How costly nutritious food is driving up malnutrition in India

The increasing cost of nutritious food is driving up malnutrition in India, where 38 percent of children under five are stunted.

The recent economic outlook of the country has been largely positive. In August, this year, Moody’s put India’s GDP growth in 2018 and 2019 at 7.5 per cent in its Global Macro Outlook for 2018-19.  It added that the growth is supported by a strong rural and urban demand and improved industrial activity. The rating agency has also stated that India is largely resilient to external pressure.

These figures may bring much cheer, however, what is worrisome is that high economic growth figures have not translated into high nutritional status for the country.  As per a report by the International Food Policy Research Institute (IFPRI), India ranked 100 of 119 countries in the global hunger index. The country is also home to the largest number of malnourished children in the world – according to a joint study by ASSOCHAM and EY, about 50 per cent of the undernourished children in the world are in India. By 2030, malnutrition will also cost India more than USD 46 billion.

The availability of affordable nutritious food in the market is one of the biggest requirements to fight malnutrition in a country. However, in South Asian countries including India, the lack of nutrient-dense food and the high cost of nutritious food is further driving up malnutrition, according to a report released by World Bank titled The Cost of Nutritious Food in India.

Inflation, seasonal variations drive malnutrition

The World Bank working paper, authored by Felipe Dizon of the World Bank and independent consultant Anna Herforth, used existing food price data from South Asian countries including Sri Lanka, Pakistan, Afghanistan and India and applied two methods to assess the affordability of nutritious foods in these countries – Cost of a Recommended Diet (CoRD) and Nutritious Food Price Index (NPI). While CoRD involves finding the cost of meeting food-based dietary guidelines using food prices and national food-based dietary guidelines. The NFPI tracks changes in the prices of nutritious food by reweighting the food Consumer Price Index (CPI) using weights that reflect the nutritional value of food items.

The general trend around the world is that the prices of nutritious food (fruits, vegetables, pulses and animal-source food) is higher than the cost of less nutritious food (such as oil and sugar), in poorer economies and in South Asia, in particular, this difference is starker. The price of a nutritious food basket has been increasing rapidly over the years when compared to a typical food basket. The difference is the highest in Pakistan and India, where figures reveal that 38 per cent of children under 5 are stunted.

India categorises food into three – ‘vegetables and fruit,’ ‘cereals and pulses,’ and ‘dairy and animal foods.’ When comparing the nutritional weightage of each, fruits and vegetables (including legumes), followed by fish, have the highest nutritional weights, while oils and particularly sugars and beverages have the lowest nutritional weights. As per the study, in India, prices have increased the fastest for vegetables, fruits, seafood, and meat products, and slowest for non-nutritional food, energy-dense food such as beverages, sugar, and oils and fats.

The National Food-Based dietary guidelines for India recommends a minimum of 300 gms of vegetables, 100g of fruits, 300 ml of dairy and 60 gms of pulses daily, however, these guidelines are rarely met. Instead, there is more emphasis on energy-dense food such as bread and cereals which may be low on micro-nutrients. This manifests into nutritional problems such as Protein Energy Malnutrition (PEM) and micronutrient deficiencies such as vitamin A deficiency (VAD) , Iron Deficiency Anemia (IDA), Iodine Deficiency Disorders(IDD) and vitamin B-complex deficiencies among the rural poor and urban slum communities.

According to the World Bank study, the rising cost of nutritious food can be largely attributed to fluctuations in the prices of vegetables. This is mostly because food such as vegetables, fruits and seafood are all highly perishable. Seasonality is also a major factor when it comes to food prices, especially in the case of nutrient-dense food. The prices of vegetable and pulse have been most affected by seasonality, while energy-high nutrient dense food is largely non-affected by perishability, seasonality and regional variations.

In order to tackle malnutrition in the country, it is important that a nutritious diet is made more affordable for the average citizen, the study argues. It adds that if policymakers want to improve diet quality in India and the South Asian region, they would have to ensure better availability of fruits, vegetables, legumes and animal-source food.