India’s enduring problem with malnutrition

By Andrew NorthBBC News, Madhya Pradesh

MukeshMalnutrition usually surfaces after six months if children fail to get enough solid foods

Deshraj reaches out for his mother’s breast as she balances him on her knees, sitting outside her low, mud-walled home.

The little boy cries, but with no strength.

Deshraj is two years old but barely larger than a newborn and crazed by hunger.

His hair is patchy, his eyes are sunken and his legs like twigs – he is so weak he can’t even walk.

But his mother turns him away; she has nothing left to give.

“We can’t get him to eat bread,” she says in an irritated tone, clearly annoyed at being asked questions, and walks away.

Deshraj is one of millions of Indian children suffering severe malnutrition, an enduring problem Prime Minister Manmohan Singh has called a “national shame”.

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Sometimes the mothers don’t know how best to look after their children”

Health worker

Yet despite supposedly spending billions of rupees on poverty and food-relief programmes – and during a period of sustained economic growth – the government has made only a dent in the problem.

It is estimated that one in four of the world’s malnourished children is in India, more even than in sub-Saharan Africa.

Weakened by hunger, they are more vulnerable to disease, with tens of thousands dying every year. Millions more will be physically and mentally stunted for life because they don’t get enough to eat in their crucial early years.

‘Hunger belt’

India has fallen in child development rankings, putting it behind poorer countries such as neighbouring Bangladesh or the Democratic Republic of Congo, according to a new study by the Save the Children charity.

So when UK Prime Minister David Cameron hosts a summit this weekend on child malnutrition worldwide, India is one of the countries of greatest concern.

Yet this is hardly a new problem. India has been arguing over what to do about hunger and the poverty that underpins it for years – while its farms produce ever more food.

Public Distribution Store in Markheda villageThe feeding centre in Markheda village is empty apart from a few sacks of emergency food

On paper there is already a multi-billion dollar network in place to look after children like Deshraj.

But too often, corruption and mismanagement mean it doesn’t work.

Deep in the so-called “hunger belt” of central India, Deshraj’s village, Markheda, has a government-subsidised food shop funded by the Public Distribution System (PDS).

It entitles every family living below the official poverty line to 35kg of grain or rice a month.

His extreme case is known too: he has been identified as one of 19 “dangerously malnourished” children in the village, making him eligible for emergency help from the local “nutrition rehabilitation centre” in the nearby town of Shivpuri.

But here it gets even more complicated.

“His family won’t agree to send him,” complains one of the health workers who suddenly arrive in the village while the BBC is there.

It is true that Deshraj’s mother does not appear overly concerned about his condition. Like most people here, she’s illiterate and doesn’t seem to understand many of the questions she is asked before walking away.

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“I can’t remember when we last saw someone from the government here”

Markheda villager

“Sometimes the mothers don’t know how best to look after their children,” says the health worker.

There are other boys and girls in this settlement of about 600 families who appear in better, although far from perfect, health.

Bottom rung

But it’s questionable too how committed the local authorities are to helping remote villages like this.

Markheda’s residents are all tribals, on the bottom rung of India’s complicated social ladder and largely out of sight. No one would find this place by accident, a half-hour drive through scrub and forest from the nearest road.

Villagers say the government PDS store is usually closed. It just happens to be open when the BBC visits, but inside it is empty apart from a few small sacks of emergency food left in one corner.

“I can’t remember when we last saw someone from the government here,” says one villager.

And Om Prakash, the government team leader, admits they came to the village because “we wanted to see what you were doing”.

In another hut, Dineshi and her husband Brijmohan are still mourning their four-year-old son, Kalua, who died a few weeks ago.

BrijmohanBrijmohan’s four-year-old son died due to lack of medical care

“He got sick and stopped eating,” says Brijmohan.

“We’d taken him to the doctor once before but we couldn’t afford to go again and he got weaker and weaker.”

There is no doctor nearby, and they have no transport. The family’s only income is from selling baskets Brijmohan makes from tree saplings.

Blades of light pierce the gloom through holes in the thatched roof, catching their three-month-old son Mukesh as his mother Dineshi rocks him in a small hammock to relieve the thick summer heat.

He is still being breast-fed: the problems for children usually begin after six months, once they should start on solids.

The family gets food from the government PDS store, but sometimes “there’s not enough, or it’s bad quality”.

“We’re often hungry,” Brijmohan says.

But there are plenty of people committed to tackling the problem.

At the nutrition rehabilitation centre in Shivpuri, Dr Raj Kumar is checking on a two-year-old girl called Anjini, brought in about a week earlier weighing just 3.8kg.

Many children are born heavier than that. Anjini has also picked up TB and pneumonia – common conditions among malnourished kids.

She is still in a dire state, barely able to lift her stick-thin limbs, but with constant feeding at the centre she has put on weight.

Dr Kumar says she will survive, but “she will be stunted for life”.

‘Left to rot’

Under pressure, India’s ruling coalition introduced a Food Security bill last year, supposed to enshrine the right to food for all. But no one is betting on when it will be passed amid the country’s current political deadlock.

And some critics say there is still not enough political will to tackle the hunger problem.

Other more free-market oriented voices argue that the whole approach of subsidising food and providing guarantees is wrong, simply creating a dependency culture.

Grain warehouse in Madhya Pradesh India has had yet another record harvest

What is really needed, suggests Arti Tivari from the nutrition centre, is for existing programmes to be “implemented properly and for people to do their jobs properly” – a polite way of saying that graft and corruption still infect the system.

It is a simple fact that no Indian child needs to go hungry.

A short drive from the nutrition centre is a massive grain warehouse, sacks of wheat piled nearly to the ceiling – part of a network of government food stores across the country.

For years now, India has been producing more food than it needs. Yet every year large quantities simply rot in these warehouses.

The situation is much better than a decade ago, insists government minister Sachin Pilot, whose portfolio is officially telecoms but who has become closely involved in food policy.

But he admits “it’s unacceptable having so many children with pot bellies and stick legs”.

India still has a very young population, and politicians often talk of this future “demographic dividend”.

But there will not be much of a dividend if so many Indian children continue to be held back and stunted in their first years of life.

PATH, Abbott and the Abbott Fund Form Innovative Partnership to Prevent Malnutrition

PATH and Abbott to collaborate with local businesses to expand the market for fortified rice in India

By Abbott

MUMBAI, India and NEW DELHI, Nov. 3, 2011 — /PRNewswire/ — PATH, Abbott (NYSE: ABT) and the Abbott Fund today announced a partnership to address malnutrition by advancing the rice fortification market in India. Currently, 200 million people suffer from hunger and malnutrition in India, more than any other country in the world. Rice is the staple food for 65 percent of the population, providing a significant opportunity to address malnutrition through rice fortification. The partnership will seek to initially benefit 500,000 people through India’s public-sector food distribution programs, with the longer-term goal of expanding the broader market for fortified rice.

To advance the partnership, the Abbott Fund has provided a three-year, $1.5 million grant for refining and scaling up the production and distribution of fortified rice using PATH’s Ultra Rice® fortification technology. In addition, Abbott nutrition scientists will work with PATH to further optimize the Ultra Rice formulation in order to reduce costs and enhance the nutritional value of the grains. Abbott experts also will help PATH to develop appropriate quality assurance systems at rice miller sites to ensure production of high-quality fortified rice. PATH will simultaneously work to strengthen the local supply of fortified grains through partnerships with local industry, including Usher Agro Ltd., one of the leading rice mills in India, with whom PATH has just signed a letter of intent.

Building on earlier introduction efforts, PATH plans to expand the distribution of fortified rice within India’s public-sector food programs, including the Mid-Day Meal Scheme, which serves school-aged children; the Integrated Child Development Scheme, which serves women and young children; and the Public Distribution System, which provides subsidized commodities to families below the poverty level. Each year, the Indian government provides approximately 25 million metric tons of rice to 325 million consumers through these programs.

“We are thrilled to partner with Abbott and the Abbott Fund on this very important project. With their technical and financial support, we will develop models for scaling fortified rice through rice supply chains and public-sector distribution channels that reach the most nutritionally vulnerable populations in India,” said Dipika Matthias, director of PATH’s Ultra Rice project.

Vivek Mohan, managing director, Abbott India, said, “Abbott is deeply committed to improving the health and well-being of people in India. Our partnership with PATH will advance one of the most cost-effective strategies for addressing micronutrient malnutrition in India. At the same time, through collaborations with local manufacturers and rice millers, this initiative will build and empower local capacity by strengthening local distribution chains.”

“PATH is a pioneer in advancing culturally appropriate and cost-effective solutions to malnutrition and other critical health challenges. By sharing Abbott’s technical expertise and applying the resources of the Abbott Fund, we look forward to helping PATH to expand the market for fortified rice, which holds great potential for reducing malnutrition in India and around the world,” said Katherine Pickus, vice president, the Abbott Fund, and divisional vice president, Global Citizenship and Policy, Abbott.

Ultra Rice Offers Significant Opportunity to Prevent Malnutrition

Micronutrient malnutrition is characterized by a lack of essential vitamins and minerals, which can compromise children’s immune systems as well as their physical and cognitive development during formative years of growth.

PATH’s Ultra Rice® fortification technology is a micronutrient delivery system that packs vitamins and minerals into rice-shaped “grains” made from rice flour and manufactured using pasta-extrusion equipment. When the grains are blended with milled rice, typically at a 1:100 ratio, the resulting product is nearly identical to traditional rice in smell, taste, and texture. It is also more nutritious, offering rice-consuming populations a chance at healthier, more productive lives.

More than 30 studies in ten countries, including India, form the evidence base for PATH’s Ultra Rice fortification technology and confirm that regular consumption of fortified rice helps to bridge dietary gaps, boost health, and prevent malnutrition in women and in children, for whom micronutrient deficiency exacts the greatest toll.

Goals for the Partnership

Building on PATH’s prior market introduction activities in India, the partnership will catalyze the rice fortification market by:


  • Increasing the overall production capacity of manufacturers of fortified grains in India. PATH will work to expand the manufacturing base of Ultra Rice in India to enhance competition, lower costs, and meet future anticipated demand for fortified rice.
  • Developing low-cost quality control equipment and systems to ensure that fortified rice meets appropriate standards. To ensure that intended levels of fortification are met, PATH and Abbott scientists will collaborate with local manufacturers to create low-cost monitoring systems for rice millers in India and around the world.
  • Developing high-quality, low-cost blending equipment to enable small and medium-sized rice mills to blend the fortified grains with milled rice. PATH will develop appropriate blending equipment, enabling small and medium-sized rice mills to cost-effectively blend the fortified grains into their rice supplies. Collectively, these millers serve the majority of people in India who receive their rice through India’s public-sector programs.
  • Expanding the introduction of fortified rice to demonstrate sustainability and scalability within India’s public-sector programs. PATH will integrate fortified grains into the rice supply chains for a wide range of public sector programs in order to demonstrate feasibility and build the case for expanded distribution.
  • Optimizing the Ultra Rice formulation to lower production costs. Abbott and PATH will advance product optimization research, with the goal of decreasing manufacturing costs, enhancing nutritional value, and maximizing affordability for public-sector buyers.


More information

PATH’s Ultra Rice technology Journal of Nutrition article on Ultra Rice and iron

About PATH

PATH is an international nonprofit organization that creates sustainable, culturally relevant solutions, enabling communities worldwide to break longstanding cycles of poor health. By collaborating with diverse public- and private-sector partners, PATH helps provide appropriate health technologies and vital strategies that change the way people think and act. PATH’s work improves global health and well-being. For more information, please visit

About Abbott and the Abbott Fund

Abbott is a global, broad-based health care company devoted to the discovery, development, manufacture, and marketing of pharmaceuticals and medical products, including nutritionals, devices, and diagnostics. The company employs nearly 90,000 people and markets its products in more than 130 countries. In India, Abbott currently employs more than 12,000 people, with headquarters in Mumbai and pharmaceutical manufacturing facilities in Goa and Baddi. The Abbott Fund is a philanthropic foundation established by Abbott in 1951. The Abbott Fund’s mission is to create healthier global communities by investing in creative ideas that promote science, expand access to health care, and strengthen communities worldwide. For more information on Abbott or the Abbott Fund, visit or

About Usher Agro Ltd.

Usher Agro Ltd. is an agri-food company engaged in the milling and processing of rice and wheat products in northern India. The company offers raw rice, parboiled/steamed rice, brown rice, husk, R-Atta, rawa, suji, chakki Atta, wheat flour, and bran products under the Rasoi Raaja brand name. In addition to a robust domestic market, the company exports its products to the United Kingdom, Dubai, the United Arab Emirates, Saudi Arabia, Oman, Iran, and Kuwait. Founded in 1996 and based in Mumbai, India, the company trades under the ticker USHER.BO and is publicly listed on the National Stock Exchange of India Ltd. and the Stock Exchange, Mumbai. For more information on Usher Agro Ltd., visit


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Malnutrition: It cuts across classes

If death is the great leveller, in Mumbai — the country’s financial capital — malnutrition among children is the leveller in life.

A three-year survey
found rich or poor, schoolchildren between nine and 18 are malnourished. Postgraduate students of Sir Vithaldas Thackersey (SVT) College of Home Science at the SNDT campus in Santa Cruz researched extensively into the eating habits of at least 10,000 students across the city before concluding that the disease spares none.

“We monitored the eating habits of students in five public and five private schools,” one of the researchers said. “We want adolescents to know the right food eating habits so that they are physically fit.

This will also help prevent diabetes or heart diseases later in life.” The study also focussed on parents and teachers.

The researchers kept checking the eating habits of the students in schools, homes and other places (restaurants, or when they were hanging out with friends etc).

“Their heights and weights too were taken into account,” the researcher said. “We spoke with students, parents and teachers several times to get the full idea. We even checked their tiffin boxes and food available in canteens.”

Dr Jagmeet Madan, principal and professor of the food and nutrition department at SVT College, headed the group that carried out the study.

She said the findings highlighted a “dual burden of malnutrition (under nutrition and over nutrition) cutting across class”.

“A high percentage of gross under-nutrition was observed in both sets of schools,” Madan said. “We found children at both ends of the financial spectrum, rich or poor, chose poor quality foods. All of them ate plenty of junk food and there was barely any physical activity. This is mainly because they are ignorant of healthy eating habits.”

At present, the study has entered Phase II where students are being sensitised about the quality of food they eat.

The Diabetes Foundation of India along with the World Diabetes Foundation in Denmark helped with the study, named MARG —

The Path. Dr Anoop Misra, director and head of the department of diabetes and metabolic disorders in Fortis Hospital, New Delhi, guided the 25 students of SVT College in their study.

Producing Under nutrition-talk by Dr. Veena Shatrugna on 18th June

he  nutritional  status  of  the  poor  in  India maybe  described  as  alarming.

Most  of  the  indicators  of  nutrition  status  such  as  adult weights,  heights  BMI,  percentage  of children who  are  severely malnourished, mean  birth weights,  infant mortality  rates,  dietary intakes and unacknowledged starvation deaths confirm this  fact.  Hunger  is as widespread as  it is invisible to the scientific eye.  The question that must be asked is how did India get into this trap of under nutrition with such serious consequences?

Chronic hunger as it exists in India can be largely traced to the rapid scientific advances in the area of food and nutrition analysis, and classification. In addition, from 1940s, the dietary requirements of populations was laid out in terms of calories, with the assumption that foods which are culturally and regionally appropriate such as rice, eggs, milk, fowl, pulses, fish, greens, etc. would be consumed in quantities  which  would  provide  calories  and  all  the  other  nutrients.    Nutrition  research  in  the  50s  and  60s,  though  brilliantly innovative and deeply committed to the welfare of Indians, simplified the science of food further, with indices and correction factors, using concepts like consumption units, biological value of proteins, RDA based on calories, calorie needs of workers, vegetable sources of proteins etc., which then became subjects for scientific research and fed into nutritional policy. Over a short period, these concepts were recast and deployed in administrative initiatives that systematically transformed the diets of the poor in India to plain cereals as the major source, or perhaps the only source of calories, devoid of any other nutrient. The consequences of this cereal overload and nutritional depletion have been  far reaching, and are responsible  for a  large measure of  the profile of  ill health, and the epidemic of chronic diseases in India.

This presentation  is an attempt  to  trace  the steps  in scientific and administrative  thinking and policy that  led to  the nutritional and health impasse the people of this country are in.

The speaker is Dr. Veena Shatrugna who has spent 34 years at the National Institute of Nutrition, Hyderabad, doing research on the nutrition questions as they impact women and children in India.  She has also worked in the area of women’s health, and has authored “Savaa laksha Sandhehalu”, a self%help book for women in Telugu with a women’s collective called Stree Shakti Sangathana. She has also written “Taking charge  of  our Bodies”  in English with  the  same  group  of women.  She  is  a member  of Anveshi,  a Women’s  studies  organisation  based  in  Hyderabad.