affects the country's socioeconomic progress. This is not due to food scarcity but due to the lack of equitable distribution of the available food. Food security depends not only on crop production, but also on the policies that affect food systems, from farm to table (World Food Conference 1974). To improve the diet consumption of whole population, when there is an increasing growth rate and unbalanced growth of working sectors, injecting money is not the solution. There are other challenges like inequitable distribution of income, lack of awareness and access to healthy food, climate change, slowdown of economy, and lower income levels that threaten the hunger of the countrymen.
Figure 1.4 Association of stunting prevalence with socio‐economic indicators. Note‐ (a) State‐wise percentage of BPL (based on MRP‐consumption) in rural and urban areas of India, 2011–2012 (b) Measurement at current prices based on 2011–2012 series, (c) State‐wise, (at constant prices based on 2011–2012 series).
Comparison of the states with lower stunting percentage and those with higher stunting percentage, based on seven indicators, was done viz. improved drinking water sources, improved sanitation facility, use of iodized salt, literacy among women, antenatal care, and anemia among children and women (Figure 1.5). These indicators also impact level of undernutrition in India (Ghosh 2020; Martorell and Young 2012). The interstate comparison showed that states who have higher prevalence of stunting, underweight and wastage have lower percentage of improved sanitation facility, literacy among women, antenatal care, and higher percentage of anemia among children and women as compared to states having lower prevalence of the same factors. These are the factors which influence absorption of nutrients, access to nutritious food, and care of feeding right diet to the child at the right time.
1.4 Institutional Interventions to Cope Up with Malnutrition
Nutrition is accredited as one of the important characters of human development, dealing with poverty reduction and scaling up the economy. As discussed above, a nutrition policy is needed because the attainment of food self‐sufficiency does not ensure nutrition security. India, being the leader in production of a number of food products, lags behind when it comes to the nutrition status of children. This gap between production and consumption urged a need to devise a policy that could ensure the upliftment of the nutrition status. In such situations, it is the institutional intervention that emerges as a problem solving resort to cope up with the issue. Since independence, the Government of India has taken various steps to deal with the burden of malnutrition which can also be called as the double burden of malnutrition. But, before moving to the policies adopted and executed, it is imperative to understand the mechanism of the causes of malnutrition. Malnutrition is not something that is caused by a single causal factor or habit or reason. Occurrence of malnutrition is a complex activity and is caused by a set of factors which can be majorly divided into (i) personal, (ii) socioeconomic, and (iii) administrative. Among the personal factors, the problem associated with the individual are insufficient dietary intake, inadequate absorption of nutrients, inadequate care of child and mother, and mismanagement of disease prevention and care. Factors relating to the habit of the child and mother can be rectified through women empowerment, awareness, proper diet, and medical care. The socioeconomic factors are poverty, unorganized livelihood, lack of resources, lack of access to health care, unavailability of safe drinking water, unhygienic surroundings, etc. These call for development efforts at societal level where the area administration needs to ensure the following: availability of safe drinking water, cleaning of the area, generation of employment options. The last and the foremost factor is the administration where despite the existence of suitable schemes and programmes to eradicate the existing causal effects, the implementation lags behind. Reasons like poor scheme implementation, low quality of food distributed, lack of awareness, and inadequate evaluation prevail. This implementation lacunae need to be addressed and taken care of. Policies play an important role in curbing the issue of nutrition (Hawkes 2005; Mozaffarian et al. 2018). Integrated approaches are required for solving the issues of hunger and malnutrition (Burchi et al. 2011). While formulating the policy there are three things that should be kept in mind as the policy directly increases the coverage of nutritious food, incorporates behavioral changes among mothers, targeting adolescent girls, prenatal and postnatal care and nutrition, and provision of nutrient rich food.
Figure 1.5 Comparison of socioeconomic indicators of states with higher rate of stunting with those having lower prevalence.
The indirect effect of a policy includes change in consumption pattern, food security, income security, food safety, and health care. And in order to make it effective it is necessary to do surveillance of implementation, research and development, extension of knowledge, and awareness programmes. The history of policy shows that there was Special nutrition programme which started in 1970–1971 to provide Supplementary feeding to children, pregnant, and lactating mothers. Also Balwadi Nutrition Programme started in the same time period. In 1975, came Integrated Child Development Services, that focused upon Supplementary nutrition, immunization, health check‐up. Day Meal Programme 1962–1963, Integrated Child Development Services 1975, Tamil Nadu Integrated Nutrition Programme 1980, Wheat‐based supplementary nutrition programme 1986, Mid Nutrition Anemia Prophylaxix Programme 1970, National Diarrhea Disease Control Programme 1978, National Goiter Control Programme 1992, National Nutrition Policy 1993, Targeted Public Distribution System 1997, National Health Policy 2002, Mahatma Gandhi National Rural Employment Guarantee Scheme 2005, National Food Security Mission 2007, National Rural Drinking Water Programme 2009, Matritva Sahyog Yojana 2010, SABLA for adolescent girls 2011, National Rural Livelihood Mission 2011, National Policy for Children 2013, National Food Security Act 2013, and National Health Mission 2013, including Janani Suraksha Yojana, Swachh Bharat Abhiyan 2014. The national food security act (NFSA) shifted the approach from welfare to right based. The act legally entitles up to 75% of the rural population and 50% of the urban population to receive subsidized food grains under Targeted Public Distribution System (nfs.gov). And under the act, the eldest woman of the house of age 18 or above is entitled as the head of the house and the ration card is issued in her name, thus empowering women too. At present, around 80 crore persons have benefitted from the act. The NFSA has a life‐cycle approach in which the nutrition is provided as per the life stage of the beneficiary. It provides prenatal care and postnatal care by entitling the pregnant women and lactating mothers to receive nutritious meal free of cost through Integrated Child Development Services (ICDS) centers, called Anganwadi Centers and to children through mid‐day meal scheme. Under NFSA, the foodgrains are made available at a subsidized price of rice at Rs 3/kg, wheat at Rs 2/kg, and coarse grains at Rs 1/kg. Mid‐day meal scheme was launched in 1962–1963 in which meal of one time (i.e. lunch) is given to children of class 1 to eighth in government primary schools. This helps to improve the school attendance of children by avoid dropping out of school and ensuring child nutrition (Laxmaiah et al. 1999; Si and Sharma 2008; Singh and Gupta 2015). Especially in the case of situations like drought, this scheme acted as a safety net for child nutrition (Singh et al. 2014). And at present 11.59 crore children have been enrolled under mid‐day meal programme and it has provided employment to 25.95 lakh cook‐cum‐helpers (mdm.nic). The gloomy picture of prevalence of undernutrition shows that despite such multipronged schemes, lags existed. Studies have shown that distribution of subsidized food does not ensure nutrition (Desai and Vanneman 2015). In future of 2050s, the population of India will increase and there will be need to develop transportation and storage infrastructure as, at present, the buffer stocks maintained are not evenly distributed across the country (Chakraborty and Sarmah 2019). Similar drawbacks in