India Studies in Business and Economics

Ramesh Chand
Pramod Joshi
Shyam Khadka Editors

Indian
Agriculture
Towards 2030
Pathways for Enhancing Farmers’
Income, Nutritional Security and
Sustainable Food and Farm Systems
Dietary Diversity, Nutrition and Food
Safety

S. Mahendra Dev and Vijay Laxmi Pandey

1 Introduction

India is faced with a triple burden of malnutrition, viz., under-nutrition, micronu-

trient deficiency and over-nutrition. In 2017, about 68.2% of the total death of chil-
dren under-5, was due to malnutrition in India (LANCET, 2019). The prevalence
of stunting among children under-5 was high at 34.7% during 2016–18 (MoHFW,
2019). The body mass index of 23% of women aged 14–49 was below normal in
2015–16 (NFHS, 2017). Moreover, two-thirds of India’s population is estimated to be
micronutrient deficient (Rao et al., 2018), which exists despite impressive economic
growth (6% in 2018–19), a high level of food grain production and an increase in per
capita net availability of food grains (GoI 2020). However, there has been a signif-
icant decline in the percentage of the population below the poverty line (Tendulkar
method) from 37.2% in 2004–05 to 21.9% in 2011–12 (GoI, 2013).1
Along with undernutrition, overweight and obesity have emerged as severe public
health problems leading to non-communicable diseases (NCD). In 2017, about 63%
of deaths in India were attributable to NCDs (WHO, 2018). It is vital to address
malnutrition challenges, especially in children and women, to ensure proper cognitive
growth, overall health and productivity.

1 The government has not released the latest 2017–18 consumer expenditure data due to comparison

problems.

S. Mahendra Dev · V. L. Pandey (B)

Indira Gandhi Institute of Development Research, Gen. Vaidya Marg, Goregaon (East), Mumbai
400065, India
e-mail: [email protected]
S. Mahendra Dev
e-mail: [email protected]

© The Author(s) 2022 39

R. Chand et al. (eds.), Indian Agriculture Towards 2030,
India Studies in Business and Economics,
https://doi.org/10.1007/978-981-19-0763-0_3
40 S. Mahendra Dev and V. L. Pandey

Sustainable Development Goal (SDG)–2 aims to end hunger, achieve food secu-
rity, improve nutrition and promote sustainable agriculture. Dietary patterns influ-
ence the production portfolio and sometime lead to environmental degradation. Food
production is one of the major causes of global environmental change (Lancet, 2019).
Therefore, interventions are needed to secure a sustainable diet that delivers food and
nutrition security for all in a manner that does not compromise future generations’
ability to ensure food and nutrition security (HLPE, 2014). The present paper aims
to study dietary pattern and malnutrition trends, impact of different food and nutri-
tion security interventions. The issues related to healthy diets and food safety are
discussed and pathways for a safe and healthy diet to achieve nutritional security in
India are suggested.

2 Changing Dietary Pattern

Consumption expenditure on different food groups and intake of calorie, protein

and fat is studied using the National Sample Survey (NSS) 50th, 61th and 68th
rounds.2 National Family Health Survey second, third and fourth rounds (NFHS-
2, NFHS-3 and NFHS-4) are used for understanding the trends in micronutrient
consumption. Comprehensive National Nutritional Survey (CNNS) for the period
2016–18 (MoHFW, 2019), has also been referred for the latest available data on
consumption pattern and nutritional status among the children and adolescents.

2.1 Consumption Expenditure on Food and Non-food Groups

The monthly per capita consumption expenditure (MPCE) has increased (in real
terms) from INR 943 to INR 1287 in rural areas and from INR 1608 to INR 2477
in urban areas during 1993–94 to 2011–12. A steady decline in the percentage of
food consumption expenditure in rural and urban areas was observed with steeper
decline in urban areas than that in the rural areas (Fig. 1a, b). This decline is in line
with Engel’s Law, that the proportional share of food expenditure declines in the
household budget with increase in income as shown in Fig. 2.
Over time, India’s food basket has also got transformed. There are changes in the
dietary pattern in rural and urban areas as per capita monthly consumption of edible
oils, vegetables, egg, fish and meat has almost doubled from 1993–94 to 2011–12.
Consumption of pulses remained nearly stagnant while of cereals reduced in the same
period (Table 1). The dominance of cereals in total expenditure has also significantly
decreased even among the poorest in rural and urban areas (Fig. 3a, b). A decline

2 As National Statistical Office (NSO) has not released the 2017–18 consumer expenditure survey
results, we could analyse consumption expenditure data only up to 2011–12. The uniform reporting
period is being used from NSS reports of these rounds.
Dietary Diversity, Nutrition and Food Safety 43

Fig. 5 Trend in calorie 2200

Calorie (Kcal)
intake (Kcal) in rural and
urban areas 2100 Rural
2000 PCC
1900 Urban
1993-94 2004-05 2011-12 PCC
Year

mechanization, dietary diversification, etc. (Deaton & Dreze, 2009; Pingali et al.,
2019).
The calorie intake was lower than the recommended guidelines of 2100 kcal in
urban and 2400 kcal in rural areas in 1993–94, and it further declined by 2011–
12 (Fig. 5). The calorie intake improved in both the areas in 2011–12, compared
with 2004–05 due to better coverage of the public distribution system (Srivastava &
Chand, 2017) and increased income. Recommended calorie intake guidelines were
revised and lowered to 2090 kcal per person per day in urban areas and 2155 kcal per
person per day in rural areas by Indian Council of Medical Research. Even with the
revised guidelines, average calorie consumption was below the norms in rural and
urban areas. However, it was above the revised norms in the highest 50 and 60% of
the MPCE classes in rural and urban areas, respectively (Fig. 6a, b).
The average calorie consumption of the poorest and the richest class in rural and
urban areas is significantly different, though, the gap has narrowed in both rural
and urban areas (Fig. 6a, b). The Gini coefficients of inequality in calorie intake
reduced from 0.16 to 0.13 in rural areas and 0.18 to 0.14 in urban areas (Srivastava &
Chand, 2017). This improvement might be attributable to better food access because
of increased income and better coverage of government food subsidy programme.
In the higher decile classes (5th decile class and above), calorie intake reduced in
both the areas, and the highest decline is in the richest decile. According to Deaton
and Dreze (2009), the calorie Engel curve’s downward shift is due to lower calorie

5000
a 3500 b
3000 4000
Calorie (Kcal)

Calorie (Kcal)

2500
3000
2000
1500 2000
1000
1000
500
0 0
0-5
5-10

20-30
10-20

30-40
40-50
50-60
60-70
70-80
80-90
90-95
95-100
0-5
5-10
10-20

30-40
40-50
50-60
60-70
70-80
80-90
90-95
20-30

95-100

MPCE Class MPCE Class

1993-94 2004-05 2011-12 1993-94 2004-05 2011-12

Fig. 6 a Per capita per day intake of calorie (Kcal) in rural areas in different MPCE class. b Per
capita per day intake of calorie (Kcal) in urban area in different MPCE class
44 S. Mahendra Dev and V. L. Pandey

Table 2 Average number of meals consumed by the households outside the house in last 30 days
Year Free meals Meals on payment
Rural Urban Rural Urban
1993–94 6 7 1 4
2004–05 11 8 1 3
2011–12 13.7 8.05 1.44 5.45
Source NSS reports

requirements, mainly associated with better health and lower activity levels. The
calorie consumption decreases even when there is undernutrition. However, number
of meals taken outside the house is increasing (Table 2), and calorie consumption
calculations ignore these consumed calories.
The share of cereals in total energy intake is highest for lowest decile class in
2011–12 (Fig. 7a, b). This indicates poor diet quality of households in lower decile
classes than the higher decile classes. According to dietary guidelines, balanced
diet should have 50–60% of total calories from carbohydrates, about 10–15% from
proteins and 20–30% from fats (NIN, 2011). EAT-LANCET norms suggest that total
calories from cereals should be about 32.44% for a healthy diet (Willett et al., 2019).
These evidence clearly show that Indian diets are unhealthy across all the income
classes as contribution of cereals in calorie intake is quite high.
The highest contribution in calorie intake after cereals was oil and fats, with 9.01%
in rural areas and 12.2% in urban areas in 2011–12 (Table 3). The increase in the
share of oils and fats from 1993–94 to 2011–12 was 3.7% point in rural areas and
a 3.4% point in urban areas. However, the share of vegetables and fruits in total
calorie intake has declined despite their increased consumption, both in rural and

a 90 b 90
80 80
Share of cereals (Percentage)

Share of cereals (Percentage)

70 70
60 60
50 50
40 40
30 30
20 20
10 10
0 0
10-20

30-40
40-50
50-60
60-70
70-80
80-90
90-95
0-5
5-10

20 - 30

95-100

10-20

30-40
40-50
50-60
60-70
70-80
80-90
90-95
0-5
5-10

20 - 30

95-100

MPCE class MPCE class

1993- 94 2004-05 2011-12 1993- 94 2004-05 2011-12

Fig. 7 a Share of cereals in total calorie intake (Rural). b Share of cereals in total calorie intake
(Urban)
Dietary Diversity, Nutrition and Food Safety 45

Table 3 Percentage of calorie consumption from food groups other than cereals
Roots & Sugar & Pulses, Veg & Meat, Milk & Oils & Misc food,
tubers honey nuts & fruits eggs & milk fats food
oilseeds fish products products
&
beverages
Rural
1993–94 2.65 4.8 4.92 2.02 0.68 6.15 5.34 2.41
2004–05 2.95 4.78 4.98 2.23 0.76 6.42 7.36 2.98
2011–12 3.01 4.9 5.2 1.85 0.82 7.07 9.01 7.04
Change 0.36 0.10 0.28 -0.17 0.14 0.92 3.67 4.63
(1993–94
to
2011–12)
Urban
1993–94 2.54 6.21 6.05 3.26 1.02 8 8.79 5.6
2004–05 2.82 5.69 6.68 3.17 1.05 8.61 10.58 5.32
2011–12 2.73 5.62 6.41 2.62 1.13 9.07 12.17 8.61
Change 0.19 -0.59 0.36 -0.64 0.11 1.07 3.38 3.01
(1993–94
to
2011–12)
Source NSS reports

urban areas. The highest percentage point increase was observed in miscellaneous
food category, mostly fast food, processed food, sugary beverages etc. (Table 3). This
diversion of calorie sources towards unhealthy foods might be one of the causes of
increasing overweight in India.

2.3 Protein Intake Trends

The average consumption of protein declined in rural and urban areas (Fig. 8) in

Fig. 8 Per person per day

Protein intaake (Grams)

62
intake of protein 60
58
56
54 Rural
52 Urban
50
1993-94 2004-2005 2009-2010 2011-2012
Year
46 S. Mahendra Dev and V. L. Pandey

a b
100 100

Protein intake ( Grams)

Protein intake (Grams)

80 80
60 60
40 1993-94 40 1993-94
2004-05 2004-05
20 20
2011-12 2011-12
0 0

MPCE class MPCE class

Fig. 9 a Protein intake in different MPCE class in rural areas (Grams). b Protein intake in different
MPCE class in urban areas (Grams)

2011–12 compared to 1993–94. The average intake of protein is above the norms in
both rural and urban areas. The recommended dietary allowance (RDA) norms for
protein consumption are 48 g and 50 g per person per day in urban and rural areas,
respectively (GoI, 2014). However, there is a vast gap in protein intake among the
MPCE classes. Wealthier households consume higher than RDA norms. The average
consumption of the poorest households is below the RDA norms in rural and urban
areas (Fig. 9a, b). Though protein consumption in the lowest decile classes (first and
second) has improved from 1993–94 to 2011–12, still there is a need to increase the
protein intake by the poor households.
Cereals are also the primary source of protein in the Indian diet (Fig. 4b), followed
by pulses, milk and milk products and egg, fish, meat and other miscellaneous foods
(Table 4). Though cereals are a moderate source of protein (NIN, 2017), they become
the major source of protein due to their large quantity of consumption. The percentage
point increase for other food products covering fast food, processed food, etc., is
highest (3.34%) in rural areas. Protein-rich foods such as milk and milk products
and egg, fish and meat have recorded a modest increase in the share of total protein
intake.

2.4 Fat Intake Trends

The per capita per day consumption of fat increased significantly by 32.5 and 25% in
rural and urban areas, respectively, during 1993–94 to 2011–12 (Fig. 10). The intake
is much higher, in urban areas (52.5 g), than the RDA norms of 26 g (RDA for rural
areas is 28 g).
There is a considerable gap in fat intake among the MPCE classes. The average
consumption of the poorest households is below the RDA in rural areas (Fig. 11a,
b). However, fat consumption in the urban areas is above the RDA (25 g) across all
the MPCE classes.
Dietary Diversity, Nutrition and Food Safety 47

Table 4 Percentage of protein intake from different food groups

Cereals Pulses Milk & milk Egg, fish & meat Other food
products
Rural
1993–94 69.42 9.76 8.81 3.66 8.35
2004–05 66.37 9.47 9.28 3.98 10.84
2011–12 62.45 10.57 10.56 4.73 11.69
Change (1993–94 to -6.97 0.81 1.75 1.07 3.34
2012)
Urban
1993–94 59.41 11.54 11.66 5.29 12.1
2004–05 56.16 11 12.33 5.47 14.98
2011–12 53.69 12.41 13.57 6.39 13.94
Change (1993–94 to -5.72 0.87 1.91 1.10 1.84
2011–12)
Source NSS reports

Fig. 10 Per person per day 60

Fat intake (Grams)

consumption of fat 50
40
30
Rural
20
10 Urban
0
1993-94 2004-05 2011-12
Year

a b 100
80
Fat intake (Grams)

80
Fat intake (Grams)

70
60 60
50
40 40 1993-94
1993-94
30 2004-05
20 2004-05 20
10 2011-12
2011-12 0
0
10-20
30-40
50-60
70-80
90-95
0-5

MPCE class MPCE class

Fig. 11 a Intake of fat for different MPCE class in rural areas (Grams). b Intake of fat for different
MPCE class in urban areas (Grams)
48 S. Mahendra Dev and V. L. Pandey

2.5 Micronutrients Intake

An adequate amount of micronutrient intake is necessary for sound health. The

problem of chronic micronutrient deficiency (hidden hunger) is relatively severe
(George & McKay, 2019). Milk and milk products, dark and green leafy vegetables,
fruits, pulses, fish, egg and meat, are rich sources of micronutrients but its content in
each food is different; therefore, various foods are required to get sufficient vitamins
and minerals. The NFHS-4 data (NFHS-4, 2017) show that only 45 and 38% of
women between the age 15–49 years consumed pulses and dark and green leafy
vegetables, respectively, at least once a week in 2015–16. The data showed an increase
in the percentage of women in the age group 15–49 years consuming milk and curd,
pulses, egg, fish and fruits at least once a week but decreases for leafy vegetables, from
1998–99 to 2015–16 (Fig. 12). There is a significant difference in the consumption
of milk, curd and fruits between rich and poor households (Fig. 13).
Recent Comprehensive National Nutritional Survey 2016–18 (CNNS) shows that
among school-age children (5–9 years) and adolescents (10–19 years), consumption
of dairy products was less frequent (61% among school-age children and 60% among

50 45.1
Percentage of women

38.3 37.4
40 33.2
28.4
30 22.9
20 1998-99
10
2005-06
0
Milk or Pulses or Dark & Fruits Eggs Fish 2015-16
curd beans green leafy
vegetables
Food groups

Fig. 12 Consumption of different food by women between 15–49 years at least once a week. Source
NFHS-2 (2000), NFHS-3 (2007), NFHS-4 (2017)
Percentage of women

100
80
60
40
20
0 Poor (Lowest
Quantile Class)
Rich (Highest
Quantile Class)

Food groups

Fig. 13 Consumption of different foods at least once in a week by women aged 15–49 years in
poor and rich households (2015–16). Source NFHS-4 (2017)
Dietary Diversity, Nutrition and Food Safety 49

adolescents) and of fruits, eggs and fish or chicken or meat was even less regular.
The report shows that mothers’ education and household wealth significantly impact
the consumption of these food groups as well as of unhealthy foods such as fried
food and aerated drinks (Fig. 14a, b; Fig. 15a, b).
The mean level of consumption of various micronutrients among the adult women
(≥ 18 years of age and involved in sedentary work) show a decline in intake of almost
all the micronutrients except for thiamine and niacin, between 1996–97 and 2011–
12 in the rural areas (Table 5). The intake of calcium, vitamin A and vitamin C
is much below the RDA. The gap from RDA in iron intake may be the primary
cause of anaemia in women of reproductive age. According to CNNS, in 2016–18,
about 28 and 22% of adolescents had anaemia and iron deficiency, respectively.
Iron deficiency was much higher in adolescent women (31%) than men adolescents
(12%). The CNNS also reported that children and adolescents in urban areas had
a higher prevalence of iron deficiency than their rural counterparts. Prevalence of
deficiency of vitamin A (16%) and vitamin zinc (32%) was also considerably high

a
100
Percentage of children

80
60
40
20
0
No Schooling <5 yrs completed 5–7 yrs 8–9 yrs 10–11 yrs >12 yrs
completed completed completed completed
Maternal Education
Milk or curd Dark Green Leafy Vegetables Fruits
Eggs Fish Chicken or Meat
Fish or Chicken or Meat Fried Foods Aerated Drinks
b
Percentage of children

100

50

0
No Schooling <5 yrs completed 5–7 yrs 8–9 yrs 10–11 yrs >12 yrs
completed completed completed completed
Maternal Education
Milk or curd Dark Green Leafy Vegetables Fruits
Eggs Fish Chicken or Meat
Fish or Chicken or Meat Fried Foods Aerated Drinks

Fig. 14 a Consumption of food groups by children of ages 5–9 years at least once per week
(Percentage). Source MoHFW 2019. b Consumption of food groups by children of ages 10–19
years at least once per week (Percentage). Source MoHFW 2019
50 S. Mahendra Dev and V. L. Pandey

a b
100 90
Percentage of children

Percentage of children
80
80 70
60 60
50
40 40
30
20 20
0 10
0

Poorest Richest Poorest Richest

Fig. 15 a Consumption of food groups by children of age 5–9 years at least once per week. b
Consumption of food groups by children of age 10–19 years at least once per week

Table 5 Mean intake of micronutrients (per day) among adult women (≥ 18 years of age) for
sedentary worker
Non-pregnant non-lactating women
Micronutrients Calcium Iron Vitamin Thiamine Riboflavin Niacin Vitamin
(mg) (mg) A (µg) (mg) (mg) (mg) C (mg)
1996–97 593 24.1 311 1.1 1 12 44
2005–06 443 13.8 254 1.1 0.6 14.2 47
2011–12 372 14.4 251 1.3 0.8 14 39
RDA 600 21 600 1.1 1.3 14 40
Pregnant women
Calcium Iron Vit A Thiamin Riboflavin Niacin Vit.-C
(mg) (mg) (µg) (mg) (mg) (mg) (mg)
1996–97 575 24.3 269 1.1 0.9 12 39
2005–06 456 14 261 1.1 0.6 13.7 42
2011–12 418 13.7 291 1.3 0.8 13.8 43
RDA 1200 35 800 1.2 1.4 14 60
Lactating women
Calcium Iron Vit A Thiamin Riboflavin Niacin Vit.-C
(mg) (mg) (µg) (mg) (mg) (mg) (mg)
1996–97 553 26.7 277 1.3 1 14 40
2005–06 447 14.7 249 1.2 0.6 15.5 46
2011–12 411 15.8 304 1.4 0.8 15.5 47
RDA 1200 21 950 1.2 1.45 15.5 80
Source NNMB 2006, NNMB 2012
Dietary Diversity, Nutrition and Food Safety 51

among adolescents (MoHFW 2019). There is a need to give more focus on the
nutritional status of adolescent women.
There is a structural shift in the dietary pattern and it points towards India’s
nutrition transition (Drewnowski & Popkin, 1997). A dietary shift towards high-value
food commodities such as vegetables and animal-sourced foods would significantly
impact the agricultural production system and environment. The intake of calorie and
protein has reduced, and the intake of micronutrients is still very low. The average
consumption of protein is above the RDA but below it in the poorest households.
The contribution of non-cereals items in calories and proteins is increasing in both
rural and urban areas. At the same time, the consumption of unhealthy foods such
as processed and fast foods, beverages, etc., increased (Table 3). However, these
trends are based on quite old data sets, and to make meaningful policy suggestions
the recent shift in dietary pattern needs to be understood.
In India, rising income, demographic transition and the spread of retail chains
have transformed households’ dietary habits (Pingali et al., 2019; Shetty, 2002). Food
expenditure elasticities have also changed over time, contributing to nutrition transi-
tion. Kumar et al. (2016) showed that consumers spend additional income on spices
and beverages, followed by animal products. Cereals are losing their importance in
Indian diets, and their demand has become more income inelastic and price elastic
suggesting that cereals are a substitute rather than a complement to animal products
in a diet (Law et al., 2019). Both price and non-price factors were responsible for
changes in consumption patterns.

3 Malnutrition Trends

Malnourished children and adolescents are at increased risk of impaired growth, poor
cognitive development, low immunity and mortality (Black & Dewey, 2014). In India,
stunting among children under five declined from 48% in 2005–06 to 38.4% in 2015–
16 at an average rate of 1% per year (Table 6). Underweight among children under-5
also declined from 42.5% to 35.7%, a 0.7% decline per year during this period.
According to CNNS, stunting and underweight among children under-5 was even
lower at 35% and 33%, respectively, during 2016–18. On the other hand, wasting has
slightly increased (19.8 to 21% during 2005–06 to 2015–16) as per NFHS-4 (2017)
data; however, CNNS shows that wasting was 17% during 2016–18. Malnutrition and
anaemia for children and women is higher in rural than that in urban areas (MoHFW,
2019). Although anaemia decreased for children and women, and BMI improved
for women, the levels are still not satisfactory. Around 58% of children and 53% of
women were anaemic in 2015–16 (Table 6).
Malnutrition is 51% in the lowest wealth quintile in 2015–16. It is very high and
nearly 2.5 times of malnutrition levels than the highest quintile (Table 7). Sched-
uled castes and Scheduled tribes have 10% points higher malnutrition than other
castes. No education category has 20% points higher malnutrition than the category
with secondary or more (Table 7). Maternal education influences nutrient intake and
52 S. Mahendra Dev and V. L. Pandey

Table 6 Nutritional status of children under five years and women (15–49): all India, per cent
Total (Rural + Urban) 2015–16 (NFHS-4)
Children under 5 years 2005–06 2015–16 Rural Urban
(NFHS-3) (NFHS-4)
Stunting (height for age) 48.0 38.4 41.2 31.0
Underweight (weight for age) 42.5 35.7 38.3 29.1
Wasting (weight for height) 19.8 21.0 21.5 20.0
Anaemia among children 69.4 58.4 59.4 55.9
Women (15–49 years)
Anaemia among women 55.3 53.0 54.2 50.8
BMI below normal (women) 35.5 22.9 26.7 15.5
Sources NFHS-3 (2007) and NFHS-4 (2017)

Table 7 Nutrition status of children under five years, stunting (height for age): all India, 2015–16
Wealth Quintile Stunting Social groups Stunting Education Stunting
(per cent) (per cent) (per cent)
Lowest 51 Scheduled Caste 43 No education 51
Second 44 Scheduled Tribe 44 Primary complete 44
Middle 36 Other Backward 39 Secondary or more 31
Class complete
Fourth 29 None of them 31
Highest 22
Source NFHS-4 (2017)

reduces malnutrition in children under-5 (Figs. 14a, 16, Jose et al., 2020; Pandey
et al., 2016).
However, the decline in malnutrition is much higher during 2005–06 to 2015–
16 compared to 1998–99 to 2005–06. Despite the non-improvement of diet quality
in terms of protein and quantity of micronutrients at the aggregate level, the nutri-
tional outcomes are getting better. The decline in malnutrition depends on several

50

0
HAZ WHZ WAZ

No Schooling <5 yrs completed 5–7 yrs completed

8–9 yrs completed 10–11 yrs completed >12 yrs completed

Fig. 16 Maternal education and anthropometry of children (0–4 years). Source MoHFW 2019
Dietary Diversity, Nutrition and Food Safety 53

multidimensional factors—(i) increased protein intake in the lowest 20% of the

MPCE class, (ii) expansion and improvement of several programmes targeting a
mix of direct and indirect causes of undernutrition, (iii) increasing efficiency in these
programmes’ delivery systems and (iv) improvements in drinking water, sanitation,
hygiene (WASH) and women’s literacy rate. Studies showed that hygiene and sani-
tation are strongly associated with nutritional status, especially for children (Jose
et al., 2020; Shively, 2015).
The NFHS-5 fact sheets of key indicators were released in December 2020 for 22
States and UTs. Table 8 presents comparison of NFHS-5 with NFHS-4 for six major
states and shows an increase in: (i) children’s dietary adequacy, drinking water, sanita-
tion facilities, clean cooking fuels, women’s education and women’s empowerment,
(ii) stunting in children under-5 in Gujarat, Maharashtra and West Bengal (WB), (iii)
proportion of severely wasted under-5 children in all the states except Karnataka, (iv)
diarrhoea in children in all the five states except Gujarat, (v) underweight children
under-5 in Gujarat, Maharashtra and WB, (vi) percentage of overweight children in
all six states. The overweight children are 2% more than wasted children. Anaemia
among the children between age 6–59 months increased in all the states, and among
women aged 15–49 years it increased in all the states except Andhra Pradesh (Table
8). The worsening of nutritional status despite improvement in WASH, maternal
education and programme coverage could be due to decline in household income,
poor maintenance of sanitation facility, increase in environmental pollution, etc., but
it has to be explored further once full data is made available.
India is also suffering from increase in overweight and obesity in the popula-
tion (8.1% point (12.6–20.7%) among the women during 2005–06 to 2015–16) that
poses more significant risks for NCDs (MoHFS, 2019). It increased by 9.3% points
(9.3–18.6%) among the men during the same period. Undernutrition in utero and
early childhood can affect individuals to become overweight and develop NCD in
adulthood (WHO, 2018). According to 2019 CNNS, overall, 2% of children under-
5 were overweight or obese during 2016–18. In the well-nourished population, it
is normal. But in India, as almost 20% of under-5 children were wasted, with the
mean weight-for-length/height z-score (WHZ score) for the population being -1.0,
the prevalence of overweight or obese at 2% was considered significantly higher and
could indicate rise of overweight and obesity in the country (MoHFW, 2019).

4 Different Interventions and Impact

Policies related to social protection are important as they would directly deliver
support to the needy. Research showed that risk and vulnerability justification should
be added since the poor do not have formal instruments for risk mitigation and coping
(Devereux, 2006).
In order to alleviate poverty and achieving food security, India adopted a two-
fold strategy of letting the economy grow fast and attacking poverty directly through
Table 8 Comparing status of child feeding, nutritional outcome and prevalence of diseases in children under-5 ([FHS -5 (2019–20) and NFHS-4 (2015–16)]
54

AP Bihar Gujarat Karnataka Maharashtra WB

Characteristics NFHS-5 NFHS-4 NFHS-5 NFHS-4 NFHS-5 NFHS-4 NFHS-5 NFHS-4 NFHS-5 NFHS-4 NFHS-5 NFHS-4
Women with 10 or more years of 39.6 34.3 28.8 22.8 33.8 33 50.2 45.5 50.4 42 32.9 26.5
schooling (%)
Population with an improved 96.7 95.6 99.2 98.4 97.2 95.9 95.3 95.3 93.5 92.5 97.5 97.2
drinking-water source (%)
Population that use an improved 77.3 54.4 49.4 26.5 74 63.6 74.8 57.8 72 52.3 68 52.8
sanitation facility (%)
Households using clean cooking 83.6 62 37.8 17.8 66.9 52.6 79.7 54.7 79.7 59.9 40.2 27.8
fuel (%)
Child feeding
Children under age 6 months 68 70.2 58.9 53.4 65 55.8 61 54.2 71 56.6 53.3 52.3
exclusively breastfed (%)
Children age 6–23 months 9.3 7.6 10.9 7.5 5.9 5.2 12.8 8.2 9 6.5 23.4 19.6
receiving an adequate diet (%)
Nutritional status and diahorrea among children under-5
Stunted (%) 31.2 31.4 42.9 48.3 39 38.5 35.4 36.2 35.2 34.4 33.8 32.5
Wasted (%) 16.1 17.2 22.9 20.8 25.1 26.4 19.5 26.1 25.6 25.6 20.3 20.3
Severely wasted (below-3 6 4.5 8.8 7 10.6 9.5 8.4 10.5 10.9 9.4 7.1 6.5
standard deviations)
Underweight 29.6 31.9 41 43.9 39.7 39.3 32.9 35.2 36.1 36 32.2 31.6
Overweight 2.7 1.2 2.4 1.2 3.9 1.9 3.2 2.6 4.1 1.9 4.3 2.1
Prevalence of diarrhoea in the 7.2 6.6 13.7 10.4 8.2 8.4 5.3 4.5 8.9 8.5 6.5 5.9
2 weeks preceding the survey
(%)
(continued)
S. Mahendra Dev and V. L. Pandey
Table 8 (continued)
AP Bihar Gujarat Karnataka Maharashtra WB
Characteristics NFHS-5 NFHS-4 NFHS-5 NFHS-4 NFHS-5 NFHS-4 NFHS-5 NFHS-4 NFHS-5 NFHS-4 NFHS-5 NFHS-4
Prevalence of symptoms of acute 2.4 0.5 3.5 2.5 1 1.4 1.5 1.2 3.2 2.4 2.8 3.3
respiratory infection in the
2 weeks preceding the survey
(%)
Anaemia among children and adults
Children age 6–59 months who 63.2 58.6 69.4 63.5 79.7 62.6 65.5 60.9 68.9 53.8 69 54.2
are anaemic (< 11.0 g/dl) (%)
Non-pregnant women age 59 60.2 63.6 60.4 65.1 55.1 47.8 44.8 54.5 47.9 71.7 62.8
15–49 years who are anaemic
(< 12.0 g/dl) (%)
Dietary Diversity, Nutrition and Food Safety

Pregnant women age 53.7 52.9 63.1 58.3 62.6 51.3 45.7 45.4 45.7 49.3 62.3 53.6
15–49 years who are anaemic
(< 11.0 g/dl)(%)
All women age 15–49 years who 58.8 60 63.5 60.3 65 54.9 47.8 44.8 54.2 48 71.4 62.5
are anaemic (%)
Source NFHS-4 (2017) and NFHS-5 (2021)
55
56 S. Mahendra Dev and V. L. Pandey

poverty alleviation programmes. We first examine here the trends in poverty and the
role of direct social protection programmes before going to the individual schemes.

4.1 Poverty Trends

Based on NSS Consumer Expenditure data there are two conclusions on the trends
in poverty. (i) Datt et al. (2016) showed that poverty declined by 1.36% points per
annum in post-1991 compared to that of 0.44% points per annum prior to 1991.
This study also showed that among other things, urban growth is the most important
contributor to the rapid reduction in poverty even in rural areas in post-1991 period.
Second conclusion is that within the post-reform period, poverty declined faster in
2000s than in 1990s. The official estimates based on the Tendulkar poverty lines
showed that poverty declined much faster during 2004–05 to 2011–12 as compared
to the period 1993–94 to 2004–05. In fact, the number of poor came down by 137
million during 2004–05 to 2011–12 while it increased by 3.4 million during 1993–94
to 2004–05. According to the Rangarajan Committee methodology, the decline from
2009–10 to 2011–12 is 92 million.3
Faster reduction in poverty is true even on the basis of multidimensional poverty
index (MPI). According to the Report of the Global MPI, 2019 (Oxford and UNDP,
2019), India has made momentous progress in reducing multidimensional poverty.
The incidence of multidimensional poverty was almost halved between 2005–06
and 2015–16, climbing down to 27.5%. Thus, from consumption based poverty or
MPI point of view, poverty declined faster during the high growth period; GDP
growth was 8.5% per annum during 2004–05 to 2011–12 as compared to 6.3% per
annum during 1993–94 to 2004–05. During the period 2004–05 to 2011–12, several
poverty alleviation programmes, like MGNREGA (Mahatma Gandhi National Rural
Employment Guarantee Act) and NFSA (National Food Security Act), were intro-
duced. These programmes were responsible for faster decline in poverty in India.
Data after 2011–12 is not available.
The importance of individual programmes in reducing poverty and improving
nutrition has been examined here.

4.2 MGNREGA

In India, the provision of employment has been extensively used as a tool of entitle-
ment protection from many centuries. After independence in 1947, central govern-
ment sponsored many schemes, beginning with the Rural Manpower programme in
1960. However, the most important programme at the state level is the Maharashtra
Employment Guarantee Scheme (EGS), introduced in 1972.

3 Rangarajan Committee estimates only for the years 2009–10 and 2011–12.
Dietary Diversity, Nutrition and Food Safety 57

The National Rural Employment Guarantee Act (NREGA) was notified in

September 2005. It is now called Mahatma Gandhi National Rural Employment
Guarantee Act (MGNREGA). Its objective is to enhance livelihood security in rural
areas by providing at least 100 days of guaranteed wage employment in a financial
year to every household. MGNREGA has been subject to much scrutiny, and assess-
ment in terms of its effectiveness as a social protection intervention.4 These assess-
ments have yielded mixed findings, in terms of the effectiveness of the programme’s
design and objectives, its impact on the socially disadvantaged, especially children
and women.
Several pathways lead to better outcomes in nutrition, health and education of chil-
dren due to social protection programme like MGNREGA. These can be grouped
into three heads (i) indirect effects of reduction in risks and vulnerabilities and
increase in livelihoods and incomes of households, (ii) women’s well-being and
intra-household decisions and (iii) direct effects of childcare facilities and linkages
with school education and ICDS.
Dev (2011), while examining the impact of MGNREGA on the well-being of
children and the impact of the scheme on women, reported positive impact of
MGNREGA on child well-being5 as well as on household incomes, empowerment
and well-being of women, in improving nutrition, health and education of children
and reducing child labour.6 Related to the issue of children in agriculture, especially
girls, is the gender aspect of recognizing women as producers and farmers and linking
to household food security. Strengthening extension training curriculum on gender
and child protection issues in agriculture can help in reducing child labour.
Narayanan and Gerber (2017) and Narayanan (2020) also showed positive
impact of MGNREGA on women and children. MGNREGA benefits the poor and
the marginalized, who generally are more undernourished and have poor health.7
MGNREGA can have links to nutrition and health at the micro level in two ways:
(i) through rise in earnings and expenditures that seem to have a positive impact on
calories, proteins and micronutrient intake in Andhra Pradesh, Rajasthan and Maha-
rashtra8 ; (ii) through the assets created under MGNREGA (Narayanan & Gerber,
2017). Narayanan et al. (2014) studied the assets created in Maharashtra under
MGNREGA, and revealed that 87% of works exist and function and over 75% of
these are directly or indirectly related to agriculture.
MGNREGA is the most important social protection programme in India. Apart
from direct benefits, it has secondary benefits such as creation of assets for agriculture
and rural development; more participation of women (more than 50% of workers

4 For example, see Dreze and Khera (2009), Khera (2008), Dev (2011), Narayanan and Gerber
(2017), Narayanan (2020).
5 Child well-being indicators are child labour, nutrition and education.
6 Studies showed a positive relationship between MGNREGA and child nutrition indicators. Also

it is shown that access to food also increased for the households including children.
7 MGNREGA provided employment to 55 million rural households in 2019–20. Majority of them

belong to poorer households as they are self-selected for doing manual unskilled work.
8 This is based on Jha et al. (2011).
58 S. Mahendra Dev and V. L. Pandey

Table 9 Allocation and offtake under NFSA, 2019–20 (in million tonnes)
TPDS ICDS MDMS Total
Allocation 52.2 2.2 2.5 56.9
Offtake 50.1 1.2 2.1 53.4
Source Food Bulletin, Department of Food and Public Distribution System (GoI)

are females); helping marginalized sections like SCs and STs; reducing distress
migration; involvement of panchayats, etc.9 The programme demonstrated varying
degrees of success across the country. The achievements are still short of potential,
which can be harnessed to strengthen the right to employment enhancing the rights
of women and children.

4.3 NFSA

The Indian Public Distribution System (PDS) is one of the instruments for improving
food security at the household level. The PDS ensures availability of essential
commodities like rice, wheat, edible oils and kerosene to the consumers through
a network of outlets or fair price shops. These are supplied at below market prices
to consumers. The National Food Security Act (NFSA) 2013 aims to provide subsi-
dized food grains to approximately two-thirds of India. It includes the Midday
Meal Scheme (MDMS), Integrated Child Development Services scheme (ICDS) and
Targeted Public Distribution System (TPDS). Further, the NFSA 2013 recognizes
maternity entitlements. The MDMS and the ICDS are universal in nature whereas
the TPDS reaches about two-thirds of the population (75% in rural areas and 50%
in urban areas).
Under the provisions of the Act, beneficiaries of the PDS are entitled to 5 kg per
person per month of cereals at INR 3 per kg of rice, INR 2 per kg of wheat and INR
1 per kg of coarse grains (millets). Pregnant women, lactating mothers and certain
categories of children are eligible for daily free cereals. In 2019–20, the offtake under
TPDS was 50 million tonnes while it was 1.2 million tonnes and 2.1 million tonnes
for ICDS and MDMS, respectively (Table 9).

4.3.1 The Impact of PDS on Food and Nutrition Security

In general, the poor and the vulnerable groups benefited from the PDS although the
impact varies across states. Narayanan and Gerber (2017) showed a range of limited
to modest positive impact on calorie intake.10 The study also indicated that most of
the studies are limited to assessing the intermediary outcomes than on undernutrition.

9 On benefits of employment guarantee schemes, see Dev (1995) and Dev (2011).
10 This is based on literature survey by Narayanan and Gerber (2017).
Dietary Diversity, Nutrition and Food Safety 59

Krishnamurthy et al. (2014) revealed an increase in consumption of protein, calcium

and iron due to the PDS (12.9%, 26.4% and 14.2% respectively).
Himanshu and Sen (2013) estimated that the value of PDS transfer was 2.4% of
MPCE for the total population, and 5.2% of MPCE for the bottom 40%. In other
words, poor benefited more than others due to these in-kind food transfers. Their
study showed that in 2009–10, total poverty ratio (Tendulkar methodology) was
30.68% with PDS transfers, while it was 33.85% without transfers in 2009–10.
One issue of NFSA is its adverse impact on diversification of cropping pattern.
The policies in India support rice and wheat due to minimum support prices, buffer
stock and PDS. These policies provide incentives for farmers to produce more of
rice and wheat which are water intensive. They act as disincentives to undertake
diversified farming.
Related criticism is that NFSA is not going to solve the problem of malnutrition
as they give mainly calories. It is possible that savings from subsidized food items
indirectly helps in consuming protein and micronutrient related foods. It is true that
the poor and vulnerable spend more on cereals. It is known that health is determined
by calorie, proteins, micronutrients, sanitation, safe drinking water, etc. NFSA mainly
provides rice, wheat and coarse cereals. It, however, has some provision for nutritious
food for women and children.

4.4 Child Nutrition Schemes

4.4.1 ICDS

The Integrated Child Development Services (ICDS), launched in 1975, aims at the
holistic development of children up to 6 years of age with a special focus on children
up to 2 years, besides expectant and nursing mothers. This is done through a service
package—health check-ups, immunization, referral services, supplementary feeding,
non-formal pre-school education and advice on health and nutrition.
The scheme has to focus more on 0–3 year children as malnutrition sets in in
utero and is likely to intensify during the 0–3 year period, if not addressed. A child
malnourished during 0–3 years will be marred physically and mentally for life. The
scheme is designed to address this problem frontally.
Mother’s malnutrition has knock-on effects on child malnutrition. Exclusive
breastfeeding for six months is necessary to avoid unnecessary infections to the
baby, develop the baby’s immunity and ensure growth. The baby must begin to
receive solid, mushy food at 6 months (i.e. together with breastfeeds) for the baby
to continue to grow in the way nature intended it to grow. The ICDS scheme accord-
ingly needs to be restructured in a manner that addresses some of the weaknesses that
have emerged and is suitable for universalization. The programme must effectively
integrate the different elements that affect nutrition and reflect the different needs of
children in different age groups (GoI, 2008).
60 S. Mahendra Dev and V. L. Pandey

Apart from the above, preliminary findings of FOCUS (Focus on children under-
6) survey conducted in May–June 2004 in six states brought out some of the prob-
lems and regional disparities in the working of ICDS (Dreze, 2006). This study
showed that Tamil Nadu scores over Northern states in infrastructure, quality of pre-
school education, immunization rates, mother’s perceptions and quality of anganwadi
workers.
Saxena (2008) informed that ICDS reached only 12.5% of children in the age
group 6 months to 6 years. The aim of the 11th Five Year Plan document was to
halve the incidence of malnutrition by the end of the Plan period, and reduce anaemia
among pregnant women and children to under 10%. It stated that to achieve these
objectives, ICDS has to be restructured with higher allocations of funds and effective
implementation.
The above studies were done more than a decade back. Jain (2015), using NFHS
2005–06, showed that the supplementary feeding component of ICDS had sizable
positive effects on heights of 0–2 year olds in 2005–06; girls who received ICDS
food daily were at least 1 cm taller than those who did not. It also indicated that the
supplementary nutrition could potentially bridge the height gap between the richest
and poorest girls by at least 28% and for boys by 19% at adulthood. However, the
study warned that one can have all these benefits only if the programme is targeted
towards 0–2-year-old children. ICDS was restructured in recent years including focus
on supplementary feeding on children below 3-years of age and pregnant and lactating
mothers. Apart from other factors, ICDS restructuring helped in decline in stunting
in recent years.
A study by Chudasama et al. (2016) evaluates ICDS programme during 2012–
2015. Some of the findings are mentioned here.
(a) A majority of pregnant women (94.7%) and lactating mothers (74.4%), and
adolescent girls (86.6%) were availing ICDS services. (b) Two-thirds (66.2%) chil-
dren were covered by supplementary nutrition (SN). (c) Only 14.6% of the AWCs
(Anganwadi Centres) reported 100% preschool education (PSE) coverage among
children. (d) More than half (55.4%) of the AWCs reported an interruption in supply
during the last 6 months. (e) Various issues were reported by AWWs (Anganwadi
Workers) related to the ICDS. The study reported gaps in terms of infrastructure
facility, different trainings, coverage, supply and provision of SN, status of PSE
activities in AWCs and provision of different services to the beneficiaries. These
gaps have to be addressed to improve the impact of ICDS on nutrition. One has to
examine the working of ICDS more thoroughly and find out the reasons for less take
off in this scheme as compared to schemes like PDS and mid-day meal scheme.

4.4.2 Mid-day Meals Scheme

The MDMS in India is a programme covering primary school children to improve

nutrition as well as increase educational enrolment, retention and attendance. Using
Young Lives project data, Porter et al. (2010) examine the effect of the scheme on
children’s nutrition and their learning. Among the children surveyed by Young Lives
Dietary Diversity, Nutrition and Food Safety 61

in Andhra Pradesh, the scheme delivered significant nutritional benefits for children
aged 4–5 years with respect to better height-for-age and weight-for-age than would
otherwise be expected, suggesting that MDMS helps reduce malnutrition. For older
children (aged 11–12 years) there is evidence of significant positive impacts on
children’s learning, although it is not clear if these effects are generated by less
hunger or by improved school attendance. The school meals have most impact in
areas affected by drought. For younger children, there are large and significant gains
in height-for-age and weight-for-age, which more than compensate for the negative
effects of the drought. The success of Tamil Nadu MDMS on nutrition and education
is well known.

4.5 Cash Transfers

Some argue unconditional cash transfers (CTs) to reduce poverty and undernutrition.
It is advocated that the system should move towards direct benefits transfer in place of
present social protection programmes. There has been a lot of discussion on universal
basic income (UBI) in both developed and developing countries. Rangarajan and Dev
(2017) say introducing UBI is unrealistic. In fact, the concept of basic income must
be turned essentially into a supplemental income.
A study on Bangladesh (Ahmed et al., 2019) showed positive relationship between
cash transfers and nutrition. They implemented randomized control trials in rural
Bangladesh, with two treatments: (a) cash transfers, a food ration or a mixed food
and cash transfer and (b) cash and nutrition behaviour change communication (BCC)
or food and nutrition with BCC. The study revealed only cash plus nutrition BCC
had a significant impact on nutritional status, but its effect on height-for-age was
large. Improved diets—including increased intake of animal source foods – along
with reductions in illness in the cash plus BCC treatment were responsible for
improvement in children’s nutrition.

4.6 COVID-19 and Safety Net Programmes

COVID-19 created health and economic crisis in India similar to many other coun-
tries. The complete shutdown of all economic activities except essential services
created an economic crisis and misery for the poor, with massive job losses and
rising food insecurity.
The central and state governments and the RBI recognized the economic crisis and
responded using fiscal and monetary policies. The Central government announced
Atmanirbhar package with INR 21 trillion (around 10% of GDP). But most of the
package relates to liquidity measures. The real fiscal stimulus seems to be around
2% of GDP. It also includes food transfers and cash transfers for the informal poor
workers including migrants. Government allocated more funds for MGNREGA.
62 S. Mahendra Dev and V. L. Pandey

India has nearly 56 million tonnes of excess stock of grains and cereals compared
to the usual norms. In March 2020, the government declared 5 kg free rations in
addition to the present entitlement of buying 5 kg at subsidized prices. In June
2020, the Prime Minister announced extension of the Pradhan Mantri Garib Kalyan
Anna Yojana (PMGKAY), a programme to provide free ration for over 80 crore
people, mostly poor, for five more months till November end. It was to help the
informal sector workers in both rural and urban areas. However, government has
to make sure that no one is excluded as there are still exclusion errors in the PDS.
State governments have also announced free basic and enhanced rations. The Central
government also announced ‘One Nation-One Ration Card’. The nutritional levels of
informal workers and unemployed poor were low even before the crisis. It will decline
further due to lack of jobs and incomes during lockdown and beyond. Therefore, there
is a need to have pulses, oils, etc. in the provision to ensure a diversified diet for them.
Anganwadis and schools can provide rations at home. Eggs can be added to improve
nutrition for children and women. Government has to make sure that the prices of
essential food items are under control. Otherwise high prices would have adverse
impact on the food and nutrition security of the poor.

4.6.1 Minimum Basic Income for the Poor in Post-COVID-19 period

Universal Basic Income (UBI) was discussed in detail during pandemic times. It is
true that a universal scheme is easy to implement. Feasibility of such a scheme is
the critical question. Targeted programme is another option but its main problem is
of identification. Narrowly targeted programmes will run into complex problems of
identification and give rise to exclusion and inclusion errors.
Rangarajan and Dev (2020) suggested three proposals to avoid the identification
problem and help in providing minimum basic income to poor and vulnerable groups
in both rural and urban areas. These are:
(a) give cash transfer to all women—above the age of 20 years—in both rural and
urban areas;
(b) expand the number of days provided under MGNREGA; and
(c) launch National Employment Guarantee Scheme in urban areas.
In all the three proposals, there is no problem of identification. A combination of
cash transfer and an expanded MGNREGA can provide minimum basic income.
a. Total cost of the three proposals
The proposal of providing cash transfers to women above 20 years costs INR 1.72
lakh crore (0.84% of GDP). The total cost of the expenditure on MGNREGA for
providing 150 days employment and 150 days for urban employment guarantee
scheme would cost INR 3.21 lakh crore in a year (1.58% of GDP). The total cost of
the three proposals would be INR 4.9 lakh crores or 2.4% of GDP. A person working
in MGNREGA and urban programme can get an additional INR 30,000 if 150 days
are provided.
Dietary Diversity, Nutrition and Food Safety 63

It may be noted, however, that the total expenditure of the proposals could be
lower due to two reasons. First, the number of days availed of by the employment
guarantee programmes could be lower as it is a demand based programme. This
is happening even now. Second, on cash transfers, some women particularly from
richer classes may voluntarily drop out of the scheme or alternatively a declaration
may be obtained from those receiving cash transfer that their total monthly income
is less than INR 6000 per month. In addition it may be noted that the government is
already incurring a total expenditure of INR 67,873 crore on MGNREGA.
In the post-COVID-19 situation, we need to institute schemes to provide minimum
income for the poor and vulnerable groups. For this purpose, it is proposed to offer
cash transfers for women, increase MGNREGA from the present 100 days to 150 days
of work in rural areas and introduce 150 days of work as an urban employment
guarantee scheme. This will cost around 2% of GDP and will help the poor, informal
workers including migrant workers and poverty and food and nutritional insecurity
can be reduced significantly.

5 Food Safety Concerns

Food safety refers to ways to prevent food-borne diseases (FBD) due to food contam-
ination in the entire food system—production, processing, storage, transport, food
distribution and at the household level. It also refers to the prevailing standards and
controls to protect consumers from unsafe foods. The Food Safety and Standards
Authority of India (FSSAI) finalizes science-based quality and safety standards for
food and regulate the manufacturing, storage, distribution, sale and import to ensure
safe and healthy food (Food Safety and Standards Act, 2006). However, several
shortcomings in FSSAI functioning are also reported (Siruguri & Bhat, 2018). Food
safety, security and nutrition (FSN) are closely linked, with unsafe food creating
a vicious circle of diseases and malnutrition, affecting the more vulnerable groups
(WHO, 2015). Nutritional and food safety objectives generally contradict, as the
most nutritious foods are usually the riskiest ones (FAO, 2016).
Economic growth, improved literacy rates, rising incomes, urbanization and liber-
alization have influenced Indians’ dietary pattern and have made them more aware
of food safety. Food safety is determined by—how food is produced, delivered and
also by how consumers procure, handle, cook, store and consume food. Access to
safe water, toilets and washing hands with soap is required for proper utilization of
the consumed food.
Food contaminations also affect the export of fresh and processed food commodi-
ties. In January 2020, the USA rejected 112 consignments of food and beverages
from India. Major Indian products rejected by USFDA include spices, shrimps and
prawns, vitamins and proteins, honey, sweets, biscuits and flavoured snacks (USFDA
Rejection Data). In 2009–10 European Union (EU) rejected around 1200 of total 3400
Indian containers of grape consignments, citing the presence of pesticide residue on
the fruit. The EU banned the import of Indian mangoes in 2014 because they were
64 S. Mahendra Dev and V. L. Pandey

infected with pests that could harm indigenous crops, which was lifted in 2015. EU
has also banned eggplant, bitter gourd and snake gourd after consignments of these
items were found infested with fruit flies. The Indian basmati rice was also subjected
to import restrictions because London’s Pesticide Safety Directorate stated that it
contained a high level of fumigants.
Spain, Italy and Germany detained the import of Indian spices owing to the pres-
ence of aflatoxin and pesticide residue. Aflatoxins are produced by fungi that infect
crops and are highly toxic and cancer-causing. Indian marine products were also
banned by the EU because antibiotic residues were more than the prescribed level.
Likewise, shrimp import by Japan was restricted on the ground of non-freshness,
foreign bodies and unhygienic practices.
Kohli and Garg (2015) reported that the FBD are infrequent and often not reported
in India and referred to a study conducted in 2006 that showed only 13.2% of house-
holds reported FBD. The FBD outbreaks, together with acute diarrhoeal diseases
and measles, constitute a majority of all reported outbreaks of diseases in India (GoI,
2020). To increase the productivity, farmers use a range of fertilizers and pesticides.
These agrochemicals are often found in trace quantities in the final product and enter
the food chain adversely affecting human health. Similarly, in animal farming, veteri-
nary drugs/antibiotics are commonly used, and which, by entering the food chain,
become injurious to human health. It is estimated that FBD costs stood at around
0.5% of the country’s GDP in 2011 (Kristkova et al., 2017); they projected that there
would be a higher consumption of food, mainly fruits, vegetables and meat, between
the period 2011 and 2030, resulting in a significant increase of FBD cases to 150–177
million in 2030 compared to 100 million in 2011.
Most cases of FBD illnesses are preventable by following food protection prin-
ciples. WHO promotes five keys to food safety measures viz., keep clean; separate
raw and cooked; cook thoroughly; keep food at safe temperatures; use safe water
and raw materials. There is a need to have food safety literacy at the household level,
especially for the women, as they are generally custodians of food preparation and
handling. In India, diverse food habits, cultural practices and the changes brought in
by globalization and scarcity of resources, especially clean water, money, appliances,
etc., at the household level, make food safety promotion a difficult task (Subbarao,
2019). According to the World Water State in 2018, around 19.33% of the population
do not have access to clean water in India, which has implications for food safety.
Clean water, sanitation and hygiene (WASH) are essential for reducing malnu-
trition and mortality rates (Headey & Palloni, 2019). The inadequate WASH leads
to diarrhoea, undernutrition, helminthiases and vector-borne diseases. Interventions
to address water and sanitation simultaneously have positively affected child health
(Checkley et al., 2004; Duflo et al., 2015; WHO, 2008). Spears (2013) studied India’s
Total Sanitation Campaign and reported a decrease in infant mortality by 4 per 1000
and an increase in children’s height by 0.2 standard deviations at the mean programme
intensity. The NFHS-4 (2017) reports that handwashing places with soap and water
availability are present in 78.4% of households. Around 3.31% of households have
handwashing places with no water or soap arrangements in India’s urban areas, and
it is even worse in rural areas. Under such circumstances, food safety issues at the
Dietary Diversity, Nutrition and Food Safety 65

household level become crucial for good health, and require interventions focusing
on improved practices at the point of consumption.
Proper cooking is needed, as inadequate cooking or not thoroughly reheating
leads to food safety risks. But in situations where cooking fuel is difficult to get
or inconvenient to use, households may try to save energy, effort, or time and may
not thoroughly reheat before consumption. Therefore, WASH (water, sanitation and
hygiene) and access to clean and convenient cooking fuel are necessary for food
safety. However, as mentioned earlier, the recent fact sheets of NFHS-5 for 22 States
and UTs showed, that despite improvements in WASH and access to clean fuels for
cooking, children and women’s nutritional status has worsened in most of the states.
There is a need to explore further the factors behind the worsening of the nutritional
status.

6 Sustainability in Consumption

Presently, India is self-sufficient in addressing calorie intake requirements by

producing staple crops (rice and wheat). Based on the review of 11 studies projecting
the consumption of foods in India up to 2050, Alae-Carew et al. (2019) reported an
increase in per capita consumption of meat, vegetables, fruits and dairy products
and consumption of cereals and pulses to remain constant. Kumar et al. (2016)
projecting the demand for 2030 reveals that demand for all the cereals is likely
to be met with domestic production in India. However, pulses, edible oils, sugar,
vegetables and fruits would be short in supply (Annexure 1). Though the produc-
tion of fruits and vegetables is sufficient to meet the demand, supply reduces due
to very high post-harvest losses. Therefore, the issue is to target hidden hunger by
using micronutrient-rich products for food and nutrition security and sustainable
food systems.
India’s dietary patterns are changing, and this trend is likely to continue (Alae-
Carew et al. 2019). These changes in dietary habits, together with a growing popula-
tion, will have consequences on food systems. They might have potential implications
for environmental sustainability through GHG emissions, ground- and surface- water
depletion, soil pollution, etc. (Foley et al., 2005) and subsequently, lead to unsustain-
able agricultural production. Green et al. (2018) quantified GHG emissions, associ-
ated with five distinct dietary patterns, based on the life cycle assessment approach.
The results showed substantial variability in the environmental impact between diets.
The rice-based dietary patterns had higher associated GHG emissions and green water
(precipitation) footprints (WFs), but wheat-based diets had lower GHG and higher
blue (irrigation) WFs. The rice and meat patterns had the highest environmental
impacts. Thus, the increased consumption of animal-sourced foods would signifi-
cantly increase GHG emissions from Indian agriculture; this is a fact, which has to
be kept in mind while adopting animal diet.
Aleksandrowicz et al. (2019) using NSSO 2011–12 data calculated the potential
changes in GHG emissions, blue and green WFs and land use (LU) that would result
66 S. Mahendra Dev and V. L. Pandey

from shifting current national food consumption patterns in India to healthy diets
that meet dietary guidelines (RDA) and also moving to diets currently consumed by
the wealthiest quartile of the population. They modelled the changes in consumption
of 34 food groups necessary to meet Indian dietary guidelines. The analysis showed
that shifting to healthy guidelines at the national level will require increased dietary
energy by 3%, fruit intake by 18% and vegetable intake by 72% in the year 2011–
12. Meeting healthy guidelines would slightly increase environmental footprints
(3–5%). However, shifting to healthy diets among those with dietary energy intake
below RDA would increase 28% in GHG emissions, 18 and 34% in blue and green
WFs, respectively, and 41% in LU. Decreased environmental impacts were shown
for those who currently consume above RDA energy (−6 to −16% across footprints).
Thus, in India widespread adoption of healthy diets may lead to small increases in
the environmental impact relative to the current status. For attaining healthy diets and
the sustainability of the food production system, it is required to improve resource
use efficiency in food production and reduce postharvest losses.

6.1 Reducing Postharvest Losses

Postharvest losses (PHL) add to food insecurity, wastage of natural resources and
wastage of labour and energy used to produce the food (UNEP 2016). A reduction
in food waste will affect the total demand for food production while simultaneously
reducing pressure on natural resources and the environment (FAO, 2019). In India,
PHL are as high as around 40% in fruits and vegetables produced every year (NAAS,
2019). The Ministry of Food Processing Industries estimated losses of 23 million
tonnes of grains, 12 million tonnes of fruits and 21 million tonnes of vegetables
for a total approximate value of 4.4 billion USD in 2018–19. This is happening
due to absence of rural infrastructure for food processing. According to Fan et al.
(2008), rural infrastructure is one of the three most effective public-spending items for
promoting agricultural growth and reducing poverty. Therefore, proper transportation
and storage facilities are must for reducing PHL.
Food processing and packaging can preserve the available nutrients and even
enhance the shelf life and nutrient content of foods. Thus, proper processing and
packaging can help make nutritious foods to reach those vulnerable groups who
cannot access or afford fresh products. If unhealthy ingredients are present in the
food, product reformulation can be carried out, e.g. reducing sodium and trans-fats
(HLPE, 2017).
There is also a need to regulate and monitor food processing by setting standards
and labelling processed food products. Enforcement of standards is required to ensure
food safety and reduce FBD. Thus, it is necessary to make the functioning of FSSAI
more effective by removing the shortcomings (Siruguri & Bhat, 2018).
Dietary Diversity, Nutrition and Food Safety 67

7 Fortification and Bio-fortification

Dietary diversity can help tackle malnutrition, but implementing it may not always be
feasible among poor households. The diet that meets all the recommended nutrient
requirements in vulnerable populations of Uttar Pradesh was over twice more expen-
sive than the diet that meets only the calorie requirements. A nutritious diet was unaf-
fordable by 75% of the households in 2018 (Kachwaha et al., 2019). Agricultural
research has focused on increasing the production and productivity of calorie-dense
staple crops. The prices of nutrient-dense non-staple foods have increased because of
high demand and relatively low supply (Bouis & Saltzman, 2017). The effectiveness
of dietary diversity may also be impacted by seasonality of crops and low bioavail-
ability of specific micronutrients. Nutrient deficiency in food can be tackled either
by providing supplements or by food fortification such as iron and folate-fortified
flour, iodized salts, etc. There was an increased focus on food fortification in the
Union Budget 2019–20. However, these approaches may not be sustainable because
they rely on a robust distribution, good infrastructure and consumer compliance
(Yadava et al., 2018). Generally, fortification is done with synthetic minerals, which
are lower in bio-availability than bio-fortification (Mitra-Ganguli et al., 2019). There-
fore, bio-fortification may be one of the more cost-effective solutions to provide the
desired levels of nutrients, e.g. rice bio-fortified with zinc, iron-rich pearl millet, etc.
(Pfeiffer & McClafferty, 2007).
Studies demonstrated the positive effects of bio-fortified crops on human health.
Meenakshi et al. (2010) reported that the bio-fortification of staples may be more
cost-effective in reducing the burden of diseases than fortification and supplemen-
tation. Stein et al. (2007) estimated that zinc bio-fortification of rice and wheat
might reduce loss of Disability Adjusted Life Years (DALYs) burden by 20–51%
and save 0.6–1.4 million DALYs each year. Scott et al. (2018) showed that consump-
tion of bio-fortified pearl millet twice daily for six months by 12–16-year-olds from
economically-disadvantaged classes had significantly improved their cognitive skills
in Maharashtra, India.
Distribution of bio-fortified cereals through PDS will ensure its reach to nutrition-
deficient groups at a subsidized price. The incorporation of bio-fortified staples in
welfare schemes, such as ICDS and MDMS, might reduce children’s malnutrition
levels. There is a need to intensify efforts by public sector institutions for the adoption
and acceptance of bio-fortified crops. To popularize the bio-fortified varieties, the
seeds’ genetic purity and vigour need to be retained (Yadava et al., 2018). Farmers
should be encouraged and given incentives to grow bio-fortified crops with assured
markets and minimum support prices for bio-fortified crops. Effective extension
services are needed to increase the awareness of the production and consumption of
bio-fortified crops.
For the successful adoption of bio-fortified crops by the consumer, food industry
participation is also vital to bring bio-fortified crops into the food system for Indian
consumers. The food industry can participate via food product development and inno-
vations that fit into the consumers’ growing demand due to increasing concerns for
68 S. Mahendra Dev and V. L. Pandey

plant-based protein, reduced food additives, lower genetically modified ingredients

and more natural foods (Walton, 2019).
For this purpose, the identification of sustainable routes to market is required
(Mitra-Ganguly et al., 2019). A HarvestPlus workshop to discuss ways to increase
the scale, reach and impact of bio-fortified foods in India highlighted a significant
demand from the food industry but lack of awareness is a major barrier (Mitra-
Ganguly et al., 2019).

8 Pathways for Safe and Healthy Diets for Nutritional

Security

The pathways for safe and healthy diets that ensure nutritional security require
meeting food demand for 18.1% of the world population whose share in total
global DALYs attributable to the child and maternal malnutrition was 25.4% in 2017
(Lancet, 2020). India’s population is projected to reach 1.5 billion by 2030, peaking
at 1.6 billion by 2048 (Lancet, 2020). This will require sustainable food systems
that cater to nutritional requirements by increasing the production efficiency of agri-
cultural systems that is faced with small landholdings, fragmentation of farmland,
climate change impacts and degradation of natural resources. However, for making
meaningful suggestions it is necessary to have recent and integrated data on food
consumption patterns and agricultural production systems.
The pathways for safe and healthy diets for nutritional security in India consist of:
(a) improving dietary diversity, (b) reducing postharvest losses, (c) bio-fortification
of staples, (d) empowerment of women, (e) enforcing standards of foods safety, pack-
aging and labelling, (f) improving WASH, (g) food safety awareness and nutrition
education, (h) implementation of food safety and nutrition programmes and (i) use
of ICT.

8.1 Improving Dietary Diversity

Availability and access to adequate amounts of diverse food groups are required to
address undernutrition and micronutrient deficiency. The household dietary diversity
can be improved by increasing crop diversity and having access to kitchen gardens,
including diverse food groups in the safety net programmes such as PDS, MDMS
and THR (take-home ration).
The Government of India has programmes for diversifying the cropping system
such as Crop Diversification Programme (CDP), National Horticulture Mission,
National Food Security Mission - Pulses. There is a need to improve the coverage
of these programmes and increase the production of fruits and vegetables rich
in micronutrients. It is required to integrate these programmes with resource
Dietary Diversity, Nutrition and Food Safety 69

conservation technologies like micro-irrigation, precision agriculture, postharvest

management infrastructure and marketing infrastructure (Manjunatha et al., 2017).
The studies showed that home production of diverse food increases affordability
and accessibility of nutritious diet. Improving access to kitchen garden (own or
community) results in a strong association with household dietary diversity and
child nutrition (Dev et al., 2020). The local food and nutrition security can check the
adverse effects of food supply shocks and food price volatility (Galhena et al., 2013),
which can immediately impact children’s nutritional status and persist in their adult
lives (Hoddinott et al., 2013). Many such non-government and government initiatives
of kitchen gardens have helped people accessing nutritious foods. Few such initiatives
are discussed here.
An initiative ‘Gardens of Hope—Emergency Kitchen Gardens’ by Utthan, a
Gujarat based NGO, helps vulnerable rural communities in four districts of Gujarat
to grow their own chemical-free vegetables at home. Despite the financial crunch
during the COVID-19 induced lockdown and the consequent livelihood crisis, the
beneficiaries’ nutritional needs were met. There is a unique sharing mechanism under
which each family growing vegetables share the produce with three other families
who do not have land, water resources, or currently not growing vegetables. It has
been estimated that each person will get nutritional security of around 700 g/day
from these kitchen gardens (Karelia, 2020).
A community-based malnutrition management programme by Vikas Samvad, a
non-profit organization, in Madhya Pradesh, developed kitchen gardens in the back-
yards of 232 families across six districts. This initiative gave people self-sustenance
and helped them during the COVID-19 lockdown when the anganwadis were closed.
Under this initiative, a network was created through which around 37 quintals of
vegetables grown were shared among 425 families. The beneficiaries included 217
malnourished children, 140 pregnant and lactating mothers and 68 elderly persons
(Sushma, 2020).
The School Nutrition (Kitchen) Garden (SNG) scheme of Government of India
aims to address the malnutrition and micronutrient deficiencies and enhance the
knowledge of children for nutritional traits of vegetables. It has been reported that
after the introduction of SNG, consumption of fresh vegetables in the daily diet among
the children increased in fourteen selected schools of Raichur and Bagalkot districts
of Karnataka (Kammar et al., 2017). Many state governments have also taken the
initiative to promote the kitchen gardens. Odisha Livelihood Mission, as part of the
farm livelihood/promotion of Nutrition-sensitive Agriculture, is promoting kitchen
gardens. The Karnataka Horticulture Department, with funds from MGNREGA is
developing kitchen gardens called ‘Akshara Kaitoota’ in government schools. The
vegetable gardens already exist in many schools to promote the consumption of
vegetables and fruits. In Chhattisgarh, kitchen gardens are encouraged to secure
livelihood for rural households by converging MGNREGA with the Panchayat and
Rural development departments. To create awareness of the significance of vegetables
and fruits, Tamil Nadu Horticulture Department has tied up with the School Education
Department to establish roof gardens. Maharashtra, in a joint initiative of Rajmata
Jijau Nutrition Mission under the Department of Women and Child Development
70 S. Mahendra Dev and V. L. Pandey

and Reliance Foundation, has developed kitchen gardens at anganwadi centres to

grow fruits and vegetables (Suri, 2020).
Thus, households should be encouraged to have their own or community kitchen
gardens with more diverse vegetables and fruits to take seasonality into account for
a better dietary diversity. Perennial vegetables and fruits and wild edible vegetables
and fruits depending on the agro-climatic conditions, should be encouraged. The
role played by information and communication technologies (ICT) is very important
in providing information regarding new crop varieties, seeds, fertilizers, weather,
raising awareness about nutrition, etc.

8.2 Reducing Postharvest Losses

Another important pathway for ensuring food and nutrition security is to reduce PHL.
India is the second-largest producer of food next to China. However, in India, only
2.2% of the farm produce is processed against around 23% in China. A high level of
PHL in India is unacceptable when a large section of the population is undernour-
ished. These high levels of losses are mostly due to improper handling, inadequate
transportation and packaging, low storage and poor postharvest management.
Boss and Pradhan (2020) reported that use of postharvest technologies like storage
bags and drums and the application of postharvest loss management practices have
positive outcomes on farmers’ price realization. New and innovative methods are
required to reduce the PHL. At Tamil Nadu Agricultural University, researchers
developed a method to control losses in package houses, transportation and retail
shops by spraying Enhanced Freshness Formulation (EFF) on trees before the harvest.
The method slows down ripening and controls losses at the farm level (ToI, 2018).
Such technologies should be encouraged after assessment of environmental and
health impacts.
Strong farm-firm linkages might also reduce PHL by providing assured markets.
These institutional services and reducing PHL can also help smallholders raise their
farm productivity and income and mitigate the risks involved in participating in the
markets for high-value crops, livestock and fishery products. However, achieving
these goals will require new institutions and innovations to develop supply chains
and facilitate linkages between farmers, wholesalers, processors and retailers. These
institutions and innovations may include various contract farming models, including
those by farmer groups and private-sector resource intermediation (Gulati et al.,
2008).
Thus, a holistic approach engaging proper postharvest storage and management
technologies, institutions for efficient marketing of the products and food processing
and packaging technologies is required to reach end consumer with its original
nutritional value, intact or enhanced.
Dietary Diversity, Nutrition and Food Safety 71

8.3 Bio-fortification of Staples and Improving Awareness

Bio-fortification may be one of the more cost-effective solutions to provide the

desired levels of nutrients. Indian diets are shifting towards high-value foods, there-
fore, require more emphasis to bio-fortifying vegetables and fruits along with staples
in India. The initiative of distributing bio-fortified staples through PDS will help in
reducing hidden hunger. There is a need to develop the supply chain for bio-fortified
crops. ICT initiatives of both public and private sectors can improve awareness among
the farmers to adopt bio-fortified crops and among consumers for safe and natural
nutrient-rich primary and processed produce. The involvement of food business firms
is required along the supply chain for broader adoption by the consumers. However,
food businesses require guidance for food product development and marketing of
bio-fortified food products (Walton, 2019).

8.4 Empowerment of Women

Empowering women positively impacts dietary diversity (Dev et al., 2017; Malapit
et al., 2015; Pandey et al., 2016). As discussed in Sect. 2.5, mother’s education has a
significant role in improving children’s dietary diversity and nutritional status. Hence,
there is a need for targeted policies to increase women’s education and empower them
for a healthy diet.
According to NSSO, India’s female literacy rate was 70.3% in 2017–18, which
has improved from 65.5% in 2011 (Census 2011). GoI has taken many initiatives to
empower women. The Right to Education Act (RTE) came into force in 2010 for
free and compulsory education for children between 6 and 14. The central govern-
ment introduced the Beti Bachao Beti Padhao (BBBP) campaign (translates to ‘save
the girl child, educate the girl child’) in 2015 to address the declining sex ratio and
improve girls’ education level. The Samagra Shiksha scheme was launched in 2018–
19 to make good quality education accessible and affordable to all. This scheme
subsumes the three Schemes of Sarva Shiksha Abhiyan, Rashtriya Madhyamik
Shiksha Abhiyan and Teacher Education. To empower the adolescent ‘SABLA’
scheme was launched in 2010 to improve their nutritional and health status and
promote awareness about health, hygiene and nutrition.
The role of women in Indian agriculture is increasing. Nearly 77% of the total
rural women workforce is employed in this sector (Labour Bureau, 2014). However,
around 83% of agricultural land in India is inherited by male members of the family
(Mehta, 2018). Land ownership rights to women is critical for their empowerment.
Conditions under which women are engaged (for example, prolonged exposure to
fertilizers, pesticides, long working hours) and the support systems to strengthen
women’s capacity to care for themselves and their children are of utmost impor-
tance. Easy access to maternity entitlements (JSY, THR), optimum quality day-care
72 S. Mahendra Dev and V. L. Pandey

facilities for children within the community and at the place of work are vital to
strengthen caring capacity and translate to higher incomes.
A greater emphasis on women’s collectives11 based on primary surveys, Agarwal
(2018) examined the impact of group farming by women on productivity and prof-
itability in Kerala and Telangana. The farms of women’s groups under Kudumbashree
(also called joint liability groups) in Kerala performed much better than the predom-
inantly male-managed individual farms in their annual value of output per hectare
and annual net returns per farm. In the case of Telangana (Samatha Dharani Groups)
and Kerala group farms perform much better in commercial crops than in traditional
food grains (Agarwal, 2018). The study demonstrated that group farming can provide
an effective alternative, subject to specified conditions and adjustment of the model
to the local context.

8.5 Enforcing Standards of Foods Safety, Packaging

and Labelling

Food safety has become a serious issue with its public health implications. FSSAI
is revising Food Safety and Standards (Packaging and Labelling) Regulations
2011, with having three different regulations dealing with packaging, labelling and
advertisement and claims requirements.
Food processing and packaging can preserve the available nutrients and even
enhance the shelf life and nutrient content of foods. Thus, proper processing and
packaging can help make nutritious foods to reach those vulnerable groups who
cannot access or afford fresh products. The micronutrients can be added to less
nutrient-dense foods by food fortification during food processing. However, forti-
fications have some limitations, as discussed in Sect. 7. Product reformulation can
be carried out, e.g. reducing sodium and trans-fats, for taking care of unhealthy
ingredients present in the food (HLPE, 2017).
There is also a need to regulate and monitor the labelling of processed food
products. The processed foods can contain high amounts of certain ingredients that
are not healthy, such as “hidden” salt, which consumers may not be aware of and
maybe desensitize to those amounts (HLPE, 2017). The evidence shows that food
label information of quality and nutrition, production and storage process, influences
informed decision-making by the consumers (Ali & Kapoor, 2009). A study in the
village of South Delhi by Bhilwar et al. (2018) reported that about 64.1% of the
consumers read food labels. Still, a majority of them (86%) only check for the
manufacture and expiry dates. Generating awareness would be required to improve
this behaviour. The factors that influence reading labels are associated with the study
participants’ educational status, socioeconomic status and body mass index (Bhilwar

11 Has shown positive results. The NGO Deccan Development Society (DDS), for example, enables
women from landless families to access various government programmes to establish land claims,
through purchase and lease.
Dietary Diversity, Nutrition and Food Safety 73

et al., 2018). Therefore, in the areas with lower education levels, regulatory policies
need to be followed strongly for promoting and marketing healthy foods.
FSSAI is overhauling the labelling regulations for packaged food products. The
draft regulations propose colour-coded front-of-pack nutrition labelling to enable
consumers to identify high fat, salt and sugar products. Accordingly, the product will
have a red colour if the total amounts of calories, fats, trans fats, sugar and sodium
per serving exceed the recommendations. However, there are some concerns from
people and food industries related to the proposed labelling regulation, such as it is
intended for individuals who are literate and nutritionally aware, the colour red is a
danger sign and might deter consumers from the products, etc. (Pande et al., 2020).
A food traceability system is an essential tool for managing food quality and safety
risks and developing effective supply chain management. The traceability techniques
used in India are radio-frequency identification (RFID) tags to track inventories,
Holograms, Barcode, Nuclear techniques and other tracking media to monitor the
production process. Dandage et al. (2017) have reported that the development of
an effective food traceability system is adversely affected by factors like restrictive
government marketing standardization and unstable actions for food safety. Inef-
ficient infrastructure in the market area and inadequate agricultural practices with
many small and medium players further make the system difficult to work.
Indian food regulation lays more emphasis on food adulteration due to it being an
important issue. However, there is a need to focus on other food safety issues, together
with food adulteration. Sudershan et al. (2008) reported about limited knowledge of
basic food microbiology of the food regulators in South India. These regulators
were not equipped to check newer adulterations. Therefore, to improve the effec-
tiveness of FSSAI in ensuring the availability of safe and nutritious food, along
with enforcing its standards and regulations there is need to increase and upgrade
technical manpower, strengthen food safety infrastructure and surveillance system
(Parliamentary Standing Committee, 2018).

8.6 Improving WASH

Access to adequate WASH and clean cooking fuel is crucial for nutritional security,
as discussed in Sect. 5. GoI has taken many initiatives towards improving WASH,
such as Jal Jeevan Mission (JJM) and Swachh Bharat Mission (SBM) (Clean India
Mission). JJM aims to provide Functional Household Tap Connection to every rural
household by 2024. Under SBM, around 10.28 crore of toilets were built, and the
coverage of rural sanitation increased from 34% in 2014 to 100% in 2019. The
usage of these toilets is reported to be around 95% (GoI, 2019). SBM is now moving
towards Phase II of SBM-Grameen to ensure that the open defecation free behaviours
are sustained, no one is left behind, and that solid and liquid waste management
facilities are accessible. These programmes will help in reducing FBD.
74 S. Mahendra Dev and V. L. Pandey

8.7 Implementation of Programmes

Pathways for a sustainable diet that is safe and healthy need sustainable food
systems and require better implementation and synergy between different policies
and programmes. To achieve SDG 2 of reducing hunger and malnutrition by 2030,
effective implementation of programmes can contribute significantly in attaining
the targets. The MGNREGA positively impacted child and woman well-being. It
positively impacted household income, empowerment and well-being of women and
improved children’s nutrition and health and education and reduced child labour.
Apart from its direct benefits, it has secondary benefits such as creating assets for agri-
culture and rural development, more women’s participation, helping marginalized
sections like SCs and STs reducing distress migration and involvement of panchayats,
etc.
The Public Distribution System (PDS) is a critical instrument towards improving
food security at the household level in India. The impact of ICDS on child nutri-
tion and protecting children’s rights is quite limited. There is a need to increase its
coverage to ensure rapid universalization, change the design and restructure it with
higher allocations of funds and effective implementation. The ICDS programme
must effectively integrate the various elements that affect nutrition and reflect chil-
dren’s different needs in different age groups. The midday meal has helped reduce
serious malnutrition, and for older children (aged 11–12), there is evidence of signif-
icant positive impacts on children’s learning. Supplemental income can be started
with old age populations by enhancing the amount of old-age pensions scheme and
making it nearly universal.

8.8 Nutrition Education and Food Safety Awareness

Education, especially for women, is found associated with a reduction in the mortality
rate, dietary diversity and improved nutrition (Alderman & Headey, 2017; Gillespie &
Haddad, 2003; Gulati et al., 2012; Spears, 2013). There is a need to make nutrition
education and nutrition information part of the education system and be integrated
with other community programmes for behavioural change and to improve the intake
of nutritious food in a safe and hygienic manner. Banerji et al. (2016) reported that
when nutrition information is provided, consumer acceptance and willingness to pay
increases for healthy food.

8.9 Use of ICT

ICT can play a vital role in providing useful information such as nutrition-sensitive
messages, healthy meal menus, recipes, etc. and educating people about lifestyle
Dietary Diversity, Nutrition and Food Safety 75

recommendations. ICT can also be used for real-time monitoring, data management
and convergence of schemes. Radio broadcasting can be a medium for comprehensive
coverage in a less expensive manner related to food safety measures, labelling, etc
(Bilali & Allahyari, 2018). Penetration of mobile phones has rapidly increased in
India. It can be used to disseminate different information related to food safety, food
handling, processing, etc. The information can be sent in the local language and can
also engage symbols and digital pictures, as smartphone users have increased.
Thus, for achieving food and nutrition security, sustainable food systems are
required through multi-pronged strategies with better targeting and coordination
between different policies and programmes. However, it is necessary to have recent
data on food consumption for making meaningful suggestions. In India, these
strategies need to focus on improving dietary diversity, kitchen gardens, reducing
postharvest losses, bio-fortification of staples with their inclusion in safety net
programmes, women’s empowerment, enforcement of standards and regulations,
improving WASH, nutrition education and behavioural change and effective use of
digital technology in more innovative ways in food systems. The recent fact sheets
of NFHF-5 indicated that besides WASH, women’s empowerment and education
status, other factors like household income, personal hygiene, health information
and nutrition knowledge might be critical for sustainability in improving nutritional
outcomes. In the future, food and nutrition security initiatives will have to be tuned
in keeping with changing demographic structure, livelihood patterns, climate change
and health-specific needs. These also have to be linked with the overall development
activities of the country.

Acknowledgements The authors thank the reviewers for useful comments on an earlier draft.

Annexure

Demand–supply projections and gaps (Million tonnes).

Commodities Year Supply projection Demand projection Demand-supply gap

Rice 2020 108.1 111.8 − 3.7
2030 122.1 122.4 − 0.3
Wheat 2010 104.2 98.3 5.9
2030 128.8 114.6 14.2
Coarse cereals 2020 50.4 42.5 7.9
2030 64.2 47.2 17.0
Total cereals 2020 262.6 252.6 10.0
2030 315.1 284.2 30.9
Pulses 2020 20.7 21.9 − 1.3
(continued)
76 S. Mahendra Dev and V. L. Pandey

(continued)
Commodities Year Supply projection Demand projection Demand-supply gap
2030 26.4 26.6 − 0.2
Food grains 2020 281.2 274.4 6.8
2030 338.8 310.8 28.0
Edible oils 2020 12.5 17.0 − 4.5
2030 19.1 21.3 − 2.1
Sugar 2020 33.4 33.1 0.3
2030 40.3 39.2 1.1
Vegetables 2020 186.4 155 − 13.1 (Post harvest
losses (PHL) 23.99%)
2030 210 192 − 32.0
Fruits 2020 97.7 81 − 2.7 (PHL 20%)
2030 116.4 103 − 9.9
Milk 2020 156.6 138 10.4 (PHL 5.03%)
2030 188.7 170 8.8
Eggs 2020 4.7 4.4 0.1 (PHL 5.02%)
2030 6.2 5.8 0.1
Source Kumar et al. (2016)

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