target="_blank" rel="nofollow" href="#ulink_2c07731d-f527-53c3-acbb-3ec1c8c88b08">Figure 1.2a from data obtained from National Family Health Survey (NFHS) 4. It shows that the highest prevalence of stunting is seen in Bihar, Uttar Pradesh, Jharkhand, Meghalaya, and Madhya Pradesh with more than 40% of children stunted, while Kerala, Goa, and Tripura have less than 25% of children stunted. Lessons can be taken from these states to improve the status in other states. Also, regional disparities were observed with higher percentage of stunting in rural area as compared to urban area. This is subject to the reasons that sanitation, antenatal care, and literacy are higher in the urban side. This means, emphasis on improvement of these parameters can help uplift the children from malnutrition.
Child wasting means low weight for height and indicates the acute food shortage or prevalence of disease in children (UNICEF). As per NFHS 4 Jharkhand, Gujarat, Karnataka, Madhya Pradesh, and Maharashtra, more than 23% of children are wasted (Figure 1.2b), while Mizoram and Manipur have less than 10% wasted children. The reasons can be similar to the reasons of stunting. There is 50% chance that a stunted child will also be wasted. The urban rural divide is prevalent in this case too. Hunger also leads to underweight children and if prolonged it leads to mortality of children. As seen in Figure 1.2c, in Madhya Pradesh, Jharkhand, and Bihar more than 40% of children are underweight, while Manipur, Mizoram, and Sikkim have less than 15% underweight population of children under five years. This shows strong association between stunting, wasting, and underweight of children as Madhya Pradesh, Jharkhand, and Bihar have the highest prevalence of all these parameters. Under five infant mortality is highest in Uttar Pradesh, Madhya Pradesh, and Chhattisgarh, i.e. more than 60 deaths per 1000 lives (Figure 1.2d). This reveals that Madhya Pradesh, Bihar, Uttar Pradesh, and Jharkhand have the highest level of malnourishment in India. Combining all the four parameters, we see that Madhya Pradesh, Bihar, Uttar Pradesh, and Jharkhand have the highest level of undernourishment in India. An insight into the economy of these states shows that Madhya Pradesh has 62% of labor force participation in agriculture and agriculture contributes 45% to the Gross State Value Added (GSVA) (Madhya Pradesh Budget Analysis 2019–20 ). Uttar Pradesh, the most populous state of India (17.11%) is the leading producer of food grains in India (Agricultural Statistics at a Glance 2018). Jharkhand is a rural state with 76% of its population living in rural area. And almost 49% of its population lives below poverty line. Bihar has 23% of its GSVA to the state's economy by agriculture (Bihar Budget Analysis 2019‐20). Apart from this out of total labor force the casual labor force of Bihar is 32.2%, Jharkhand 23.6%, Madhya Pradesh 28.2%, and Uttar Pradesh 21.3% and they are not able to find job after COVID‐19 outbreak. Percentage of population below poverty line of Bihar is 33.7%, Jharkhand 36.7%, Madhya Pradesh 31.7%, and Uttar Pradesh 29.4% and Uttar Pradesh has 17.12% of population, while Bihar, Madhya Pradesh, and Jharkhand comprise of 9, 6, and 3% of population, i.e., 35% of the population of India. These states are mainly agriculture dependent making the population more vulnerable. Madhya Pradesh and Uttar Pradesh being highly populous states in spite of having high number of beneficiaries under Integrated Child Development Scheme are still among the poor performers. This implies that unequal distribution of income might be the reason that despite economic growth and food production, prevalence of hunger is there.
Figure 1.2 Status of undernutrition in India. (a) Prevalence of stunted children. (b) Prevalence of child wasting. (c) Prevalence of underweight children. (d) Under‐five mortality rate.
Source: Based on NFHS 2015–16 .
(See insert for color representation of the figure.)
1.3.1 Trends Over Time
The performance of the states over two National Family Health Survey (NFHS) reveals that the situation has improved over the years in most of the cases (Figure 1.3). NFHS 3 conducted in 2005–2006 and NFHS 4 conducted in 2015–2016 although not strictly comparable, have substantial results to show. The reduction in percentage of children who are stunted was highest in Arunachal Pradesh (32%), Tripura was followed by Himachal Pradesh and Punjab. It is noteworthy that Tripura, Himachal Pradesh, and Punjab are among the top five states with the least percentage of stunted children. While Uttar Pradesh, Madhya Pradesh, and Jharkhand could not make substantial efforts to reduce the stunted children percentage and remain at the top five states with the highest percentage of stunted children. In case of child wasting, the results have been striking. Meghalaya, Mizoram, and Tripura have shown the highest level of reduction in percentage of population wasted, while increase in child wasting has been observed in Orissa, Haryana, Andhra Pradesh, Chhattisgarh, West Bengal, Uttar Pradesh, Assam, Gujarat Sikkim, Karnataka, Maharashtra, Goa, and Punjab with highest increase in the percentage. Madhya Pradesh has reduced by 26% indicating efforts done by the government. Despite this fact Madhya Pradesh, Jharkhand, Gujarat, Karnataka, and Maharashtra have higher percentage than the national average. Child underweight situation means weight‐to‐age situation Mizoram has reduced by 39% and is the state with the least percentage of underweight children. Under‐five infant mortality again is highest in Madhya Pradesh, Jharkhand although Madhya Pradesh has reduced it by 30% but the highest decrease of 62% was witnessed in Arunachal Pradesh.
Figure 1.3 Trend of undernutrition over time in India 2005–2006 vs 2015–2016.
Average Annual Rate of Reduction – It is the average relative percentage decrease per year in prevalence or rate (WHO). A positive sign indicated reduction in the prevalence and negative sign indicates increase in the prevalence. It is calculated by the formula:
where Y t + n is the prevalence of the next year, Y t is the prevalence of the given year, and b% is the annual rate of reduction (UNICEF 2015).
The calculation of Average Annual Rate of Return revealed that the AARR of stunting in India is 2.2% which means till 2030 the prevalence will be reduced up to 33% if the situation remains same. This is a positive pace but slower in speed because the target of SDG is to reduce the stunting prevalence by 50% by 2030 from the level of 2012. The AARR of wasting (Table 1.2) shows that there are states like Arunachal Pradesh, Tripura, Himachal Pradesh, Punjab, Mizoram, Chhattisgarh, West Bengal, and Nagaland which have an AARR of more than 3%. These states will reach around 50% reduction by 2030. But at the same time, states like, Bihar, Tamil Nadu, Madhya Pradesh, Rajasthan, and Jharkhand have AARR lower than 1.5% which brings down the national average and makes reaching the SDG target tough.
In conclusion, we can say that the most vulnerable states in terms of hunger security are Madhya Pradesh, Uttar Pradesh, Jharkhand, and Bihar. The states which have performed well in reducing the prevalence are Tripura and Himachal Pradesh. Both the states have least prevalence of hunger. Giving us a lesson, although centrally sponsored schemes are there, still regional disparity makes the difference. States with higher dependence on agriculture and tribal population have higher level of hunger, indicating unequal income distribution and lack of improvement in influencing factors.
1.3.2