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Transcript of NSF National Seminar on Malnutrition Report
POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE
EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION
ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGEINE POVERTY
LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL
UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY
SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH
RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION
FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT
HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD
HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD
POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE
EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION
ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGEINE POVERTY
LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL
UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY
SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH
RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION
FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT
HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD
HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD
POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE
EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION
ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGEINE POVERTY
LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL
UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY
SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH
RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION
FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT
HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD
HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD
POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE
EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION
ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGEINE POVERTY
LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL
UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY
SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH
RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION
FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT
HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD
HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD
POVERTY ILLITERACY LIVELIHOOD HYGIENE
EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION
ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGEINE POVERTY
LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL
UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY
SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH
NATIONAL SEMINAR ON MALNUTRITION : ISSUES AND CONCERNS
A REPORT
Narotam Sekhsaria Foundation
MALNUTRITION : ISSUES AND CONCERNS
Report on the National Seminar held on 11 - 12 January 2010, Mumbai
Jointly organised by Narotam Sekhsaria Foundation, PG Department of Economics,
SNDT Women's University, Mumbai and Directorate of Health Services,
Maharashtra State
Mumbai
Documented by: Lakshmi Menon
Layout by: Anita Rajagopalan
Cover Design by: Anita Rajagopalan
© Narotam Sekhsaria Foundation, 2010
Narotam Sekhsaria Foundation th
102 Maker Chambers III, 10 Floor
Nariman Point, Mumbai – 400021
Tel. (91-22) 22824589
Website:
Printed by: Prime Printers
www.nsfoundation.co.in
CONTENTS
Foreword
Abbreviations
4
5
SECTION I - Introduction
Background
Objectives
Participants
Programme
8
9
9
9
SECTION II - Proceedings
Day 1
Presidential address
Welcome address
Keynote address
Chief guest's address
Panel presentations and discussion
Vote of thanks
Day 2
Session 1:Political economy of malnutrition
Session 2:Effects of malnutrition on mortality and morbidity:
national profile and regional; rural-urban; caste, class,
gender, ethnicity and religious variations
3Session :Discourse on micronutrient deficiencies, food and
nutrition supplements
4Session :Policy, schemes and programmes concerning
nutrition: role of the government and NGOs
Valedictory Address
12
13
14
17
22
29
30
34
39
43
46
SECTION III - Recommendations
Recommendations
Sustainable solutions
48
51
ANNEX
Annex 1 - Programme Schedule
Annex 2 - List of Participants
56
57
FOREWORD
Padmini Somani
Director
Narotam Sekhsaria Foundation
Mumbai
The current economic recession and rising inflation brings to fore the urgency to deal with the issue of malnutrition in India.
We felt it necessary to hold a national seminar to understand the issue in all its complexities. We also thought it useful to work
with the academia and the state health department. Thus the National Seminar, “Malnutrition in India: Issues and Concerns”
was co-organised with the Post-Graduate Department of Economics, SNDT Women's University, Mumbai and the
Directorate of Health Services, Maharashtra State. The participants included students and faculty members, government
health officials, NGOs and community-based organisations and activists who have been working on development issues,
especially on poverty, health and malnutrition. The issues that were brought up and discussed were multi-disciplinary,
covering economic aspects, nutrition and health and human rights, and also focused on marginalised groups like the
scheduled castes and tribes, people living below the poverty line, religious minorities and vulnerable groups such as women
and children.
This report covers the proceedings of the Seminar in detail. Section I gives the background, objectives and outline of the
Seminar's programme. Section II includes the inaugural programme in detail, such as the keynote address and the chief
guest's address which set the tone and direction for the Seminar. The panel presentations and the discussion which followed
too have been covered in detail. The presentations of the four sessions on the second day have been condensed; the full
presentations are available in a compact disc which accompanies this report. As there were 30 presentations , many speakers
did not have sufficient time for full presentation. That there was inadequate time for a meaningful discussion in each session is
deeply regretted. Session III of this report includes recommendations gleaned from the presentations of the keynote speaker,
the chief guest, panel speakers as well as other presenters. The recommendations will help future action plans.
I thank Prof. Dr. Vibhuti Patel for guiding the Foundation in conceptualising and executing the idea the Foundation put forth
to her, the Directorate General of Health Services for being co-organisers, for sharing Government interventions to tackle
malnutrition and for deputing staff members to participate in the discussion.
Foreword 4
Adv.
ASHA
BMI
BPL
BV
CD
CESCR
DGHS
FAO
GDP
ICDS
ICESCR
ICMR
ICU
ID
IDD
IGIDR
IGNOU
IIPS
IMR
INGO
IPR
MDG
MDMP
MMR
MNCs
NBSAP
NFHS
NGO
NNMB
NRHM
NSS
NMIMS
NSF
PDS
PEM
Advocate
Accredited Social Health Activist
Body Mass Index
Below Poverty Line
Biological Value
Calcium Deficiencies
Committee on Economic, Social and Cultural Rights
Directorate General of Health Services
Food and Agriculture Organization
Gross Domestic Product
Integrated Child Development Scheme
International Covenant on Economic, Social and Cultural Rights
Indian Council of Medical Research
Intensive Care Unit
Iron Deficiency
Iodine Deficiency Disorder
Indira Gandhi Institute of Development Research
Indira Gandhi National Open University
International Institute for Population Sciences
Infant Mortality Rate
International Non-Governmental Organisation
Intellectual Property Rights
Millennium Development Goal
Mid-day Meal programme
Maternal Mortality Rate
Multinational Companies
National Biodiversity Strategy and Action Plan
National Family Health Survey
Non-governmental Organisation
National Nutrition Monitoring Bureau
National Rural Health Mission
National Sample Survey
Narsee Monjee Institute of Management Studies
Narotam Sekhsaria Foundation
Public Distribution System
Protein Energy Malnutrition
Abbreviations
Abbreviations 5
PIL
PRIs
PUCL
RCH
RDA
SHGs
SGRY
SRS
THR
TRIPS
UNICEF
VAD
WHO
Public Interest Litigation
Panchayati Raj Institutions
Peoples Union of Civil Liberties
Reproductive and Child Health
Recommended Daily Allowance
Self Help Groups
Sampoorna Gramin Rozgar Yojna
Sample Registration System
Take-home Rations
Trade-Related Aspects of Intellectual Property Rights
United Nations Children Fund
Vitamin A Deficiency
World Health Organization
Abbreviations 6
SECTION I - Introduction
Background
Objectives
Participants
Programme
8
9
9
9
Section I
Malnutrition, in children as well as adults, continues to be a
major problem in India. About 60 million children in India
are malnourished and almost 50 per cent of the Indian
women and 44 per cent of the men are undernourished. The
prevalence of undernutrition and malnutrition in India is
amongst the highest in the world, almost twice that in Sub-
Saharan Africa, a region that is despoiled by internal wars,
famines and the spread of AIDS. The National Family
3)Health Survey (NFHS- also found high levels of anemia
among women and children. Both malnutrition and anemia
have increased among women since NFHS- in 1988-99. As 2
per the India Hunger Index Report twelve states in India fall
under the 'alarming' category and one state Madhya
Pradesh falls under the 'extremely alarming' category and
twelve other states fall in 'serious' category.
Disaggregated data reveals that socio-economically
disadvantaged groups across geographical regions are most
at risk of malnutrition. The prevalence of undernutrition is
5higher in rural areas ( per cent) than in urban areas (38 0
53per cent); higher among scheduled castes ( per cent) .2
5and scheduled tribes ( 6.2 per cent) than among other
castes (44.1 per cent). The proportion of underweight is
higher (60 per cent) amongst the lowest wealth quintile.
There is also large inter-state variation in trends in under
nutrition. In India, six states account for almost 43 per cent
of all underweight children. In states like Maharashtra,
Orissa, Bihar, Madhya Pradesh and Rajasthan at least one
in two children are underweight. Nutrition divide which
exists between the different economic quintiles is
increasing at a rapid pace.
Chronic undernutrition has exposed the country to
deficiencies and pandemic anemia. Lack of access to clean
drinking water, sanitation and access to sustained
livelihoods has compounded the problem. A myriad of
factors contribute to malnutrition situation in India. Food
insecurity, inappropriate infant and young-child feeding
and caring practices, exposure to infections, micronutrient
deficiencies, chronic illnesses, and lack of access to health
care are some of the contributors to this malady.
Anemia can lead to reduced productivity, greater
susceptibility to infections, and slow recovery from
infections. Among women, poor pregnancy can increase the
risk of obstructed labour, low-birth-weight babies, post-
partum hemorrhage and other complications. More than
one-third of the married women and men are too thin,
according to the body mass index (BMI), an indicator
derived from height and weight measurements. In India
and most of South Asia the nutritional paradox lies in the
coexistence of grain mountains and hungry millions.
Considering its impact on health, education and
productivity, persistent undernutrition is a major obstacle
to human development and economic growth in the
country; especially among the poor and the vulnerable, the
prevalence of malnutrition is the highest.
The 50th Round of the National Sample Survey (NSS) in
1993-94, drew attention to the fact that the country doesn't
have a “comprehensive programme” to address the
nutrition situation in India. The public distribution system
(PDS) is the only programme and it has a limited impact.
The NFHS 2 survey (1998-99) also showed that the
nutrition situation in the country had not improved and that
urban poor and rural areas were still at risk.
Malnutrition: Issues and Concerns
Section 1: Introduction 8
Background
The country's main early child development intervention,
the Integrated Child Development Services (ICDS), has
been in existence for the past three decades but it has not
succeeded in making a noteworthy dent in child nutrition.
Government interventions in addressing the issue of
undernutrition have been skewed towards food-based
interventions and other determinants of malnutrition have
been completely neglected.
The civil society has reacted rather sharply to this issue.
Their initiatives in giving shape to democratic practices
such as monitoring government programmes like ICDS and
Public Interest Litigation (PIL) at the Rajasthan High court
and finally the Right to Food Campaign have at least
pressured the government to make some commitments.
In spite of the magnitude of the problem, the issue of
malnutrition has not received enough attention in public
debates and electoral politics. The media has also only
highlighted the sensational aspect of the issue. Given the
complexity and magnitude of problem, it is imperative that
civil society and academia strive to understand the issues
and promote the participation of all important
stakeholders.
As a step forward in this direction, Narotam Sekhsaria
Foundation (NSF) together with the Post-Graduate
Department of Economics, SNDT Women's University,
Mumbai, and the Directorate of Health Services,
Maharashtra organised a two-day national-level seminar
titled “Malnutrition: Issues and Concerns”.
Objectives
T h e o b j e c t i v e s o f t h e s e m i n a r w e r e t o :
1. Bring to focus the magnitude of the problem of
malnutrition
2. Understand the complexity of the issue
3. Bring together the Government, civil society and
academia on a common platform to discuss the issue,
and
4. Help build partnerships for further action.
Participants
Over 150 participants attended this national seminar.
They included 90 from the academic field and about 55
from non-governmental organisations (NGOs). The
participants were from Andhra Pradesh, Delhi, Gujarat,
Jharkhand, Karnataka, Maharashtra and Punjab. Some
government officials from the Maharashtra State Health
Department also attended the seminar. (See Annex 2 for
List of Participants)
Programme
The Seminar was inaugurated with a Presidential address
given by Prof. Dr. Vibhuti Patel, Professor and Head, PG
Department of Economics, SNDT Women's University.
Prof. Dr Chandra Krishnamurthy, Hon. Vice Chancellor,
SNDT Women's University, Mumbai was unable to
attend.
The highlight was the keynote address by Prof. Dr. Veena
Shatrugna, former Deputy Director and Head, Clinical
Division, National Institute of Nutrition, Hyderabad, and
Consultant, Indian Institute of Public Health, Hyderabad.
The Right to Health was the theme of the address by the
chief guest, Adv. Anand Grover, UN Special Rapporteur on
the Right of Everyone to the Enjoyment of the Highest
Attainable Standard of Mental and Physical Health. This
was followed by a panel discussion on Discourse on
Nutrition and Malnutrition. The four panel members were
Prof. Dr. Sumati Kulkarni, Retired Professor, International
Institute for Population Sciences (IIPS), Mumbai, Prof. Dr.
Sulabha Parsuraman, Prof., IIPS, Mumbai, Prof. Dr.
Sangita Kamdar, Prof. of Economics, Narsee Monjee
Institute of Management Studies (NMIMS), Mumbai, and
Dr. Srijit Mishra, Associate Prof., Indira Gandhi Institute of
Development Research (IGIDR), Mumbai.
Section 1: Introduction 9
Malnutrition: Issues and Concerns
The 2nd day of the seminar was organised according to
four themes in four sessions:
1. Political economy of malnutrition
2. Effects of malnutrition on mortality and morbidity:
national profile and regional; rural-urban; caste, class,
gender, ethnicity and religious variations
3. Discourse on micronutrient deficiencies, food and
nutrition supplements
4. Policy, schemes and programmes concerning nutrition:
role of the Government and NGOs
Thirty presentations were made on these four themes.
(See Annex for Programme Schedule)
10
Malnutrition: Issues and Concerns
Section 1: Introduction
SECTION II - Proceedings
Day 1
Presidential address
Welcome address
Keynote address
Chief guest's address
Panel presentations and discussion
Vote of thanks
12
13
14
17
22
29
Day 2
Session 1:Political economy of malnutrition
Session 2:Effects of malnutrition on mortality and
morbidity: national profile and regional; rural-
urban; caste, class, gender, ethnicity and
religious variations
Session 3:Discourse on micronutrient deficiencies, food
and nutrition supplements
Session 4:Policy, schemes and programmes concerning
nutrition: role of the government and NGOs
Valedictory Address
30
34
39
43
46
Presidential Address
In her presidential address, Prof. Dr. Vibhuti Patel gave
an introduction to the topic of malnutrition and put it in
the larger social and economic context.
She pointed out that malnutrition was a multidimensional
problem linked with purchasing power, social behaviour,
livelihood sources and survival struggles, equity and
equality, human rights and dignified life. Malnutrition
indicated deficit, excess or imbalance of one or more than
one essential nutrients/ calories. Morbid obesity could be as
devastating as acute malnutrition. Debates in the 1970s,
between Prof. Dandekar and Rath versus Prof. Sukhatme
and these three stalwarts of Pune School of Economics
versus Prof. Minhas brought the issue of calorie intake
centre stage. As a result, ensuring 2100 calories for the
urban poor and 2300 calories for the rural poor guided
several anti-poverty programmes from the fifth Five Year
Plan (1974-79) onwards. Development economists world
over had been seriously debating the “food first” policy. But
they talked only about macro-economic food security and
did not highlight nutrition security.
The human development approach popularised by Prof.
Amartya Kumar Sen avers that nutrition affects
development as much as development affects nutrition.
Visionary leaders like MGR who started a mid-day meal
programme in Tamil Nadu 40 years back, believed in this.
Around 52 per cent of the women and 74 per cent of the
children were victims of undernutrition, a silent
catastrophe. The gap between the overfed population
crowding the gymnasiums and underfed millions groping
for food in the empty cans and garbage was widening.
Women and children suffered due to self-denial, learning to
live with far less food and nutrition than what the body
needed. Women-headed households suffered the most. So
many illnesses among poverty-ridden people were linked to
malnutrition. If we deconstructed the infant mortality rate
(IMR), one-eighth of the child deaths were of tribal
children. Gender inequality in nutrition was a norm in
India. Because state policies focused on reproductive and
child health (RCH), elderly women and adolescent girls got
neglected in nutrition programmes. Recent studies had
shown that Indian adolescent boys were also facing
moderate malnutrition.
Section II : Proceedings - Day 1 12
Day 1, 11 January 2010
Leni Chaudhuri, Programme Manager, NSF, welcomed the participants and chaired the
first day's sessions. Also welcoming the participants, Prof. Dr. Vibhuti Patel explained that the
PG Department of Economics of the SNDT University, Mumbai has focused on development
economics through its teaching programmes and research, curricular, co-curricular and extra-
curricular activities and responded to major economic challenges in the country.
Section II : Proceedings - Day 1
Malnutrition: Issues and Concerns
Leni Chaudhuri
Prof. Dr.Vibhuti Patel
Presidential Address
Markets were aggravating malnutrition. There were also
other controversial issues such as “chemicalisation” of food
and the use of biotechnology for food and nutrition security.
There was a need to examine the India Micronutrient
Investment Plan proposed by the international non-
government organisation, Micro-nutrient Initiatives and
the Government of India (2007-2011).
Various nutrition-deficiency diseases like night-blindness
(Vitamin A deficiency or VAD), goitre (iodine deficiency or
IDD), iron deficiency (ID), protein energy malnutrition
(PEM) and calcium deficiency (CD) needed urgent
attention or else the demographic dividend will become a
demographic catastrophe.
In this context, she pointed out that it was encouraging to
receive papers from scholars working in different parts of
India examining malnutrition from an inter-disciplinary
perspective - economics, sociology, anthropology, home
science, health science, and nutrition science.
Prof. Dr. Patel was also happy at the proactive participation
of implementing agencies such as the Directorate of Health
Services of the Government of Maharashtra. She concluded
her address thanking NSF and specially Padmini Somani,
Leni Chaudhuri and Anushakti Tayade for collaborating
with SNDT University and for supporting this important
event.
Welcome Address
Padmini Somani, Director, NSF, pointed out that the
Foundation focused on education, health and livelihood
issues and explained the reason for holding this seminar. As
the Foundation was still new to the issue, there was need for
better understanding especially the complexities of
malnutrition. It was also interested in knowing the
government perspective and building up partnership with
academia and activists.
13
Malnutrition: Issues and Concerns
Padmini Somani
Section II : Proceedings - Day 1
Keynote address
In her keynote address, Prof. Dr. Veena Shatrugna focused
on the reasons for the massive nutritional deficiencies in the
country. At any given point around 50 per cent of the
children in India were starving, because of poverty and non-
availability of food or absence of foods appropriate for
children. Even if they were not starving, children had
multiple nutrient deficiencies; this was given an exotic
name, hidden hunger, which was nothing but multiple
vitamin and mineral deficiency.
India was one of the first underdeveloped countries in the
world to address the problem of hunger by releasing a
document which addressed calorie requirements for
Indians based on the occupation of the person. British
experts had analyzed and given nutritive value to over 300
foods in 1937 itself (government publication, Health
Bulletin No.23 (5), 1937,1st edition). It was recognised by
then that some foods like cereals, potatoes, sugar, etc. were
a concentrated source of calories, but most other foods
contained multiple nutrients such as proteins, vitamins and
minerals and also calories, etc.
During the famines in the 1940s and the Second World War,
the colonial government in India did not have a department
of food. Because of the need to dispatch food to the war
front, in the midst of food shortage and famine,
the colonial government was forced to set up a
department with nutrition experts to address questions of
hunger. The first book “The Nutritive value of Indian
foods and the planning of satisfactory diets” reflects the
confidence of science. It came up with calorie requirement
of different population – classified into sedentary,
moderate and heavy workers based on the nature of work
and activity. The text clearly states that “... it is important
to plan a diet which first provides foods rich in vitamins,
minerals, proteins, iron and other nutrients and then fill
the calorie gap with cereals, potatoes, sugar etc”.
This simple rule was quickly forgotten by the late 1940s and
50s. Attempts were made to justify cereals as a good source
of most nutrients. It was well known that the proteins from
cereals and pulse are different from the proteins found in
foods such as egg, milk, meat, and fish. eggs meat. Cereal
proteins were of a poor quality or of low biological value
(BV) when compared with animal proteins such as milk,
eggs meat. It was obvious that cereal proteins did not
support children's optimum growth and development or
help pregnant and lactating women. Using calculations and
adjustments for differences in BV, nutritionists stated that
perhaps a combination of cereals and pulse proteins came
close to the animal protein value, but certainly animal
protein was the standard. Despite this knowledge, most
nutritionists over time advised cereal pulse proteins, thus
denying Indian children good quality proteins from milk
and eggs.
After independence, nutrition researchers came up with
new ideas. For instance, Dr. Patwardhan set aside concerns
for good quality proteins when he said that consuming a
“typical Indian cereal pulse diet” would provide adequate
proteins. He ended up endorsing and promoting a
vegetarian diet, despite the fact that Indians had different
food habits such as those who ate eggs, meat, pork, beef,
even insects and wild animals.
Malnutrition: Issues and Concerns
14Section II : Proceedings - Day 1
Prof. Dr.Veena Shatrugna
He recommended that people eat cereal and pulse protein
in a ratio of 2:1 at every meal, that is, for every 100g of cereal,
a person must consume at least 20g of pulse in the same
meal for the protein to be of some value. This prescription
was an attempt to homogenise the diet of the whole nation.
He of course did not try to find out the number of Indians
who could afford and scientifically eat this cereal-pulse
combination.
The biological value of proteins was important. Animal
proteins were the closest to the proteins which humans can
utilise. Egg protein was a standard with a BV of 100; milk
protein came very close to egg protein while pulses and
cereals had a BV of 65 and soyabean only 45.
Nutrition scientists in India had been concerned with the
cost of milk, eggs and meat, and have stated that the people
could not afford it. They spent the better part of their careers
convincing the government that milk consumption could be
minimised or done away with. During the famine of the
1960s, giants in nutrition research came up with the theory
that the “protein gap” was a myth. They said that they found
that when people ate enough cereals they got to consume
sufficient protein - 100 g of rice had 6-8 g of protein, and a
person eating 350-400g of cereal was bound to get 24-30g
of protein The scientists had forgotten about the BV or even
the cereal- pulse protein ratio by then.
The traditional cereal-pulse diet of the Indian upper class/
upper caste was recommended for adequate protein-calorie
consumption. This diet consisted of rice, dal, pulses,
vegetables, spices, curd and a sweet, but the poor ate only
cereal with chillies and tamarind water; their diet consisted
of bajra roti and chutney which had calories and fibre. If
foods rich in proteins and vitamins were not included in the
diet, the calories merely got converted into fat.
In the 1960s, the country was asking children from a poor
background to also eat a cereal-pulse diet, in effect asking
milk, curd, chocolate, etc. To get their proteins, the children
would have to eat more cereals. Top nutrition researchers
did not sit back and reflect on the fact that children would
not be able to eat more of the same cereal. It was well known
that at least 30-40 per cent of children's calorie intake must
be derived from fat, but children were already consuming
80 per cent of the calorie from cereals. A child could not get
adequate calories from cereals even if she ate the whole day
(1 g of cooked cereals provided only 0.5 to 1 calorie.) It is
well known that many middle class mothers added dollops
of ghee in their children's diet. It made sense because 1 g of
ghee gave 9 calories, 1g of carbohydrate gave 4 calories. To
put on the required weight and height, children's diet
should contain good-quality protein and 30-40 per cent of
calories from fat.
Though many studies pointed to the importance of high-
quality protein and fat for children's growth, it was believed
that the country could not afford milk and so studies were
conducted with groundnut cake instead. Then protein
sources with anti-nutrients such as soya bean were being
used in the ICDS programme. People with cardiac diseases
were advised to use soya bean to lose weight, but soya bean
was being given to undernourished children to gain weight
and was also included in the ICDS programme. The
bureaucracy used calories and calorie norms to calculate
poverty. Cereals became a proxy for calories; it was simple
calculating below poverty line (BPL) families based on
calories. Wages too were based on calorie norms. Many
school lunch programmes did not include eggs, instead they
have bananas notwithstanding the fact that eggs and
bananas were not the same. This had resulted in creating a
H i n d u c e r e a l - c o n s u m i n g v e g e t a r i a n n a t i o n .
The micronutrient lobby had taken advantage of the
nation's calorie-centred (read cereal-centred) consumption
pattern.
children to make sacrifices for the nation and not to desire
Malnutrition: Issues and Concerns
15Section II : Proceedings - Day 1
The multi-million dollar micronutrient industry had
identified “hidden hunger” as a problem, and was lobbying
with the government to endorse fortification of different
foods to sell their products - pills containing vitamins, iron
and zinc to people subsisting on pure cereal calories.
Instead of ensuring that people had access to adequate
intake of nutritive food rich in proteins, minerals and
vitamins, like fruits, vegetables, meat, eggs and milk, the
government was encouraging industry to give people
cereals fortified with iron and zinc.
In Gujarat, wheat flour was being fortified with iron, despite
the fact that wheat is rich in phytates which inhibit iron
absorption. [Phytates are phosphorus compounds found
primarily in cereal grains, legumes, and nuts. They bind
with minerals such as iron, calcium, and zinc and interfere
with iron absorbtion]. Furthermore, the marketing of
fortified wheat flour, was pushing small enterprises such as
chhakis (small flour mills) out of business.
The WHO recommendation for children stated that :
Ÿ 30-40 per cent of calories must come from fats (low
volumes and energy densities);
Ÿ Vitamin A, calcium, and iron – must come from milk, egg,
flesh foods, vegetable, fruit, etc. ( which also contribute
additional calories); and
Ÿ Cereals and pulses must be used to bridge the calorie gap.
However in India, the whole picture was reversed. As a
result of the cereal load, only 30 per cent of the children had
adequate calories and this has resulted in massive mineral
and vitamin inadequacy. This now had a diagnosis which
sounds like a disease “micronutrient deficiencies”.
Obviously children (and even adults) could not afford the
recommended nutrient-rich foods. More than 50 per cent of
children were underweight and short. Research showed
that children's bodies were shrinking to cope with such
severe under nutrition.
Chief Guest's Address
The chief guest Adv. Anand Grover's address was titled,
“Malnutrition and Achieving the Right to Health”.
To start with, Adv. Grover said he was happy that there
were academics at this seminar. He was also happy that the
presidential address was critical of the academics because
they accepted the situation as it was, and that was
unacceptable; this was the first message for the seminar -
not only for academics, but also for all individuals who were
conscientious about the right to food. People tended to be
comfortable as the Home Minister (who Adv. Grover met
recently) said and who also publicly acknowledged that the
economic liberalisation of the early 1990s had not benefited
the poor, in fact it had widened the disparity between the
rich and the poor. Prof. Shatrugna had correctly said that
the path this country had taken to accommodate itself to
this economic situation was by forcing food styles on people.
It was distressing that vegetarianism and cereal foods had
become the norm, and poor people and tribal people who
thrive on non-vegetarian food had to suffer.
Adv. Grover's special message was to fight for holistic and
wholesome foods and accessibility to food. He pointed out
Malnutrition: Issues and Concerns
17Section II : Proceedings - Day 1
Adv. Anand Grover
His address focused on six main points:
1. International instruments,
2. Rights-based approach to health and nutrition,
3. Intellectual property rights,
4. Constitutional and legal provisions, right to food as
human right, and
5. The way forward.
1. International instruments
The right to health was covered by the following
international instruments:
Ÿ Universal Declaration of Human Rights, Art. 24
Ÿ International Convention on the Elimination of All
Forms of Racial Discrimination, Art. 5(e)(iv) 1965
Ÿ Convention on the Elimination of All Forms of
Discrimination against Women (CEDAW, Art. 11(1)(f),
12, 14(2)(b) 1979)
Ÿ Convention on the Rights of the Child, Art (24) 1989
Ÿ International Convention on the Protection of the Rights
of All Migrant Workers and Members of their Families ,
Arts. (28, 43 (e), 45(c)
Ÿ Convention on the Rights of Persons with Disabilities ,
Art. 25 (2006)
Ÿ The Charter of Fundamental Rights of the European
Union (2000)
Ÿ European Convention of the Protection of Human
Rights and Fundamental Freedoms (1950)
Another important international instrument is Article 12 of
the International Covenant on Economic, Social and
Cultural Rights (ICESCR), 2000 on the Right to Health
states “The right of everyone to the enjoyment of the highest
attainable standard of physical and mental health”.
that the right to health is impacted by accessibility to food. The General Comment No. 14 adopted by the Committee on
Economic, Social and Cultural Rights (CESCR), 22nd
Session, Geneva in 2000, noted that the State parties are
under immediate obligation to guarantee that the right to
health care is exercised without discrimination, and that
concrete steps are taken towards full realisation, with
emphasis on vulnerable and marginal groups. It also called
for reducing maternal and infant mortality, ensuring
environmental and industrial hygiene, and controlling
epidemic and occupational and providing health care
services. The governments are obliged to respect, protect
and fulfill the health rights of every individual; the citizens
have the right to availability, accessibility, acceptability and
quality goods and services (i.e. access to nutrition, special
provisions for vulnerable groups).
The State should also respect, protect and fulfill the right to
health which extended to the underlying determinants of
health, including social and environmental factors. These
determinants impacted health care needs and health care
delivery. Malnutrition was a leading cause of child
mortality, and Intellectual Property Rights (IPR) limiting
biodiversity compromise availability of essential medicines
and nutritional resources. The right to food was a key
environmental determinant as food was necessary in both
achieving and maintaining good health. Achieving
nutritional sustainability is a prerequisite of achieving
health sustainability.
The right to food was a right under international law which
indicates specifically production, conservation and
distribution making full use of technical knowledge. Prof.
Shatrugna was right when she said that technical progress
did not mean putting micronutrient into foods separately.
Lawyers have been using this phrase in a not so
knowledgeable way. With regard to food cases, the lawyers
Malnutrition: Issues and Concerns
18Section II : Proceedings - Day 1
per calorie requirements of 2000 calories per person per
day; they were not concerned about the basis of this data.
Right to food is key environmental determinant and if the
right to food is not realised in the way Prof. Shatrugna has
mentioned, the right to health will not be realised either.
2. Rights-based approach to health and nutrition
Adv. Grover pointed out that a rights-based approach to
health and nutrition should be non-discriminative,
transparent, participatory, proportionate, accountable and
be monitored. It should meet the targets set for the
Millennium Development Goal (MDG) # 1 to eradicate
extreme poverty and hunger. India was far from achieving
MDG 1.
The State had the obligation of making food accessible to
people without discrimination. Pushing cereals down poor
people's throats is discriminatory as it becomes a caste and
class issue; the right to food should also look at issues of
inequality; as women had to sacrifice for their husbands and
children, they eat last and the least amount of food. The
needs of food-exporting and food- importing countries have
to be taken into account for equitable access to food and
food supplies. India, China and European countries were
buying large tracts of land in Africa, not caring about the
effect on African people. Were they being treated in an
equitable manner? Similarly, it was necessary to question if
SC/ST and poor people in India were treated in an equitable
manner. A look at the data on undernutrition showed that
India has yet to realise the right to food. Progress could be
said to be achieved when greater number of people enjoy
high levels of nutrition. Furthermore there is no
transparency in government policies. There should be
participation of people who were affected by government
decisions and policies. People should aggressively
articulate their views for people-centred policies.
were only concerned about determining workers wages as Accountability was important but rarely exercised. It was a
popular belief that accountability is ensured in a
democracy. Yet India is at the bottom of the list when it
came to poverty and hunger. However the government tried
to explain otherwise by juggling statistics. It was very
shameful that India had high levels of malnutrition, infant,
child and maternal morbidity and mortality rates. Lawyers,
nutritionists, academics and individuals should make it
clear to the government that such poor development
indicators were not acceptable. To be involved in social
action, it was necessary to be caring, mindful of people's
distress, and understand their pain and suffering. For
instance, during the struggle of pavement dwellers in the
early 1990s, Adv. Grover too had middle class prejudices.
But because he was taking up the PIL cases of pavement
dwellers, he visited the families, interacted with them and
created a bond with them. In doing so, he was able to
understand their problems and suffering. Hence it was
necessary for academics to bond with the people,
understand their problems, and take action, otherwise the
dry statistics they collected would have no meaning and
there would be no change.
3. Intellectual property rights
The issue of patents too affected the right to food. The
Trade-Related Aspects of Intellectual Property Rights
(TRIPS) extended protection to micro-organisms, non-
biological and microbiological processes and plant
varieties. Patents were granted for drugs, medicines and
agrochemicals. Strong IPR law severely limited sustainable
food production, and thus was at the root of malnutrition.
Examples of patenting which compromised India's
biodiversity included: Indian basmati rice variety by Rice
Tech (US), Nap Hal wheat by Monsanto (European Patent
Office), entire gene sequences of rice by Syngenta
(Switzerland), and medicinal properties of turmeric, neem,
jamoon, bitter gourd and such other Indian varieties and
Malnutrition: Issues and Concerns
19Section II : Proceedings - Day 1
the associated knowledge, by US and European
multinational companies (MNCs). People must oppose
such measures which made profit at the cost of people's
health. It was advisable to link with other organisations and
put international pressure on the government.
4. Constitutional and legal provisions
There were also Constitutional and legal provisions for the
right to food in India.
Ÿ Article 21 of the Indian Constitution articulates the right
to health: No person shall be deprived of his life or
personal liberty except by procedure established by law.
• Article 47 articulates the right to food and its relationship
to health: The state shall regard the raising of the level of
nutrition and the standard of living of its people and the
improvement of public health as among its primary
duties.
The Draft Right to Food Act (June 2009) states:“It is
imperative to create and enforce legal entitlements and
obligations to ensure that every person is assured physical,
economic and social access to adequate food with dignity as
is necessary to lead an active and healthy life.” The right to
food and IPR is contained in Chapter VIII (Section 24.8) on
Prevention of commercial interference of the Right to Food
Act (2009):
a. Banning and preventing the promotion of baby foods for
infants at any level – with the public, with professionals
or using any media
b. Banning and preventing commercial promotions
targeted at public health professionals and health
workers
c. Refraining from any partnership with the commercial
food sector for either design or implementation of
nutrition-related schemes
d. Preventing government officials and employees from
taking any action that could be construed as involving a
conflict of interest in so far as it might be hostile to the
right to food
e. Ensuring that any interaction with the commercial food
sector on matters of food policy or nutrition-related
schemes is accountable and transparent. Transparency
should be ensured through public hearings, public
notice of interaction and disclosure of records
5. Right to food as human right
The above-mentioned provisions of the draft Right to Food
Act were critical in protecting the human rights to food and
health. The connection between nutrition and public health
outlined in the draft Right to Food Act makes restrictive IPR
law in the realm of biodiversity a matter of international
human rights law. Protections under international human
rights law must be based on community action in order to
work towards MDG 1 to eradicate extreme poverty and
hunger. Using human rights will help sustain the right to
food movement.
6. The way forward
Community involvement was the key to moving forward:
Ÿ Families, especially farmers, should not remain objects of
the interventions but become the subjects and the
controlling factors in the process
Ÿ It was important to engage civil society, not just NGOs.
Ÿ Building capacities of the community so that they could
participate in decision-making, monitoring the progress
of the interventions, and holding governments
accountable
Ÿ The community must be empowered with information —
information about their rights and the government's
policies and progress of implementation of the policies
and programmes
Malnutrition: Issues and Concerns
20Section II : Proceedings - Day 1
Despite having strong jurisprudence on the right to health
and right to food by way of constitutional and legal
provisions, it was not articulated politically in the manner it
should be; it was subverted by policies being introduced
through conspiracies. The MNC lobby was good at
influencing Indian bureaucrats. India has a vibrant civil
society which was able to demand the right to food law.
Though still in the formative stage, it had important
provisions on the right to health. There was an urgent need
to push this agenda forward and make sure it was not
merely an IPR issues but issues that Prof. Shatrugna talked
about so as to realise the right to food and right to health.
In 1990s, when the world was reeling under HIV-AIDS, the
drug to treat the disease then cost more than US$ 10,000
per year per person. Many people died as they could not
afford the expensive drug. By early 2000, a strong people's
movement forced CIPLA to sell the drug at US$ 350 per
person per year. It was not IPR that prevailed in this case but
the right of the people to healthy life. The same action could
be undertaken to prevent farmers' suicide, malnutrition
deaths in Melghat and also to make the government
responsible for providing good quality food and for people
to have easy access to sanitation and drinking water and
healthcare facilities.
Adv. Grover concluded expressing his happiness that this
seminar had tied up with the academics and advised the
people in the academia to collaborate with NGOs to make
the government listen.
Malnutrition: Issues and Concerns
21Section II : Proceedings - Day 1
Panel Presentation and Discussion
The next session, Panel Discussion chaired by Prof.
Shatrugna had four presentations. They include the
following: a) National Family Health Survey 2, b)
Nutrition in India Salient Findings from National Family
Health Survey 3, c) Can a Malnourished India Race to the
Top of the World?, and d) Agrarian Distress, Food
Security and Malnutrition
1.National Family Health Survey 2 by Prof. Dr.
Sumati Kulkarni, Retired Professor, IIPS, Mumbai
Prof. Kulkarni focused on NFHS 2 as she was its All India
Coordinator. She pointed out that in the first national
survey (NFHS 1) conducted in 1992-93, nutrition data
was collected from representative sample of women and
children. Many estimates were given by background
characteristics of age, education, and standard of living to
know the prevalence of malnutrition in different groups.
In 1997, Dr. Ramalingam Swamy talked about a South Asian
enigma: while 30 per cent of African babies were
malnourished, 50 per cent of South and South East Asian
babies were malnourished. Such a high rate of malnutrition
in a region where development was higher than in Africa
was surprising. He tried to examine the causes for the
higher malnutrition in South Asia. Was it poverty?
But South Asian purchasing power was higher ; agricultural
performance, per capita and daily energy supply were also
higher in South Asia. Another argument was that the
predominant vegetarian diet of Indians was the cause of
malnutrition. However, most Indians consumed milk and
milk products and ICDS programmes provided dietary
supplements to children. He concluded that cause for the
difference was the lower social status of women in South
Asia. In India, one third of babies were underweight at birth,
in Bangladesh, one half of babies were underweight at birth,
but in Africa only one sixth of babies were under weight at
birth. Birth weight was the single most important predictor
of malnutrition.
Traditionally, in a patriarchal society, the neglect of women
from childhood through adolescence and during
pregnancy, led to anemia and to low birth weight of babies.
These children grew into adults and the same cycle
continued. Hence it was important to go beyond food
security issues and examine such deep-rooted social issues.
NFHS 1 which was done in 1992-93 relied on survey using
height and weight measurements with children. The NFHS
2, conducted in 1998-99, had wider scope. Field tests
covered women aged 15 to 49 years ever married and
children up to three years. Infant practices were covered
including breastfeeding and supplementary feeding
practices. Dietary patterns of women covered what food and
how often they consumed. Malnutrition among children
was measured by height for age for linear growth and and
chronic malnutrition, weight for height and weight for age
for chronic and acute malnutrition and acute
undernutrition.
Malnutrition among children: The WHO standards were
comparable to Indian children. In India nearly half the
children were under weight, and 16 per cent were wasted.
Section II : Proceedings 22Section II : Proceedings - Day 1
Malnutrition: Issues and Concerns
Prof. Dr.Sumati Kulkarni
high on the list with high malnutrition.It is a matter of
serious concern that malnutrition had a negative
correlation with standard of living; even in urban areas and
also in households with high standards of living, one-
fourths of children were malnourished. Lifestyle and
inappropriate cooking practices were some of the causes
identified. NFHS-2 found that despite a strong preference
for male children, there was no evidence that girls in the age
group 0-3 years were more malnourished than boys. The
extent of undernourished children was less among children
aged six months, maximum malnourishment was between 1
and 2 years. This had important policy implications because
ICDS programmes covered children aged 5-5 years. Thus
we see that data can speak if we look with a proper mindset.
There was high malnutrition in Bihar, UP, Rajasthan and
Orissa. But it was surprising to find high levels of
malnutrition even in developed states, like West Bengal,
Maharashtra and Gujarat. Kerala and Goa have less
malnutrition.
There were many indicators of malnutrition. Improper
feeding practices were the cause of malnutrition among
children of age group of 0-3 years. Exclusive breastfeeding
was very important but only 55 per cent of the children
below four months breastfed exclusively. WHO
recommended exclusive breastfeeding without even water
up to six months. Only one third of the children received
supplementary foods. Information about appropriate
feeding practices needed to be disseminated well.
Anemia was another indicator of malnutrition; 74 per cent
of the children six months to 3 years were anaemic. Of these
33 per cent had mild anaemia, 46 per cent had moderate
and 5 per cent had severe anaemia. It was also surprising
A study of 58 developing countries showed that India was that Punjab too was in this category. One of the reasons
could be that in Punjab children were fed large quantities of
milk, which was not conducive to iron absorption. In Kerala
and Nagaland, 44 per cent of the children were anaemic,
and in Rajasthan, 10 per cent were severely anaemic.
Malnutrition among women: In India, 52 per cent of the
women had anaemia. Many women had body mass index
lower than 18. One third women in the age group of 15 years
and 49 years had chronic anaemia. There was chronic
energy deficiency in Orissa and Bihar. Chronic energy
deficiency was also high in West Bengal, Maharashtra and
Karnataka. Some data was intriguing: malnutrition was
lowest in Arunachal Pradesh, Punjab, Kerala and Goa. The
consumption of milk, fruits, eggs, chicken and fish was less
likely to cause this problem of chronic energy deficiency. At
the same time, 11 per cent of the women suffered from
obesity with BMI of over 25 and this problem was mostly
found in Punjab and Delhi. The sample, taking into account
all sections of society, shows that 35 per cent of the women
have high anaemia, 15 per cent moderate anaemia and 2 per
cent severe anaemia. Sixty-five per cent of the schedule tribe
women and women from poor households had anaemia.
Anaemia was low among Jain and Sikh women. Fifty per
cent of women from Assam, Meghalaya, and Arunachal
Pradesh had anaemia which was surprising because these
were meat and fish-eating communities. Apart from
poverty and dietary patterns, diseases such as diarrhoea
and respiratory illnesses affected (depleted) nutrition
supply. Disease management was important as also
nutritional and health care of adolescent girls and pregnant
and lactating women.
Malnutrition: Issues and Concerns
Section II : Proceedings 23Section II : Proceedings - Day 1
2.Nutrition in India Salient Findings from
National Family Health Survey 3 by Prof. Dr.
Sulabha Parasuraman, Professor, IIPS, Mumbai
Prof. Dr. Parasuraman gave a detailed presentation of the
National Family Health Survey-3 (NFHS-3) which was
conducted in 2005-06, focusing on child and adult
nutritional status and issues. She concluded with the
following points:
Ÿ Children in India suffered from some of the highest
levels of stunting, wasting and underweight in the world,
and the situation has not improved much
Ÿ Anaemia levels among children were very high and it
had actually increased since NFHS-2
Ÿ Most recommended infant and young child feeding
practices were widely ignored by parents
Ÿ The ICDS programme, which had been in operation for
more than 30 years, had not been able to reduce
malnutrition to acceptable levels in any state
Ÿ The adult population suffered from a dual burden of
undernutrition and overweight/ obesity
Ÿ Almost half the number of women and more than 40 per
cent men in most population subgroups were either too
thin or too fat.
3. Can a Malnourished India Race to the Top of the
World? by Prof. Dr. Sangita Kamdar, Professor
(Economics), NMIMS, Mumbai
Prof. Dr. Kamdar's presentation provided a link between
poverty and nutrition. The definition of poverty line often
relied on the expenditure necessary to obtain a certain
minimum amount of food or nutrient basket. But there was
no strong relation between an increase in income and an
increase in nutrition. Increased income might not translate
into increased calorie consumption. She therefore pointed
out that direct nutrition supplements may have a far greater
impact on undernutrition than an increase in income.
The positive link between poverty and under nourishment
was established through work capacity. A state of good
nourishment was desirable as it meant more stamina,
physical and mental health and higher resistance to illness;
it raises work capacity and hence the ability to earn
What were the implications of undernourishment among
the people for India's growth potential? India had been
growing rapidly since the introduction of economic
reforms. The growth in the working age population had
been cited as one of the factors that led to a sustained
economic growth of 9 per cent in recent years.
Malnutrition: Issues and Concerns
Section II : Proceedings 24Section II : Proceedings - Day 1
Dr. Sulabha Parasuraman Dr. Sangita Kamdar
The 'demographic dividend' was the increase or the bulge in
the working-age population. The Indian population in the
15-24 years age group grew from around 175 million in 1995
to 210 million in 2005. In 2020, the average Indian would
be only 29 years old, compared with 37 in China and the US,
45 in West Europe and 48 in Japan. This trend was seen as
significant on the grounds that what mattered was not the
size of the population, but its age structure.
For the demographic dividend to take shape and contribute
meaningfully to economic growth, there was need to ensure
that this workforce was 'employable'. Education and
training for imparting skills was necessary to reap the
demographic dividend. Health and nutrition were needed
to improve labour productivity. Malnutrition had
substantial economic costs: productivity losses to
individuals were estimated at more than 10 per cent of
lifetime earnings, and gross domestic product (GDP) lost to
malnutrition ran as high as 2 to 3 per cent.
The Government's policy responses to malnutrition were to
improve access to food through the public distribution
system (PDS), income support such as food-for-work
programmes and employment guarantee schemes where
people were paid often in food grains for working on public
projects; food programmes for young children through
mid-day meal schemes and nutrition supplementation
programmes such as the Integrated Child Development
Services (ICDS) and basic health services to young children,
pregnant women and lactating mothers.
Prof. Kamdar concluded by explaining that it was not
poverty (and the resultant lack of food) alone that caused
malnutrition. Evidence showed that the damage from
malnutrition occurred either when the child was in the
womb or in the first two years of life, and much of the
impairment of brain development and future productivity
in these early periods of life was irreversible. Therefore
supplementary feeding through school feeding
programmes for nutritional purposes was often too late and
too little as there was always a budget constraint on
nutritional programmes.
She made the following recommendations:
• There is a very clear need to focus on the very young
• Public policy needs to promote healthy nutrition practices
during pregnancy and the first two years of life it should
promote and support traditional practices such as
adequate rest during pregnancy and breast feeding.
• An information campaign is needed
• Need to support fortification of commonly consumed
foods with micronutrients such as iodine, iron, vitamin A
and zinc and encourage women to take iron supplements
during pregnancy.
4. Agrarian Distress, Food Security and
Malnutrition by Dr. Srijit Mishra, IGIDR, Mumbai
Dr Mishra's presentation focused on the agrarian crisis, its
adverse impact on nutrition and the social and economic
situation of farmers.
Section II : Proceedings 25
Malnutrition: Issues and Concerns
Section II : ProceedingsSection II : Proceedings - Day 1
Dr. Srijit Mishra
He said there were two dimensions to the agrarian crisis:
1. The agrarian (livelihood) crisis which threatened the
livelihood of farmers (particularly small and marginal
farmers). It could cause displacement of people
2. The agricultural (developmental) crisis which lay in the
neglect of agriculture (designing of programmes and
allocation of resources). It could cause displacement of
ideology.
The number of poor and undernourished farmers had
increased significantly. Further there had been a decline in
food production, in yield, prices and employment which
had contributed to rural distress provoking farmers'
suicides. Climate change impacts were a cause for concern:
it would cause an increase in temperature, decrease in the
number of monsoon days, and an increase in the intensity of
rainfall and the frequency/intensity of cyclonic storms.
Crop yield was likely to decrease and hunger risk would
increase.
Government interventions had been mainly in the form
debt waiver, which was merely a book-keeping exercise that
at best would reduce the mental burden for loan from
formal sources. It did not necessarily lead to an increase in
investment for production. This intervention raised two
questions of equity: 1) across regions/states and 2) across
size-class of farmers. Debt waiver did not give credit
guarantee for non-willful default.
Instead innovations were required at technological and
institutional levels. Technological innovations included,
community-managed sustainable agriculture, non-
pesticide management, botanical extracts as a last resort,
farmer field schools (FFS) and use of local resources.
Institutional innovations included FFS and self help groups
(SHGs).
Dr. Mishra concluded with the following remarks and
recommendations :
Ÿ Risk mitigation interventions need to go beyond suicides
and debt waivers. It should address yield, price, credit,
income, weather and other uncertainties
Ÿ There is need to spruce up of public investments that will
increase returns to cultivation. Skill enhancement and
linking of opportunities to local resources are required to
increase income from non-farm avenues
Ÿ Success of the credit and input markets require effective
regulation
Ÿ Interventions should encourage technological and
financial products that would reduce costs while
increasing returns
Ÿ Institutions that can organise farmers are required.
Q&A/Discussion
Q. Kamini Kapadia said that most of the analysis had been
about undernourishment. Community workers need to look
at dif ferentials between malnourishment and
undernourishment. They needed a sharper analysis in
terms of nourishment for which population and seeing
disaggregated data in relation to malnourishment and
undernourishment would help get a sharper picture of the
situation. Some of the speakers had used the term
interchangeably and some of them had used it specifically.
A. Prof. Shatrugna answered that this demand was
legitimate. Undernourishment was increasing and it is also
necessary to focus on obesity among the rich and middle
class. It cannot be treated as a homogenous whole. It is
necessary to acknowledge that there were three Indias – the
very rich, the middle class and the very poor. While the
middle class was getting into a trap of obesity, the very poor
suffered low BMI.
Malnutrition: Issues and Concerns
Section II : Proceedings 26Section II : Proceedings - Day 1
Prof. Dr. Kulkarni said undernourishment was the result of
inadequate intake of food. There were many questions that
needed to be asked: did women consume milk and milk
products and other foods? There was malnourishment
among children and it was necessary to examine the
dietary patterns of children who were breastfed and not
given supplementary food.
Q. Dr. Santosh Chowdhury who worked in the rural areas
and among tribal people said that there was malnutrition in
rural Maharashtra and in tribal areas. Farmers were selling
cows despite their usefulness. There was a need to improve
the traditional culture. Not much importance was given to
agriculture. In urban areas dietary patterns and lifestyle
had changed and the problem there is of obesity.
A. Dr. Mishra said the solution was in appropriate
interventions. He related the experience of the Society for
the Elimination of Rural Poverty in Andhra Pradesh. The
intervention for livelihoods was started by local self help
groups working at village, taluka levels. The government
officials too believed in self empowerment and supported
and facilitated the people's initiative. So there was a
structure at village, district levels for facilitators and also
structure for the people's involvement at village and district
levels.
Alternative technology was being used for cultivation and
local resources including cows were used in cost-effective
ways. Alternative institutional structure, such as in Nagpur,
helped to scale up agricultural production.
Q. Preeti Singh wanted to know how to make the urban
poor and rural people aware of nutrition issues. She
pointed out the need to pay attention to education of the
poor and disadvantaged and give them information on
nutrition.
Q. Venkat pointed out that in rural areas, the spending
pattern had changed with priority given to mobile phones
and television, and he said there was need to educate
people.
A. Dr. Mishra said that people's movement was required
for consumer education and good health and nutritional
practices.
Q. Prof. Savaddati posed three questions: 1) How reliable
was the NFHS data? What measures were taken for error
margins as accurate data was important to bring about
changes in policies and programmes. 2) She requested Prof.
Dr. Kamdar to clarify her statement that there was no link
between economic development and nutrition. She said
that there was a definite link that without economic
development and with increasing purchasing power there
was need for education which should be implemented in the
next phase. 3) Why had Dr. Mishra not mentioned the role
of malnutrition in farmers' suicide.
A. Prof. Dr. Parasuraman answered that the NFHS studies
were reliable. She pointed out that when she mentioned a
percentage she spoke only in approximate terms. When she
said 52 per cent it may not be exactly 52 per cent but
thereabouts. Research surveys provided statistics for policy
makers and administration to take appropriate action. She
pointed out that malnutrition and undernutrition were
treated separately. She had mentioned sub groups under
malnutrition and undernutrition. It was important to
ensure that the programmes were relevant and that they
reached the right groups – the lowest strata of society. Prof.
Dr. Kulkarni added that those interested may look up her
article on care taken to provide reliable data in the
Economic and Political Weekly special issue on NFHS-2
for article written by her with title, “NFHS-2 - the Inside
Story: Inputs and Processes”.
Malnutrition: Issues and Concerns
Section II : Proceedings 27Section II : Proceedings - Day 1
Prof. Dr. Kamdar responded to Prof. Savaddati's query that
education was necessary but was not sufficient.
Q. Bandu Sane of Melghat regretted that farmers' suicides
continued to rise. When they questioned the authorities
about malnutrition deaths (in Melghat) they were told that
the matter was in the court. When the bureaucrats were not
interested in solving the problems, how could a change be
brought about in people's lives?
A. Dr. Mishra replied that the agricultural production
pattern was changing - if a farmer uses his field to grow one
crop, say cotton, then if the crop failed, he had nothing to
live on, nothing to feed his family. The farmers' suicide was a
symptom of a larger crisis. For every one farmer who
committed suicide there were several thousands who were
in distress. Hence there was need to look at the larger
picture and to seek solutions to the problems in a holistic
way.
Q. Dr. Ratnavalli wanted to know if Prof. Dr. Shatrugna's
slide on relation between mother and daughter was based
on generational study.
A. Prof. Shatrugna said that there was no disparity between
NFHS data and National Nutrition Monitoring Bureau
(NMNB) data, which was from 10 states in northern India.
She pointed out that while she admired the commitment to
figures/statistics, when half the country was starving it
hardly mattered if the malnutrition rate was 62 per cent or
58 per cent. She said that India was blessed with a good crop
of groundnuts which had lot of oil, and was high in protein
which could be easily processed and should be used more
than soya. Soya was difficult to process and the process
destroyed the nutrients. Its fibre content was high which
inhibited absorption of other nutrients.
Though it had a role in managing cardiovascular diseases
and might help in menopausal problems, it was also known
to be responsible for breast cancer. America rejected soya
for these reasons and also because it caused allergies. Soya
oil had high fatty acids and was very low in proteins.
In answer to Dr. Ratnavalli's query, Prof. Shatrugna said
that in India, the average height had remained the same in
the last 60 years. Genetics came into play once the
maximum potential was reached. Food, medicine and high
quality protein are required for proper growth.
She further said that it was not a good idea to pick up a
concept that was developed for another discipline and mix it
in nutrition. Short was not beautiful, one must have normal
weight for height. Cardiovascular disease, hyper tension,
and diabetes set in early in short people as weight was
distributed around a short height; that was why weight for
height was developed. It is necessary to have normal weight
for height. But 35 per cent of Indians do not have normal
weight for height. This measurement was also being used
for children which was wrong as children had the potential
to grow taller.
With these words, Dr. Shatrugna closed the session on
panel discussion.
Malnutrition: Issues and Concerns
Section II : Proceedings 28Section II : Proceedings - Day 1
Vote of Thanks
Dr. Ruby Ojha gave the vote of thanks on behalf of the Post-Graduate Department of Economics, SNDT Women's
University. She was happy that the National Seminar on “Malnutrition: Issues and Concerns” organised by Narotam
Sekhsaria Foundation, the PG Department of Economics, SNDT Women's University and the Directorate of Health
Services, Maharashtra State, Mumbai on 11-12 January 2010 at SNDT Women's University, Churchgate Campus,
Mumbai went off smoothly. She thanked Prof. Vibhuti Patel the Director of PG Dept of Economics who ably guided the
team.
She also thanked the following people:
Ÿ Prof. Dr. Chandra Krishnamurthy, the Honorable Vice Chancellor, SNDT Women's University, Mumbai, who could not
be present, for her encouragement and support
Ÿ Dr. Madhu Madan, Registrar of SNDT University for granting permission to hold this event and for making available
university infrastructure
Ÿ Padmini Somani, Director, Narotam Sekhsaria Foundation, Mumbai for co-organising and supporting the seminar
Ÿ Leni Chaudhuri and Anushakti Tayade, programme officers from NS Foundation for meticulously designing and
executing the seminar
Ÿ Prof. Dr. Veena Shatruguna, Former Dy. Director & Head Clinical Division, National Institute of Nutrition, Hyderabad
and Consultant, Indian Institute of Public Health, Hyderabad for keynote address
Ÿ Adv. Anand Grover, UN Special Rapporteur on the right of everyone to the enjoyment of highest attainable standard of
mental and physical health for the Chief Guest's address Dr. S.K. Dakhure, Director, Health Services, Government of
Maharashtra who made a special effort to involve the Government of Maharashtra it his crucial event, but who could not
be present at the seminar
Ÿ Participants of the Panel Discussion on Discourse on Nutrition and Malnutrition: Prof. Dr. Sumati Kulkarni, Retired
Professor, IIPS, Mumbai, Prof. Dr. Sangita Kamdar, Professor of Economics, NMIMS, Mumbai, Prof. Dr. Sulabha
Parsuraman, Professor, IIPS, Mumbai and Srijit Mishra, Associate Prof., IGIDR
Ÿ Chairpersons: Prof. Dr. Veena Shatrugna, Prof. Pushpa Savaddatti, Professor, Karnataka University, Dharwar; Dr Veena
Devasthali, Reader, PG Dept of Economics, SNDT Women's University, Mumbai; Dr. Sunita Kaistha, Reader, Jesus and
Mary College, University of Delhi and Prof. Dr. Vibhuti Patel
Ÿ Dr. S.V. Rathod, Consultant of National Rural Health Mission, Maharashtra for his valedictory address.
Ÿ All the participants who made presentations
Ÿ SNDT University teaching staff, Geeta Shah and Dr. Rekha Talmaki of SNDT UG College for their valuable suggestions
Ÿ SNDT University PGSR office staff, Mr. Mohanan, Accounts Officer Mr. Rajendra Vategaonkar and the non-teaching staff
of PF|GSR office for their technical support
Ÿ The staff of Narotam Sekhsaria Foundation
Ÿ Student volunteers for their assistance
Ÿ All the participants of the seminar
Malnutrition: Issues and Concerns
Section II : ProceedingsSection II : Proceedings - Day 1 29
1. Malnutrition: A serious concern towards young
India by Dr. K. Srinivasa Rao, Sr. Faculty, PG Dept. of
Commerce, Vivek Vardhini (AN) College, Hyderabad,
Andhra Pradesh.
Dr. Rao pointed out that malnutrition was a multi-
dimensional problem because it was related to the process
of socio-political transformation like social behavior,
household livelihood, state services, equality and human
rights with dignity. India had a higher prevalence of child
malnutrition, as manifested in stunting and underweight,
than any other large country and was home to about one-
third of all malnourished children in the world in early
2000.
There were, however, substantial inter-state differences in
child malnutrition and also in the progress made in
overcoming the problem since the early 1990s. Therefore it
was necessary to have the multi-sectoral view of nutrition
security, defining it as physical, economic and social access
to, and utilisation of an appropriate, balanced diet, safe
drinking water, environmental hygiene and primary health
care for all. The persistence of widespread malnutrition
might seem surprising considering the recent overall
shining performance of the Indian economy. The cost in
terms of health, well-being and economic development was
tremendous. Between 1993 and 2006, net state domestic
product per capita nearly doubled in the wake of 4.5 per cent
average annual growth.
The presenter identified various social and economic effects
of malnutrition and examined the existing measures to
overcome the problem. He also made recommendations for
sustainable economic and appropriate social development
programmes to achieve inclusive growth, which included
expanding and improving nutrition education, providing
clean drinking water and addressing non-food factors.
2. The Political Economy of Malnutrition in India:
the need to move towards the paradigm of food
sovereignty by Dr. Vanmala Hiranandani, Reader-cum-
Deputy Director, Center for the Study of Social Exclusion
and Inclusive Policy, SNDT Women's University, Juhu
Campus, Mumbai.
This paper pointed out that poverty and food insecurity
were viewed as the main causes of malnutrition; yet,
structural causes of poverty and hunger had received
inadequate attention. Therefore, a food-centered approach
to nutrition had dominated policy-making. In post-
independent India, food subsidies, supplementary food,
health and nutrition education, pre-school education, and
health services had characterised government approaches
to tackle the problem. Despite these efforts, undernutrition
remained a silent catastrophe in India; a UNICEF survey of
2009 revealed that 52 per cent of women and 74 per cent of
children were anaemic.
Day 2 - 12 January 2010
SESSION I - Political Economy of Malnutrition
Chairperson: Prof. Pushpa Savaddati, Professor, Karnataka University, Dharwar
Prof. Dr. Savaddati thanked Prof. Dr. Vibhuti Patel for inviting her to participate in this
seminar and introduced the topic of the first session. She pointed out there were six
presenters and each presenter had eight minutes to present which allowed 10 minutes
for discussion. Dr. Pushpa Savaddati
Section II : Proceedings - Day 2 30
Section II : Proceedings - Day 2
Malnutrition: Issues and Concerns
Dr. Hiranandani argued that malnutrition, food insecurity
and poverty were inherently political issues. She pointed
out that the limitations of the concept of food security that
was congruent, for instance, with a market-oriented
economy in which people ate McDonald's burgers, while the
fast food chain extinguished the livelihoods of small-scale
farmers and ravaged the planet by its ecological footprint.
She therefore emphasised the need for a paradigm of food
sovereignty that counteracted neo-liberal notions on food
as a commodity, rather than a right. Food sovereignty, put
forth by Via Campesina, the largest international farmers'
association, focused on protecting and sustaining rural and
urban livelihoods. The presentation emphasised the need
for agricultural production for subsistence and local
markets rather than for the production of cash crops that
destroyed the food security of millions of farming families in
India. Food sovereignty also brought gender justice and
protected the livelihoods of indigenous populations (e.g.
adivasis) within its ambit. Thus, the paper concluded that
food sovereignty was a much-needed alternative that must
be made the cornerstone of policy-making to eliminate
malnutrition and hunger.
3. Neo urbanisation - A saga of desire,
displacement and deprivation by Adv. Shalini Mathur,
Lucknow
This paper looked at the phenomenon of urbanisation in
post-globalised India, which had led to further deprivation
of the poor, especially the women. Neo-liberalisation had
replaced socialistic ethos and has created a false sense of
hope. While open market and availability of more goods in
the market place have increased the level of desire yet
decreasing purchasing power has not only increased huge
disparity but also has caused emotional upheavals related to
migration which meant displacement.
The presenter, viewing the situation as a social activist,
raised such pertinent questions as, had migration helped?
Had awareness about facility of health and education
resulted in the access to health and education? What had
happened to community life? Though women were more
visible now than before, it was important to find out what
professions they were in and what were their
responsibilities; and importantly, what was the state of
their health and nutrition?
4. Political Economy of Hunger by ManiMala, Delhi
This presentation made in Hindi, brought to fore the issue
of chronic hunger in villages and cities of India. The
presenter described it as one of intense avoidable suffering:
of self-denial, of learning to live with far less than the body
needs. State authorities continued to regard starvation as a
temporary aberration caused by rainfall failures rather than
as an element of daily lives. The authorities continued to
craft minimalist responses, to spend as little money as was
absolutely necessary to keep people threatened with food
shortages alive. The duties of State officials were not legally
binding, in ways that they could not be punished for letting
citizens live with and die of hunger.
The government programmes were woefully inadequate to
address destitution; in fact, they tended to be blind to or in
denial of the fact that large numbers of people lack even the
elementary means and power to survive with dignity. The
presentation urged the State to acknowledge the conditions
of malnutrition, identify people threatened by them, and
address and prevent the enormous suffering, sickness and
death caused by malnutrition.
5. Malnutrition among Adivasis of Maharashtra by
Shubhangini A. Joshi, Lecturer, SNDT Women's
University, Juhu Campus, Mumbai.
The presentation gave a background of the situation of
Malnutrition: Issues and Concerns
31Section II : Proceedings - Day 2
35adivasis in Maharashtra. Adivasis comprised 6 tribes
among 5653 distinct communities of India. Despite being
skilled craftspeople and knowledgeable about animals and
plants of forests, they were being pushed to the brink of
survival. Displaced from their homes, denied basic human
rights, they faced a relentless cycle of abject poverty,
deprivation and hunger, leading to malnutrition among
adivasis, the worse-affected were their children.
In 2001, more than 8000 children up to 6 years died in the
tribal belt of Maharashtra due to malnutrition. A
Government survey reported that 86 per cent of the families
7were food deficient, 8 per cent per cent did not have
5enough food for six months in a year; 6 per cent of the tribal
3 children were undernourished and 8 per cent were
9 anaemic. In 1994, 8 per cent of rural population had a
calorie intake of less than 2400. Melghat and Nandurbar
reported high rates of infant mortality rate (IMR) with one-
eighth of the total child deaths were those of tribal children.
The presenter pointed out that the problem of malnutrition
among the adivasis was not a medical one but was related to
social and political-economy. A strong political will was
required to bring the adivasis into the mainstream of
society. It was also necessary to restore their livelihoods
and ensure food security and stability so as to save the
vulnerable adivasi tribes from becoming extinct.
6. Prevalence of malnutrition in India:
a disturbing phenomenon by Dr. Ruby Ojha, PG
Economics Dept., SNDT Women's University, Mumbai.
This presentation pointed out that mere economic
development or increased food production did not by itself
necessarily ensure nutrition for all. Using extensive data
3from NFHS 2 and , it showed the effects of malnutrition:
nutritional status of children (stunted, wasted and
underweight), nutritional status of urban and rural adults
both undernutrition and obese; prevalence of anaemia in
India; correlation between prevalence of anaemia and
development indicators; correlation between child
malnutrition and development indicators.
The paper emphasised the need to tackle the problem of
nutrition both through direct nutrition intervention for
especially vulnerable groups as well as through
development policies, which would create conditions for
improved nutrition. Economic growth alone, though
impressive, would not reduce malnutrition sufficiently to
meet the nutrition target. If this was to be achieved, difficult
choices about how to scale up and reform existing nutrition
programmes or introduce new ones have to be made by the
Government and other agencies involved in nutrition in
India.
Q &A/Discussion
1. Dr. Alex George pointed out that Dr. Srinivas Reddy's
paper only examined food-related aspects of
malnutrition. He said that non-food issues need to be
examined. His presentation did not provide link between
water and sanitation and malnutrition. For instance, if a
child was suffering from diarrhea, the absorption of
nutrition will not take place. Dr. Reddy answered that
water and sanitation were environmental issues.
Environment should be protected and unless issues of
32
Malnutrition: Issues and Concerns
Section II : Proceedings - Day 2
sanitation and water were addressed, it would aggravate
malnutrition and health problems. Environmental
issues could not be separated from malnutrition and his
paper dealt with both.
2. Prof. Dr. Vibhuti Patel asked Dr Shubangini Joshi what
kind of royalty was she expecting for the tribal
community Dr. Shubangini Joshi expecting. Dr. Joshi
replied that she expected royalty for forest areas which
were used for national parks and wild life sanctuaries; a
portion of the income should be given to the tribal
community as compensation for taking away their land
and livelihood. They should also be compensated
adequately for the industrial development projects that
come up in the forest land inhabited by the tribal people.
3. A query was made about there being no data regarding
the diet of the tribal people and this affected welfare
programmes. The discussion involved the following:
data on tribal diet was available in national institutes in
Hyderabad and Nagpur. These institutes conducted
annual surveys on the tribal consumption patterns in
rural and urban areas and this data was made available
to the Planning Commission for necessary action.
Unfortunately the surveys were stereotype and there
was no improvement on consumption patterns of the
tribal people.
Subhangi Joshi responded that there was no data
available on the tribal nutritional status. The details of
calories, proteins, fat in the food tribals consumed were
not listed. She had come across calorie deficit, types of
hunger but there was no data specifically about the
nutritional intake of any particular tribe.
Prof. Dr. Shatrugna said the diet survey was usually on
amount of food eaten by the family or a person, the
nutritive value of rice, wheat and converted to nutrients.
However tribal food was not analysed. She pointed out
nutritionists were programmed only to analyse cereals,
pulses, vegetables, fruits. There was very little analysis
on non-vegetarian food. But tribal people ate roots,
birds, insects, snakes. As a result the survey data was not
comprehensive. Even tubers, roots and other forest
products eaten by tribals do not have botanical names
and are not documented. Preeti Singh pointed out that
there was a wide variation between tribals in different
areas such as in Andaman Islands and those in
Jharkhand. Shubangi responded that her paper was
specifically on tribals of Maharashtra and that she did
not do a comparative study of tribals in other states.
4. In a comment to Vanmala, Radha Holla said that the
word access had been co-opted by neoliberals to mean
access through market using money. It was equivalent to
the co-option of the word “choice” in reproductive rights.
Choice in developed countries now meant choice
between abortion and non-abortion. In developing
countries, choice was about choice of contraceptives;
there was no other choice. She pointed out that the word,
access should not be allowed to reach the point choice
had reached. It is necessary to reclaim the word access to
mean “Right to food” and bring it back into civil society
dialogue.
5. Another issue raised was that the paradigm of
development needed to change.
6. One participant said that the issue of malnutrition was
in programmatic mode. Why was the ICDS programme
treated as if it was a disease like TB and malaria
programmes? Why should a demand be made of
something that already existed? But water had been
privatised, and soon it would be the turn of fresh air
33Section II : Proceedings - Day 1
Malnutrition: Issues and Concerns
to be privatised. So right to food should not be
compartmentalised into PDS, ICDS. He asked if political
mileage was being gained by providing food to people,
w h i c h w a s i n f a c t p e o p l e ' s b a s i c r i g h t .
7. Bandu Sane of Melghat pointed out that to enable better
studies it was necessary to go the villages and
understand the real situation and problems people face;
34Section II : Proceedings - Day 2
Malnutrition: Issues and Concerns
only then could appropriate solutions be found.
8. Another comment made was that there was enough food
grains but people were unable to purchase food grains.
Prof. Sadavatti summed up the session with a brief outline
of each presentation. She thanked all presenters and the
participants for their contribution to the discussion.
Day 2 - 12 January 2010
SESSION 2 - Effects of Malnutrition on Mortality and Morbidity: National
profile and regional; rural-urban; caste, class, gender, ethnicity and
religious variations
Chairperson: Dr. Veena Devasthali, PG Economics Department, SNDT Women's
University, Mumbai
Dr. Devasthali regretted the lack of time and said that chairpersons have the
unenviable task of keeping to time especially in this session which had 10
presentations. The topic of this session covered a wide range and it would be
interesting to hear the full presentations, but because of severe time constraints, she
urged the presenters to confine their presentations to seven minutes each.
1. Migrant women labour malnutrition and
poverty: A case study by Dr. Preeti Singh, Associate
Professor, Jesus and Mary College, New Delhi
This presentation was a study on 40 Rajashthani migrant
women labourers in three construction sites in Delhi. On an
average each family had four undernourished children
having a daily intake of less than five hundred calories each.
The women were working for survival. They earned Rs. 90
per day as casual labourers for about 20 days in a month.
The men lazed around, drank alcohol or were unemployed.
The women were frail and emaciated but they had to pick up
heavy building material. They were not given food, shelter,
clothes or medical facilities. They were breastfeeding
children aged up to 5 and 6 years. The family ate rice/roti
mixed with water and achaar (pickles) given by affluent
families.
The methodology adopted was to observe the families and
their work. Each woman was interviewed individually and
also in a group. Time was also spent with the children in
informal interaction for gathering information. Remedial
situation for these families was taken up through a small
group. Recommendations include overtime wages for
migrant workers and provisions for facilities such as
bathrooms, basic education, nutrition education through
charts, BPL identification cards to benefit PDS.
2. Malnutrition among rural tribal women: A socio-
economic study in Jharkhand state by Dr. Renu
Dewan, Reader in Psychology, Ranchi Women's College,
Ranchi University, Jharkhand
This presentation stated that nutrition was a basic
determinant of health. Malnutrition was one of the most
devastating problems worldwide and was inextricably
linked with poverty, lack of development, education,
awareness, self assertiveness, etc. In India, gender in-
equality in nutrition was present from childhood to
adulthood. Here the basic health condition of tribal women
and girls in Jharkhand was very poor - 72.9 per cent women
and 82.40 per cent children had anaemia. The literacy rate
of tribal women was 39.38 per cent and that of tribal men
was 67.94 per cent.
While Jharkhand was rich in natural resources like
minerals, forests, fountains, mountains and industries,
people lived in poverty and penury. According to the
Government estimates, around 23.22 lakh families in rural
Jharkhand live below poverty line, out of which 8.79 lakh
belong to schedule tribes.
3. Malnutrition in Karnataka State by Prof. Pushpa M.
Savadatti, Post Graduate Dept of Economics, Karnataka
University, Dharwad, Karnataka State
This presentation provided details of food consumption
patterns in Karnataka which revealed that cereals and
millets were the main food items, and that foods that were
rich in vitamins, minerals and protein were consumed in
lesser quantities. The nutritional status in the state revealed
that nearly 50 per cent of the children in Karnataka suffer
from malnutrition. Children's malnutrition status in the
state indicated that around 44 per cent of the children under
age five were stunted or too short for their age, due to
undernourishment. As a result of malnutrition, one in 28
children in the state died before his/her first birthday. One
in 18 children died before reaching age five. Infant mortality
in rural areas was higher than the urban areas.
Undernutrition was also serious among teenagers in the
state.
More than half of the girls and two-third of the boys aged 15-
19 suffered from undernutrition. Adults too suffered from
malnutrition. Around one-third of the adults were too thin.
Undernutrition was very common among adults in rural
areas and SC/ST women. Anaemia was a real problem
among women and children in Karnataka: 70 per cent of
the children (6-59 months) were anaemic, 52 per cent of the
women had anemia, and 63 per cent of the pregnant women
were anaemic.
Though the government of Karnataka spent huge amount of
money annually on health programmes of women and
children, the nutritional scenario in the state was still
worrying. The presentation concluded stressing on the
need to find out the efficacy of various programmes run by
the government.
4. Dietary intake and nutritional status of the tribal
population of Gujarat by Dr. Ratnawali, Asst. Professor,
Centre for Social Study, Surat, Gujarat
Gujarat had 15 per cent tribal population. Despite the
relative prosperity of the state, the tribal people had poor
nutritional status. Using the data from NFHS and the
National Nutrition Monitoring Bureau (NNMB), this paper
discussed the nutritional intake and its linkages, impacting
upon the health status of the tribal population of Gujarat. It
was observed that there was considerable decline in the
food intake of the community across the age groups and
sexes over the years. Nearly one-fourth population was
protein-calorie deficient. The resultant impact was
reflected in increasing trend of poor nutritional indicators
and higher vulnerability of the population to morbidity. The
presentation stated that the situation called for a proper
look into the various nutritional programmes and sincere
interventions to improve the nutritional status of the tribal
population.
35Section II : Proceedings - Day 2
Malnutrition: Issues and Concerns
5. A Study on the health status of tribal women:
Problems and practical solutions by Poonam Singh
and Sushma Singh, P.N. Doshi Women's College, Ghatkopar
and JVM College of Arts, Com & Sc. , Airoli, Navi Mumbai
This presentation discussed the study conducted to
examine the problems of monitoring health status of tribal
women, Warli and Kokni tribes of Koknipada, Thane (W) in
Maharashtra.
This presentation stated that in order to improve the health
status of the tribal women, the health care delivery should
be designed for each specific tribal group to cater to their
specific needs and problems by ensuring their personal
involvement. It pointed out the need for a region-specific
study of tribal women, for better understanding of their
lives and problems so that planning welfare programmes
would be more meaningful, significant and effective.
The following were some recommendations for strategies
based on the study:
Ÿ Formulating realistic development health plans based on
needs of tribal women.
Ÿ Promoting nutritional and health education among
working, lactating and pregnant tribal women.
Encouraging healthy nutrition through local produce and
local recipes
Ÿ Imparting health education by local tribal women with
guidelines provided by health functionaries.
Ÿ Training tribal girls as "dais"/nurses.
Ÿ Maintaining a health card for each tribal family
containing vital information like blood group status,
haemoglobin level, genetic disorders.
6. Health Status of Tribal People in Thane
District, Maharashtra by Dr. Rekha Talmaki, S.N.D.T.
Arts Commerce and Science College for Women, Mumbai
This presentation threw light on the health status of tribals
in Thane District of Maharashtra, where more than 75 per
cent tribal people resided. The study reported that the
health condition of tribal population had not only not
improved but was in fact deteriorating. They lived below
the poverty line and were undernourished or malnourished.
The presentation pointed out that the Scheduled Tribe
population in Maharashtra was 73.18 lakhs, i.e. 9 per cent of
the population of the state with 47 tribes. They were
vulnerable because of their geographical location and also
because they were unable to demand their rights. They had
lost access to forest produce and were not able to increase
the productivity of their lands through water and other
resources. Thane district was home to four different tribal
groups, the Katharis, Koknas, Kolis and the Warlis.
The Warlis were more sensitive to nutrition and health
issues because of their vegetarian diet, they depended on
the forest and the forest produce. Children below age five
suffered from hunger and malnutrition. In the forest belt of
Jowhar, Mokhada and Wada Taluka, the tribal population
was shrinking and it is a serious issue. The politicians
blamed it on the tribal social mores and not on the
administration. But the inadequacies of the government
administration too were responsible. Some other issues
include: why did the government not prevent child
marriages? Why were the tribal women not attended to
during child birth? Why did they have go to witch-doctors?
7. Effect of income level on nutritional status of
rural pregnant women by Tejashree L. Shende,
Dept of Home Science, Women's College of Home Science &
B.C.A, Loni, Maharashtra
This presentation provided the results of a study
undertaken to assess the association between socio-
36Section II : Proceedings - Day 2
Malnutrition: Issues and Concerns
economical and dietary factors with anaemia prevalence, in
which 100 pregnant women from rural areas of Rahata
taluka district Ahmednagar were selected randomly.
Information was collected through self-structured
questionnaire and 24-hour dietary recall method. The
results showed that among the selected pregnant women, 11
per cent belonged to low-income and 89 per cent to middle-
income group respectively. Almost all women had three
meals pattern a day. The quality of the diet was better
among the middle-income women than among the low-
income women. The mean nutritional intake of the low
income of pregnant women was below minimum
nutritional requirements of Recommended Daily
Allowance (RDA) as compared to middle-income group.
Results indicated that in low-income group pregnant
women, 45.5 per cent suffered from moderate anaemia and
54.5per cent suffered from mild anaemia. There were no
cases of severe anaemia and none were in normal Hb group.
In the middle-income group no one suffered from severe
anaemia. Only 10.11 per cent of the pregnant women
suffered from moderate anaemia while 44.94 per cent
suffered from mild anaemia and 44.94 per cent of pregnant
women in middle-income group showed normal Hb level.
8. Malnourishment of Muslim women: Case study
of Mumbra Kausa by Swatija Manorama and Farhat Ali,
CAFYA: a project to monitor Sachar Recommendations and
Status of Muslim Women, Mumbai
This presentation gave the preliminary findings of the
research study done by CAFYA a coalition of five
organisations: Centre for Enquiry Into Health and Allied
Themes (CEHAT), Awaz-e-Niswan, Forum Against
Oppression of Women, Youth for Unity and Voluntary
Action (YUVA) and Akshara. The CAFYA project monitors
Sachar Recommendations and the status of Muslim
Women. The presentation raised serious concerns
regarding malnourishment among urban women belonging
to Muslim community in Mumbra Kausa. It also aimed at
estimating the expenditure on health and food for the
Muslim community. The paper also discussed the issue of
political economy of malnourishment.
It pointed out that malnourishment and poverty went hand
in hand, especially for Muslim women – who had low
literacy and minimal opportunities for productive work due
to lack of training and cultural practices. Mumbra-Kausa
had peculiar history of predominantly Muslims who settled
in this part of the city after 2001 following the anti-Muslim
riots and attacks on Muslims.
The preliminary findings of the study were that families had
no steady income, no permanent shelter to prove their
economic status, and single, divorcee and deserted women
were unable to prove they belonged to below poverty line.
Their life was a struggle due to biases and anti-Muslim
feelings of the administration. The management of solid
waste, drainage facilities was dismal, causing disease.
People in this locality had poor access to public health care
due to lack of adequate hospitals and inefficient facilities,
and they were forced to depend on private hospitals. As a
result, people suffered severe indebtedness.
9. Assessment of and correlation between nutrient
intake dietary pattern and anthropometric
parameters among college going day scholar girls
and hostel girls in the city of Mumbai by Twinkle N.
Thakkar, S.V.T. College of Home Science, S.N.D.T.
University, Juhu Campus Mumbai.
Ms Thakar presented the results of a study conducted to:
i) assess, compare and correlate the dietary pattern,
nutrient intake and anthropometric measures a among
college going day scholar girls and hostel girls in Mumbai
37Section II : Proceedings - Day 2
Malnutrition: Issues and Concerns
city; ii) study their macronutrient and micronutrient
discrepancies in the die; and iii) to study their health related
problems. The study revealed the incidence of poor quality
of diet in college students. It pointed out the need to target
first-year college students for interventions designed to
increase their daily intakes of fruit, non-fried vegetables,
low-fat dairy, and whole grains.
10. A Study of causes and effects of malnutrition
on mortality and morbidity by Sharvari Kulkarni, Dept
of Mathematics and Meghana Shinde, Dept. of English,
Model College, Dombivli East, Mumbai
This presentation described the problems caused by
malnutrition, such as, deficiency diseases like rickets,
complaints with NFHS data. It was difficult to decide which
data to rely on. night blindness, anemia, goiter (iodine
deficiency) kwashiorkor (protein deficiency). The
presentation also pointed out that while the main cause of
malnutrition was lack of food and poor quality of diet, there
were other related causes leading to malnutrition and
morbidity. They were: illiteracy, low standard of living, lack
of medical facilities, no proper sanitation, perennial
unemployment, lack of infrastructure, early marriage,
drought and famine, wrong government policies and debt.
Q&A/Discussion
1. A question was posed to Dr. Rekha Talmaki to provide
statistics on malnutrition in other grades. Dr. Talmaki
replied that the data was taken from Dr. Takale's research
study, which took into consideration 5,600 babies and
concluded that less than 1000 babies were in normal
category; 10 per cent were in Grade I category of
malnutrition which is mild malnutrition, 29 per cent in
Grade II – moderate malnutrition, 32 per cent in Grade
III- severe malnutrition and 18 per cent in Grade IV-
acute malnutrition.
2. Alex George of Save the Children, New Delhi, pointed out
that the NFHS study had one lakh sample which was
highly inadequate even for IMR. So he suggested using
the Sample Registration System (SRS) data conducted
annually with a bigger sample size. SRS data was
available for 2008 and also for 2009. He further
illustrated that when NFHS data was broken down by
states, it came to only 7000 households per state, except
in UP where they had a bigger sample. NFHS was
probably popular because it was promoted by the
government. The discussion on this asserted that the SRS
data too could be used. Dr. Ratnawali said SRS data was
problematic because it could not be relied on as in the
case of maternal mortality. There were no such
complaints with NFHS data. It was difficult to decide
which data to rely on.
3. Another question was if there were legal provisions and
government programmes to protect migrant workers.
Legal provisions and government programmes such as
ESIS and PF were available in the organised sector but
such provisions were not available in unorganised sector.
4. To a question about the source of data on child marriage
in Melghat, the speaker answered that it was taken from a
local newspaper, Lok Prabha, Sept 2009 issue.
Malnutrition: Issues and Concerns
38Section II : Proceedings - Day 2
1.Markets and malnutrition: Reinforcing the
hunger bazaar by Radha Holla, Campaign Coordinator,
Breastfeeding Promotion Network of India (BPNI), Delhi
Almost 50 per cent of children under five in India were
suffering from under nutrition. Undernutrition was
primarily caused by lack of food, which in turn was the
result of structural problems such as lack of access to food,
unemployment, and destruction of livelihoods as well as
lack of knowledge of the right kinds and right quantities of
foods to consume.
The presentation made the following observation:
malnutrition problems deepened as food was increasingly
becoming a tool of gaining wealth and power. Food for
health and nutrition became food as a commodity for trade.
The answer to hunger was increasingly presented as a
glamorised quick fix - a mix of chemicals in the name of
food. Little attention was paid to inequities that deny people
access to food. Helping the rise of corporate food power was
reductionist science that reduces food into its chemical
components – from breastmilk to artificial milks, from
3butter and cream to Omega and other fatty acids, from
millets and cereals to “artificial” food fortification. The
chemicalisation of food as the answer to hunger diverted
attention away from the real causes of hunger and
malnutrition, and paved the way for short-term remedies:
remedies that have long-term health implications and
which destroyed people's control over decisions of what to
eat and how to access it. The presentation also included
several sustainable solutions to tackle and prevent
malnutrition. (See section III-Recommendations)
2. Invisible Economic Burden of “Hidden Hunger”
by Dr. G. Subbulakshmi, Ex-Director, Dept of PG Studies
and Research in Home science, SNDT Women's University,
Mumbai
Dr. Subbulakshmi shared her experiences as a nutritionist.
She said that she had worked in rural areas, tribal areas and
in urban slums and her experiences showed that food-based
approach is only a preventive measure. For curative
measures supplementation was requried. As mentioned by
Prof. Dr. Shatrugna in her keynote address, food-based
approach of wholesome food should be aimed for.
Unfortunately supplementation was needed where severe
malnutrition had to be treated and if haemoglobin was very
low (below 10) then it became irreversible, hence the need
for supplementation. A normal person could remain
healthy by eating a good balanced diet. She said she was
interested in traditional food ingredients which were
therapeutic in nature such as haldi, ginger, ajwain and some
sources of unconventional sources which could be used to
treat health problems. These needed to be tracked and made
available to people as wholesome food rather than
identifying and isolating the ingredient and making it a
pharmaceutical product.
Day 2 - 12 January 2010
SESSION 3 - Discourse on micronutrient deficiencies, food and nutrition
supplements
Chairperson: Dr. Sunita Kaistha, Reader, Jesus and Mary College, University of Delhi
39Section II : Proceedings - Day 2
Malnutrition: Issues and Concerns
Dr. Sunita Kaistha
Many companies talked about social upliftment and wanted
to allocate funds for such work. Academics were unable to
continue with their research due to lack of funds in
academic institutions. If Roche, a pharmaceutical
company, was willing to fund academicians' research, she
said there was nothing wrong. But the funders had to be
sincere and the researchers should not be biased in giving a
positive report because they were funding the research. She
did not think there was a problem in getting money from
companies for that and nutritionists, food technologists,
social workers, community workers have to work together.
There was also the problem of PDS where the food grains
and other items were not available. Her work in Mumbai,
Hyderabad and other cities revealed that poor people were
exchanging their ration card with upper class people to buy
sugar as it provided energy. Thus it is necessary to educate
people and examine teaching methods in colleges of home
science. She then related her experience of a teaching
method used by preparing 114 small messages on nutrition
for children to take home. Children also shared other
children's messages and gave these messages to their
mothers, aunts, grandmothers and other family members.
The result could be seen in their lunch boxes which then had
more nutritious snacks.
While Dr. Subbulakshmi shared her experiences, her power
point presentation was displayed. It covered the following
points: vitamin and mineral deficiencies are both highly
prevalent in developing countries. In developing countries,
it was thought that intakes of expensive animal-derived
foods were the only way to good health. On the other hand,
over nutrition and obesity and the related health problems
in well developed nations were also well known. Moreover,
there was great awareness that vegetarianism was the main
solution to these problems. Low micronutrient intakes were
mostly influenced by customs and traditions and
socioeconomic status. Poor people were more likely than
others to suffer from micronutrient malnutrition. The
economic burden of micronutrient deficiencies had been
estimated to be around 10 million in terms of "healthy life
years" lost in India each year. The main focus should be on
ensuring women and female adolescents and children
achieved the various micronutrient goals. Investing in
female nutrition through educational programmes would
reduce the cost of micronutrient deficiencies.
3. Micronutrient malnutrition in India by Geeta
Shah, S.N.D.T. College of Arts and S.C.B College of
Commerce and Science, Mumbai
This paper pointed out that India had the highest number of
malnourished people, and child malnutrition rate was
unacceptably high. One-third of approximately two billion
people suffering from vitamin and micronutrient deficiency
were in India.
Micronutrients were required in small quantities and were
responsible for vital functions of the human body.
Micronutrient malnutrition had been a persistent problem
in India, and as recent data suggested, some forms of
micronutrient malnutrition were reaching their peak. The
Indian Government was committed to prioritise and work
toward resolving micronutrient malnutrition. The Indian
Micronutrient Investment Plan for 2007 - 2011 was
proposed by the Micronutrient Initiative, an international
non-government organisation working in collaboration
with the Government of India.
The presentation examined the magnitude of the problem,
the initiatives taken by the government to tackle it and the
results obtained with those efforts; to consider newer
options and commitments required that were available for
tackling the problem of micronutrient malnutrition.
40Section II : Proceedings - Day 2
Malnutrition: Issues and Concerns
4. A Midterm review of Project SARAS, a food-
based micronutrient supplement trial by Dr.
Ramesh D. Potdar, Centre for the Study of Social Change
(CSSC), Mumbai
Dr. Potdar presented the mid-term review of the 'Project
Saras' for discussion and suggestions. The project was a
randomised controlled in poor slum undernourished
women in Bandra East in Mumbai, to determine whether
daily consumption of green leafy vegetables, fruit and milk
from at least three months prior to conception, and
throughout pregnancy, would improve maternal
micronutrient status, reduce pregnancy risks, improve
neonatal weight, infant survival, growth, cognitive
development and reduce metabolic and cardiovascular risk
factors.
In the project, 5122 eligible women were randomised,
stratified by age and body mass index, and received colour-
coded identity cards before supplementation. Thirty recipes
(test and control) of several local snacks like samosas, were
offered to women as one daily snack, six days per week, at 45
distribution centres, eating directly observed by project
clerks, and recorded. It studied women's last menstrual
period dates, women missing two periods were given a urine
pregnancy test, and if positive, they were studied further. All
babies were measured within 72 hours post-delivery with
repeat development records at one, three, six and 12
months, and every year subsequently. The trial aimed to
study approximately 1,500 pregnancies. To date, the study
covered 1034 pregnancies and 858 deliveries and infants
have been followed up.
5. “Obesity” a reflection of malnutrition -- A
growing concern by Manjusha Bhakay, Sr. Lecturer,
Dept. of Food Science and Nutrition, SMRK. BK. AK Mahila
Mahavidyalaya , Nashik, Maharashtra
This presentation dealt with the problem of overnutrition
causing obesity. The presenter defined obesity as a
generalised accumulation of excess fat in the body leading
to more than 20 per cent of the desirable weight. Obesity
had reached epidemic proportions in India in the 21st
century, with morbid obesity affecting 5 per cent of the
country's population. Lifestyle changes and intake of high
calorie food were among the causes associated with morbid
obesity. The presentation pointed out that the formulation
of a broad food policy that encompassed both –
undernutrition and overnutrition, was the only answer to
this problem.
6. Malnutrition in Maharashtra by Bandu Sane, Khoj,
Melghat, Maharashtra
Bandu Sane made a heart-rending presentation appealing
to participants to help identify strategies to solve the
problem of malnutrition deaths, which continued despite
court interventions and widespread media coverage. His
paper pointed out that every year, around two lakh children
died of malnutrition in Maharashtra. Around 10,000
children died in Melghat area of Amravati district alone. In
1993 journalist/activist Sheela Barse filed a Public Interest
Litigation (PIL) in Nagpur bench of Mumbai High Court to
bring the Government's attention to the severity of the
problem. Two more petitions were filed and between 2004 -
2005, the media played a significant role in drawing
attention to malnutrition deaths in Melghat. Through a suo
moto petition the case was transferred to Mumbai High
Court and an order for establishing a Malnutrition Control
Committee to reduce child deaths in the tribal areas was
passed. Fresh petition was filed in 2007 to highlight the
increasing deaths of mothers and children in Melghat, and
the Mumbai High Court, Nagpur bench passed 19-points-
order which were never implemented.
41Section II : Proceedings - Day 2
Malnutrition: Issues and Concerns
Following the setting up the Rajmata Jijau Mother and
Child Health and Nutrition Mission at Aurangabad, two
reports were submitted to the Government and many health
officials and politicians had visited the area. During the
period 1993-March 2009, some attempts were made to
address the problem, but the short-sighted measures only
provided temporary solutions. It was shocking that there
was no infrastructure even after several petitions on 27
issues. There had been no integration between ICDS and
National Rural Health Mission (NRHM), nor there been
registration of birth, deaths and marriages.
7. Micronutrient Deficiency's Effects on Indian
Economy by Dr. Daksha Dave
Dr. Dave presented the results of a study which aimed to:
1) analyse the micronutrient malnutrition in India, 2)
evaluate micronutrient deficiencies effects on Indian
Economy, and 3) suggest some strategies for improvement
of micronutrient malnutrition. The presentation pointed
out that the micronutrient deficiency was wide spread in
India, and that a large number of the people were exposed to
micronutrients malnutrition because their diet, though
adequate, was not balanced. The Indian diet was heavily
weighted in favor of carbohydrates, with less consumption
of animal products and vegetables and more of cereals and
sugar.
The animal products content in diet was low partly because
a large section of people were vegetarian.
The presentation examined the link between nutrition and
labour productivity, and malnutrition and GDP. It
identified a nutrition strategy consisting of four important
complements: supplementation, food fortification,
bio fortification and dietary management, and concluded
with suggestions for an action plan.
Q&A/Discussion
One participant requested Geeta Shah to give the sample
size of the study or the percentage of people suffering from
malnutrition. As this was a very specific question, the
chairperson , Dr. Sunita Kaistha suggested that the person
who raised this query collected a copy of the paper from the
seminar organisers, and this was agreed to. Due to severe
time constraints, the chair person closed this session.
42Section II : Proceedings - Day 2
Malnutrition: Issues and Concerns
1.Government schemes and programmes
concerning nutrition by Dr. Suhas V. Ranade, Asst.
Director, Family Welfare, Directorate General of Health
Services (DGHS) Maharashtra
This presentation gave an insight in to the Government's
various malnutrition programmes. It pointed out that
cultural and social factors were causing malnutrition.
Various factors influenced child malnutrition and steps to
check malnutrition were taken by the government at the
levels of pregnancy, child delivery, postnatal care, child
care, adolescent care, community nutrition programmes.
Some of the specific programmes included: the
Navsanjeevani Yogana to tackle malnutrition and infant
deaths especially in tribal area, the Matrutav Anudan
Yogana for antenatal care for tribal women; the Janani
Suraksha Yogana programme for SC/ST and BPL people to
reduce IMR and MMR; the Pada Swayamsevak, in which
local volunteers from the pada were selected and trained to
improve liaison between villagers and health institutions;
the Bharari Phatak programme which had honorary mobile
doctor with two paramedical, equipped with vehicle and
medicines, to provide medical services in remote tribal
area, and activities carried out were examining and treating
antenatal and postnatal care and children 0-6 yrs,
examining and treating , and referral for children in Grade
III and Grade IV category of malnutrition, and examining
of ashram schools; Child Treatment Camps to treat severe
acute malnutrition among children. Other activities which
were carried out in the tribal areas to improve health status
of the children, included: pediatric ICU, warm room at PHC,
use of Boko peti, referral for seriously ill Anganwadi
children, and appointment of accredited social health
activists (ASHA).
Day 2 - 12 January 2010
SESSION 4 - Policy, schemes and programmes concerning nutrition: Role
of Government and NGOs
Chairperson: Prof. Dr. Vibhuti Patel, Professor and Head, PG Department of
Economics, SNDT Women's University, Mumbai,
Prof. Vibhuti Patel explained that this session had seven presentations on government
initiatives. She said that the seminar got serious hearing from representatives of
Government of Maharashtra. There were some gaps as revealed in Swatija's paper
regarding the situation of in which Muslims were living. The Maharashtra government
had earmarked Rs 299 crores for Ministry of Minority Affairs, not a single rupee was
utilised and only two months left to spend it. This was reported as headline news in local
newspapers. However, she acknowledged that other departments had been proactive so
far as public private partnership was concerned.
43Section II : Proceedings - Day 2
Malnutrition: Issues and Concerns
As the seminar programme was lagging behind, presenters were allowed only three minutes for each presentation.
Prof. Dr. Vibhuti Patel
Dr. Suhas V. Ranade
2. Food security and nutrition security in India:
Need for reappraisal of the policy by Swati Vaidya,
Dept. of Economics, Smt. B. M. Ruia Girls' College,
Gamdevi, Mumbai
The paper pointed out that the advent of global food crisis
had seriously threatened the macro-economic food security
situation in India. Achieving food security at macro-level
meant that there was enough food stock available for the
people, but this did not guarantee entitlement of food to
each household or to each member in every household. The
macro-economic food security made no mention of
nutrition security. For instance, the available diet might
consist of only carbohydrates, causing undernutrition or
malnutrition though there was no widespread hunger and
starvation.
The paper further described the macro-level evidence on
food security, hunger, starvation deaths and examined the
extent of malnourishment in India. It reviewed the policy
measures that aim to provide poor people with food, as an
entitlement. It also described the political economy of
nutrition security in the light of changing dynamics of
maintaining food security in times of the global food crisis;
the diversion of agricultural land to non-agricultural use
due to aggressive industrialisation. The paper also
reviewed the indigenous agriculture methods and their role
in achieving nutrition security.
3. Intervention programmes to combat
malnutrition by Beauty Gogoi, Research and Teaching
Assistant, Indira Gandhi National Open University
(IGNOU), New Delhi
This paper stated that nutrition affected development as
much as development affected nutrition. Till the end of the
fourth Five Year plan (1969-73), India's main emphasis was
on the aggregate growth of the economy.
But from the beginning of the fifth Five Year plan (1974-79),
the combating malnutrition became a national priority to
improve the nutritional status of the vulnerable section of
the society viz. women and children. The paper pointed out
the need to tackle the problem of malnutrition both through
direct nutrition intervention for specially vulnerable groups
as well as various development policy instruments which
will create conditions for improving nutrition status.
4. Impact of Mid Day Meal programme on
educational and nutritional status: A way to
inclusive growth By Prof. P. Malyadri, Head Dept. of
Commerce, Vivekananda Government College, Hyderabad
This paper attempted to investigate the impact of the Mid
Day Meal programme (MDMP) on education, health and
nutrition in two districts of Andhra Pradesh and also made
some suggestions for preparation of nutritious and
economical MDMP programme for sustainable
development in education, health and nutrition to
accomplish inclusive growth.
It pointed primary education was boosted by massive
programmes like Sarva Siksha Abhiyan, which aimed to
provide easy access to all children especially those who
were involved in physical labour, street children, migrant
children. Despite this, parents were unable to send their
children to school due to their poor economical status.
The Government of Andhra Pradesh had addressed this
fundamental problem by implementing the midday meal
scheme that provides children with at least one
nutritionally adequate meal a day. This programme was
known to lead to higher attention spans, better
concentration, and improved class performance.
44Section II : Proceedings - Day 2
Malnutrition: Issues and Concerns
It also provided parents with a strong incentive to send
children to school, thereby encouraging enrollment and
reducing absenteeism and dropout rates. School meal
programmes supported health, nutrition, and education
goals and consequently had a multi-pronged impact on a
nation's overall social and economic development.
5. Women's work and family well-being by Dr. Sunita
Kaistha, Reader, Jesus and Mary College, University of
Delhi
This presentation examined the impact of social
protection/inclusion measures including providing mid-
day meals at school, child care support for working women
and cash transfer programs especially for visits to health
centres on children's health, education and nutrition.
It pointed that working women, including those who were
forced to work – to make ends meet or otherwise, were
unable to reconcile their responsibilities of work and child
care. It argued that in view of the close relationship
between women's earning and children's well-being, social
inclusion measures mentioned above which increased
women's access to better- paying jobs were likely to have
positive implications for children's well- being specially
health and nutrition through its income effect. As food was
more likely to fall under the control of women within the
household than cash, it would benefit the entire household
specially children. Moreover, with increasing 'feminisation
of poverty', with less food to go around, it was invariably the
women who gave up their food to feed the family.
6. Current nutrition programmes in India by
Nitinkumar H. Umraniya, Lecturer, Chitrini Women's
College of Education, Prantij, Dist.: S.K. (Gujarat)
This paper described nutritional programmes in India. It
pointed out that the nutritional problems in India were
protein energy malnutrition (PEM), iodine deficiency
disorders (IDD), Vitamin A deficiency (VAD) and anaemia.
Besides, fluorosis was also prevalent, and lathyrism was
localised to certain regions. The Nutrition Cell in the
Directorate General of Health Services provided technical
advice on all matters related to nutrition. The State
nutrition divisions, set up in 17 States and Union
Territories, assessed the diet and nutritional status in
various groups of population, conducted nutrition
education campaigns, and supervise supplementary
feeding programme and other ameliorative measures.
Surveys conducted by State nutrition divisions and
National Nutrition Monitoring Bureau (NNMB) under the
Indian Council of Medical Research (ICMR) revealed that
malnutrition and other deficiency disorders were found
more in young children, and among pregnant and lactating
women.
7. The Primacy of Malnutrition, Education and
MDGs by Madhulika Sharma, Junior Research, Dept. of
Education & Community Service, Punjabi University,
Government policies to improve nutritional status and
education were linked to achieving the Millennium
Development Goals 1 and 2. This paper stated that the
challenge was in bringing universal socio-educational
revolution to check malnutrition, and suggested that
immediate priority should be given to formulate a set of
effective mechanisms at national level to reduce
malnutrition keeping in mind the objectives of MDGs. It
recommended bridging the gap between government
mechanisms and NGOs and curbing malnutrition in
targeted rural and urban areas. There was no time for
Q&A/Discussion.
45Section II : Proceedings - Day 2
Malnutrition: Issues and Concerns
Valedictory Address by Dr. N. J. Rathod, Consultant,
National Rural Health Mission
Dr. Rathod stated that malnutrition was a global problem.
The poor and disadvantaged population suffered from
malnutrition. Affluent societies face the problem of
overnutrition. People's movement would be a useful to
identify malnutrition and bring it to the notice of the
concerned authorities for appropriate interventions. He
suggested the following points that needed to be
considered when dealing with malnutrition:
Ÿ Breastfeeding should be encouraged. It should be
initiated
Ÿ Routine immunisation is required to maintain
nutritious status of children
Ÿ Children should be sent to anganwadi and also mothers
should go there
Ÿ Safe drinking water should be provided
Ÿ Anaemia among adolescent girls and women should be
prevented/corrected
Ÿ Iodide salts should be made available
Ÿ Early marriage should be discouraged as it is related to
low birth weight of children
Ÿ Women should be trained in correct child feeding
practices
Dr Rathod concluded his valedictory address by urging
everyone to take responsibility in order to combat
malnutrition and related problems.
Closing ceremony
Padmini Somani of Narotam Sekhsaria Foundation gave a
concluding speech. She said that the Malnutrition Seminar
was indeed very enlightening. She said malnutrition was a
multi dimensional problem and must be tackled from all
angles. She was impressed by the presentations and the
range of issues brought out. She hoped to work with
members of the academia on malnutrition. She invited
participants to contact the Foundation with comments,
suggestions and also proposals for plan of action so as to
work together. She acknowledged that Leni had suggested
the need to discuss malnutrition from NGO perspective and
also to get experts to talk in an academic atmosphere.
Certificates of attendance were then distributed. Ms
Somani thanked Dr. Rathod and Dr. S.V. Ranade, Asst.
Director of Family Welfare, DGHS, Maharashtra for giving
the valedictory address and a presentation on various
government initiatives respectively and also Dr. Dakure of
DGHS for his cooperation. She also thanked Prof. Dr.
Vibhuti Patel of SNDT Women's University and her NSF
team mates Leni, Anushakti, Leela from the Accounts and
Administrative department and other office staff.
46Section II : Proceedings - Day 2
Malnutrition: Issues and Concerns
Dr. N.J. Rathod
SECTION III - Recommendations
Recommendations
Sustainable Solutions
48
51
Section III : Recommendations 48
Several recommendations were made in various
presentations. These recommendations are categoried
under broad subjects for easy reference, which include the
following:1) Awareness raising, 2) Peoples participation, 3)
Government programmes, 4) Government policies, 5)
Vulnerable groups6) Tribal upliftment, 7) Migrant workers
8) Micronutrient deficiency, and 9) Sustainable solutions
for battling malnutrition.
1. Awareness raising
Ÿ Improve nutrition education and raise awareness on
nutrition and healthy living
Ÿ Importance of nutritive value of food and ensure that
children get adequate food rich in proteins, minerals,
iron and zinc
Ÿ Encourage people to consume milk, eggs, meat which are
sources of animal protein
Ÿ Create awareness on breastfeeding and young child
feeding practices
Ÿ Raise awareness on problems of obesity and its
prevention
Ÿ Raise awareness on personal and environmental
hygiene
Ÿ Involve television, radio and other powerful media to
spread the message of healthy diet and living
Awareness raising for specific groups
Ÿ Make it mandatory for schools to provide nutrition
education for students and parents
Ÿ Increase awareness of teenagers and young adults on
daily intakes of fruit, vegetables, non-fried food, low-
fat dairy and whole grains. To avoid junk food such as
vada pav, burgers, pizza, and sweetened carbonated
drinks
Ÿ Raise awareness in schools and colleges about the
importance of physical activity
Ÿ Provide nutritional information also for the educated
and wealthy groups of people
Ÿ Provide nutrition education/awareness for vulnerable
2. People's participation
• Collaborate with the academia and NGOs to act on the
malnutrition problem
Ÿ Build a strong people’s movement and participate
actively
• Use the UN procedure to bring about change
• Involve self-help groups in malnutrition programmes
• Popularise local nutritious snack food such as, idli, dosa,
thepla, dhokla and thalipeeth instead of burgers, pizzas
and pasta
• Increase female literacy and female autonomy, especially
in rural areas
3. Government Programmes
Ÿ Require better co-ordination and implementation of
government programmes
Ÿ Review and revive existing programmes and policies
Ÿ Introduce programmes which will: i) administer
regularly 2 doses of vitamin A to all children under 5
years of age, ii) administer iron tablets to all pregnant
women and lactating mothers, and iii) administer iron
tablets to at least 70 per cent of adolescent girls in rural
areas
Ÿ Encourage women to practise sustainable agriculture
Ÿ Encourage capability approach to development
Ÿ Incorporate National Biodiversity Strategy and Action
Plan (NBSAP) to reduce poverty, encourage female
Section III : Recommendations
Malnutrition: Issues and Concerns
groups
autonomy and improve nutrition security
Ÿ Ensure that social protection measures/ programmes
recognise women's dual roles
Ÿ Frame programmes without further burdening
mothers. Mothers must be intertwined with those of
their children
Intervention programmes for farmers
Ÿ Introduce risk mitigation programmes for farmers
which will go beyond suicides and debt. It should
address yield, price, credit, income, weather and other
uncertainties
Ÿ Spruce up of public investments that will increase
returns to cultivation. Skill enhancement and linking of
opportunities to local resources are required to
increase income from non-farm avenues
Ÿ Introduce effective regulation of credit and input
markets
Ÿ Establish institutions that can organise farmers
Ÿ Encourage technological and financial products that
would reduce costs while increasing returns
Programmes for preschool children and mothers
Ÿ Improve the quality of ICDS services
Ÿ Ensure regular monitoring of the ICDS programmes
Ÿ Involvement of mothers in anganwadi activities
Ÿ Continue Mid Day Meals programmes because they
have positive impact on annual school enrolment, daily
school attendance, and has employment implications
for women
4. Government Policies
Ÿ Plan food policies with focus on nutritive value of
food and not to calories
Ÿ Provide cereals at low cost, so that people's money can
be spent on other foods, as a large portion of wages is
spent on cereals – rice and wheat
Ÿ Prevent malnutrition by providing food not
micronutrients
Ÿ Promote healthy nutrition practices during pregnancy
and the first two years of life; it should promote and
support traditional practices such as adequate rest
during pregnancy and breastfeeding
Ÿ Develop parks, jogging tracks & playgrounds for
physical activity
Ÿ Formulate a national strategy on agricultural and food
prices
Ÿ Put tax on fatty foods
Ÿ Provide subsidy on fruits and vegetables
5. Vulnerable Groups
Ÿ Take steps to increase the capacity of vulnerable
groups to earn more and have access to food
Ÿ Link nutrition with health care, water supply and
sanitation services and PDS at community as well as
household levels
Ÿ Entrust SHGs with monitoring of nutrition programme
Ÿ Ensure that foodgrains are available food through PDS
on fixed dates of the month. Relaxation norms for
setting up fair price shops may increase the coverage
and distribution in the future.
Ÿ Ensure transparency in distribution and proper
targeting of PDS
Ÿ Involve private sector in storage and transport
Ÿ Provide rationed supply of pulses and edible oil at
subsidised rates to the poorest, landless families only
under PDS
6. Tribal Upliftment
Ÿ Ensure strict measures to prevent malnutrition deaths
among tribal women and children in Melghat
Ÿ Formulate realistic development health plans based
on needs of tribal women
Malnutrition: Issues and Concerns
Section III : Recommendations 49
Ÿ Promote nutritional and health education among
lactating and pregnant tribal women
Ÿ Encourage tribal women to address their own
nutritional needs through a better utilisation of locally
available, nutritious food.
Ÿ Train tribal women to impart health education
Ÿ Train tribal girls and women as "dais"/nurses
Ÿ Maintain a health card for each tribal family where vital
information like blood group status, haemoglobin level,
genetic disorders
Ÿ Give royalty to be given to Adivasis for the use of forests
for national parks, wild life sanctuaries
Ÿ Redistribute land
Ÿ Give rights of ownership in forest produce
Ÿ Ensure decent wages
Ÿ Plan community-based programmes
Ÿ Undertake analysis of institutional, systemic and
structural issues causing malnutrition in adivasis
Ÿ Conduct authentic, systematic and continuous field
research in food habits of tribals
Ÿ Ensure that health interventions take in to
consideration tribal culture, and tribal perspectives.
Ÿ Empower tribal women socially, economically and
politically
Ÿ Train anganwadi workers to record the causes of
malnutrition properly
Ÿ Fully utilise Government-allotted funds for tribal
welfare
Ÿ Improve education status of tribals
Ÿ Reduce vitamin deficiency by systematic use of crops
growing in their area, e.g. ragi or nachni and neera
drink have high levels of proteins and iron
Ÿ Document medicinal plants which are found in the
forests
Ÿ Improve facilities for transport and communications
and healthcare
Ÿ Make available drinking water and sanitation facilities
Ÿ Provide door-to-door health and nutrition services
Ÿ Government to display political will and ensure that
maximum benefits are realised through NRHM by:
- using people's participation as a basis for increased
- greater accountability
- enhanced service delivery
7. Migrant workers
Ÿ Issue identification cards
Ÿ Issue BPL status & Allotment of PDS cards
Ÿ Have mobile dispensaries at construction sites
Ÿ Have part time schools at construction sites
Ÿ Participation of NGOs
Ÿ Ensure that employers provide snacks and tea
Ÿ Provide nutritional education
Ÿ Ensure overtime wages for extra hours of work
Ÿ Provide bathrooms and toilet facilities
Ÿ Provide basic education to coolies and their children
Ÿ Provide social security and safety net for good nutrition
8. Micronutrient deficiencies
Ÿ Make it mandatory for universal double fortification of
salt with iodine and iron
Ÿ Motivate industry to promote fortification of at least 50
per cent of marketed wheat flour, bread, biscuits, milk,
edible oil, sugar and tea, with relevant fortificants and
take steps to facilitate fortification.
Malnutrition: Issues and Concerns
Section III : Recommendations 50
Sustainable solutions
The following recommendations were made for battling
malnutrition by Radha Holla, BPNI, New Delhi
Children need adequate quantities of wholesome, diverse
foods to grow and develop in the best manner possible.
These foods should meet their requirements of various
nutrients, as well as calories. Nearly 70 per cent of India's
children do not get as many calories as they need or the
diverse foods required to meet their micronutrient needs.
The following are recommendations for sustainable
solution to prevent and tackle malnutrition:
Sustainable solutions for children
As a result of the Right to Food Campaign and the Peoples
Union of Civil Liberties (PUCL) cases filed as part of the
campaign, the Supreme Court of India gave some landmark
orders: provision of hot cooked meals in schools and in the
ICDS, and banning of contractors from the schemes. This
was intacit recognition that replacing hot cooking meals
with packaged foods does not ensure improvement of
malnutrition.
However, much more needs to be done. In the context of
dealing with malnutrition in children, the following
strategies need to be adopted:
1. Universalised maternity entitlements. Women need
adequate nutrition and care, including health care,
during pregnancy, after delivery and when they
breastfeed. They need skilled counselling and support to
begin breastfeeding within the first hour. During the six
months of exclusive breastfeeding, they need to stay
close to their children, at the risk of losing their wages.
Therefore it is necessary to have maternity entitlements
that include:
Ÿ Compensation for staying home to breastfeed the very
young child at the risk of losing wages or affecting their
economic status, on the lines of the “Dr.Muthulakshmi
Reddy Maternity Benefit Scheme” in Tamil Nadu, where
women are given cash support of Rs 1,000 per month for
six months starting from the 7th month of pregnancy, for
care during pregnancy and after delivery.
Ÿ Adequate nutrition during pregnancy and lactation,
including good quality supplementary nutrition for
pregnant and lactating mothers through the ICDS
Ÿ Adequate access to quality health care services
Ÿ Adequate access to skilled counselling and support for
early initiation of breastfeeding and exclusive
breastfeeding.
2. Exclusive breastfeeding for children up to six months.
ICDS and the health system should mainstream
providing skilled counselling and support for women to
practice exclusive breastfeeding for six months through
adequate training of frontline workers such as ASHA,
anganwadi workers and ANMs. Mitanins in Chhattisgarh
have shown the way.
3. Skilled counselling and nutritional support for children
under three. Children require solid foods that are calorie-
dense, including fats, after six months of age
(complementary feeding).
Malnutrition: Issues and Concerns
Section III : Recommendations 51
Radha Holla
Nutritious and carefully designed take-home rations
(THR) based on locally procured food should be provided
as “supplementary nutrition” for children in this age
group. Currently THRs are in the form of just grain – this
is inadequate.
Also, THRs must be combined with nutrition counselling
and nutrition and health education sessions for mothers
and family members to ensure that children of this age
group are given appropriate and adequate foods at home.
Further, skilled counselling is also required to educate
the family on the psycho-social and learning needs of the
child.
4. Pre-school and hot, cooked meals for all children in the
age group of 3 years – 6 years. Preschool education is very
significant in helping children to prepare for formal
schooling. Preschool education assists children both to
enter school and to remain in the system. The ICDS must
provide a centre-based play-school facility at the
anganwadi with the worked trained in conducting
preschool activities.
For these children a culturally acceptable, varied,
adequate, energy meal that has multiple nutrients
including micronutrients like Vitamin A and Zinc must
be provided at the Anganwadi centre.
5. Day care centres or crèches. Women across the country
work long hours at paid and unpaid work, often starting
to work very soon after delivery. They need support to
provide adequate care and attention to their children.
They need safe places or crèches, close to their work
sites, run by trained workers, where they can keep their
infants, and where their older children will receive hot
cooked meals and health care.
Crèches must be designed to meet the varying needs of
children of different age groups. Infants 0-6 months
need to be breastfed on demand. Children 6mths-3
years of age need 5-6 small but nutritious and energy-
dense meals a day. Children 3-6 years of age need 3-4
small but nutritious meals a day.
Existing crèche schemes such as the Rajiv Gandhi
Crèche Scheme and provision for crèches under the
NREGA must also be expanded and strengthened.
6. Second anganwadi worker for ICDS centres. Adequate
care of children under three, which includes skilled
counselling on breastfeeding, nutrition and learning
needs, combined with effective preschool education for
children aged 3-6 years cannot be achieved without the
involvement of two anganwadi workers (along with the
anganwadi helper). The availability of at least two
anganwadi workers at each anganwadi centre would
make it possible for one of them to concentrate on
providing the home-based services, while the other can
provide centre-based activities such as pre-school.
7. Convergence between the Health and the Women and
Child Development Department at all levels including
provisioning of basic health care services including
Nutritional Rehabilitation Centres for highly
malnourished children. Regular interventions like
health screening and referral, growth monitoring,
immunisation and de-worming must be carried out by
the ICDS and health department together.
There are several factors that affect the nutritional status
of children, including food and health factors. Tackling
malnutrition effectively will require that the health
department and the ICDS work together at all levels.
Malnutrition: Issues and Concerns
Section III : Recommendations 52
8. Investing in the ICDS workforce through training and
capacity building. The training programmes should
recognise pre-school education and nutrition
counselling as essential components. Within the overall
framework, training curriculum, material and
approaches should be developed in a decentralised
manner, to be appropriate to the specific state/district
level.
9. Building in a comprehensive monitoring and evaluation
system. A more robust, regular and independent
monitoring and evaluation system, where workers are
not forced to under-report malnutrition is needed. As
things stand, the most reliable source of information on
child nutrition is the National Family Health Survey
(NFHS). However, the NFHS surveys have been
conducted at intervals of 6-7 years. Further, these
surveys are too small to produce nutrition indicators at
lower levels of aggregation than the State level (e.g. the
district level). Ideally, NFHS-type surveys should be
conducted every five years on a scale that would allow
the estimation of district-level health and nutrition
indicators, and every year on a smaller scale. At the very
least, national NFHS-type surveys should be conducted
at intervals no larger than three years. Expert scrutiny
of this issue is urgently required.
A high-level overseeing mechanism should be created
which will serve as a strategic oversight, technical
support and ensure convergence and accountability in
the range of interventions concerned with child
nutrition.
10. Improving governance and involving communities.
Decentralisation is the key to reducing corruption. A
decentralised approach is required, fostering
participatory planning, community ownership,
responsiveness to local circumstances, and the
involvement of Panchayati Raj Institutions (PRIs). Key
decisions, including decisions on recruitment and
transfers should be taken locally. Procurement of food
should be done at the village level without private
contractors, as the Supreme Court has ordered.
Medicine kits and pre-school kits should be procured
locally. Monitoring and evaluation should also be
carried out at the block and district level with the active
involvement of PRIs.
Other sustainable solutions
In addition to the above, the government must ensure the
following in order to maintain food security and thereby
reduce malnutrition and micronutrient deficiencies.
1. Safeguard the rights of local food producers and
communities to the land, water and biodiversity, to
produce diverse foods and be paid fairly for their
produce. Production of staple foods for basic needs
should have priority over production for exports.
2. Ensure livelihoods for all who can work, particularly in
the unorganised sector, at wages that are adequate to
sustain life and their nutritional well being with dignity.
3. Universalise public distribution system based on
nutritional norms of above 2400kcal/person/day as well
as the adequate protein and all nutrients, and accessed
through diverse foods such as millet, pulses, dairy
products, fruit and vegetables.
4. Maintain the price of basic foods like oil, grain, milk,
pulses, vegetable and eggs at levels that people can afford
to buy.
5. Ensure that any food or ingredient introduced in public
food and public health programmes undergoes strict
Malnutrition: Issues and Concerns
Section III : Recommendations 53
holistic independent scientific assessment and is
subject to regulation. No new chemical, industrial
additive or fortified food or therapeutic food should be
introduced in the public health and public food
programmes till all conditions of providing adequate
food and water are in place.
6. Ensure access to safe and adequate water as a public
good.
7. Ensure independent and unbiased research by
providing public funds. The source of funding for
research studies which are used for programme inputs
should be verified to ensure that there is no conflict of
interest.
Malnutrition: Issues and Concerns
Section III : Recommendations 54
8. Ensure that international bodies are not used to
undermine food sovereignty and nutrition security. All
interactions of government with any international or
commercial body should be transparent and subject to
democratic scrutiny. No industry representative should be
in government delegations for any international
negotiations such as CODEX. There should be no direct or
indirect commercial participation in health, food and
nutrition related policies at all levels of governance
nationally.
Annex
Annex 1 - Programme Schedule
Annex 2 - List of Particpants
56
57
Programme : 11th January, 2010
1.30 p.m to 2.00 p.m: Registration
2.00 p.m to 3 p.m : Inaugural Function
Welcome: Ms. Padmini Somani, Director, Narotam Sekhsaria Foundation, Mumbai.
Key Note Address: Prof.Dr. Veena Shatrugna, Former Dy. Director & Head Clinical Division, National
Institute of Nutrition Hyderabad and Consultant Indian Institute of Public Health, Hyderabad.
Presidential Address: Prof. Dr. Chandra Krishnamurthy, Hon. Vice Chancellor, SNDT Women's
University, Mumbai.
Chief Guest Address:
3 p.m. to 3.30 p.m. Tea/Coffee Break
Panel Discussion: Discourse on Nutrition and Malnutrition
3.30 p.m. to 5.00 p.m.
Speakers: Prof. Dr. Sumati Kulkarni, Retired Professor, IIPS, Mumbai
Prof. Dr. Sulabha Parsuraman, Professor, IIPS, Mumbai
Prof. Dr. Sangeeta Kamdar, Prof. & Head, Economics, NMIMS Deemed Univ., Mumbai
Dr. Srijit Mishra, Associate Professor, IGIDR, Mumbai
Programme: 12th January, 2010
10 am to 4.00 p.m
Technical sessions – Paper Presentation & Discussion
Session 1 - Political Economy of Malnutrition
Session 2 - Effects of Malnutrition on Mortality and Morbidity: National profile and regional; rural-urban; caste, class,
gender, ethnicity and religious variations
Session 3 - Discourse on micronutrient deficiencies, food and nutrition supplements
Session 4 - Policy, schemes and programs concerning nutrition: Role of Government and NGOs
4.00 p.m. to 4.30 p.m.
Valedictory Session
Adv. Anand Grover, UN Special Rapporteur on the Right of Everyone to the
Enjoyment of Highest Attainable Standard of Mental and Physical Health
Annex - Programme Schedule 56
Annex 1 - Programme Schedule
Malnutrition: Issues and Concerns
Speakers
1. Prof. Dr. Veena Shatrugna, Consultant, Indian Institute of Public Health, Hyderabad ([email protected])
2. Adv. Anand Grover, UN Special Rapporteur on the Right of Everyone to the enjoyment of the highest attainable
standard of mental and physical health ([email protected])
3. Dr. N. J. Rathod, Consultant, National Rural Health Mission
4. Prof. Dr. Sumati Kulkarni, Retired Professor, International Institute for Population Sciences (IIPS), Mumbai,
5. Prof. Dr. Sulabha Parsuraman, Prof, IIPS, Mumbai ([email protected])
6. Prof. Dr.Sangita Kamdar, Prof. of Economics, Narsee Monjee Institute of Management Studies (NMIMS), Mumbai,
7. Dr. Srijit Mishra, Associate Prof., Indira Gandhi Institute of Development Research (IGIDR), Mumbai
Paper Presenters
1. Dr. Suhas V. Ranade, Asst. Director, Family Welfare, Directorate General of Health Services (DGHS) Maharashtra,
Mumbai
2. Dr. K. Srinivasa Rao, Sr. faculty, PG Dept. of Commerce, Vivek Vardhini (AN) College, Hyderabad
3. Dr. Sunita Kaistha, Associate Professor, Jesus and Mary College, University of Delhi ([email protected])
4. Sharvari Kulkarni, Dept of Mathematics, Model College Dombivli (E), Mumbai ([email protected])
5. Meghana Shinde, Dept. of English, Model College, Dombivli (E), Mumbai ([email protected])
6. Dr. Preeti Singh, Associate Professor, Jesus and Mary College, University of Delhi ([email protected])
7. Dr. Ratnawali, Assistant Professor, Centre for Social Study, Surat, Gujarat ([email protected])
8. Manjusha Bhakay, Sr. Lecturer, Dept. of Food Science And Nutrition, SMRK.BK.AK Mahila Mahavidyalaya, Nasik.,
Maharashtra ( [email protected])
9. Dr.Ramesh D.Potdar, Centre for the Study of Social Change (CSSC), Mumbai. ([email protected])
10. Nitinkumar H. Umraniya, Chitrini Women's College of Education, Tal. Prantij, Dist.: S.k. (Gujarat.)
11. Madhulika Sharma, Junior Research Fellow, Dept. of Education & Community Service, Punjabi University, Patiala,
Punjab ([email protected])
12. Geeta Shah, S.N.D.T. College of Arts and S.C.B College of Commerce and Science, Mumbai ([email protected])
13. Tejashree L Shende, Dept of Home science, Women's College of Home Science & B.C.A, Loni, Maharashtra.
Annex 2 - List of Participants 57
Annex 2 - List of Participants
Malnutrition: Issues and Concerns
14. Dr. Renu Dewan, Reader in Psychology, Ranchi Women's College, Ranchi University, Jharkhand
15. Swatija Manorama, CAFYA, Mumbai. ([email protected])
16. Farhat Ali, CAFYA, Mumbai. ([email protected])
17. Dr. Vanmala Hiranandani, Reader-cum-Deputy Director, Center for the Study of Social Exclusion and Inclusive
Policy, SNDT Women's University, Juhu, Mumbai. ([email protected])
18. Radha Holla, Campaign Coordinator,IBFAN Asia/BPNI, Delhi ([email protected])
19. Shalini Mathur, Lucknow, Uttar Pradesh. ([email protected])
20. Swati Vaidya, Dept. Of Economics,Smt. B. M. Ruia Girls' College, Gamdevi, Mumbai. ([email protected])
21. Beauty Gogoi, Research and Teaching Assistant, IGNOU, New Delhi ([email protected])
22. Dr. G. Subbulakshmi, Consultant, Impact India Foundation, Mumbai ([email protected])
23. ManiMala, Delhi ([email protected])
24. Prof. P.Malyadri, Head Dept. of Commerce, Vivekananda Government College Vidyanagar, Hyderabad , Andhra
Pradesh. ([email protected])
25. Twinkle N. Thakkar, College of Home Science, S.N.D.T. University – Juhu , Mumbai ([email protected])
26. Poonam Singh, PN Doshi Women's College, Ghatkopar. Mumbai ([email protected])
27. Sushma Singh, JVM College of Arts, Commerce & Science, Airoli. Mumbai
28. Prof. Pushpa M. Savadatti, Post Graduate Dept of Economics, Karnataka University, Dharwad, Karnataka
29. Bandu Sane, Khoj Melghat , Maharashtra ([email protected])
30. Shubhangini A, Joshi, Lecturer, Dept. Food Technology, P.V. Polytechnic, SNDT Women's University, Juhu ,Mumbai
31. Rekha Talmaki, S.N.D.T. Arts Commerce and Science College for Women, Mumbai
32. Dr. Daksha Dave, SNDT University, Mumbai
58Annex - List of Participants
Malnutrition: Issues and Concerns
Organisers
Narotam Sekhsaria Foundation
1. Padmini Somani, Director ([email protected])
2. Leni Chaudhuri, Programme Manager ([email protected])
3. Anushakti Tayade, Project Officer ([email protected])
SNDT Women's University
1. Prof. Dr. Vibhuti Patel, Head, PG Economics Department, Director PGSR, SNDT Women's University, Mumbai.
2. Dr. Veena Devasthali, Reader, PG Economics Department, SNDT Women's University, Mumbai
3. Dr. Ruby Ojha, Reader, Dept. of Economics, PGSR, SNDT Women's University, Mumbai
Annex - List of Participants 59
Malnutrition: Issues and Concerns
Annex - List of Participants 60
Malnutrition: Issues and Concerns
List of Participants
No. Name Organisation Email
1. Saurandi Vaidya Shramjeevi Sanghatan
2. Kishor P. Kadam SNDT College of Arts & [email protected] SCB College of Com. & Sci., Churchgate, Mumbai
3. Dr. Kalpana Modi PVDT College of Edn. for Women, [email protected] SNDT Women’s University, Mumbai.
4. Rajaram Rokade State Bureau of Nutrition, [email protected] Public Health Dept.,
Govt. of Maharashtra.
5. Dr. R. D. Patil
6. Bandya L.Sane Khoj Melghat [email protected]
7. Mr. Phad Sanjay Dept. of Economics, PGSR, [email protected] Phulchand SNDT Women’s Univ. Churchgate, Mumbai.
8. Ms. Reena Mary George [email protected]
9. Keda V. Deore P.V.D.T College of Education, Mumbai
10. Mr. Kishan Choure Vidhayak Sansad [email protected]
11. Dr. Ruby Ojha PGSR Eco. Dept., [email protected] SNDT Women’s Univ. Mumbai.
12. Dr. K. S. Ingole Dept. of Economics [email protected] PGSR, SNDT University
13. Dr. Arvind S.More. ADHO, Health Dept., Zilla Parishad, [email protected] Nashik, Maharashtra.
14. Dr. Alex George Save the Children, New Delhi [email protected]
15. Dr. Ramesh Bansod ADHO, Camp, Dharni, [email protected] Zilla Parishad, Amaravati.
16. Dr. Nini Gulla [email protected]
17. Radha Merchant Bhatia Hospital [email protected]
18. Bhavisha Sanadhya St. Jude [email protected]
19. Snehal Kulkarni St. Jude [email protected]
20. Prof. D. D. Jadhav PGSR Dept. of Sociology, SNDT Univ., Mumbai
Annex - List of Participants 61
Malnutrition: Issues and Concerns
No. Name Organisation Email
21. Vaishali Wankhede Dept. of Sociology [email protected]
22. Sumati Shinde Dept. of Eco. G. E. I. S. Mahila Mahavidyalaya, Dombivali
23. Surekha Gaikwad Dept. of Eco. G. E. I. S. Mahila Mahavidyalaya, Dombivali
24. Pratibha Loke Physics, Dept, G. M. D. Arts, B. W. Commerce & Science College,
Sinnar Dist., Nashik
25. A. D’Souza BUILD, Mumbai
26. Dr. Ankita Srivastava Masum, Pune [email protected]
27. Dr. Vivek Korde Mumbai [email protected]
28. Dr. Rekha K.Talmaki SNDT College of Arts, Com., Sci. [email protected] for Women, Churchgate.
29. Jayashree Gadapa Bal Asha Trust, Anand Niketan, [email protected] Dr. E. Moses Road, Mahalaxmi, Mumbai .
30. Pradnya Shinde Ambuja Cement Foundation pradnya.shinde@ambujacement .com
31. Dnyaneshwar Tarwade Apnalaya, Mumbai [email protected]
32. Kamini Kapadia JSA, Mumbai [email protected]
33. Dr. Padma Shetty Aga Khan Health Service India [email protected]
34. Sajeda Shaikh SNDT college of Arts, Com. & Sci. for Women, Churchgate, Mumbai.
35. Prin. Dr. Kute P. V. D. T. College of Education, [email protected] SNDT Univ. for Women, Mumbai
36. Meena Prakash P. V. D. T. College of Education, pvdt [email protected] SNDT Univ. for Women, Mumbai
37. Varsha Raj Observer Research Foundation [email protected]
38. Dr. Ritu Khatri J. N. U., New Delhi [email protected]
39. Dr. Vaibhao Ambhore TISS, Mumbai [email protected]
40 Rajani C. Patak S. N. D. T. College of Arts & S. C. B. College of Com. Sci., Mumbai
Annex - List of Participants 62
Malnutrition: Issues and Concerns
No. Name Organisation Email
41. Mr. Nilkanth Waghmare S.N.D.T. College of Arts & Commerce.
42. Dr. Hansa A. Dave P.V.D.T. College [email protected]
43. Dr. Mehta Meena B. Dr. B. M. Nanavati College [email protected] of Home Science
44. Dr. Subhash Waghmare P.V.D.T. College, Mumbai [email protected]
45. Sarika Dinkar K.Rangoonwala Foundation [email protected] (India) Trust, Mumbai.
46. Madhuri Nigudkar S.V.U. College of Home Sci., [email protected] S.N.D.T. Univ. Mumbai.
47. Prajakta Bhadgaonkar S.N.D.T. College of Arts & Com. [email protected] Mumbai.
48. Bhupendra Uttam P.V.D.U. College of Education [email protected] Bansod. S.N.D.T. Univ. Mumbai - 20.
49. Suhas Chavavan S.N.D.T. College of Arts & [email protected] SCB Com.
50 Bhavna P. Mehta S.N.D.T. College of Arts & SCB Com.
51. Sushma Shende Sneha, Mumbai [email protected]
52. Chandrika Bahadur Reliance Foundation [email protected]
53. Vaijanath G Suryawanshi S.N.D.T. College 54. Mankare D. Raghunath S.N.D.T. College [email protected]
55. Putul Sathe S.N.D.T. College [email protected]
56. Namrata Gawkar S.N.D.T. College of Arts & SCB [email protected] College of Com. & Sci.
57. Ravindra Hande [email protected]
58. Harsha Chopra CSSC, Mumbai [email protected]
58. Devi Shiva Shankaran CSSC, Mumbai [email protected]
59. Sarah [email protected]
60. Preeti Naik CSSC, Mumbai [email protected] 61. Mahesh Rajguru Rangoonwala Foundation [email protected]
Annex - List of Participants 63
Malnutrition: Issues and Concerns
No. Name Organisation Email 61 Mahesh Rajguru Rangoonwala Foundation [email protected]
62. Sonal Shukla Vacha, Mumbai [email protected]
63. K. Venkat Bhaktivedanta Hospital [email protected]
64 Dr. Santosh Bhaktivedanta Hospital [email protected]
65. Kanchan S. Chavan S.N.D.T. Juhu
66. Prof. B. M.Jani Rajkot [email protected]
67. Ram Pradhan S.N.D.T. University 68. Prashant Kamble S.N.D.T. University, Mumbai
69. Ramesh Gaikwad S.N.D.T. Gaikwad University
70. Dr. Harshita R. Mehta S.N.D.T. University
71. Sonali Wadke Hajare Staff S.N.D.T. Univ. Churchgate. 72. Bangar Macchender P.V.D.T. College, Suryakant SNDT Univ., Churchgate,
73. Asha Sonawane S.N.D.T. College, Churchgate, Mumbai.
74. Vidya D.Gaikwad S.N.D.T. College, Churchgate, Mumbai
75. Rohini Kor S.N.D.T. College, , Churchgate, Mumbai
76. Kartiki Jadhav S.N.D.T. College, Churchgate, Mumbai.
77. Deepali Gaikwad S.N.D.T. College, Churchgate, Mumbai
78. Dr. Madhuri Sutey S.N.D.T. College, Churchgate, Mumbai
79. Prabhakar Nair Institute for Community Organisation & Research (ICOR), Mumbai
80. Savita Tayade S.N.D.T.College, Churchgate,
Mumbai 81 Pandurang Barkale
82. Dr. Amin Kaba Aga Khan Health
83. Manisha Rao P. G. Dept. of Sociology, SNDT Univ. [email protected]
Annex - List of Participants 64
Malnutrition: Issues and Concerns
No. Name Organisation Email
84. Tanuja Palav S.N.D.T. University
85. Sayali Nanavare Vikas Adhayan Kendra, Malwani, Mumbai
86. Aarti Shidruk Vikas Adhayan Kendra, Malwani, Mumbai
87. Pradeep Shinde Mumbai Mobile Creche
88. Sudha Kashelikar AIILSG Bandra, Mumbai [email protected]
89. Dinesh Mishra Yuva, Mumbai [email protected]
90. Sejal K.Sota S.N.D.T. College, Churchgate. 91. Meher Jyoti Sangle History Dept., SNDT, Churchgate 92. Hume, Nilesh English Dept, SNDT, Churchgate [email protected]
93. Suresh Garud Lecturer in B. V. A. (Dra & Ptg), S.N.D.T., Churchgate.
94. Dr. Rohini Sudhakar Dept of Community Ed., [email protected] SNDT Univ.
95. Anita H. Panot College of Social Work, [email protected]
Nirmala Niketan, 38, Marine Lines, Mumbai - 20.
96. Dr. Tannaz Birdi Foundation For Medical Reasearch, [email protected] 84A, R. G. Thadani Marg, Worli, Mumbai - 400 018.
97. Varsha Parchure Apnalaya, Mumbai [email protected]
98. Meenal Gandhe Population First [email protected]
99. Pratibha Agarwal P. D. Karkhanis Arts & Com. College Ambarnath.
100. Jayeeta Choudhury Consultant [email protected]
101. Sabina Yeasmin Vacha [email protected]
102. Leena Joshi Apnalaya, Mumbai [email protected]
103. Jyoti R. Parulkar Siddharth College, Mumbai.
104. Grazilia Almeida Kotak Education Foundation [email protected]
105. Naresh R. Bodkhe Chetana’s College of Eco., [email protected] Bandra (East). 106. Ankur Singh Chavhan Sneha, Mumbai [email protected]
Annex - List of Participants 65
Malnutrition: Issues and Concerns
No. Name Organisation Email
107. Sanjay P. Shedmake PVDT College of Education, Mumbai. [email protected]
108. Shubha Sharma Dept. of Economics , S.N.D.T. University
109. Jyoti Gaikwad Dept. of Economics SNDT Univ. [email protected]
110. Leena Singh Dept of Management Studies, Bedekar College, Thane (W)
111. Avnish Agarwal GIMS College, Hotel Management, Andheri
112. Dipti Bharadwaj
POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE
EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION
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UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY
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RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION
FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT
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HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD
POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE
EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION
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HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD
POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE
EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION
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POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE
EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION
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Narotam Sekhsaria Foundation was established in 2002 by Mr. Narotam Sekhsaria as a not for profit initiative to focus on
education, health and livelihood. The Foundation supports charitable and philanthropic initiatives but also partner with
government and private developmental enterprises. It works towards promoting excellence among individuals, improve the
quality of life of those living on the edges of society, recognizing innovation and preserving the traditional culture and art forms.
The Foundation believes that if each individual has access to health care and to pursue a meaningful education and through it
an opportunity for livelihood, this is the only way that India will truly move forward. The Foundation strives to partner
In pursuing the above goals the Foundation nurtures meritorious students through the scholarship program, supports mid
career professionals through its fellowship program, supports initiatives of mass learning and innovative education models. It
supports community health initiatives, strengthens public health infrastructure and institutions and encourages private
charitable initiatives in health care. It partners with initiatives which provide opportunities for capacity building and skill
training for employment.
with initiatives which believe in the same goals and contribute towards their realization