Nutrition—lessons from Indian experience

In the realm of research on nutrition-agriculture linkages, we tend to forget, more often than not, that national policies are more important than household-level attempts at raising income or diversifying cropping patterns or composition of crop outputs. In many countries like India - particularly Kerala and Tamil Nadu states - and Sri Lanka, the national governments or the state governments played a pivotal role in addressing malnutrition.
The second missing element in the discourse seems to be the lack of understanding about the role of behavioural changes in ensuring an improvement in nutrition. A priori reasoning suggests that good policies could fail to address the question of malnutrition unless backed by proper behavioural changes in households. We can cite a few examples from recent International Food Policy Research Institute (IFPRI) studies in Bangladesh where it has been shown that behavioural change at household level is sine qua non for nutritional improvement at household level. Available empirics also point out that endowments matter but not so significantly as other variables would affect nutrition.
Leveraging Agriculture for Nutrition in South Asia (LANSA) has produced an interesting and insightful research brief on agriculture-nutrition linkages and child nutrition in India. LANSA has also produced one on Bangladesh (discussed in the FE  earlier - see 'Policy changes for nutritional improvement', April, 16, 2016). However, the purpose of presenting the findings is that Bangladesh has possibly a lot more to learn from Indian experiences. It may be mentioned here that, among South Asian countries, India has one of the highest rates of child under-nutrition in the world; the country is a home to around 40 per cent of  stunted children in the world. These children tend to face lifelong severe economic, health, and cognitive disadvantages and costs. Despite improvements in some states in recent years, the levels continue to be high. It is thus no wonder that 'understanding the reasons for high prevalence of child under-nutrition in India in the face of the relatively strong economic performance has emerged as an important research topic and is an area of focus of LANSA's research in the region.'
Indian studies, having explored association between agricultural prosperity and rural child under-nutrition, concluded that agricultural prosperity, among other things, has a positive influence in reducing child under-nutrition. "Access to toilets and piped drinking water were included in all the equations and showed positive impact on reducing under-nutrition. It was observed that inequality in landholding dampens the positive effect of agricultural prosperity on nutrition outcomes. However the influence of aspects of agricultural prosperity is not the same for different indicators of under-nutrition in children such as underweight or stunting".
Interestingly, in an unexpected departure from conventional wisdom, increasing crop diversification did not show favourable impacts on nutritional outcomes. Given that a large part of India is under dry-land and rain-fed farming, characterised by greater crop diversification, this finding highlights the need for targeting agriculture policies to these agro-ecological areas, to ensure that agricultural growth is consistently translated into higher labour productivity and better wages. The analysis indicates that it is not merely by crop diversification alone but focus on agricultural policy together with social provisioning of  (WASH) Water, Sanitation and Hygiene can help ensure better nutritional outcomes.
"A further district-level cross-sectional analysis linked child underweight rates to agricultural land productivity (used as a proxy for agricultural prosperity) and provisioning of public services, the results showed a positive relationship between agricultural land productivity and child nutrition, consistent with the state-level analysis. The district-level analysis enabled the study to capture agro-climatic conditions, agricultural development and delivery of public services. The results emphasise the policy implications for public health provisioning such as vaccinations and access to healthcare facilities in rural areas and public provisioning for maternal health and women's education as well as social provisioning of food for vulnerable communities."
A distinctive feature of child nutrition outcomes in India and their evolution is the striking and substantial heterogeneity across different states. The Indian National Family Health Survey data showed that the prevalence of stunting among under-five  children ranges from 24 per cent in Kerala to 57 per cent in Uttar Pradesh. The more recent Rapid Survey of Children by the Ministry of Women and Child Development and UNICEF, shows a similar trend albeit with slight reductions in levels at 20 per cent for Kerala and 51 per cent for Uttar Pradesh. The evolution of stunting prevalence over time and its associations with drivers such as economic and agricultural growth is also characterised by significant heterogeneity across the states, with economic progress including agriculture growth strongly correlated with nutritional outcomes in some states but very weakly in others. "Some of these differences across states are attributable to the differential endowments that are commonly used to explain nutritional outcomes, such as income and sanitation. However, it would appear that there is also substantial variation across states in how endowments like income and sanitation are converted into improved nutrition by households."
The LANSA study by another group of researchers attempted to understand and explain the observed heterogeneity in childhood nutrition outcomes across the Indian states, and compared some states with poor nutrition outcomes (Madhya Pradesh, Bihar, Odisha and Gujarat) with a benchmark good performer state, Tamil Nadu. The study surprisingly attributed modest proportions of differences in stunting to just endowment differences. This study finds the superior track record of food and nutrition policies of Tamil Nadu since the 1980s as being key to its superior performance in terms of nutrition, The state's "capacity and willingness" to address the problem of under-nutrition is highlighted as a key factor distinguishing good and bad performing states.
The writer is a former Professor of Economics at Jahangirnagar University.
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