Child malnutrition is among the most pressing public health issues in India today. Equally alarming is the country’s food security crisis. Analysing ‘Young Lives Survey’ data from the states of Andhra Pradesh and Telangana, this article shows that there are sizeable negative effects of food insecurity on children’s nutrition – particularly among those towards the upper end of the health distribution.
Child malnutrition is one of the most pressing public health issues in India today. According to the Global Hunger Index report (von Grebmer et al. 2021), India recorded the highest child wasting rate in the world, at 17.3%, during 2016-2020. Moreover, 34.7% of children under the age of five are affected by stunting in India. The Sustainable Development Framework (2018) reports that nearly four out of 10 children in the country do not reach their full potential owing to chronic malnutrition (Government of India and United Nations, 2018). Besides, with one in every three children being malnourished, malnutrition is also considered as the predominant risk factor for deaths in under-five children, accounting for 68.2% of the total deaths in this age group.
Equally alarming is India’s food security1 crisis. The ‘State of Food Security and Nutrition in the World’ (SOFI) report (Food and Agriculture Organization (FAO), International Fund for Agricultural Development (IFAD), United Nations Children’s Fund (UNICEF), Work Food Programme (WFP), and World Health Organization (WHO), 2020) shows that while 27.8% of India’s population suffered from moderate or severe food insecurity during 2014-2016, the proportion rose to 31.6% in the period 2017-2019. The number of food-insecure people grew from 426.5 million in 2014-2016 to 488.6 million in 2017-2019. India accounted for 22% of the global burden of food insecurity, the highest for any country, in 2017-2019. Currently, India ranks 101st among 116 countries, according to the Global Hunger Index 2021 (Von Grebmer et al. 2021).
From a policy perspective, a question of paramount importance in this context is: Are these two problems interrelated? More specifically, can the food security crisis in India be responsible for the child and adolescent malnutrition problem? In recent research, (Dhamija et al. 2021), we examine the relationship between food insecurity and child malnutrition in context of India. We attempt to not only answer the question, ‘Does food insecurity lead to child malnutrition?’ but, also, ‘Are some children affected more by food insecurity than others?’
The data used here comes from the Young Lives Survey (YLS)2. YLS surveyed two cohorts of children, in the states of Andhra Pradesh and Telangana, younger (YC) and older (OC). The data were collected over five waves, with the first round of data collection taking place in 2002, the second in 2006-2007, the third in 2009-2010, the fourth in 2013-2014, and the final round in 2016-2017. For our study, we use data from rounds 2 to 5 for the YC, when children were around the age of 5, 8, 12, and 15 years, and rounds 2 and 3 for the OC, when children were around the age of 12-15 years. We exclude round 1 (2002) data for both cohorts, and the round 4 (2013-14) and round 5 (2016-17) rounds of data for the OC, as information on household food insecurity was not collected for them in these rounds.
We measure food insecurity at the household level and consider a household as ‘food insecure’ if it was moderately or severely food insecure as per the Household Food Insecurity Access Scale (HFIAS). We measure child and adolescent malnutrition using two widely used anthropometric indices for nutrition surveillance – height-for-age z-score3 (HAZ), and weight-for-age z-score (WAZ). Using the YLS data, we estimate (i) The average effect of food insecurity on child malnutrition employing various contemporary econometric approaches, including propensity score matching4, inverse propensity weighting estimator5, and comparisons of the selection on unobservable and observable estimators; and (ii) The distributional effects of food insecurity on child malnutrition by employing conditional and unconditional quantile treatment effect (QTE) estimators6. Estimation of distributional effects, in addition to the average effect, allows us to test whether the impact of food insecurity is constant across the HAZ and WAZ distributions of children or whether food insecurity affects children at different parts of the distribution differently.
Effect of food insecurity on child malnutrition
Our results suggest that WAZ (HAZ) of children from food-insecure households is, on average, 0.10 standard deviations (SD) (0.07 SD) lower than the WAZ (HAZ) of children from food secure households. Moreover, the average adverse effect of food insecurity on child health is higher for children living in urban households, children belonging to upper caste and non-minority households, and children from relatively less poor households compared to their respective counterparts. Our results suggest that the adverse effect of food insecurity on the health of children is likely to be more severe for children towards the upper end of the health distribution than those towards the lower end.
We believe this could be due to the fact that children from the lower end of the health distribution come from relatively more disadvantageous backgrounds, and therefore have access to government schemes, which allow them to partially mitigate the adverse effects of food insecurity7. This might also explain why we find the average adverse effect of food insecurity on child health to be higher for children living in urban households, children belonging to upper caste and non-minority households, and children from relatively less poor households compared to their respective counterparts. To the extent that most urban, upper caste8, non-minority, and relatively less poor households have limited or no access to government schemes and safety nets such as Antodaya Anna Yojana (AAY)9 like their counterparts (since they are not likely to be perceived to be in a severely disadvantageous position), they have no means to mitigate the adverse effects of household food insecurity.
These findings suggest that policymakers in India should not only focus on households that are considered to be in most disadvantageous positions (for example, rural households, lower caste and minority households, households living below the poverty line, etc.) when it comes to ensuring access and affordability of a balanced diet for children. Therefore, to address the problem of malnutrition in India, creating opportunities for food systems to increase the supply of affordable and nutritious foods for children across socioeconomic backgrounds is crucial.
The issue addressed in this study is timely and relevant not only considering India’s nutritional targets of 2022 (under the National Nutrition Mission), but also because the challenges of the Covid-19 crisis are likely to deteriorate the already critical situation India faces in terms of malnourishment. A policy-driven reduction in food insecurity is especially paramount if India is to reap the benefits of its demographic dividend, and aim for a more productivity workforce. Our findings call for greater focus on nutritional support for children under the umbrella of the National Food Security Act. Specifically, improvements in the indicators of malnutrition would require effective improvements in the functioning of the Integrated Child Development Scheme (ICDS)10 and the Mid-Day Meal Scheme (MDMS)11 considering the large impacts these schemes have had on the nutrition of children especially in times of economic distress (Jain 2015, Afridi 2010, Dhamija and Sen 2021). In addition, interventions that create safety nets to protect households against income shocks can also play a key role.
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- Food security is described as “a situation that exists when all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for a active and healthy life"(Food and Agriculture Organization, 2019).
- The YLS is a comprehensive survey aimed at understanding drivers of childhood poverty in Ethiopia, India, Peru, and Vietnam.
- The z score expresses the anthropometric values such as height or weight as a number of standard deviations below or above median value of the reference population. (Standard deviation is a measure that is used to quantify the amount of variation or dispersion of a set of values from the average of that set.)
- Propensity score matching is a statistical technique that attempts to estimate the effect of a treatment, policy, or intervention by accounting for covariates that predict receiving the treatment.
- As an alternative to the propensity score matching estimator, the inverse propensity score weighting technique estimates the treatment effect by assigning a higher weight to those observations in the treatment group who are more likely to be assigned to the control group and lesser weight to those observations who are more likely to fall in the expected treatment group.
- QTEs measure the change in the trajectory of outcome distribution as assignment to treatment changes, that is, whether most of the changes in outcomes of the individuals between the treated group and controlled group are in the tails, in the middle, or throughout the distribution.
- It should be noted that our findings do not imply that relatively well-off households are more likely to be food insecure. However, households with financial status just above the minimum threshold to be beneficiaries of various government schemes are unlikely to benefit from these safety nets in the scenario of food insecurity. This is likely to be true in our data as YLS is based on a pro-poor sample. Hence, the negative effect of food insecurity on malnutrition is severe among children from these non-beneficiary households as compared to households who have access to various safety nets in the form of government schemes.
- Basu and Das (2015) find that Scheduled Caste households consume more PDS (public distribution system) foodgrains relative to upper caste households.
- The AAY scheme offers 35 kilograms of rice and wheat at highly subsidised prices to 25 million poorest households.
- The ICDS scheme offers supplementary nutrition, preschool non-formal education, nutrition and health education, immunisation, health check-ups, and referral services to children in the age group of 0-6 years, along with support to pregnant women and lactating mothers.
- Launched in 1995 as a centrally sponsored scheme, the Mid-Day Meal (MDM) scheme provides children in government and government-aided schools (later extended to cover more groups of schools) with a nutritious, prepared midday meal. The scheme aims to improve the nutritional status of children studying in class one to eight, and to encourage children from disadvantaged sections to attend school more regularly and concentrate on school activities.
- Basu, Deepankar and Debarshi Das (2015), “Social Hierarchies and Public Distribution of Food in Rural India”, The Journal of Development Studies, 51(12): 1653-1666.
- FAO (2019), ‘The State of Food Security and Nutrition in the World: Safeguarding Against Economic Slowdowns and Downturns’, Report.
- FAO, IFAD, UNICEF, WFP and WHO (2020), ‘The state of food security and nutrition in the world 2020: Transforming food systems for affordable healthy diets’, Report.
- Dhamija, G, M Ojha and P Roychowdhury (2021), ‘Hunger and Health: Reexamining the Impact of Household Food Insecurity on Child Malnutrition in India’.The Journal of Development Studies, forthcoming. Available here.
- Dhamija, Gaurav and Gitanjali Sen (2021), “Lasting impact of early life interventions: evidence from India’s Integrated Child Development Services”, The Journal of Development Studies, 57(1): 106-138.
- Government of India and United Nations (2018), ‘Sustainable Development Framework 2018-2022’, Report.
- Jain, Monica (2015), “India’s struggle against malnutrition—is the ICDS program the answer?”, World Development, 67: 72-89.
- Afridi, Farzana (2010), “Child welfare programs and child nutrition: Evidence from a mandated school meal program in India”, Journal of Development Economics, 92(2): 152-165. Available here.
- Von Grebmer, K et al. (2021), ‘2021 Global Hunger Index: Hunger and Food Systems in Conflict Settings’, Report.