The South Asian Enigma: What is the conundrum and how to dodge India out?

We have often come across the prevalence of the high rates of malnutrition in India. When we compare the extent and severity of malnutrition among children of India and sub-Saharan African countries, we often believe that India would be certainly better off since those countries still lag behind in terms of growth and development. However, that is not true. It is, in fact, a fallacy that needs to be broken and the reasons behind the same need to be understood.

A comparison with Ethiopia

The child undernourishment rates for India are worse than an underdeveloped Sub-Saharan country such as Ethiopia. As a part of the ‘Productive Safety Net Programme (PSNP), the Ethiopian government has introduced nutrition education for parents. Women in Ethiopia receive support from the PSNP from the fourth month of pregnancy until their child’s first birthday. In India, the government-funded childcare centres (Anganwadi centres under the Integrated Child Development Services, or ICDS) have been providing similar nutrition education in rural areas but the efficiency, quality of service and outreach have been poor.

The Ethiopian government’s policies are based on a basic understanding of the situation- the key to resolving this issue lies in the nourishment of the children during their first 1000 days, i.e. from conception to their second birthday. Since proper nutrition is provided along with adequate sanitary conditions during pregnancy, only 24% of Ethiopian children are born underweight as compared to 36% in India. Differences in child weaning further contribute to this growing gap.

What is the Paradox? ‘South Asian Enigma’

When compared with the Sub-Saharan countries, India is better off in most of the economic indicators such as: the rate of growth of the economy, development and infrastructure, the size of the GDP, levels of poverty, overall literacy rates and so on. But, when it comes to the rate of child malnutrition, food security and child stunting; India is worse off. It thus makes us question the unique paradoxical scenario of high growth rates on the one hand and high rates of malnutrition on the other! This paradox is referred to as the ‘South Asian Enigma’, that is evident in India. 

Case for India vs. Sub- Saharan Africa and the underlying causes

It is now clear to us that only economic indicators are not sufficient to explain this phenomenon but there are several other social and cultural reasons that have led to such high levels of child malnutrition in India. Some reasons that have been suggested are as follows:

One of the main reasons for the highest number of malnourished children in India is its population size. India alone has 50% more people than 47 countries of Sub-Saharan Africa put together.

Poverty is a major underlying cause for malnutrition and stunting in these countries, however, the purchasing power (average level) in sub-Saharan Africa and India are identical.

The status of women and low birth weight (LBW) of Indian children are the key reasons for this phenomenon. Children born with lower birth weight (less than 2500 grams) are generally malnourished in early stages of infancy. This means that the child was malnourished in the womb itself, reasons being: poor diet, poor health and poor nutritional intake of the mothers during pregnancy. More than 50% of Indian women are anaemic and iron deficient, which means they are not healthy enough to give birth to healthy babies. Thus, the social and health status of women in the patriarchal Indian society are the root cause for malnutrition. The women in the Sub-Saharan African countries, on the contrary, are healthier and the birth weight of their children is much higher as compared to Indians.

Apart from this, the quality of child care and insufficient breastfeeding also contribute to higher malnutrition among Indian children. Breast milk has immunological properties that help build up stronger immune systems to diseases. A large proportion of children in India are deprived of exclusive breastfeeding within a few hours of birth because of several factors including lack of knowledge and inability of the weak mothers to produce enough breast milk. Opposed to this, the health status of women is better in the Sub-Saharan African countries that enables them to feed their children and take better care of them post-delivery.

Another major contributor to the high rates of malnutrition among Indian children is extremely low levels of sanitation that cause several diseases such as fever, flu and diarrhoea among children. The prevalence of very high rates of open defecation in the rural and urban areas of India call for very unhealthy, morbid and faecal-germ intensive environment in the surroundings. The faecal germs cause intestinal diseases that reduce the nutrition absorbing capacity of the body, especially among small children and the density of population affects these rates even more largely.

The reasons for open defecation are the lack of toilets and shortage of water. The rates of open defecation in sub-Saharan Africa are lower than in India. This is mainly due to the absence of the ‘caste’ factor in those countries unlike in India.

Thus, observing from the comparison between India and other sub-Saharan countries, it could be said that it is a challenge for India to do better, especially when it has the resources to achieve it.

What could be done and what’s The Way Forward?

So far, it is clear that India is a very unique case in terms of social and cultural beliefs and practices as compared to other countries. Thus, it is imperative for us to come up with new policies that would aim to change the social norms and framework about several aspects of the Indian society in this transitioning epoch. We need to focus on improving the social and health status of women; the quality of childcare after delivery; immunization and breastfeeding; and eradicating the practice of open defecation. Some policy suggestions are as follows:

1 Gender equality and the upliftment of the social status of women in India:

The exceptionally high rates of malnutrition in India are rooted deep in the soil of inequality between men and women. Evidence from all around the world shows that better education among females widens their scope and they are entitled to wider opportunities in terms of taking part in decision-making in their household; exercising their rights; better nutrition consumption and thus achieving better health status. It also helps them in seeking jobs and engaging in remunerative activities, thus contributing to their households in economic/monetary terms. This not only helps in the attainment of better standards of living but also adds to the quality of child rearing. These women (mothers) are more likely to provide better care for their children in terms of nutrition and education, thus, it leads to a multiplier effect.

India has a population of 1.3 billion people (as per 2017) of which 50% are women. Thus, bringing about gender equality is the most fundamental path to success and development of India.

2. Improving health and sanitation; and increasing sanitation awareness:

Health and Sanitation are one of the most essential, crude and sensitive developmental areas that need focus in India. All the government sanitation schemes so far have been focused mainly on the construction of toilets such as under the ‘Swachh Bharat Mission’. The emphasis, however, needs to be on their usage in order to eradicate open defecation. Thus, only technocratic policies are not sufficient. Policies that focus more on creation of awareness and on behavioural change through Behaviour Change Communication (BCC) are required to be framed and implemented on a larger scale in the rural parts of the country.

3. Consensus, Contribution and Action:

Finally, it is very important for us to realise that all of this cannot be achieved in isolation. We need to have a consensus at the macro level for bringing about these changes in society. Political decisions and government policies need acceptance and backing by the citizens in order to execute these actions and effectively implement them in practice. People's contribution and participation are essential to such large scale transitions for achieving better results. It is also important to note that such type of structural changes in social and cultural frameworks do not take place immediately, but over several years and generations.

Manasvini Abhyankar