Last year, the New York Times splashed stark images of child malnutrition in India's hinterland across its front page. More recently, another front-page article in the Times reminded the world that India's hunger problem hasn't gone anywhere and told the story of how various social-safety-net programs have failed to help. As the article explains, India still faces endemic problems with chronic malnutrition and hunger -- rates of child nutrition here compare unfavorably with many countries in sub-Saharan Africa -- that government initiatives have failed to address.
The story of why hunger persists in India is long, sometimes depressing, and full of paradoxes, the central one of course being the fact that the country actually has a booming economy and robust food stocks. But really it's a story of poor planning, social exclusion, gender inequality, and above all, a government that's failing to translate new capital into broad prosperity for its people. Because of this, the various schemes for food distribution debated in the recent Times article, which are part of the conversation as India's long-delayed National Food Security Bill wends its way slowly through the political system, will likely do little to create a long-lasting solution to hunger in India. Any real effort will have to start with the country's social and governance problems, and include nutrition programs that pick their targets better.
India's nutrition programs have failed to provide what the most vulnerable members of its population need -- and the new bill under development isn't likely to do enough to address them either. We've known for a long time that the period beginning before a woman gives birth and ending around the second year of her child's life are the crucial years for addressing nutrition. Miss this window, and the battle is largely lost. India's programs are only now just starting to take this "window of opportunity" paradigm into account. But to actually translate a policy into action, reaching all children under 2 with everything that they need (breast-feeding, high-quality foods, immunizations and preventive health care, hygiene and sanitation, and above all, mothers who are healthy themselves), an approach is required that goes far beyond food distribution.
Taking social exclusion, the evidence has consistently shown that marginalized social groups -- particularly lower castes, certain tribes, and some religious minorities -- have poorer access to social-safety-net services and are also more likely to be excluded from India's rapid economic growth. The stories from Madhya Pradesh portrayed in the Times this year and last year exemplify this social exclusion (as does Foreign Policy's recent story on the resource wars in the nearby provinces of Chhattisgarh and Jharkhand), as they describe the precarious conditions that exist for India's tribal populations, migrant laborers, and extreme poor.
In 2006, the Supreme Court of India asked the government to universalize projects such as the Integrated Child Development Services, the world's largest health, immunization, and nutrition program for young children. This has certainly helped expand services to excluded geographic areas and groups, but ensuring quality of service and reaching the more vulnerable children is still a challenge.
Gender is a problem as well. Research has shown that empowering women is one of the most effective ways to improve nutrition, especially for children. Studies by the International Food Policy Research Institute (IFPRI), where I work, have demonstrated that the low status of women contributes to hunger and malnutrition -- not just among the women themselves, but among their children too.
It's easy to see this process at work in India. South Asia, including India, is one of the worst places in the world to be a woman, especially a poor woman. Sex-selective abortion, female infanticide, low rates of female education, early marriage, domestic violence, and social exclusion of widows create misery across the life cycle. These gender imbalances lead directly to poor nutrition among women, as well as compromising their children's nutrition. Our research in Bangladesh, for example, shows that women who condone domestic violence have children who are more undernourished than those who do not condone violence.
When it comes to children, malnourished women are much more likely to give birth to a low-weight baby -- birth weight being an important predictor of child survival. Not surprisingly, one-third of babies born in India are born with low birth weight, compared with one-sixth in sub-Saharan Africa.
The extent to which women are allowed to control household spending also affects childhood nutrition. Numerous studies, including those by IFPRI, have shown that income or assets controlled by women are more likely to be spent on items that benefit children and themselves, such as food, clothing, and health care, than assets controlled by men.