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Resource centre on India's rural distress
 
 

India’s Malnutrition Dilemma by David Rieff

“This is a country on the make.” The speaker was a young assistant to one of India’s rising political stars. And from his perspective, it did look that way. We were sitting in the lobby restaurant of New Delhi’s luxurious Taj Mahal Hotel. That evening, the Taj was not only the place for a government reception following Prime Minister Manmohan Singh’s decisive re-election victory, but it was also the scene of a huge party for the aptly named Yes Bank as it celebrated $100 million in financing for a new private hospital.

India is indeed booming: receptions of this kind have become commonplace since the early 1990s. The pace of change is impressive by any standard, and even more so in a country that, as recently as the late 1980s, had an economy in which it was said you needed the intercession of a member of Parliament just to get a telephone line. Today, middle-class Indians can enjoy many of the same pleasures and habits as their opposite numbers in Shanghai or Berlin, from cappuccino bars to multiplexes. It is hard to spend time in any major Indian city without getting the sense that the middle class is optimistic about their country’s prospects.

When Lloyd Blankfein, chairman of Goldman Sachs, declares that the 21st century will be India’s and that of the other so-called BRIC countries (Brazil, Russia and China), he has sound reasons for saying so. The self-confidence of the Indian corporate elite is even more arresting. Mukesh Ambani, head of one of the country’s principal conglomerates, expressed a common view when he insisted that the 21st century “belongs” to India — though he largely attributes this to demography, contrasting India’s young population with the aging populations of the United States, Western Europe, Japan and China.

But there is a ghost at the party, and its name is malnutrition. India is often compared — and often compares itself — with China, but the fact is that as China became an economic powerhouse it greatly reduced malnutrition. In an all-fronts effort, China cut child malnutrition by two-thirds between 1990 and 2002. Today only 7 percent of Chinese children under age 5 are underweight, whereas the figure for India is 43 percent. Even in sub-Saharan Africa, which most people assume to have the direst poverty statistics, the average child-malnutrition rate is 28 percent.

The youthfulness that leaders like Ambani claim as the country’s great competitive advantage could turn out to be the greatest stumbling block to Indian development and make it an also-ran to China. The science is disturbingly clear: if you are malnourished until age 3, your neural formation suffers, and most of that underdevelopment is fixed for life.

As Prof. Lawrence Haddad, director of the Institute of Development Studies in the United Kingdom, puts it, “India is an economic powerhouse and a nutritional weakling.” Haddad has studied India for decades, advising both the national government and several Indian states — nutrition in India being largely a state matter in practical terms. No one is quite sure why the nutrition situation in India is so dire. The lack of women’s empowerment in both rural and urban areas is thought to play a major role. And so far, at least, the central government has been very slow to act. While India’s per capita gross domestic product grew fourfold between 1992 and 2006 (the last period for which there are accurate statistics), the percentage of children age 3 and under who are underweight declined only to 46 percent from 52 nationally, and actually increased in some states.

It is not clear that those who live in this newly prosperous India even take in the depth of the nutrition crisis. The activist Harsh Mander told me it was possible for middle-class people to live in ignorance of the poor and to persuade themselves that poverty was not as bad as all that. There is a great deal of denial. Haddad said that when he asked Indian journalists what the malnutrition rate was, they consistently underestimated it by half and were often incredulous when told the actual figures.

Besides, chronic malnutrition is not necessarily visible. As Sejal Dand, an activist who runs a small N.G.O. in the northeastern tribal areas of Gujarat state, put it to me, “If all the kids in a village are mildly stunted, that is, smaller than normal by World Health Organization standards, or if the child is somewhat but not acutely underweight and this is the way everyone looks, it’s hard to mobilize either the villagers themselves or local officials.” Even activists complain about the passivity among the Indian poor, rural and urban alike.

These activists are at least persuaded that the national government and many of the states are sincere in wanting to address malnutrition. In 2008, Prime Minister Singh declared under-nutrition “a curse we must remove,” and he reaffirmed that commitment after his re-election. Moreover, it is almost certain that, after years of activist effort, a Right to Food Act will pass in Parliament. Most drafts call for a government-subsidized minimum of 25 kilograms (55 pounds) of food grain per family per month. There are enforcement provisions, the most important of which is that individual bureaucrats could be fined for failure. And yet many in India still seem convinced that while there are doubtless some things the government can and must do — even among most free marketers, the Right to Food Act is no longer controversial — only some version of “trickle down” economics will resolve the problem in the long term.

The Right to Food movement is deeply divided between those who believe the bill is a good first step and those who believe it is doomed to failure unless Indian society is radically overhauled. But that overhaul would presumably involve a state willing to follow a course closer to that of China: a capitalist economy, to be sure, but one in which the state gave more of the orders (and saw that they were carried out). In India at present that outcome seems unlikely. A great many food activists seem both bewildered by the new capitalist India in which they find themselves and increasingly nostalgic for the all-controlling state that prevailed before the 1980s. After all, as Professor Haddad pointed out to me, it is not as if India lacks either the resources or the capacity to address food issues head-on. The proof of this is that famine, for so long the great curse of the country, killing millions, generation in and generation out, is now controlled. One grimly sardonic explanation for India’s success at grappling with famine and its failure at coping with malnutrition was offered by N. C. Saxena, one of the great Indian experts on nutrition, who now consults for Unicef. “Famine is something that can be portrayed in the media effectively,” he told me, “whereas chronic malnutrition — well, it’s very difficult to portray that, isn’t it?” Saxena added that the Indian state was capable when coping with emergencies but had trouble handling challenges that were endemic — a view I heard expressed by many experts and activists.

Overcoming malnutrition requires not just an end to denial but also a decision that eradicating malnutrition is as much of a priority for India as its recent decision to build a hundred new ships for its navy over the next decade. Biraj Patnaik, a principal architect of the Right to Food campaign, is intransigent on the topic: “My question is if the government can spend 25 billion U.S. dollars on defense, why can’t it spend an equivalent amount on ensuring the food security of the people of India?” Smiling, he added: “Of course it’s a rhetorical question. I know perfectly well — we all know perfectly well — that neither the government this country now has or, for that matter, is ever likely to have, will ever lower the defense budget. But sometimes it’s vital to ask rhetorical questions.”

For many Indians, the Chinese example provides a counterpoint and possibly even a model. As an aid worker put it to me, “Democracy is without question good for adults, but I’m not convinced it’s necessarily the friend of small children.” What she meant was that the undemocratic Chinese government had the power to make malnutrition a priority and spend what it took to reduce it to comparatively inconsequential levels.

Of course it doesn’t require a highly authoritarian regime to run a successful nutrition program: Brazil and Thailand both did so in the 1980s. But these efforts nonetheless depended on a very heavy government hand. In an emergency, even democracies declare martial law. Chronic malnutrition is an emergency; it just doesn’t look like one. So while China advances, India risks not only being left behind but also squandering a moment otherwise filled with excitement and promise.

David Rieff, a contributing writer, is at work on a book about the international politics of food.