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Food Security, Poverty and
Malnutrition in Asia
Anil B. Deolalikar
University of California, Riverside
Food Security – What does it really mean?
Food security has several dimensions:
• Food availability, which depends on aggregate food production and distribution (both geographical and seasonal) of food
• Access to food, which is a function of purchasing power (which in turn depends on access to livelihoods and employment) and intra-household allocation of food
• Conversion of food into nutrients in the body, which depends on morbidity, access to safe water and sanitation, environmental hygiene, and access to quality health care.
Objective of Food Security
The ultimate objective of food security is to
prevent hunger and malnutrition.
This objective has often been lost with the
preoccupation on food production, food
availability, and generation of livelihoods.
Food production in Asia has increased
rapidly over the last 40 years …
Annual percent growth in cereal production, by region, 1970-2010
0
1
2
3
4
North and Southeast Asia
(Cambodia, China, Indonesia, S
Korea, Laos, Malaysia, Myanmar,
Philippines, Thailand & Vietnam)
South Asia (Bangladesh, India,
Nepal, Pakistan & Sri Lanka)
18 Asian countries (All others plus
Afghanistan & Iran)
1970-79 1980-89 1990-95 1996-2010
… but the incidence of “hungry” persons in South
Asia has not fallen much…
Percent of "hungry" or undernourished persons, by country, 1990-2006
0
10
20
30
40
50
Chi
na
Cam
bodi
aLao
s
Indo
nesia
Mya
nmar
Philip
pine
s
Vie
tnam
Ban
glad
esh
Indi
a
Nep
al
Pakista
n
Sri Lan
ka
1990-92 2000-02 2005-07
… and Asia accounts for two-thirds of all
undernourished persons in the world (with India
and China alone accounting for >40%)
Distribution of 1 billion hungry people in the world, by region, 2010
China, 15.3
Other Asian
countries, 22.1
India, 28.1
Other countries
outside Asia, 34.6
South Asia has the highest rates of child malnutrition in the world – even higher than Sub-Saharan Africa – even though incomes are significantly higher in South Asia.
South Asia accounts for 56% of all the underweight children in the world, with India alone accounting for 40%.
Underweight prevalence among under-5 year olds, by region, circa
2000
47
28 27
16 17
75
44
30 29
18 17
85
0
5
10
15
20
25
30
35
40
45
50
South
Asia
Easte
rn/S
outh
ern
Afric
a
Wes
t/Cen
tral A
fric
a
Mid
dle Eas
t/Nor
th A
fric
a
East A
sia/
Pacifi
c
Latin
Am
eric
a/Car
ibbe
an
CEE/C
IS
Girls Boys
In particular, India and Bangladesh have the
highest child malnutrition rates in Asia.
% of children 0-59 months moderately or severely underweight,
circa 2005, selected Asian countries
48
46
45
38
37
36
32
28
28
20
9
7
6
0 10 20 30 40 50
India
Bangladesh
Nepal
Pakistan
Laos
Cambodia
Myanmar
Indonesia
Philippines
Vietnam
Thailand
China
Mongolia
And these rates have fallen slowest in India over the past decade. In fact, Bangladesh has done as well as Vietnam in bringing down its child underweight rate.
Relative decline in child stunting rate in four Asian countries,
circa 1990 and circa 2005
20
40
60
80
100
circa 1990 circa 2005
20
40
60
80
100
India
Bangladesh
Vietnam
Indonesia
Indeed, India has made much more progress in other indicators, such as infant mortality, but child malnutrition rates have remained stubbornly high.
Relative decline in infant mortality and child malnutrition rates,
India, 1992-93 to 2005-06
70
80
90
100
1992-93 2005-06
70
80
90
100
Child stunting rate
Child underweight rate
IMR (preceding 10 years)
IMR (preceding 5 years)
Why is child malnutrition so
important?
Children who are malnourished in the first two years of life suffer permanent damage – not just to their physical growth in stature, but also to their cognitive development.
Rough estimates suggest that child malnutrition, including micronutrient deficiencies, cost the Indian economy roughly 3-5% or more of its GDP in terms of resulting morbidity, premature deaths, impaired cognition, and lost labor productivity.
Even these might be underestimates, as the full cost of under-nutrition is not fully known.
For instance, there is recent medical evidence to suggest that low birth-weight children and children who are under-nourished are more likely to develop chronic illnesses, such as diabetes, as adults.
India already has the largest number of adults with type 2 diabetes and their number is growing rapidly – having doubled over the past 10 years. Indeed, India’s diabetes prevalence rate is larger than that of many Western countries with much higher levels of income.
What accounts for this rigidity in the child
malnutrition rate, especially in India?
Is it slow economic growth?
In fact, India has had the highest rate of
economic growth during the 1995-2005
period.
Rigidity in child malnutrition
The problem is that India’s IMR and child malnutrition
have been very unresponsive to economic growth – more
so than in other countries of the region
Elasticity of IMR and child malnutrition rates with
respect to GDP per capita, circa 1995-circa 2005
Country
IMR (past 5
years)
Stunting rate Under-
weight rate
Indonesia -0.51 -0.79
Vietnam -0.40 -0.37
Bangladesh -0.34 -0.31 -0.27
India -0.19 -0.11 -0.11
Is poverty the cause of child
malnutrition in India?
There is evidence to suggest that low income
and poverty are not the main reasons for the
high child malnutrition rates in India.
In fact, child malnutrition is high in relatively
prosperous states such as Gujarat.
Children under 3 years who are underweight, by state, 1992-93 to 2005-06
25
30
35
40
45
50
55
60
And
hra Pra
desh
Ass
amBih
ar
Guj
arat
Har
yana
Him
acha
l Pra
desh
Kas
hmir
Kar
nata
ka
Ker
ala
Mad
hya Pra
desh
Mah
aras
htra
Oris
sa
Punja
b
Raj
asth
an
Tamil
Nad
uU
.P.
W B
enga
l
All
Indi
a
1992-93 1998-99 2005-06
And 25% of children in the top wealth
quintile are stunted. These children are
unlikely to face food insecurity.
% of children aged 0-59 months who are moderately or severely
malnourished, by wealth quintile, 2005-06
60
54
49
41
25
57
49
41
34
20
0
10
20
30
40
50
60
70
Bottom quintile Second quintile Third quintile Fourth quintile Top quintil
Stunting Underweight
Disconnect between agriculture
and nutrition
There is also a strong disconnect between
agricultural productivity growth and reductions in
hunger and child malnutrition in South Asia.
Even as agricultural productivity and rural incomes
have increased appreciably in India, mean calorie
intake has actually fallen and the proportion of
children who are underweight and stunted has
remained stubbornly high.
In India, crop yields have increased over
the last 40 years …
Figure 1: Average crop yields (kgs./hectare) of all food grains and
coarse cereals, India, 1972-73 to 2004-05
400
600
800
1,000
1,200
1,400
1,600
1972-73 1983 1993-94 1999-2000 2004-05 1972-73 1983 1993-94 1999-2000 2004-05
Food grains Coarse cereals
Source: Indiastat.com
… while mean calorie intake has actually
declined … Figure 2: Calorie intake per person per day, by rural/urban residence,
India, 1972-73 to 2004-05 (in '00 calories)
19
19
20
20
21
21
22
22
23
23
Rural Urban
Calories ('00 kcal.)
1972-73 1983 1993-94 1999-2000 2004-05
Source: Author's calculations from NSS unit record data
… and child malnutrition has stagnated …
Figure 4: Percent of children under 3 years who are underweight or
stunted, India, 1992-93 to 2005-06
48
52
46
47
38
46
35
40
45
50
55
Stunting Underweight
1992-93 1998-99 2005-06
Source: nfhsindia.org
There is no association observed across Indian
states between crop yield growth and reduction
in child malnutrition rates…
Figure 5: Percent change in the proportion of underweight children under 3
years of age from 1992-93 to 2005-06, in comparison to crop yield growth
(kharif food grains) over 1991-92 to 2000-01, across Indian states
-45
-35
-25
-15
-5
5
15
-30 -20 -10 0 10 20 30 40 50 60
% growth in kharif food grain crop yield over 1991-92 to 2000-01
% c
han
ge
in p
rop
ort
ion
of
un
der
wei
gh
t ch
ild
ren
,
19
92
-93
to
20
05
-06
Source: nfhsindia.org and indiastat.com
…or between crop yield growth and calorie
intake …
Figure 3: Percent change in mean calorie intake from 1993-94 to 2004-05, in
comparison to crop yield growth (kharif food grains)
over 1991-92 to 2000-01, across Indian states
-14
-12
-10
-8
-6
-4
-2
0
2
4
6
-40 -20 0 20 40 60 80 100 120 140
% growth in kharif food grain crop yield over 1991-92 to 2000-01
% c
han
ge
in m
ean c
alo
rie
inta
ke,
19
93
-94
to
20
04
-05
Source: NSS unit record data and indiastat.com
Direct nutritional interventions
What about the role of direct agricultural and
nutritional interventions in reducing child
malnutrition rates?
India has no shortage of interventions and
programs aimed at providing food security:
Public Distribution System (supply of food grains and sugar at controlled prices to the “poor” through “fair-price” shops)
National Rural Employment Guarantee Scheme (NREGS), which is a type of public-works scheme
Integrated Child Development Services (ICDS) – a direct nutrition supplementation program
Midday Meal Scheme – a school lunch program
Indeed, the Intensive Child Development Services (ICDS) has been around for more than two decades and is the largest child feeding program in the world.
It supposedly reaches 92% of villages in the country.
It had a central government budget allocation of $3 billion last year, with additional amounts spent by the states.
But there have been few rigorous evaluations of the program.
A recent evaluation found that if one considers children who received supplemental feeding, then the program’s impact was significant – on average, it resulted in an increase of half a standard deviation in child height among children 0-2 years of age (but no effect on children 3-5 years of age).
But the problem was that despite 92% village coverage, only 7% of 0-2 year olds and 15% of 3-5 year olds in a national household survey reported receiving daily supplementary feeding.
Concluding Thoughts
So why is child malnutrition so stubbornly high in South Asia?
There are several reasons:
• Child malnutrition in South Asia starts at birth. Nearly one-third of babies born in India have low birth-weight (<2,500 gms).
• The incidence of low-birth-weight babies is so high because many pregnant women are themselves malnourished. About a third of pregnant women in India have BMI of less than 18.5; and nearly 60% of pregnant women are anemic.
• Women’s poor health is related to the social status of women in South Asia. Women, especially young mothers, often eat last in the family – and only after the men and children have eaten. Thus, they have a residual claim on food in the family. Young mothers also are assigned hard work in their in-laws’ families – not only household chores but also work on the family farm.
• Low birth-weight babies are at high risk of malnutrition during infancy and childhood. Poor breastfeeding and infant feeding practices tip them into malnutrition. Fewer than one-fifth of babies are breastfed within the first hour and only a third are breastfed 24 hours of birth. These practices are obviously cultural.
• Child malnutrition in South Asia is also
related to gender and birth order. The gap in
mean heights of children aged 0-59 months
between South Asia and Sub-Saharan Africa
is much greater for girls than for boys and
for second and third births than for first
births.
Mean height-for-age Z-scores by sex and birth order, South Asia and
Sub-Saharan Africa, circa 2005
-1.6
-1.3
-1.4 -1.4
-1.5
-1.7-1.6
-1.4
-1.5
-1.9
-2
-1.75
-1.5
-1.25
-1
Boy Girl First birth Second birth Third birth
Sex Birth order
Sub-Saharan Africa South Asia
The concept of food security has to more
directly address nutritional security for
women and children as its central objective.
The causes of maternal and child malnutrition
in South Asia are complex – often rooted in
culture and habits. This is why simple-minded
solutions have so far been elusive.
