” was also notable with a share of 6.5 percent
and 7.7 per cent respectively in calorie intake from non-cereal food in rural India
and 8.6 percent and 9 per cent respectively in urban areas. The shares of “sugar and
honey” and “pulses, nuts and oilseeds” were around 4-6 per cent each in both rural
and urban areas. The share of “roots and tubers” was noticeably higher in rural areas
with 4 percent than in urban 3 per cent. The share of “meat, eggs & fish” was about
one per cent in both sectors (Table-5.7 and Table-5.8).
Inter-State variation was more pronounced in rural than in urban India. The
share of “milk and milk products” was between 1 per cent and 19 per cent in the
rural sector and ranged from 4 per cent to 15 per cent in the rural sector of all the
major States. In both sectors, inter-State variation was wide in case of “meat, eggs
and fish”, but low for “oils and fats”, and also low for “miscellaneous food, food
products and beverages”. “Sugar and honey” usually had a higher contribution in
States with higher average levels of living, while “roots and tubers”, and also
“vegetables and fruits”, had a larger share in poorer States such as Bihar, Jharkhand,
Assam, Orissa and West Bengal. Looking at the average calorie consumption, rural
sector is higher than the urban sector. However, many states are below the average
of all India level in terms of average calorie consumption especially in rural sector.
At the all-India level Protein intake per consumer unit per day was about 73g
in the rural sector and 72g in the urban. The range of inter-State variation for major
States was much wider in the rural sector (from 60g per capita to 88g) than in the
urban (68g to 79g). In some of the poorer States, protein intake was markedly lower
in the rural sector than in the urban like Jharkhand with average protein intake of
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65g in rural sector while it is 75g in urban. The protein intake in rural sector of states
like Punjab, Haryana and Rajasthan is higher than that of urban sector (Table-5.7
and Table-5.8).

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129
 Cereals formed the most important source of protein among the 5 food
groups, the share of cereals in protein intake being 60 per cent for rural and 51 per
cent for urban India. In the rural sector the share of cereals ranged between 39 per
cent and 68 per cent in all major States. In the urban sector the share of cereals was
36 per cent to 63 per cent in all other major States. The States with the more than all
India level contributions of cereals to protein intake were Bihar, Chhattisgarh,
Jharkhand, Madhya Pradesh, Uttar Pradesh, Orissa, and Rajasthan in rural sector. In
urban sector, the States with the more than all India level contributions of cereals to
protein intake were Assam, Bihar, Chhattisgarh, Gujarat, Haryana, Jharkhand,
Madhya Pradesh, Uttar Pradesh, Orissa and Rajasthan.
The share of milk and milk products in protein intake was 9 per cent in rural
India and 12.5 per cent in urban India. It was noticeably above the national average
in Haryana (rural: 25.3 per cent and urban: 20 per cent), Punjab (rural: 23 per cent
and urban: 21.5 per cent), Rajasthan (rural: 18.5 per cent and urban: 17 per cent),
and Gujarat (rural: 15 per cent and urban: 16.5 per cent). It is evident that rural
sector is consuming more milk and hence more protein intake from milk than that of
urban sector.
The contribution of pulses to protein intake was 8.3 per cent in rural India
and 10 per cent in urban India. There is visible gap between rural and urban sector
protein intake from pulses. In all major States, Andhra Pradesh, Chhattisgarh,
Gujarat, Karnataka, Madhya Pradesh, Maharashtra, Punjab, Tamil Nadu and Uttar
Pradesh in the rural sector contributing higher than the all India average in rural
sector. The protein intake from pulses in urban sector of states Andhra Pradesh,
Chhattisgarh, Gujarat, Karnataka, Madhya Pradesh, Maharashtra, Punjab, and Tamil
Nadu is higher than the national average.
The share of meat, fish and egg in protein intake was 5.8 per cent in rural and
in 7.6 per cent urban sector in India. The protein intake from meat, fish and egg is
significantly higher than the all India average in urban sector in states such as
Andhra Pradesh, Assam, Madhya Pradesh, Kerala, Tamil Nadu and West Bengal.
There is big gap between the protein intake from this food item in rural and urban
sector of India. Rural sector consumes less of this item and hence less protein intake
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from the item than urban sector. There is also strong variation among different states
in protein intake from this item in both rural and urban sector (Table-5.7 and
Table-5.8).
Table-5.9: Percentage Share of Food and, Cereals in Total Household
Consumer Expenditure, and Percentage Contribution of Cereals to Calorie
Consumption in Major States, 2009-10

Percentage Percentage
Percentage
State expenditure on calories from
expenditure on food
cereals cereals
Rural Urban Rural Urban Rural Urban
(1) (2) (3) (4) (5) (6) (7)
Andhra Pradesh 58.1 44.8 13.6 9.6 60.0 52.2
Assam 64.4 52.9 20.7 12.8 70.0 62.3
Bihar 64.7 52.9 21.3 14.8 68.8 62.1
Chhattisgarh 58.2 43.7 15.4 10.4 69.0 58.6
Gujarat 57.7 46.2 10.7 7.6 50.3 44.2
Haryana 54.0 43.1 7.3 5.8 48.2 45.9
Jharkhand 60.9 51.5 19.2 11.9 65.9 57.8
Karnataka 56.5 42.3 12.3 9.0 56.6 49.7
Kerala 45.9 40.2 8.0 6.3 47.4 43.8
Madhya Pradesh 55.8 41.7 13.6 7.6 61.6 52.4
Maharashtra 54.0 41.0 11.3 6.6 53.6 44.9
Orissa 61.9 48.4 18.6 11.8 70.3 62.9
Punjab 48.2 44.3 6.9 6.2 46.1 43.0
Rajasthan 54.8 48.0 12.0 8.4 56.1 52.5
Tamil Nadu 54.7 45.0 9.0 7.7 56.1 50.1
Uttar Pradesh 57.9 46.3 15.2 9.3 63.0 55.5
West Bengal 63.4 46.2 18.3 9.1 63.7 53.2
All-India 57.0 44.4 13.7 8.1 60.4 50.4
Source: Nutritional Intake in India, NSS 66th Round, Report No. 540, January 2012
Among the food groups, cereals make the largest contribution to calorie
intake contributed around 60 per cent for rural India as a whole and about 50 per
cent for urban India. The contribution of cereals varies across the major States
from 46-48 per cent in Punjab, Kerala and Haryana to 70 per cent in Orissa and
Assam in the rural sector and from 43-44 per cent in Punjab, Kerala and Gujarat
to 62-63 per cent in Orissa, Assam and Bihar in the urban sector. The all India
percentage calorie from cereals is 60.4 percent for rural and 50.4 per cent for
urban areas (Table-5.9). For India as a whole the share of cereals in household
consumer expenditure is 13.7 per cent for the rural sector and 8.1 per cent for
the urban. Inter-State variation in share of cereals is quite high especially in the
rural sector, where the highest share of cereals among the major States is Bihar
with 21.3 per cent contribution which is about three times the share for Punjab
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and Haryana which contributed is around 7 per cent. In general, States with a
large proportion of expenditure on cereals are seen to be more dependent on
cereals for their calorie intake (Table-5.9).
5.6 Inter-state Variation in Anthropometrics Measures of India
Anthropometric indicators of nutrition in India, for both adults and children,
are among the worst in the world. Improvement in these indicators appears to be
relatively slow looking at the economic growth rate of the country. Government
report suggests that around 48 per cent children of the country, under age of five
years, have stunted growth, indicating that half of the children are chronically
malnourished in India. According to national family health survey, the proportion of
underweight children remained virtually unchanged between 1998-99 and 2005-06
from 47 per cent to 46 per cent for the age group of 0-3 years. Undernutrition levels
in India remain higher than for most countries of sub-Saharan Africa, even though
those countries are currently much poorer than India, have grown much more
slowly, and have much higher levels of infants and child mortality.
Table-5.10: Countries with >20 percent Prevalence of Child Malnutrition (2005-11)
Countries Proportion ( per cent) of
children
underweight (< 5 years age)
Timor-Leste 45.3
India 43.5
Bangladesh 41.3
Niger 39.9
Burundi 35.2
Somalia 32.8
Sudan 31.7
Lao PDR 31.6
Pakistan 30.9
Djibouti 29.6
Côte d’Ivoire 29.4
Ethiopia 29.2
Nepal 29.1
Cambodia 29
Congo, Dem. Rep 28.2
Central African Republic 28
Mali 27.9
Nigeria 26.7
Burkina Faso 26
Myanmar 22.6
Sri Lanka 21.6
Sierra Leone 21.3
World 15.7
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Source: World Development Indicator 2013
India is among the top 10 countries with highest percentage of Prevalence of
child malnutrition, underweight. Malnourishment in children has been linked to
poverty, low levels of education, and poor access to health services. It increases the
risk of death, inhibits cognitive development, and can adversely affect health status
during adulthood. Adequate nutrition is a cornerstone for development, health, and
the survival of current and future generations. At 43.5 percent, prevalence in India,
three times more than that of world average and more than any Asian and African
countries except Timor-Leste (Table-5.10).
The levels of child undernutrition in India are very high, both in absolute
terms as well as relative to other countries. Even today, close to half of all Indian
children are underweight, and about half suffer from anaemia. These are appalling
figures, which place India among the most “undernourished” countries in the world.
According to the 2013 World Development Indicators, countries have more than 40
per cent prevalence of underweight children Bangladesh, India and Timor-Leste.
While Nepal, Pakistan and Sri Lanka have somewhat lower levels of child
undernutrition, the whole south Asian region stands apart from the rest of the world
in this respect.
While 19.8 per cent of children, under five years of age, are wasted in the
country, which indicates that one out of every five children in India is wasted, 43 per
cent of children under five years of age are underweight for their age. As per the
World Bank report, the rate of malnutrition cases among children in India is almost
five times more than in China, and twice than in Sub-Saharan Africa. Nearly half of
India's children- approximately 60 million - are underweight, 45 per cent have
stunted growth (too short for their age), 20 per cent are wasted (too thin for their
height, indicating acute malnutrition), 75 per cent are anaemic, and 57 per cent are
deficient in Vitamin A. Several factors are responsible for malnutrition, one of them
being the inappropriate feeding and caring practices for children, especially during
the first two to three years of age.
Body Mass Index (BMI), defined as the ratio of weight (in kilos) to the
square of height (in meters). Recent nutrition trends can be further scrutinized from
available data on adult weights and heights. The proportion of individuals with low
BMI, like that of underweight children, declined steadily during the last 30 years or
so. In spite of this, Indian adults today (like Indian children) have some of the
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highest levels of undernutrition in the world, with 36 per cent of adult women
suffering from low BMI rising to well over 40 per cent in several states (Table-
5.11).
Table-5.11:Body Mass Index and Nutrition Status of Indian Adults, 1975-79 to 2004-05
Adults Proportion ( per cent) of adults with Body Mass Index below 18.5
1975-79 1988-90 1996-97 2000-01 2004-05 Per cent decline
(1975-79 to
2004-05)
Men 56 49 46 37 33 41
Women 52 49 48 39 36 31
Sources: National Nutrition Monitoring Bureau (1999, 2002, 2006).
Note: These figures apply to the nine “NNMB states”: Andhra Pradesh, Gujarat, Karnataka,
Kerala, Madhya Pradesh, Maharashtra, Orissa, Tamil Nadu, and West Bengal. Data for
1975-79 and 1988-90 exclude West Bengal; data for 1996-7 exclude Madhya Pradesh.
Table-5.12: Status of Malnutrition of Children under Five Years of Age by State / UT
State Percentage of Percentage of Percentage of
underweight children stunted children wasted children
less than 5years less than 5years less than 5years
Sikkim 19.7 38.3 9.7
Mizoram 19.9 39.8 9.0
Manipur 22.1 35.6 9.0
Kerala 22.9 24.5 15.9
Punjab 24.9 36.7 9.2
Goa 25.0 25.6 14.1
Nagaland 25.2 38.8 13.3
Jammu & Kashmir 25.6 35.0 14.8
Delhi 26.1 42.2 15.4
Tamilnadu 29.8 30.9 22.2
Arunachal Pradesh 32.5 43.3 15.3
Andhra Pradesh 32.5 42.7 12.2
Assam 36.4 46.5 13.7
Himachal Pradesh 36.5 38.6 19.3
Maharashtra 37.0 46.3 16.5
Karnataka 37.6 43.7 17.6
Uttaranchal 38.0 44.4 18.8
West Bengal 38.7 44.6 16.9
Haryana 39.6 45.7 19.1
Tripura 39.6 35.7 24.6
Rajasthan 39.9 43.7 20.4
Orissa 40.7 45.0 19.5
Uttar Pradesh 42.4 56.8 14.8
India 42.5 48.0 19.8
Gujarat 44.6 51.7 18.7
Chattisgarh 47.1 52.9 19.5
Meghalaya 48.8 55.1 30.7
Bihar 55.9 55.6 27.1
Jharkhand 56.5 49.8 32.3
Madhya Pradesh 60.0 50.0 35.0
Source: Source: National Family Health Survey- 3, IIPS, Mumbai, 2005-06.
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5.6.1 Prevalence of Child and Women Malnutrition
Many states are facing severe problem of malnutrition of children under 5
years of age. As per the National Family Health Survey 3 (2005-06), the states with
highest percentage of children under weight, stunted and wasted are Madhya
Pradesh, Jharkhand and Bihar with above 50 per cent children are under weight and
around 50 per cent children are stunted. The states which have above 40 per cent of
children are under weight and stunted are Orissa, Uttar Pradesh, Chhattisgarh,
Gujarat, and Meghalaya along with the above states which are above 50 per cent of
under-weight children. Looking at the national level, underweight children are still
above 40 per cent and stunted children are around 48 per cent which reflects that
around 50 per cent of children in India chronically malnourished while 19.8 per cent
of children in the same age group are acute malnourished; too thin for their height.
This indicates that out of every five children in India, one is wasted and 43 per cent
of children are underweight for their age. The states such as Madhya Pradesh,
Jharkhand, Bihar, Chhattisgarh, Gujarat, and Meghalaya have underweight and
stunted children above the national level (Table-5.12).
According to the statistics of the Ministry of Statistics and Programme
Implementation, during the period between National Family Health Survey (NFHS-
2 in 1998-99 and NFHS 3 in 2005-06), a decline has been observed in case of
stunted growth and underweight among children under 3 years of age, whereas the
percentage of case of acute malnutrition, children too thin for their height, has
increased. The over all performance of nutritional status among children has
improved in third National Family Health Survey as compared to the previous one.
The proportion of children under three years of age who are underweight decreased
from 43 percent in NFHS-2 to 40 percent in NFHS-3, and the proportion severely
underweight decreased from 18 percent to 16 percent. Stunting decreased
significantly from 51 percent to 45 percent. Severe stunting also decreased, from 28
percent to 22 percent. However, there is an increase in weight-for-age actually
produced an increase in wasting and severe wasting over time (Table-5.13). The
proportion of stunting and wasting are in opposite movement and not clear why
wasting increase while stunting is declining.
The decrease in stunting over time was greater in rural areas than urban areas
which declined from 54 per cent to 45 per cent and for severe stunting it is declined
from 30 per cent to 24 per cent. The prevalence of children who were underweight
135
decreased slightly more in urban areas than rural areas, but there was very little
improvement in the percentage of children who were severely underweight in urban
areas (Table-5.13).
Table-5.13: Trend of Percentage of Malnourished Children under-Three Years of Age
NFHS-3 (2005-06) NFHS-2 (1998-99)
Measure of Nutrition Urban Rural Total Urban Rural Total
Height-for-age
Percentage below-3SD 16.4 23.8 22.0 19.7 30.2 27.7
Percentage below-2SD 37.4 47.2 44.9 41.1 54.0 51.0
Weight-for-height
Percentage below-3SD 6.8 8.3 7.9 5.3 7.1 6.7
Percentage below-2SD 19.0 24.1 22.9 16.3 20.7 19.7
Weight-for-age
Percentage below-3SD 10.6 17.4 15.8 11.3 19.6 17.6
Percentage below-2SD 30.1 43.7 40.4 34.1 45.3 42.7
Number of children 6,436 20,105 26,541 5,741 18,475 24,215
Source: National Family Health Survey-3, IIPS, Mumbai, 2005-06.
Table-5.14: Percentage of Malnourished Children Under-Five Years of Age
Height-for-age Weight-for-height Weight-for-age
+2SD

+2SD
-3SD

-2SD

-3SD

-2SD

-3SD

-2SD

Number of Children
Mean Z-Score (SD)

Mean Z-Score (SD)

Mean Z-Score (SD)

Percentage below

Percentage below

Percentage below

Percentage below

Percentage below

Percentage below
Percentage Above

Percentage Above

<6 8.4 20.4 -0.6 13.1 30.3 4.1 -1.2 10.9 29.5 1.0 -1.4 3,845
6-8 10.8 25.9 -1.0 10.1 29.3 3.1 -1.1 13.7 34.7 0.6 -1.5 2,570
9-11 12.8 32.0 -1.2 10.9 28.9 1.6 -1.2 14.1 36.7 0.2 -1.6 2,086
12-17 21.7 46.9 -1.8 7.3 23.3 1.7 -1.1 14.2 40.2 0.3 -1.7 4,642
18-23 30.4 57.8 -2.2 7.6 22.2 1.1 -1.1 19.5 45.9 0.2 -1.9 4,636
24-35 28.9 55.9 -2.2 5.0 16.7 0.9 -1.0 17.7 44.9 0.4 -1.9 9,335
36-47 27.8 54.3 -2.1 4.7 15.5 1.0 -0.9 16.6 45.6 0.2 -1.9 9,780
48-59 23.9 50.3 -2.0 4.1 15.7 1.3 -1.0 15.3 44.8 0.3 -1.9 9,762
Sex
Male 23.9 48.1 -1.9 6.8 20.5 1.7 -1.0 15.3 41.9 0.4 -1.8 24,346
Female 23.4 48.0 -1.9 6.1 19.1 1.4 -1.0 16.4 43.1 0.3 -1.8 22,309
Source: National Family Health Survey-3, IIPS, Mumbai, 2005-06.
According to the NFHS-3 report of India, almost half of children under five
years of age, about 48 percent, are stunted and 43 percent are underweight in India.
The proportion of children who are severely undernourished is also notable with 24
percent according to height-for-age and 16 percent according to weight-for-age.
136
Wasting is also quite a serious problem in India, affecting around 20 percent of
children under five years of age. The proportion of overweight children under five
years of age is negligible. Less than 2 percent have a weight-for-height estimate
more than two standard deviations above the median for the sample population and
less than 1 percent is more than two standard deviations above the median on the
weight-for-age indicator.
The proportion of children who are stunted or underweight increases rapidly
with the child’s age through age 20-23 months (Table-5.14)). Undernutrition
decreases thereafter for stunting and levels off for underweight. The level of
undernutrition is at its peak at age 20 months for both are stunted or underweight.
Generally, wasting decreases throughout the age range. However, during the first six
months of life, when most babies are breastfed, 20-30 percent of children are
undernourished. It is notable that at age 18-23 months, when many children are
being weaned from breast milk, 30 percent of children are severely stunted and one-
fifth is severely underweight. This is clearly the result of undernourished mother.
The percentage of underweight girls under five years of age is higher than boys less
than five years of age. In cases of stunted growth and acute malnutrition, girls are in
a better condition than boys. The rural India witnesses more cases of malnutrition
among children less than 5 years of age as more cases of stunted, wasted and
underweight children were reported from rural areas.
Under-nutrition among the children is a major problem throughout India.
The under-nutrition situation is significantly varied in different states. Some states
are considerably better positioned than others. Under-nutrition is most pronounced
in Madhya Pradesh, Uttar Pradesh, Bihar, Gujarat and Jharkhand in relation to
stunted. In case of percentage of wasted (Weight for Height) children, Rajasthan,
Madhya Pradesh, Bihar, Jharkhand, Meghalaya, Tripura and Tamilnadu are above
the all India average of 20 per cent. Chattishgarh, Bihar, Jharkhand, Madhya
Pradesh, Uttar Pradesh, Meghalaya, and Gujarat are states where the percentage of
underweight children is above the national average. Though, Orissa is not above the
national average in any of these categories based on the third national family health
survey, but the percentage is quite high with 45 per cent stunted, 19.5 per cent in
wasted and 40.2 per cent in underweight children which is very close to national
average. Nutritional problems are relatively least evident in Mizoram, Sikkim,
Manipur, and Kerala and relatively low in Goa and Punjab (Table-15).
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Table-5.15: State-Wise Percentage of Malnourished Children Under-Five Years of Age
in India
Height-for-age Weight-for-height Weight-for-age
(Stunted) (Wasted) (Underweight)

Mean Z-Score (SD)

Mean Z-Score (SD)

Mean Z-Score (SD)

Percentage Above
Percentage below

Percentage below

Percentage below

Percentage below

Percentage below

Percentage below
-3SD

-2SD

-3SD

-2SD

-3SD

-2SD
+2SD

+2SD
States

India 23.7 48.0 -1.9 6.4 19.8 1.5 -1.0 15.8 42.5 0.4 -1.8
Delhi 20.4 42.2 -1.6 7.0 15.4 4.0 -0.5 8.7 26.1 1.0 -1.3
Haryana 19.4 45.7 -1.8 5.0 19.1 1.4 -1.0 14.2 39.6 0.2 -1.7
Himachal
16.0 38.6 -1.5 5.5 19.3 1.1 -1.0 11.4 36.5 0.5 -1.6
Pradesh
Jammu &
14.9 35.0 -1.3 4.4 14.8 2.3 -0.7 8.2 25.6 0.5 -1.3
Kashmir
Punjab 17.3 36.7 -1.5 2.1 9.2 1.5 -0.5 8.0 24.9 0.5 -1.2
Rajasthan 22.7 43.7 -1.7 7.3 20.4 1.6 -1.1 15.3 39.9 0.4 -1.7
Uttaranchal 23.1 44.4 -1.8 5.3 18.8 2.3 -0.9 15.7 38.0 0.3 -1.7
Chhattisgarh 24.8 52.9 -2.0 5.6 19.5 1.3 -1.1 16.4 47.1 0.0 -1.9
Madhya
26.3 50.0 -2.0 12.6 35.0 1.0 -1.6 27.3 60.0 0.1 -2.3
Pradesh
Uttar Pradesh 32.4 56.8 -2.2 5.1 14.8 1.2 -0.8 16.4 42.4 0.1 -1.8
Bihar 29.1 55.6 -2.1 8.3 27.1 0.3 -1.4 24.1 55.9 0.1 -2.2
Jharkhand 26.8 49.8 -1.9 11.8 32.3 0.6 -1.5 26.1 56.5 0.2 -2.2
Orissa 19.6 45.0 -1.7 5.2 19.5 1.7 -1.0 13.4 40.7 0.5 -1.7
West Bengal 17.8 44.6 -1.7 4.5 16.9 1.9 -0.9 11.1 38.7 0.5 -1.6
Arunachal
21.7 43.3 -1.6 6.1 15.3 3.4 -0.7 11.1 32.5 0.6 -1.4
Pradesh
Assam 20.9 46.5 -1.8 4.0 13.7 1.2 -0.8 11.4 36.4 0.3 -1.6
Manipur 13.1 35.6 -1.4 2.1 9.0 2.2 -0.6 4.7 22.1 0.5 -1.2
Meghalaya 29.8 55.1 -2.0 19.9 30.7 2.6 -1.2 27.7 48.8 0.2 -2.0
Mizoram 17.7 39.8 -1.6 3.5 9.0 4.3 -0.3 5.4 19.9 1.2 -1.1
Nagaland 19.3 38.8 -1.4 5.2 13.3 4.7 -0.5 7.1 25.2 0.8 -1.2
Sikkim 17.9 38.3 -1.4 3.3 9.7 8.3 -0.1 4.9 19.7 1.3 -0.9
Tripura 14.7 35.7 -1.5 8.6 24.6 2.2 -1.2 15.7 39.6 0.1 -1.7
Goa 10.2 25.6 -1.1 5.6 14.1 4.3 -0.7 6.7 25.0 1.9 -1.1
Gujarat 25.5 51.7 -2.0 5.8 18.7 1.2 -1.0 16.3 44.6 0.1 -1.8
Maharashtra 19.1 46.3 -1.8 5.2 16.5 2.8 -0.9 11.9 37.0 0.9 -1.6
Andhra
18.7 42.7 -1.7 3.5 12.2 2.2 -0.7 9.9 32.5 0.6 -1.5
Pradesh
Karnataka 20.5 43.7 -1.7 5.9 17.6 2.6 -1.0 12.8 37.6 0.5 -1.6
Kerala 6.5 24.5 -1.1 4.1 15.9 1.2 -0.9 4.7 22.9 0.4 -1.2
Tamil Nadu 10.9 30.9 -1.1 8.9 22.2 3.6 -1.0 6.4 29.8 1.9 -1.3
Source: National Family Health Survey-3, IIPS, Mumbai, 2005-06.
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Table-5.16: Percentage of Adult at Different Body Mass Index (BMI)
Women Men
(Age 15-49) 15-19 20-29 30-39 40-49 Total 15-19 20-29 30-39 40-49 Total
Mean BMI 19.0 20.0 21.1 21.9 20.5 18.3 20.1 21.0 21.2 20.2
18.5-24.9 50.8 53.7 51.6 49.8 51.8 40.2 60.4 61.4 58.6 56.5
(Normal)
<18.5 (Total Thin) 46.8 38.1 31.0 26.4 35.6 58.1 33.0 25.5 26.2 34.2
17.0-18.4 (mildly 25.9 21.7 17.0 14.1 19.7 28.8 21.8 16.7 15.8 20.4
thin)
<17.0 20.9 16.4 14.0 12.3 15.8 29.3 11.3 8.9 10.4 13.8
(moderately/severe
ly thin)
≥25.0 2.4 8.2 17.4 23.7 12.6 1.7 6.5 13 15.2 9.3
(overweight/obese)
25.0-29.9 2.1 6.8 13.5 17.4 9.8 1.4 5.8 11.2 12.9 8.0
(overweight)
≥30.0 (obese) 0.2 1.4 3.9 6.4 2.8 0.2 0.7 1.8 2.3 1.3
Number of 22147 36413 31321 21900 11178 12251 21396 18015 14079 65742
Women 1
Source: National Family Health Survey-3, IIPS, Mumbai, 2005-06.
A widely used indicator of nutritional status for adult is body mass index
(BMI) which is defined as the weight in kilograms divided by the height in metres
squared (kg/m2). The mean BMI for women age 15-49 in India is 20.5. For ease of
calculation only ever married women are considered here. Usually, chronic energy
deficiency is indicated by a BMI of less than 18.5. Chronic energy deficiency (CED)
refers to an intake of energy less than the requirement for a period of several months
or years. More than one-third (36 percent) of women have a BMI below 18.5,
indicating a high prevalence of nutritional deficiency. Among women who are thin,
almost half (45 percent) are moderately or severely thin. The proportion of ever-
married women who are thin (33 percent) has decreased slightly from 36 percent in
NFHS-2 (data not shown). CED is particularly pronounced for rural women,
illiterate women, and women living in households with a low standard of living.
More than average levels of CED are observed in women between 15 to 29 years of
age (Table-5.16).
Women with a BMI of 25.0-29.9 are considered to be overweight and those
with a BMI of 30.0 or above are identified as obese. Thirteen percent of women are
overweight or obese. Out of that 10 percent are overweight and 3 percent are obese.
This is a growing problem in India, with the percentage of ever-married women age
15-49 who are overweight or obese increased from 11 percent in NFHS-2 to 15
percent in NFHS-3. Indian women suffer from a dual burden of malnutrition, with
139
nearly half (48 percent) being either too thin or overweight. The proportion of
women who are too thin or overweight is fairly constant across all subgroups,
indicating that as undernutrition decreases, overnutrition increases by approximately
the same amount. Therefore, nutrition programmes in India need to tackle both of
these problems on a priority basis (Table-5.16).
The mean body mass index is similar for men (20.2) and women (20.5) age
15-49. The mean BMI for men varies within a narrow range across population
subgroups. Thirty-four percent of men age 15-49 are thin, compared with 36 percent
of women. Forty percent of men who are thin are considered to be moderately or
severely thin. The patterns of thinness for subgroups of men are similar to the
patterns for women. However, the percentage overweight or obese is lower for men
which are 9 percent for age group 15-49 than 13 per cent for women of age group
15-49. Only one per cent of men are obese as compared to 3 per cent of women.
Only 57 percent of men and 52 percent of women have a BMI within the normal
range of 18.5-24.9 (Table-5.16).
The mean BMI varies little from one state to another. The proportion of
women who are too thin is particularly high in Bihar (45 percent), followed closely
by Chhattisgarh and Jharkhand (43 percent each), Madhya Pradesh and Orissa (41
per cent each). West Bengal, with an incidence of around 39 per cent, is not far from
these states. These states tend to have more than double, the proportion of
undernourished women of states such as Kerala and Punjab, which are at the other
end of the spectrum. Rather than CED, what seems to be an important issue in these
two states is overweight or obesity. About 30 per cent of women suffer from
overweight and obesity taken together (Table-5.17).
The percentage of women who are overweight or obese is highest in Punjab
(30 percent), followed by Kerala (28 percent). This problem is also prevalent among
women in Kerala (28 per cent), Goa (20 per cent) and Tamilnadu (21 per cent).
However, what these states have in common with the others is that in all these states
about 50 per cent of women suffer from malnutrition of one form or another. It
appears that, with a much higher incidence of malnutrition, the eastern states, mainly
Bihar, Jharkhand, Orissa and West Bengal, emerge as the repository of women’s
malnutrition in India. Do these higher levels of women’s malnutrition suggest that
norms and discriminatory practices against women are more rigid and intense in

140
these states or it is only the food practices that keep malnutrition rate higher in those
states (Table-5.17).

141
 The mean BMI for men does not vary much by state, but the percentage of
men who are too thin varies substantially among the states. Over 40 percent of men
age 15-49 are too thin in Tripura, Madhya Pradesh, and Rajasthan. The problems of
overweight and obesity are also prominent among men in Delhi, Punjab, Kerala and
Goa (17 per cent, 22 per cent, 18 per cent and 15 per cent, respectively) (Table-
5.17).
While the focus of attention in the field of nutrition continues to be on the
substantial proportion of women with a chronic energy deficiency, the NFHS-3
findings on the percentage of overweight and obese women clearly demonstrate that
this problem cannot be ignored. This phenomenon is becoming a well-recognised
aspect of the nutrition transition, with changes in dietary patterns and levels of
physical activity leading to an increase in overweight and obesity [Popkin et al 2001,
Griffiths and Bentley 2001]. The substantial proportion of overweight or obese
persons, together with continuing high overall levels of under-nutrition, produces
dual burden of nutritional disorders for the country.
5.7 Conclusion
In this chapter, we have examined recent evidence on nutrition in India, and
discussed possible interpretations of the facts and present a comparable study of
nutrition consumption in different states of India. Taken together, the continued poor
performance of India in improving child and adult nutrition and the relatively low
levels of calorie intake in a significant proportion of the population suggest that
purely voluntary explanations such as reduced intake due to reduced needs or
diversification of the diet may not suffice. Factors outside the control of households
may also be at work. There is strong evidence of a sustained decline in per-capita
calorie consumption during the last two decades or so.
The above analysis reveals some disquieting patterns and trends, and thereby
raises a number of issues. The period of higher growth and onset of a reasonable
reduction in poverty did not seem to improve nutrition intake of both men and
women significantly. There may be various reasons for the increase in malnutrition
among women in India. It may be due to the failure of the market or of the state or
due to gender inequality or because of changing food habits, does not augur well for
various reasons. Malnutrition amounts to deprivation in one of the most elementary
and central aspects of well-being. This must be addressed specifically with specific
142
policy towards women. Obesity and obese is emerging as another related challenge
before the policy makers now. This problem must be addressed at the early stage.
India's efforts to tackle the challenge of malnutrition among children have, in
the past, focussed primarily on distributing supplementary foods under the
Integrated Child Development Services (ICDS) programme. While the ICDS
services expanded rapidly nationwide targeting children between 3-6 years of age,
but this time it needs better coordination among all the concern institutions and
better monitoring system.
With an aim of moving towards a more balanced multi-sectoral programme
to tackle this persistent challenge, the Government of India has recently restructured
the ICDS programme. The revised programme will now focus on providing
supplementary foods to pregnant women, nursing mothers and children under three
years of age. It will also work to improve mothers' feeding and caring practices as
well as promote immunization and growth monitoring of children among people.

143