Work Book-3

RAU'S IAS
STUDY CIRCLE
BLUE WORKBOOKS
INDIAN ECONOMY AND

ECONOMIC DEVELOPMENT
[Module - II]
GENERAL STUDIES
PRELIMS PAPER-I
MAINS PAPER-III
WORK BOOK-3
1. India’s Hunger and Malnutrition Paradox: Issues and
Policy Concerns and Options
2. Practice Questions
INDEX
INDIAN ECONOMY AND
ECONOMIC DEVELOPMENT
WORK BOOK-3
CHAPTER PAGE
CHAPTER NAME
NO. NO.
India’s Hunger and Malnutrition Paradox: Issues and
1. 1-19
Policy Concerns and Options
2. Practice Questions 20-29

India’s Hunger and Malnutrition
1 Paradox: Issues and Policy
CHAPTER Concerns and Options
CONTENT
1. Introduction: Paradox & Conceptual Clarity on Hunger and Malnutrition
2. Assessment of Incidence of Hunger or Undernourishment
3. Trends in Hunger and Malnutrition
3.1 Food Adequacy – Square Meals and Adequacy Perception
3.2 Food Adequacy – Food Intake Norms
3.3 Food Adequacy –Anthropometric Norms
3.4 Food Adequacy and Child Mortality
4. Nutritional Situation Analysis according to NFHS-3 (2004-05) and NFHS-4
4.1 Child undernutrition
4.2 Undernutrition in women and girls
4.3 Safe drinking water, sanitation and hygiene
5. Global Hunger Index- Inequalities of Hunger
6. Determinants of Undernutrition
7. Poverty, Malnutrition and Economic Growth
8. Policy Response to Hunger and Malnutrition: Assessment and Options
9. National Nutrition Strategy, 2015
9.1 Vision 2022 - "Kuposhan Mukt Bharat"
9.2 Goal, Objectives and Monitorable outcomes
9.3 Identification of Focus Districts- Including Poor Performing States And Districts
9.4 Criteria used For Identification of Districts:
9.5 Guiding principles
9.6 Nutritional Interventions
9.7 Maternal Care, Nutrition and Health
9.8 Adolescent Care, Nutrition and Health
9.9 Addressing Micronutrient Deficiencies - including Anemia
10. Concluding Remarks – Way Forward
1. Introduction: Paradox & Conceptual Clarity on Hunger and Malnutrition

Indian Economy is facing a paradoxical situation wherein despite being the fastest growing emerging
economy, with adequate food availability at macro level, the extent of hunger reflected in terms of
undernutrition or malnutrition is still at ‘severe’ level, as measured in terms of Global Hunger Index, requiring
urgent intervention through appropriate policies and programmes.
The problem of hunger is complex. Thus there are different terms to describe its different forms.
RAU’S IAS STUDY CIRCLE | INDIAN ECONOMY AND ECONOMIC DEVELOPMENT | MODULE – II | WORK BOOK - 3 1
INDIA’S HUNGER AND MALNUTRITION PARADOX: ISSUES AND POLICY CONCERNS AND OPTIONS
Hunger is usually understood to refer to the distress associated with lack of sufficient calories. Hunger, as
understood in everyday life, is a state of unease or discomfort for an individual on account of not having
enough food. It is associated with a set of symptoms that could vary in a range and intensity depending on the
extent and the duration for which a person experiences food deprivation. Hunger has an obvious element of
subjectivity that makes it difficult to assess its incidence accurately in a society. This is more so in a poor
developing country, where hunger also poses some difficult policy challenges.
The Food and Agriculture Organization of the United Nations (FAO) defines food deprivation, or
undernourishment, as the consumption of too few calories to provide the minimum amount of dietary energy
that each individual requires to live a healthy and productive life, given his or her sex, age, stature, and
physical activity level. Undernutrition goes beyond calories and signifies deficiencies in any or all of the
following: energy, protein, or essential vitamins and minerals. Undernutrition is the result of inadequate intake
of food in terms of either quantity or quality, poor utilization of nutrients due to infections or other illnesses,
or a combination of these factors. These in turn are caused by a range of factors including household food
insecurity; inadequate maternal health or childcare practices; or inadequate access to health services, safe
water, and sanitation. Malnutrition refers more broadly to both undernutrition (problems of deficiencies) and
over-nutrition (problems of unbalanced diets, such as consuming too many calories in relation to requirements
with or without low intake of micronutrient-rich foods).
In fact, these terms are often interchangeably used viz. while hunger refers to inadequacy of food or
undernourishment, malnutrition refers to an imbalance of both macro and micronutrients, which could be (and
not necessarily) because of inadequate or inappropriate intake and/or inefficient biological utilization due to
physiological or environmental factors. Estimation of poverty in India involves the use of a minimum
consumption expenditure level (poverty line), which was originally anchored in an average (food) energy
adequacy norm. Thus, there is some overlap in the concepts, but they are indeed different and require a
distinct policy focus.
2. Assessment of Incidence of Hunger or Undernourishment

To assess the incidence of hunger or undernourishment, typically, the approach is to compare the actual food
intake to the required level. The required level or food adequacy can simply be defined in terms of frequency
of ‘square meals’ in a day, especially in a situation where even one or two square meals a day are not seen as a
normal occurrence. Alternately, it can be defined in terms of a set of recommended dietary allowances (RDA)
for an average individual in a society. The allowances for food adequacy can cover macronutrients like
proteins, carbohydrates and fats measured in terms of kilo calories of energy intake per day, with stipulation
on how those calories are to be sourced from different food-types to ensure balanced intake of the
macronutrients. The allowances can also cover the intake of vital micronutrients like vitamins and minerals
essential for a healthy physical life. Both these approaches to food adequacy are in use to collect data on
hunger or more generally food inadequacy in the country, even though one of them, as is shortly highlighted,
may not be relevant any more. There are, however, several issues that complicate the approach.
 First, the implication of not getting even two square meals on a regular basis, or not having food intake
that meets the RDA on macronutrients may have some visible impact on a person’s health and ability to
sustain normal activity. The same is, however, not true for a person whose food intake does not meet the
RDA on micronutrients. Micronutrient deficiency is less visible. It is often referred to as ‘hidden hunger’
and its incidence in the population is difficult to ascertain. It becomes visible only when a person faces a
severe deficiency in the intake of a micronutrient resulting in health impairment.
 The second issue follows from the first and relates to the duration of time for which a person’s intake of
square meals is erratic or, her food intake is less than the RDA, for her to be categorized as
undernourished or malnourished. Generally, if on an average, the food energy intake of an individual is
less than what is needed for a sedentary lifestyle for a year, then that individual is considered to be
undernourished or facing hunger.
 Third, if one defines hunger with respect to a set of norms (RDA), there is a problem arising from the fact
that the required level of food varies significantly with age, sex, physical activity, climate and even
topography of the habitation where a person resides. There are also significant differences between
individuals in the way their bodies utilize food intake. Individuals adapt to fluctuation in food intake
without adverse physiological effects and also differ in the extant of their adaptation due to differences in
their metabolic rates and ability to build body reserves. In other words, the wide inter-individual variation
in calorie and nutrient requirement, consistent with a normal functioning of the body, raises the possibility
of overestimating the incidence of hunger if the assessment is made on the basis of food intake.
 Fourth, this opens up the possibility of looking at the symptoms of hunger as a means to assess the
incidence of undernourishment, rather than making an assessment on the basis of food intake norms.
Thus, anthropometric indicators like low weight for age (underweight), short height for age (stunted), low
weight for height (wasted) or the composite Body Mass Index (BMI, i.e., the ratio of the weight in
kilograms to the square of the height in meters) become relevant for measuring undernourishment or even
malnourishment. By focusing on hunger symptoms in children, where the consequences of hunger and
malnutrition are least desired, for both personal and societal reasons, the incidence of undernourishment
or malnourishment in the population can be more easily assessed. The use of anthropometric indicators
potentially also helps in getting a sense of the intra-household inequalities in food intake and the
consequence on health and productivity of individuals. But the question then is are these symptoms and
the corresponding indicators reflective of body adaptation to undernourishment or, are they its symptoms.
If these conditions are considered as a symptom of hunger, there is a need for intervention to address
hunger. However, if they are an indication of body adaptation to hunger, it could be left as it is. It
becomes necessary then to consider public interventions to address chronic hunger, both visible and
hidden (to the extent feasible), in any society on social, ethical and economic grounds.
 Finally, there is also the issue that surfaces now and then about the appropriateness of using developed
country anthropometric standards for measuring undernourishment or malnourishment in India, given the
racial, climatic and cultural differences.
Trends in Hunger and Malnutrition

3.1 Food Adequacy – Square Meals and Adequacy Perception
The question on food adequacy has three sub-components – food adequacy throughout the year, food
adequacy for some months during the year, and inadequate food intake throughout the year.
As can be expected, with an improvement in food adequacy throughout the year, proportion of households not
having adequate food for some months during the year shows a decline over the NSS survey rounds. From 16
per cent of households reporting adequate food only for some months during the year in 1983, the proportion
declines to less than one per cent in 2009-10. At the state level, the proportion of households reporting food
adequacy is the lowest in Assam, Bihar, Odisha, and West Bengal. Over the years, Assam and Bihar have
improved the situation of food adequacy in both rural and urban areas. However, Odisha and West Bengal
continue to lag behind, despite some improvement. Difference in food adequacy across states is much less in
urban areas as compared to rural areas. There are also variations in food adequacy within a state across
Monthly Per Capita Consumption Expenditure (MPCE) classes. In the better performing states, food adequacy
can be observed among all households even within the lowest MPCE class. As against that, almost half of the
households in rural West Bengal and 60 per cent of households in rural Assam among the lowest MPCE class
report food inadequacy in 1993-94. Clearly, food inadequacy is most pronounced among households
belonging to lowest MPCE class, in backward states like Assam, Bihar, Odisha and West Bengal. All the four
states are in the Eastern region and high proportion of food inadequacy among rural households in these states
merely reflects the overall economic backwardness of this region.
It is also possible to analyst the food adequacy for households across occupational and social groups. The
condition of food adequacy has improved in both rural and urban India among different types of households
by occupation and so also among different social groups. For the country as a whole, food adequacy does not
seem to be a problem for any social group or household by any type of occupation. At the state level, in the
case of Odisha and West Bengal the problem of food inadequacy is much more pronounced among agriculture
labour households and ST households. The proportion of agriculture labour households in rural Odisha,
reporting not having adequate food in all the months during 2009-10 is more than 10 per cent, while it is
around 7 per cent in rural West Bengal. Similarly, across social groups, the proportion of ST households not
having adequate food in all the months during 2009-10, is more than 10 per cent in rural West Bengal and 9
per cent in rural Odisha. Coarse cereals have historically been the mainstay of diet for STs in India. However,
over the years, excessive importance to only two types of crops – rice and wheat in the agricultural pricing
policy, and in the PDS has resulted in a decline in the cultivation and availability of coarse cereals. This may
have contributed to food insecurity among the tribes. Addressing the food adequacy needs of the tribal
population requires support for the cultivation and distribution of coarse cereals through an improved PDS
network in the tribal areas. This also has the advantage of substitution of cereals by more nutritious coarse
ones.
3.2 Food Adequacy – Food Intake Norms
Using the NSS consumer expenditure data, it is possible to estimate the proportion of households with food
intake that meets the recommended average norm for food adequacy. The NSS survey collects information on
consumption and expenditure related to a large number of food and non-food items. In order to capture intake
of macro and micronutrient, the standard methodology used is to multiply the nutrient content of the food by
its quantity consumed. This gives an estimate of the nutritional intake for the household as a whole.
NSSO defines malnutrition as the proportion of population with calorie intake of less than 70 per cent of the
norm. A male in the age group of 20-39 years is considered as one consumer unit who requires 2700 kilo
calories per day. Based on age and gender, each person is assigned a certain consumer unit, and the
corresponding required calorie intake is calculated. If the actual consumption is less than 70 per cent of the
required calorie intake, then that person is considered to be malnourished. Using this norm the state-wise food
adequacy is analyzed for 1993-94 and 2009-10 based on the respective NSS rounds. In 1993-94, Maharashtra,
Bihar, Tamil Nadu, Uttar Pradesh, Andhra Pradesh and Madhya Pradesh contribute two-thirds to the total
malnourished in rural India. By 2009-10, except for Bihar, Uttar Pradesh and Madhya Pradesh, with
deterioration in the incidence of malnourished and an increase in their share of malnourished in the total rural
malnourished in the country, all the others are able to bring down the share of their malnourished. In the case
of West Bengal, the incidence of malnourished more than doubles from over 7 to nearly 19 per cent and also
in its share in the total rural malnourished. In the urban areas Maharashtra, Tamil Nadu, Uttar Pradesh,
Andhra Pradesh, Karnataka and Gujarat account for nearly two-thirds of the malnourished in the country.
Here again for Uttar Pradesh there is a deterioration in the incidence of malnourished, with the result that its
share in the total urban malnourished in the country increases. But in the case of Maharashtra and Tamil
Nadu, there is decline in the incidence and in their share of urban malnourished in the country.
Two conclusions can be drawn from the limited analysis in this section so far. (i) First, even though there is
improvement in food adequacy over the years, nutritional improvement is not commensurate; in fact there is
deterioration in some regions. In other words, ensuring full stomach is undoubtedly necessary for a hunger-
free nation, but it is by no means sufficient for ensuring productive and healthy life for all. (ii) Second, while
it is possible to say something about the nutritional intake for a household as a whole, the same cannot be said
about the intra-household variation, especially across gender and age, in food intake. There is therefore a need
to look at other approaches that can potentially address these concerns.
3.3 Food Adequacy –Anthropometric Norms
In looking at hunger symptoms as a means to assess the incidence of undernourishment and malnourishment,
it is convenient to focus on children as they are an important vulnerable group. Nevertheless, there are two
data bases that provide some information on child malnutrition at state level in India, namely the NFHS and
the Integrated Child Development Scheme (ICDS) data of the government. The NFHS is a large-scale, multi-
round survey conducted on a representative sample of households throughout India. Information on ICDS
published by the Ministry of Health and Family Welfare, Government of India is based on state level
consolidated reports that in turn avail information primarily from Anganwadi centres. The ICDS programme
service children in the age 0 to 5 years (or more accurately below 6 years). There are differences in scope,
coverage, and the target population of these two databases. The other major problem in the analysis of child
malnutrition for this report arises from the fact that while NFHS data is available only for three years – 1993-
94, 1998-99 and 2004-05, ICDS data is available for selected years, starting with 2006. Thus, in building the
aggregative picture using the two databases at the state level, it is possible to highlight only broad trends.
At the national level, while the incidence of child malnutrition (age up to 47 months) is 42.5 per cent as per
NFHS in 2004-05, it is 44.5 per cent according to ICDS in 2006 (for children up to 5 years). To look at the
trends in the incidence of underweight children over a longer period, NFHS data on underweight children for
age group 0 to 47 months for 1993-94 and 2004-05, and for age group 0-35 months for 1998-99, and ICDS
data for the age group 0-5 years for 2006, 2009 and 2012 has been picked up for all India and selected states.
At the all India level, it appears that ICDS is settling down after the first few years and seems to be working to
deliver on its objectives, as shown by a sharp decline in the underweight children after 2009. Trends at the
state level show faster pace of improvements as per NFHS data in some states like Andhra Pradesh and
Punjab for part of the period. In the case of Gujarat and West Bengal, ICDS seems to be performing better. In
Gujarat, the reported improvement in the functioning of Anganwadi centres seems to be contributing to
improvements in child nutrition. Haryana seems to be an outlier in this set with ICDS data showing only a
marginal improvement in the nutrition status of children so far.
3.4 Food Adequacy and Child Mortality
Prolonged periods of inadequate food intake and a poor diet, especially in combination with low birth weights
and high rates of infection, can result in stunted and underweight children. The most extreme manifestation of
persisting hunger and malnutrition is mortality. There is evidence to suggest that chronic food inadequacy,
especially among the children, impairs their health through increased vulnerability to diseases, especially the
communicable diseases in the case of India. This in turn leads to a higher mortality rate (number of deaths per
1000 in the specified age group) for the children. Therefore, mortality rate is seen as an important symptom of
hunger, undernourishment as well as malnourishment.
1. Nutritional Situation Analysis according to NFHS-3 (2004-05) and NFHS-4 (2015-16)

High levels of maternal and child undernutrition in India have persisted, despite strong constitutional,
legislative policy, plan and programme commitments.
4.1 Child undernutrition:
India is home to the largest number of children in the world. Nearly every fifth young child in the world lives
in India. Children and women together constitute around 70% of India’s people - representing not just the
present human resource base - but also the future. This resource base is eroded by undernutrition - which
undermines their survival, health, cumulative learning capacities and adult productivity and must be urgently
addressed.
Nearly every third child in India is undernourished – underweight (35.7%) or stunted (38.4%) and 21% of
children under five years are wasted as per NFHS 4 (2015-16). Moreover, the NFHS-4 data indicates that
every second child is anemic (58.4%). Recent data, especially for challenging states is promising, suggestive
of acceleration. However, the pace of reduction remains low and calls for focused interventions in the area for
optimal results (Figure 3.1)
Figure 3.1: Child Undernutrition
The state-wise status of underweight, stunted, and wasted Children are given in figures 3.2, 3.3 and 3.4
respectively
Figure 3.2: Underweight Prevalence in Children (0-5 Years)
Figure 3.3: Stunting in Children (0-5 years)
Figure 3.4: Wasting in Children (0-5 years)
4.2 Undernutrition in women and girls

As per NFHS 3, every third woman in India was undernourished (35.5 % with low Body Mass Index) and
every second woman (15-49 years) was anemic (55.3%). About 15.8 % were moderately to severely thin, with
BMI less than 17. Bihar (45%), Chhattisgarh (43%), Madhya Pradesh (42%) and Odisha (41%) were the states
with the highest proportion of undernourished women. The findings from NFHS 4 (2015-16) highlight that
nutritional status of women and girls (in the age group 15-49 years) has improved for all States.
Maternal care: NFHS-4 findings reveal that there is better care for women during pregnancy and childbirth -
contributing to reduction of maternal deaths and improved child survival. Almost all mothers have received
antenatal care for their most recent pregnancy and increasing numbers of women are receiving the
recommended four or more visits by the service providers.
Overall, the Total Fertility Rate (TFR) or the average number of children per woman has also gone down from
2.7 in NFHS-3 to 2.2 in NFHS-4. However, in terms of absolute values, institutional births continues to
remain extremely low in Nagaland (32.8%), Meghalaya (51.4%), Arunachal Pradesh (52.3%), Jharkhand
(61.9%) and Bihar (63.8%), which are the bottom five states with respect to institutional births. NFHS 4
findings reveal that around 26.8 per cent of currently married women in the age-group 20-24 years were
married before attaining the age of 18 years.
Micronutrient deficiencies: Deficiencies of key vitamins and minerals such as Vitamin A, Iron, Iodine and
Zinc continue to coexist and interact with protein and energy deficits and need to be addressed synergistically,
through a multipronged approach.
Infant and Young child feeding practices: There has been improvement in the early initiation of breastfeeding
rate, from 23.4% in NFHS-3 to 41.6% in NFHS-4. Similarly, there has been an overall improvement over
NFHS 3 levels in children under six months who were exclusively breastfed, from 46.3% to 54.9%. Children
aged between 6-8 months receiving solid or semi-solid food and breastmilk has gone down from 52.6% to
42.7%.
Prevention and management of common neonatal and childhood illness: The prevention and management of
common neonatal and childhood illnesses is critical for breaking the vicious cycle of malnutrition and
infection, wherein infections such as diarrhea, acute respiratory infections and measles adversely impacting
nutrition status and undernutrition increases susceptibility to infections, perpetuating this cycle. Effectively
managing the onset of infections such as diarrhea and acute respiratory infections, adequate care and referral
of severely undernourished and sick children remains a challenge.
4.3 Safe drinking water, sanitation and hygiene
NFHS 4 (2015-16) shows that families are now more inclined to use improved water and sanitation facilities.
Over two-thirds of households in every State/UT (except Manipur) have access to an improved source of
drinking water, and more than 90% of households have access to an improved source of drinking water in 19
States/Union Territories. More than 50% of households have access to improved sanitation facilities in 26
States/Union Territories. Similarly, in 20 States/ UTs, more than 50% households use clean cooking fuel,
which reduces the risk of respiratory illness and pollution.
2. Global Hunger Index- Inequalities of Hunger
The Global Hunger Index (GHI) is a tool designed to comprehensively measure and track hunger at the
global, regional, and national levels. The International Food Policy Research Institute (IFPRI) calculates GHI
scores each year to assess progress and setbacks in combating hunger. The GHI is designed to raise awareness
and understanding of the struggle against hunger, pro-vide a means to compare the levels of hunger between
countries and regions, and call attention to the areas of the world in greatest need of additional resources to
eliminate hunger. To capture the multidimensional nature of hunger, GHI scores are based on four indicators:
1. UNDERNOURISHMENT: the share of the population that is under-nourished (that is, whose caloric
intake is insufficient);
2. CHILD WASTING: the share of children under the age of five who are wasted (that is, who have low
weight for their height, reflect-ing acute undernutrition);
3. CHILD STUNTING: the share of children under the age of five who are stunted (that is, who have
low height for their age, reflecting chronic undernutrition); and
4. CHILD MORTALITY: the mortality rate of children under the age of five (in part, a reflection of the
fatal mix of inadequate nutrition and unhealthy environments).
There are several advantages to measuring hunger using this combination of factors (Figure 3.5). The
indicators included in the GHI formula reflect caloric deficiencies as well as poor nutrition. By including
indicators specific to children, the index captures the nutrition situation not only of the population as a whole,
but also of children—a particularly vulnerable subset of the population for whom a lack of dietary energy,
protein, or micronutrients (essential vitamins and minerals) leads to a high risk of illness, poor physical and
cognitive development, and death. The inclusion of both child wasting and child stunting allows the GHI to
capture both acute and chronic undernutrition. By combining multiple indicators, the index minimizes the
effects of random measurement errors. The current formula was introduced in 2015 and is a revision of the
original formula that was used to calculate GHI scores from 2006 to 2014. The primary differences are that
child stunting and child wasting have replaced child underweight, and the four indicator values are now
standardized.
Figure 3.5: Composition Of The Global Hunger Index
GHI scores are calculated using a three-step process.

 First, values for each of the four component indicators are determined from the available data for each
country. The four indicators are undernourishment, child wasting, child stunting, and child mortality.
 Second, each of the four component indicators is given a standardized score on a 100-point scale,
based on the highest observed level for the indicator globally.
 Third, standardized scores are aggregated to calculate the GHI score for each country, with each of
the three dimensions (inadequate food supply, child mortality, and child undernutrition, which is
composed equally of child stunting and child wasting) given equal weight.
This calculation results in GHI scores on a 100-point scale, where 0 is the best score (no hunger) and 100 is
the worst. In practice, neither of these extremes is reached. A value of 0 would mean that a country had no
undernourished people in the population, no children younger than five who were wasted or stunted, and no
children who died before their fifth birthday. The scale below shows the severity of hunger—from low to
extremely alarming—associated with the range of possible GHI scores:
The statement by the International Food Policy Research Institute, which produced the report for 2018 said,
“India is ranked 103rd out of 119 countries (as compared 100/1119 in 2017), and has the third-highest score in
all of Asia It further stated, “At 31.1, India’s 2018 GHI (Global Hunger Index) score is at the high end of the
‘serious’ category, and is one of the main factors pushing South Asia to the category of worst performing
region on the GHI this year, followed closely by Africa South of the Sahara.” India is ranked below many
neighboring countries, including China (25th spot), Nepal (72), Myanmar (68), Sri Lanka (67) and
Bangladesh (86). Pakistan is placed at the 106th position.
In the Global Hunger Index score, India's position was 76 (out of 96 countries) in 1992, 83 in 2000 (out of 115
countries), 102 in 2008 (out of 118 countries), 97 in 2016 (out of 118 countries), 100 in 2017 and 103 in 2018
(out of 119 countries) Hunger Index Scores for India was 48.1% in 1990, 46.4% in 1992, 42.3 % in 1995,
38.2% in 2000, 38.5 % in 2005, 36.0% in 2008, 29.0 % in 2015, 28.5 % in 2016, 31.4% in 2017 and 31.1% in
2018.
Malnutrition continues to be a significant public health problem in India despite having several major
programmes to address the issue, namely the Integrated Child Development Scheme ICDS, Mid –Day Meal
(MDM) and also Food Security Act. As Hunger levels in developing countries have fallen from 38.2% in
2000 to 31.1% per cent in 2018, but efforts to curb hunger must be accelerated in order to meet an
international target to eradicate it by 2030, according to the annual index and India along with Indonesia and
Nigeria is among 43 countries that have `serious’ hunger levels. Under nutrition is an underlying factor in
many diseases in both children and adults, and it contributes greatly to the disability-adjusted life years
worldwide. Preventing under-nutrition has emerged as one of the most critical challenges to India’s
development planners in recent times.
3. Determinants of Undernutrition
Undernutrition is the outcome of a complex interaction between insufficient dietary intake, absorption and
inadequate prevention and management of disease/infections- these are the immediate determinants of
undernutrition. Underlying determinants include the lack of access to health and child care services, safe
drinking water, sanitation and hygienic environments, lack of access to household food security and
livelihoods, and inadequate caring and feeding practices for children and women. Care practices are critical as
they translate food and health resources into nutrition outcomes for National Nutrition Strategy children and
women. These include infant and young child feeding practices, health, hygiene, care for girls and women,
psychosocial care and early learning. Direct or Nutrition specific interventions mostly focus on improving the
immediate and underlying determinants of undernutrition, with impact visible over a shorter period of time.
Basic determinants include factors such as poverty, livelihoods, social protection safety nets, agriculture,
public distribution systems, education and communication- especially female literacy and girls’ education,
women’s empowerment and autonomy in decision making, control and use of resources (human, economic,
natural), shaped by the macro socio- economic and political environments and the potential resource base.
Indirect and/ or nutrition sensitive interventions mostly address these determinants, through multi-sectoral
action and policy instruments with longer term impact. Recent findings over the last decade from Bangladesh,
Brazil, Thailand, Senegal and Vietnam point to the fact that improvements in nutrition have come from
interventions in multiple areas which include both direct nutrition interventions and indirect interventions
focusing on underlying determinants. No single standalone intervention has been able to lead to substantive,
rapid and sustainable reductions in maternal and child undernutrition. A comprehensive approach is therefore
called for which addresses multi-sectoral and inter related determinants of undernutrition across the life cycle,
as also mandated by the National Nutrition Policy 1993 and reinforced two decades later in the latest Strategy.
4. Poverty, Malnutrition and Economic Growth

In the case of undivided Bihar, Madhya Pradesh and Uttar Pradesh, along with Odisha, there has been
deterioration over time, both in terms of poverty (HCR) and malnourishment (proportion of population not
being able to access 70 per cent of the calorie RDA) in rural as well as urban areas. In 1993-94, these states
account for 54 per cent of the poor and 34 per cent of the malnourished in rural areas, and 33 per cent of the
poor and 22 per cent of the malnourished in urban areas. By 2009-10, they account for 65 per cent of the poor
and 51 per cent of the malnourished in rural areas and 42 per cent of the poor and 28 per cent of the
malnourished in urban areas. If in addition, malnourishment is seen in terms of the child mortality rate for the
age group 0 to 4 years, these very states also experience an increase in their share in the total child mortality in
the country from 53 per cent in rural areas and 35 per cent in urban areas in 1991, to 61 per cent in rural areas
and 45 per cent in urban areas in 2011. Thus, there is a relationship between the two variables, poverty and
malnourishment, howsoever the latter is measured (Figure 3.6). This has policy implication for addressing
malnourishment.
Figure 3.6: Relationship between Poverty and Malnutrition, 2011-12
However, the relationship between malnourishment and economic growth, or malnourishment with agriculture
growth, is not as obvious empirically.
5. Policy Response to Hunger and Malnutrition: Assessment and Options

It is indeed a matter of concern that in India despite having attained self-sufficiency in food production for
nearly three decades and with mounting public food stocks at its command, there is still hunger, both
undernourishment and widespread malnourishment. From the analysis in the preceding section it may appear
that by bringing down poverty, hunger can be sustainably addressed. However, that may not be the case.
There are several states where poverty HCR is low, but indicators on malnourishment are relatively high. It is
well known that non-availability of foodgrains is not always the cause of hunger. Hunger can persist in
situations where food availability does not decline or where there are adequate stocks available in the country.
The problem of hunger is social, economic, and political. India’s food production is enough to eradicate
hunger, but the supplies are not evenly distributed and therein lies the crux of the hunger problem.
Sen (1977, 1981) explains this phenomenon through entitlement approach. A person’s entitlement is the
alternative sets of commodity bundles that a person can acquire through endowments (legal, physical) or
exchange entitlement mapping. If a person is legally alienated from land, or a person loses physical ability to
work, then it might lead to hunger and starvation even if there is overall growth in foodgrains production.
Similarly, drop in the relative price of goods that the person produces, fall in real wages, and rise in relative
prices of foodgrains, adversely affects the exchange entitlement mapping for the individual, resulting in
hunger and starvation. Similarly, merely being a food producer does not ensure access to food. Access to food
can be achieved through legal and economic entitlement. Legal entitlement involves ownership right to the
food produced. Economic entitlement can be ensured by creating employment opportunities, ensuring
minimum wages, stabilizing food prices, and facilitating access to food through the PDS. Entitlements can be
realized if there is availability of food. However, availability is only a necessary condition. Food production
not only ensures food availability (supply side), but it also improves entitlement through employment creation
and subsequent income generation (demand side).
These are (a) Chronic food insecurity: caused due to energy deficit for a prolonged period of time. Policy
interventions to eradicate chronic food insecurity calls for both demand side (purchasing power, social
security) measures, and supply side interventions (agricultural policies, export-import policies, distribution
policies); (b) Nutritional food insecurity: caused due to deficiency of micronutrients. Policies involve food
fortification and their supply through PDS, providing micronutrients to children below 5 years of age through
ICDS; (c) Absorption food insecurity: caused due to non-availability of potable water and poor sanitation.
Policies involve providing basic infrastructure, and creating awareness. (d) Transitory food insecurity: caused
due to natural calamities. Policies involve appropriate disaster management. Transitory food insecurity can
also be caused when there is a decline in accessibility to food which might happen in case of abnormal price
increases, or lack of physical accessibility in the event of natural calamity. If appropriate disaster management
system is not put in place then transitory food insecurity can become a permanent phenomenon.
Thus, hunger can be a result of host of factors and these factors can be arranged in a sequence that runs from
food self-sufficiency, food availability, food entitlement, and nutritional adequacy. Policy corrections can be
made once the predominant source is identified. It could well be the case that more than one factor
simultaneously impacts a situation, especially at the local level in a specific region, resulting in hunger which
makes designing of policies quite complicated. India has been implementing several programmes that seek to
address each of the above factors that impact hunger. The agriculture policy addresses the concerns of food
self-sufficiency and availability, the poverty alleviation strategy and programmes that of food entitlements,
and several specific programmes the issue of nutritional adequacy. Some of the interventions, particularly at
the central level, are listed below:
 Agriculture Policy and Nutrition: Given the huge dependence on the sector, improving agriculture
performance assumes importance for achieving inclusive growth, in general, and addressing the
persisting problem of malnourishment, in particular. Apart from crop agriculture, livestock
management assumes great significance in ensuring agricultural growth and livelihood opportunities
in the agrarian economy. Not only is the growth rate of livestock sector higher than that of crop
sector, the long term trend suggests that variability of livestock output is less than that of crop output.
Livestock acts as a cushion against vulnerability for rural households that are primarily dependent on
crop agriculture. Agriculture is fundamental to India’s inclusive and sustainable economic
transformation. It has to therefore play a more significant role in promoting nutrition security. At the
same time, there is a need for and scope to address specific concerns on hunger in all its dimensions in
the country. The usual determinants of hunger like feeding practices, mother’s education, access to
Anganwadi services, immunization rates and the lack of hygiene and sanitation that emerge as critical
factors have to be addressed. Some major central government initiatives covering these issues are
analysed in the remaining part of this Chapter.
 Public Distribution System: PDS, since its inception in the 1960s, has been an important means to
improve food availability and nutritional security for the population, particularly the economically
deprived ones. Mid-Day Meal Scheme
 The Mid-Day Meal Scheme (MDMS) is a flagship programme of the Government of India, initiated
in 1995 (in 2408 select Blocks) with the objective of enhancing enrolment, retention and attendance at
the primary school level, and also to simultaneously improve nutritional levels among children
studying in government and government-aided schools. It is expected to improve their learning
ability. Since 1997-98 it has been universalized, and from 2008-09 onwards even the upper primary
school level has been brought under this programme. Initially, only dry rations were being distributed
under the programme, but from 2002 provision for cooked mid-day meal in schools has been made
under the direction of the Supreme Court. Under this scheme, for children studying at primary level,
450 calories and 8-12 grams of protein are provided per day. In case of upper primary students, the
provision has been fixed at a minimum of 700 calories and 20 grams of protein per day. A freshly
cooked meal offers a better range of nutrients and packaged food is costlier, per rupee nutrient yield.
One of the important drawbacks of this programme is the lack of infrastructure like storage facility,
cooking shed and utensils. This leads to poor hygiene conditions, which occasionally are seen to
blowup into serious health hazards. Lack of support staff for implementing this scheme is another area
of major concern. In some places teachers and students have to often spend a considerable amount of
time preparing meals, rather than focusing on school curricula
 Total Sanitation Campaign/Swatch Bharat Abhiyan: With more than 600 million people (WHO and
UNICEF 2013) defecating openly, India is the largest open lavatory in the world. Sanitation is not
only important for ensuring a healthy life, but access to toilet facilities, especially for the women,
gives a sense of dignity and privacy. A mere provision of toilet facilities is not enough, it has to be
used and for this awareness has to be created through campaigns and information dissemination at the
grassroots level. Total Sanitation Campaign (TSC) was initiated by the Government of India in 1999
with the objective to eradicate the practice of open defecation. Under TSC, the concept of sanitation
goes beyond eradication of open defecation to include personal hygiene, home sanitation, safe water,
garbage disposal, excreta disposal and waste water disposal. TSC gives more emphasis on
information, education and communication (IEC) in order to create awareness among the rural people,
thereby generate demand for sanitary facilities. In that sense TSC is a demand driven approach. The
programme is implemented with a focus on community-led and people-centred initiatives with
financial incentives being provided to BPL households for construction and usage of individual
household latrines (IHHL). Assistance is also extended for construction of school toilet units,
Anganwadi toilets and Community Sanitary Complexes (CSC), apart from undertaking activities
under solid and liquid waste management. The TSC has been renamed as ‘Nirmal Bharat Abhiyan’
(NBA) with a target of an open-defecation-free rural India by 2022. Intervention in the form of SBA
has revolutionized the sanitation campaign and as on date around 8.5 crore toilets have been
constructed, of which 96% are being used by the owner households especially in rural areas. 25 States
have declared open defecation free and about 90% of the population is using toilets thereby improving
sanitation conditions.
Impact of poor sanitation is not restricted to health outcomes alone. It has implications on educational
outcomes as sick children do not attend schools. Further, inadequate sanitation and lack of separate
toilet facilities for girls reduces school attendance among girls, and therefore is a major constraint
towards removal of gender disparity in education. Economic loss due to poor sanitation is also quite
substantial. A World Bank study puts it at Rs 2.4 trillion in a year, which is roughly 6.4 per cent of
GDP in 2006. Out of this annual loss of Rs 2.4 trillion, Rs 1.3 trillion is on account of premature
death, diarrhea being the largest contributor. In this context, the study estimates that comprehensive
sanitation and hygiene interventions can avert up to 45 per cent of health-related economic losses. The
incidence of diarrhea has been reported to decline by about 25% in India after SBA is enforced.
 National Rural Health Mission: National Rural Health Mission (NRHM) has been launched in April
2005 with the objective of providing accessible, affordable, and reliable healthcare facilities to the
rural population, particularly to the poor and the vulnerable sections. Though the programme is in
operation throughout the country, it has special focus on eight Empowered Action Group States
(EAGS) namely Bihar, Jharkhand, Chhattisgarh, Madhya Pradesh, Uttar Pradesh, Uttarakhand,
Odisha, Rajasthan; eight north-eastern states; two north-Indian states namely, Himachal Pradesh, and
Jammu & Kashmir. Decentralized village and district-level health planning is at the core of this
programme. The most important cadre in this programme is the Accredited Social Health Activists
(ASHA), which is to facilitate access to healthcare services to the rural population. Realizing the
collective importance of different health and family welfare programmes as well as disease control
measures for the over-arching objective of population stabilization within a reasonable time-frame,
different programmes have been brought under NRHM.
 NRHM is further supplemented by announcement of Ayushman Bharat which has significantly
improved the access to health services by targeting to cover 50 crore people under PMJAY
 Integrated Child Development Scheme: The Government of India launched ICDS with the primary
goal of achieving nutritional security of children, pregnant women, and lactating mothers. The
programme initiated on a pilot basis in 33 Community Development Blocks in 1975, has been
universalized as per the Supreme Court order in November 2001. The programme aims at achieving
its objective through a comprehensive set of six services which are (a) Supplementary nutrition
programme (SNP); (b) Non-formal pre-school education (PSE); (c) Immunization; (d) Health check-
up, (e) Referral services; and (f) Nutrition and Health Education (NHE). Despite the detailed
planning, the outreach of this programme remains low with close to 40 per cent of eligible
beneficiaries still outside its purview and only one-third of eligible children receiving food from
AWCs. Low spread of AWCs is cited as one of the reasons for this low coverage. As against an
estimated requirement of 1.7 million AWCs, there are approximately 0.6 million AWCs across the
country. Provision of supplementary nutrition is an important component of this programme.
However, despite low awareness about food entitlement, proportion of beneficiaries is higher,
implying that the beneficiaries may not be getting as per their actual entitlements. The implementation
of ICDS leaves much to be desired in many states, largely due to the fact that it receives very low
priority in the political and local development agenda. Tamil Nadu, where it is otherwise, has done
much better than many other states in bringing down hunger and malnutrition. It ensured the required
public policy attention, the necessary budget allocations and the infrastructure in place to combat
hunger and malnutrition. In fact in Tamil Nadu, the priority to tackle hunger and malnutrition is
embedded in the political discourse ever since the initiation of school meals through public
contribution in 1956.
6. National Nutrition Strategy, 2015

9.1 Vision 2022 - "Kuposhan Mukt Bharat" - Free from malnutrition, across the life cycle
This is elaborated as –
“Healthy, optimally nourished children, realizing their growth and development potential, active learning
capacity and adult productivity; Healthy, optimally nourished women realizing their social and economic
development potential; In protective, nurturing, gender sensitive and inclusive community environments –
That enhance human and national development in the present - and in the future”.
The National Nutrition Strategy is committed to ensuring that every child, adolescent girl and woman attains
optimal nutritional status- especially those from the most vulnerable communities. The focus is on preventing
and reducing undernutrition across the life cycle- as early as possible, especially in the first three years of life.
This commitment also builds on the recognition that the first few years of life are forever - the foundation for
ensuring optimum physical growth, development, cognition and cumulative lifelong learning.
9.2 Goal, Objectives and Monitorable outcomes
The National Nutrition Strategy will contribute to key national development goals for more inclusive growth,
such as the reduction of maternal, infant and young child mortality, through its focus on the following
Monitorable targets (Figure 3.7):
Figure 3.7: Monitorable Outcomes
That is,
 To prevent and reduce undernutrition (underweight prevalence) in children (0- 3 years) by 3
percentage points per annum from NFHS 4 levels by 2022.
 To reduce the prevalence of anemia among young children, adolescent girls and women in the
reproductive age group (15- 49 years) by one third of NFHS 4 levels by 2022.
The achievement of the above Monitorable targets will contribute to improved learning outcomes in
elementary education, improved adult productivity, women’s empowerment and gender equality and the
National Development Agenda. Achievement of these national development goals will also significantly
shape progress towards global sustainable development goals.
In a longer term perspective, the strategy will also aim to progressively reduce all forms of undernutrition by
2030. The focus of this strategy over the next five years is on preventing and reducing child undernutrition.
While undernutrition affects large segments of the population – the strategy accords priority to and focus on
the most vulnerable and critical age groups, which also determine nutrition in later life and inter
generationally.
The above goals will also contribute significantly to shaping the achievement of global Sustainable
Development Goals related to ending hunger, achieving food security and improved nutrition, ending poverty,
ensuring healthy lives, ensuring inclusive and equitable quality education, achieving gender equality and
empowering women and girls. At least 12 of the 17 Sustainable Development Goals contain indicators that are
relevant for nutrition, demonstrating that nutrition is the foundation for ensuring sustainable development.
This will also contribute to achieving global nutrition targets endorsed in 2012, through the World Health
Assembly Resolution 65.6, committing to a comprehensive implementation plan on maternal, infant and
young child nutrition. This specified a set of six global nutrition targets for 2025 that aim to:
 Achieve a 40% reduction in the number of children under-5 who are stunted;
 Achieve a 50% reduction of anemia in women of reproductive age;
 Achieve a 30% reduction in low birth weight;

 Ensure that there is no increase in childhood overweight;
 increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%;
 Reduce and maintain childhood wasting to less than 5%.
9.3 Identification of Focus Districts- Including Poor Performing States And Districts
The implementation of the National Nutrition Strategy will include representation from all States and UTs,
while focusing on districts with high prevalence of malnutrition and /or performing poorly. There will also be
some representation of best performing districts and good practices within States - along with poor performing
ones, to encourage performance and create a demonstration or ripple effect within and across states. In order
to synergize impact - efforts will be made to cover districts already identified, such as the 184 High Priority
Districts identified National Health Mission High Priority Districts (based on lowest 25 % districts on health
related indicators), the 200 ICDS nutrition high burden districts (200) and 162 districts covered under ISSNIP,
with flexibility to states in the finalization of districts.
9.4 Criteria used For Identification of Districts:
 High prevalence of Child Undernutrition: Recent district level data on nutrition and health for the
specific/ limited purpose of inter district comparison (or comparison within a cluster of states covered
by the survey) is available in the recent NFHS-4 data. Figure 12 shows the district wise prevalence of
stunting for children below five years, as given in NFHS-4.
 High/low prevalence districts identified across States, for which data is available, as well as within the
State. The analysis of high/low prevalence across districts has been conducted using the parameters of
women with low BMI and using anemia prevalence in children, adolescent girls and women, based on
NFHS-4 data.
Identification of Focus Districts: Currently, the focus areas/ high priority districts vary as per Ministries and
their respective schemes. For example, out of the 184 High Priority Districts chalked out under the National
Health Mission (NHM) implemented by the Ministry of Health & Family Welfare and the list of 200 High
Burden Districts identified within the ICDS program and 162 Districts covered within the ISSNIP, both
implemented by the Ministry of Women and Child Development (MoWCD), only 39 districts are common.
As evident in Figure 3.8, there is a lack of synergy in the efforts made by MoWCD and MoH&FW to address
the challenge of under nutrition. When we take other Ministries like Drinking Water and Sanitation, etc. the
number of common high priority districts reduces further. The multidimensional nature of factors affecting
nutrition calls for a coordinated and combined effort from all stakeholders to attain optimal outcomes.
Figure 3.8: High Burden/ Priority Districts of ICDS, NHM &
ISSNIP
The recent NFHS-4 data presents the status of nutrition of women and children in details. Since national, state
and district level data is available, it is important that different Ministries and States/ UTs work in close
collaboration and converge their efforts to maximize the gains.
9.5 Guiding principles
The implementation of the National Nutrition Strategy will be guided by the following key principles of
action.
 A life cycle approach - A life cycle approach will be adopted, with a focus on critical periods of
nutritional vulnerability and opportunity for enhancing human development potential.
 Early preventive action - emphasis on preventing under nutrition, as early as possible, across the life
cycle.
 Inclusive and gender sensitive : It will be rooted in a rights based framework that seeks to promote the
rights of women and children to survival, development, protection and participation - without
discrimination.
 Community empowerment and ownership : Families and communities will be enabled for improved
care behaviors and nutrition of children and women, to demand quality services, to contribute to
increased service utilization and to participate in community based monitoring.
 Valuing, recognizing and enhancing contribution of Anganwadi workers, helpers and ASHAs
 Decentralization and flexibility: Contextually relevant, decentralized approaches will be promoted,
with greater flexibility at State, district and local levels for greater and sustained programme
effectiveness and impact, in harmony with the approach of cooperative federalism.
 Ownership of Panchayati Raj institutions and urban local bodies
 Foster innovation
 Informed by science and evidence
 Ensure that there is no conflict of interest
9.6 Nutrition Interventions
Infant and Young Child Care and Nutrition - These interventions will focus on children under 3 years, through
the promotion of
 Universal early initiation (within 1 hour of birth) and exclusive breastfeeding for the first six months
of life.
 Universal timely and appropriate complementary feeding after six months, along with continued
breastfeeding for two years or beyond.
 Universal growth monitoring and promotion of young children-using WHO CGS with counseling of
mothers/families using the Mother Child Protection Card.
 Universal access to infant and young child care (including ICDS, crèches, linkages with
MGNREGA), with improved supplementary nutritional support/THR through ICDS.
 Enhanced care, improved feeding during and after illness, nutritional support, referrals and
management of severely and acutely undernourished and/or sick children.
9.7 Maternal Care, Nutrition and Health
 Improved supplementary nutritional support during pregnancy and lactation (ICDS).
 Improved antenatal care - including health and nutrition counseling (also family support for extra diet
and rest to ensure adequate weight gain), IFA supplementation, consumption of adequately iodized
salt and screening /management of severe anemia.
 Enhanced maternity protection (through the effective implementation of PMMVY)
 Institutional deliveries, lactation management, improved post-natal and new born care.
 Promoting marriage at the right age, first pregnancy at the right age, inter pregnancy recoupment/
birth spacing and shared care/ parenting responsibilities.
 Promoting Women’s Literacy and Empowerment
9.8 Adolescent Care, Nutrition and Health
 Equal care of the girl child at different stages of the life cycle- linked to the Beti Bachao Beti Padhao
initiative.
 Improved access to health care, counseling support through school health programmes, ARSH and
deworming as per MHFW National Deworming Initiative.
 Improved access to nutritional support through Mid-Day Meals in schools (MHRD) and through
SABLA for out of school girls.
 Universal access of girls in school and girls out of school to IFA supplementation.
 Girls’ education, skill development and female literacy.
 Changing gender constructs -Gender sensitization and life skills for adolescents.
 No Child Marriage- Marriage of young women after the age of 18 years.
9.9 Addressing Micronutrient Deficiencies - including Anemia
 Community Nutrition (Interventions addressing the community)
 Ensuring universal access to safe drinking water, sanitation and hygiene, in an open defecation free
environment, through Swachh Bharat.
 Prevention and treatment for malaria through the Use of bed-nets and/or intermittent preventive
therapy for malaria (as per MHFW protocols) in malaria-endemic areas; Facilitating mosquito control
measures; Other relevant health /disease control measures specific for the state/district, relevant for
improving nutrition at community levels - such as JE, kala azar etc.
 Ensuring access to household food security, social protection systems and safety nets.
 Nutrition Education to ensure that optimal feeding and caring practices, dietary diversity nutritious
foods; sanitation and hygiene and healthy lifestyles are promoted-addressing undernutrition and also
the dual burden of malnutrition. (This includes Nutrition Education in the school curriculum and in
colleges).
 Focused Interventions to reaching the most nutritionally vulnerable community groups (such as SC,
STs, minorities, others) and address multiple nutritional vulnerabilities such as those related to
seasonal distress, disease outbreaks, natural disasters (such as floods, drought, earthquakes) and other
situations.
 Flexible responses to other State/district specific needs for improving nutrition at community levels.
7. Concluding Remarks
In India virtually all public programmes at the central and state level have aspects that directly or indirectly
address the poverty and hunger issue. In the absence of convergence and synergy among the various
interventions, resources get thinly spread across different programmes. With high overhead (administrative)
costs, it leaves very little to spend on the actual developmental or programme activity. Attempts to bring about
convergence across programmes, purely at an administrative level, suffer from ‘turf-issues’ with no line
department or public agency wanting to play second fiddle to other or, allow a curtailment in the scope of
their influence and discretion. For the central sector or centrally sponsored schemes directed at poverty
alleviation or, with specific focus on addressing hunger and malnutrition, which now involves considerable
resources, an alternative administrative arrangement for programme convergence and results can be evolved.
The proposed arrangement requires identifying a few Ministers of State in the Union Cabinet and assigning to
them the states of their respective constituency, with an explicit responsibility for ensuring convergence in at
least those central schemes that are focused on hunger and malnutrition eradication. Since it involves a few
social sector ministries, senior nodal officers of the schemes (of the rank of Joint Secretary or above) included
in this convergence exercise, from the same ministry as the minister, can be assigned to help the minister in
the said task. The identified ministers need to be given the charge of this assignment right at the beginning of
their tenure, with an implicit understanding of achieving certain performance benchmark by the end of their
five-year term.
Therefore, it is important that at the state and district-level there is an integrated and a coordinated approach to
the implementation of the public programmes. In regions where there is a large burden of hunger, the focus
has to be on involving the local community in service delivery and oversight. Synergy and convergence
between different programmes at the grassroots level can ensure a more holistic and result driven approach to
eradication of hunger on a sustainable basis.
Class Notes
2
CHAPTER Practice Questions
PREVIOUS YEAR QUESTIONS FOR PRACTICE
Q.1 Which of the following is/are the (a) 1 and 2 only

indicator/indicators used by IFPRI to (b) 1, 2 and 3 only
compute the Global Hunger Index Report? (c) 1, 2 and 4 only
(Prelims 2016)
(d) 3 and 4 only
1. Undernourishment
2. Child stunting
Q.3 With reference to 'Initiative for Nutritional
3. Child mortality Security through Intensive Millets
Select the correct answer using the code given Promotion', which of the following
below. statements is/are correct? (2016)
(a) 1 only 1. This initiative aims to demonstrate the
(b) 2 and 3 only improved production and post-harvest
(c) 1, 2 and 3 technologies, and to demonstrate value
(d) 1 and 3 only addition techniques, in an integrated
manner, with cluster approach.
2. Poor, small, marginal and tribal farmers
Q.2 Which of the following are the objectives of
have larger stake in this scheme.
‘National Nutrition Mission’? (Prelims
2017) 3. An important objective of the scheme is
to encourage farmers of commercial
1. To create awareness relating to
crops to shift to millet cultivation by
malnutrition among pregnant women
offering them free kits of critical inputs
and lactating mothers.
of nutrients and microirrigation
2. To reduce the incidence of anaemia
equipment.
among young children, adolescent girls
Select the correct answer using the code given
and women.
below.
3. To promote the consumption of millets,
(a) 1 only
coarse cereals and unpolished rice.
(b) 2 and 3 only
4. To promote the consumption of poultry
eggs. (c) 1 and 2 only
Select the correct answer using the code given (d) 1, 2 and 3
below:
MCQS ON THE TOPIC FOR PRACTICE
Q.1 What role do women play in food security? (c) They weed the fields, but never plough
(a) Their main role is preparing meals. or plant them, as only men are strong
(b) They play a central role as producers of enough for those activities.
food, managers of natural resources, (d) Their efforts focus mainly on vegetable
income earners and caretakers of gardens and chickens; men are involved
household nutrition. with cereal crops and larger livestock.
PRACTICE QUESTIONS
was grown so is not related to wealth or

Q.2 What are entitlements to food? age.
(a) The term refers to social welfare (c) Most vitamin D in the body does not
programmes, e.g. the Fair Price food come from food so access to food is not
shops in India. an important determinant of vitamin D
(b) It means the pathways through which status.
people access food, whether by (d) Diets containing sufficient other
production, purchase, social protection nutrients to promote growth can increase
programmes or other means. the requirement of vitamin D so that it
(c) When countries enact right-to-food becomes limiting.
legislation, then people are entitled to
food. Q.5 Which region has the greatest number of
(d) The term is a reference to agrarian hungry people?
reform programmes that provide farmers (a) Africa
with land titles. (b) Asia and the Pacific
(c) Latin America and the Caribbean
Q.3 What difference will urbanization make for (d) Middle East
hunger and malnutrition?
(a) No significant difference; low-income Q.6 Which of the following is not a
urban and rural people face similar recommended type of data to inform
constraints in accessing food and whether a patient is diagnosed as
consume similar diets in developing malnourished:
countries.
(a) Gastrointestinal symptoms
(b) It will reduce poverty and hunger
(b) Serum albumin level
because these are almost entirely
(c) Body mass index
concentrated in rural areas.
(d) Functional capacity
(c) Urban dwellers depend more than rural
people on purchases to acquire food, (e) Dietary intake
have little opportunity to grow their own
food, and so are much more vulnerable Q.7 Which of the following are not data that
to food price increases. should be collected during a nutrition
(d) Poor city folk eat mainly sorghum, assessment?
millet, maize and root crops, so a lot (a) Family nutrition history
more of those foods will need to be (b) Anthropometric measurements
produced as the world urbanises. (c) Biochemical data
(d) Physical exam information
Q.4 Vitamin D deficiency can often be found as (e) Food and nutrition patient history
a single nutrient deficiency, that is, in an
otherwise well-nourished person. The main
Q.8 When a person goes hungry for a long
reason this can happen is because:
period of time (many years) they can:
(a) Foods containing large amounts of
(a) Be stunted in height
vitamin D are eaten by both poor and
wealthy people according to various (b) Be more prone to disease
cultural reasons. (c) Have brain functioning affected
(b) The content of vitamin D in foods (d) All of the above
depends on the soil in which the food
PRACTICE QUESTIONS
Q.9 The people most at risk for malnutrition 1. Union Health Ministry
are: 2. Ministry of Drinking Water and
(a) Children Sanitation
(b) Poor people & people living in 3. Ministry of Human Resource
developing countries Development
(c) Mothers who are pregnant or lactating (a) 1 and 2
(d) All of the above (b) 1 and 3
(c) 2 and 3
Q.10 Malnutrition can be caused by: (d) 1, 2 and 3
(a) Household food insecurity
(b) Inadequate care and feeding practices Q.13 Which of the following statements are
(c) Poor sanitation and lack public health correct?
services 1. out 'Atal-Amrit Abhiyan' is a health
(d) All of the above sector scheme
2. It has been launched by the Central
Q.11 Which of the following statements are Government for the BPL people
correct about the National Family Health (a) 1 only
Survey (NFHS)? (b) 2 only
1. The National Family Health Survey (c) Both 1 and 2
(NFHS) is a large-scale, multi-round (d) Neither 1 nor 2
survey conducted in a representative
sample of households throughout India
Q.14 Which of the following statements are
2. The first survey was conducted in 1992- correct?
93
1. The National Index for Performance on
3. India has so far conducted four National Health Outcomes has been launched by
Family Health Surveys Niti Aayog
(a) 1 only 2. It aims to create awareness about the
(b) 1 and 2 Government's Health scheme across the
(c) 1 and 3 country
(d) 1, 2 and 3 (a) 1 only
(b) 2 only
Q.12 "Swachh Swasth Sarvatra initiative", (c) Both 1 and 2
aimed at strengthening health centres in (d) Neither 1 nor 2
open defecation free blocks is a joint
initiative of
PRACTICE QUESTIONS
QUESTIONS FROM PREVIOUS YEARS’ UPSC MAIN EXAMINATIONS
Q1. How far do you agree with the view that the focus on lack of availability of food as the main
cause of hunger takes the attention away from ineffective human development policies in India?
(2017)
PRACTICE QUESTIONS
PRACTICE QUESTIONS
Q2. Public health system has limitation in providing universal health coverage. Do you think that
private sector can help in bridging the gap? What other viable alternatives do you suggest?
(2015)
PRACTICE QUESTIONS
PRACTICE QUESTIONS
Q3. NFSA is expected to eliminate hunger and malnutrition in India. Critically discuss various
apprehensions in its effective implementation along with the concerns it has generated in WTO
(2013).
PRACTICE QUESTIONS
PRACTICE QUESTIONS
Q.4 Critically examine the effect of globalization on the nutritional status of Children and aged
population in India. (2013)
Q5. Identify the Millennium Development Goals (MDGs) that are related to health and nutrition.
Discuss the success of the actions taken by the Government for achieving the same (2013)
Q6. Discuss the extent, causes, and implications of the ‘nutrition transition’ said to be underway in
India. (2011)
Q7. The last National Family Health Survey (NFHS) displayed a very dismal picture of nutrition as
regards several indicators for average Indians. Highlight the salient aspects of this problem.
(2009)
PRACTICE QUESTIONS FOR MAIN EXAMINATIONS
Q1. What are the “top three things” that need to happen in order to reach SDG 2?
Q2. The ongoing trends indicate that food insecurity in the world is rising while malnutrition
indicators such as stunting and wasting are improving. How we can reconcile this apparent
contradiction?
Q3. ‘The Economic Growth story of our Country does not resonate with its status in Global Hunger
Index reported for the current years 2017 and 2018’. In light of above statement; suggest few
remedial measures for eradication of this problem.
RAU'S IAS
STUDY CIRCLE
Indian Economy and General Studies (Integrated)
Economic Development
[Pre - Main Examination] Module-II Foundation Program / Course
Blue Workbooks BLUE WORKBOOKS FOCUS

focus
CIVIL SERVICES EXAMINATION
Primary study material MAGAZINE RAU’S HOUSE JOURNAL
This module-II contains the following (for foundation studies) Monthly current
workbooks. for syllabus of Pre and affairs notes/ compilation made
Mains. Thrust area is Clarity of from newspapers, magazines,
ü WORK BOOK-1 Government sources, Yojana,
Concepts.
ü WORK BOOK-2 Kurukshetra, etc.
ü WORK BOOK-3 PRELIMS P

MAINS COMPASS M
ü WORK BOOK-4 COMPASS (C3) (C3)

Annual revision study PRELIMSCOMPASS
Annual compilations of MAINSCOMPASS
ü WORK BOOK-5 all themes important for
material for Prelims
the upcoming Mains exam with
ü WORK BOOK-6A based on C3 (Core – Current - & probable questions and model
ü WORK BOOK-6B related Concepts) approach. answer structures.
ü WORK BOOK-7 WEEKLY GSI MONTHLY
ü WORK BOOK-8 (FOUNDATION) CURRENT
TESTS AFFAIRS TESTS
ü WORK BOOK-9 for both Pre and Mains. For course
revision and progress tracking from the focus magazine
ü WORK BOOK-10
PRELIMS TEST QIP PRELIMS

Revision classes for
SERIES
current affairs and
UPSC level Thematic contemporary issues important
after GSI Foundation Tests for Prelims
QIP + TEST SERIES DAILY NEWS

(MAINS) SIMPLIFIED
l Issues and theme Daily video lessons
based answer writing classes,
on current affairs from The Hindu
including
l Tests, Test discussions and Newspaper
evaluation
NEW DELHI CAMPUS BENGALURU CAMPUS JAIPUR CAMPUS

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RAU'S IAS

INDIAN ECONOMY AND

2. Practice Questions 20-29

1. Introduction: Paradox & Conceptual Clarity on Hunger and Malnutrition

2. Assessment of Incidence of Hunger or Undernourishment

Trends in Hunger and Malnutrition

1. Nutritional Situation Analysis according to NFHS-3 (2004-05) and NFHS-4 (2015-16)

Figure 3.3: Stunting in Children (0-5 years)

Figure 3.4: Wasting in Children (0-5 years)

4.2 Undernutrition in women and girls

4.3 Safe drinking water, sanitation and hygiene

2. Global Hunger Index- Inequalities of Hunger

Figure 3.5: Composition Of The Global Hunger Index

GHI scores are calculated using a three-step process.

4. Poverty, Malnutrition and Economic Growth

5. Policy Response to Hunger and Malnutrition: Assessment and Options

6. National Nutrition Strategy, 2015

 Achieve a 30% reduction in low birth weight;

Q.1 Which of the following is/are the (a) 1 and 2 only

MCQS ON THE TOPIC FOR PRACTICE

was grown so is not related to wealth or

QUESTIONS FROM PREVIOUS YEARS’ UPSC MAIN EXAMINATIONS

PRACTICE QUESTIONS FOR MAIN EXAMINATIONS

Blue Workbooks BLUE WORKBOOKS FOCUS

Primary study material MAGAZINE RAU’S HOUSE JOURNAL

ü WORK BOOK-3 PRELIMS P

ü WORK BOOK-4 COMPASS (C3) (C3)

PRELIMS TEST QIP PRELIMS

QIP + TEST SERIES DAILY NEWS

NEW DELHI CAMPUS BENGALURU CAMPUS JAIPUR CAMPUS

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