Hunger and malnutrition

The first principle

Hunger is not having enough to eat; malnutrition is the body not getting or not using the nutrients it needs, and a child can be malnourished in a home with a full grain bin. Whether food turns into nutrition depends on the household's ability to buy a varied diet, on clean water and sanitation that keep infections away, and on the mother's own health and power to care for her child. India has largely solved the first problem through grain, and is still working on the second, which is a problem of health, women's status and governance as much as of food.

The core

Forms of malnutrition

• Undernutrition. Stunting (low height for age) shows long term deprivation, wasting (low weight for height) shows recent acute hunger or illness, and underweight (low weight for age) combines both. Stunting before the age of two is largely irreversible.
• Hidden hunger. Deficiency of micronutrients such as iron, iodine, zinc, vitamin A and folic acid can coexist with enough calories, and its most visible form in India is anaemia.
• Overnutrition. Overweight, obesity and diet related diseases such as diabetes are rising, especially in cities and among richer households, as diets shift to processed food.
• The triple burden. India faces all three at once, often in the same district and sometimes in the same household, so a single grain based policy cannot answer it.

The numbers

The National Family Health Survey (NFHS) 5, 2019 to 21, found that among children under five, 35.5 per cent were stunted, 19.3 per cent wasted and 32.1 per cent underweight. Anaemia affected 67.1 per cent of children aged 6 to 59 months and 57.0 per cent of women aged 15 to 49, both higher than in NFHS 4, which shows that more food has not meant better nutrition.

Why availability is not the answer

• Entitlements, not supply. Amartya Sen showed in his study of the Bengal famine of 1943 that people starve when they lose the means to command food, not only when food runs short. India's Food Corporation of India (FCI) usually holds grain above buffer norms while children remain undernourished, which is the clearest proof.
• The food budget squeeze. When public spending on health, schooling and transport is thin, the poor pay for these out of pocket, and rising non food costs push down spending on pulses, milk, eggs and vegetables. The Household Consumption Expenditure Survey 2022 to 23 of the National Statistical Office (NSO) found food took less than half of average monthly spending even in rural households, so cheaper grain does not by itself buy a better diet.
• Low dietary diversity. Cheap cereals through the public distribution system (PDS) fill the stomach, but diets remain poor in protein, fats and micronutrients.
• Water, sanitation and infection. Repeated diarrhoea and gut infections from unsafe water and open defecation stop the body from absorbing what is eaten, so water, sanitation and hygiene (WASH) is a nutrition policy.
• Women's status. Undernourished mothers have low birth weight babies, early marriage brings early pregnancy, and women with little say over money or time cannot follow good feeding practice. The United Nations Children's Fund (UNICEF) report "The Asian Enigma" (1996) used this to explain why South Asia has more child undernutrition than poorer sub Saharan Africa.

Dimensions

The vicious cycle and human capital

• How the cycle runs. A poor, undernourished girl becomes a mother too early, her baby is born small, the stunted child learns less and later earns less, and the household stays poor, so the cycle passes to the next generation.
• Human capital. Stunting lowers cognitive development and school performance, and anaemia lowers stamina and productivity in adults, so malnutrition reduces the return on every rupee spent on schools and skills.
• Breaking the cycle. The first 1,000 days, from pregnancy to a child's second birthday, give the highest return, so the steps are: maternal nutrition and antenatal care, exclusive breastfeeding and good complementary feeding, WASH and immunisation, girls' education and later marriage, women's income through self help groups (SHGs), and a diverse diet including millets, pulses, eggs and fortified staples, all delivered together through convergence at the village level.

Equity and governance

• Social equity. NFHS 5 shows higher stunting and anaemia among Scheduled Tribes, Scheduled Castes, rural children, the poorest wealth group and children of mothers with no schooling, so malnutrition follows the lines of caste, tribe, class and gender.
• Regional. States such as Bihar, Jharkhand, Uttar Pradesh and Meghalaya have far higher stunting than Kerala, which mirrors gaps in health systems and women's status more than in food output.
• Welfare governance. Outcomes depend on whether the Anganwadi worker is trained and paid on time, whether take home rations reach the child, and whether the PDS shop opens, so malnutrition is a test of the State's delivery capacity.
• Measurement. The Global Hunger Index (GHI), published by Concern Worldwide and Welthungerhilfe, combines undernourishment, child stunting, child wasting and child mortality. The government has rejected its ranking, arguing that three of four indicators concern children and that undernourishment rests on a small opinion poll, but India's own NFHS data on stunting and wasting show the problem is real.

In practice

The right to food

• PUCL v Union of India (2001 onward). In this petition by the People's Union for Civil Liberties (PUCL), the Supreme Court read the right to food into Article 21 and, through interim orders from 28 November 2001, turned the mid day meal, the Integrated Child Development Services (ICDS) and other schemes into legal entitlements, appointing Commissioners to monitor them.
• National Food Security Act (NFSA), 2013. It covers up to 75 per cent of the rural and 50 per cent of the urban population, gives 5 kg of grain per person a month to priority households and 35 kg per household to Antyodaya Anna Yojana (AAY) families, treats the eldest woman as head of household for the ration card, and provides maternity benefit of at least ₹6,000.

Programmes

• Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY). Started in April 2020 as extra free grain during the pandemic, it has made NFSA grain entirely free since January 2023, and was extended for five years from January 2024.
• One Nation One Ration Card (ONORC). Aadhaar linked portability lets a migrant draw rations from any fair price shop in the country.
• ICDS (1975) and Saksham Anganwadi and Poshan 2.0. ICDS gives supplementary nutrition, preschool education, health checks and immunisation through Anganwadis; since 2021 it runs under the umbrella of Saksham Anganwadi and Poshan 2.0, with the Poshan Tracker app recording growth monitoring and rations in real time.
• POSHAN Abhiyaan (2018). The National Nutrition Mission targets stunting, wasting, anaemia and low birth weight through convergence of ministries and community events such as Poshan Maah.
• PM POSHAN (2021). The mid day meal scheme, renamed Pradhan Mantri Poshan Shakti Nirman (PM POSHAN) in 2021, gives a hot cooked meal to children in government and aided schools, raising attendance and nutrition together.
• Anaemia Mukt Bharat (2018). Its 6×6×6 strategy gives iron and folic acid supplements, deworming and testing to six target groups.
• Rice fortification. Rice fortified with iron, folic acid and vitamin B12 has been supplied through the PDS, ICDS and PM POSHAN in every district since March 2024.

Issues and way forward

• Calories over nutrients. The PDS mainly gives rice and wheat, so states such as Odisha and Karnataka have added millets; adding pulses, edible oil and millets nationally would improve diets.
• Exclusion and leakage. Coverage is still based on Census 2011, so newer and migrant poor can be left out, and Aadhaar authentication failures deny rations; a fresh count of the eligible and offline fallback would help.
• Weak Anganwadi system. Workers are underpaid, overloaded with data entry and short of space, so better pay, training and buildings matter more than new apps.
• Fragmented delivery. Nutrition sits across health, women and child development, food, education and water ministries; district convergence plans with one accountable officer can join them.
• Hidden hunger and obesity. Fortification and supplements must be backed by diet diversity, and rising obesity needs front of pack labelling and nutrition education.
• Women at the centre. Delaying marriage, keeping girls in school and raising women's income through SHGs address the root that food schemes cannot reach.

Common confusions

• Hunger and malnutrition. Hunger is lack of food; malnutrition includes undernutrition, hidden hunger and overnutrition, and can occur without hunger.
• Stunting and wasting. Stunting is low height for age and shows chronic deprivation; wasting is low weight for height and shows acute loss.
• Food security and nutrition security. Food security is access to enough food; nutrition security adds diet quality, health care, clean water and care practices.
• ICDS and POSHAN Abhiyaan. ICDS is the delivery scheme through Anganwadis; POSHAN Abhiyaan is a mission that sets targets and drives convergence.

For the exam

• Keyword bank: undernutrition, stunting, wasting, hidden hunger, triple burden, entitlement failure, Asian enigma, first 1,000 days, WASH, NFSA, PMGKAY, One Nation One Ration Card, Poshan 2.0, PM POSHAN, right to food.
• Practise the previous year questions on this topic →
• Use in an answer:
  • Introduction with data: "NFHS 5 (2019 to 21) found 35.5 per cent of children under five stunted and 57.0 per cent of women anaemic, even as government granaries held surplus grain."
  • Introduction with a judgement: "In PUCL v Union of India, the Supreme Court read the right to food into Article 21 and turned the mid day meal and ICDS into legal entitlements."
  • Conclusion: "India has largely won the battle for calories; the battle for nutrition will be won in the first 1,000 days, in clean water and in the status of women."
  • Conclusion: "Malnutrition is finally a test of governance, since grain in the godown helps only when the Anganwadi, the ration shop and the health worker reach the same child."