Malnutrition in Gujarat has been in the news owing to the Chief Ministers’ comments in a recent newspaper interview. (Full transcript of the particular question is available here). The comments reaffirm widespread public perceptions about malnutrition – that it is primarily a consequence of lack of access to adequate food. Moreover, the comments also suggest that in more developed states like Gujarat, malnutrition is a middle class phenomenon rather than a serious consequence of poverty. Does the data on malnutrition support these assumptions? This blog analyses the data to share some facts and figures about malnutrition in Gujarat.

A lot has already been written about the issue of malnutrition in Gujarat and without getting into the details, I would just like to present some facts.

First, I think it’s important to start with the definition of malnutrition. Malnutrition is the condition that occurs when one’s body does not get enough nutrients. It is not necessarily correlated with lack of quantity of food – as is often assumed.

While there are many technical definitions of malnutrition, most measures incorporate three main components. These are:

• Height-for age, which is referred to as stunting and reflects a failure to receive adequate nutrition over long periods of time and is also affected by recurrent and chronic illness.
• Weight-for-height (wasting), which measures body mass in relation to body length and describes current nutritional status.
• Weight-for-age or a measure of how underweight you are. This represents the long-term effects of malnutrition in a population and does not vary according to recent dietary intake.

Second, it is important to note that malnutrition is not limited to adult malnutrition. However, as official data suggests, it is children under 5 years of age who suffer the most.

So what is the truth about malnutrition in Gujarat? Let’s take a look at some of the numbers (See Table below).

	NFHS III				ICDS (as on 31.12.2009)	ICDS (as on 31.3.2012)
	% of children age 6-59 months, 2005-06
	Height for age (stunted)	Weight for age (Underweight)	Any Anaemia	Severe Anaemic	Any Malnutrition (severe, mild, moderate)
Bihar	55.6	55.9	78	1.6	NA	82.12
Madhya Pradesh	50	60	74.1	3.4	43.86	23.19
Rajasthan	43.7	39.9	69.7	6.7	47.31	39.18
Gujarat	51.7	44.6	69.7	3.6	56.87	34.04
Punjab	36.7	24.9	66.4	6.6	34.85	27.01
Haryana	45.7	39.6	72.3	4.3	43.91	43.54
Maharashtra	46.3	37	63.4	1.8	37.89	18.85
India	48	42.5	64.2	2.6	45.84	37.32

Source: National Family Health Survey-III, available online at: http://www.rchiips.org/NFHS/report.shtml and Integrated Child Development Services, available online at: http://wcd.nic.in/icdsdatatables.htm

As can be seen from the table above, in 2005-06, according to the third round of Indian National Family Health Survey (NFHS III), in Gujarat, 52% of children under five years of age were stunted,  45% were underweight and over 70% were anaemic. It is often argued that there is a correlation between malnutrition and vegetarianism. However, this does not hold statistically. As is evident, despite Haryana being a state which is even more predominantly vegetarian than Gujarat (2% of protein intake in rural Gujarat is from eggs, meat etc while only 1% from Haryana[1]), it rates better in most nutrition figures except anaemia. Thus, vegetarianism alone cannot be an explanation.

Four years later, in 2009-10, according to the Integrated Child Development Services (ICDS) own website, Gujarat continued to fare badly on malnutrition amongst ICDS beneficiaries with 57% of ICDS beneficiaries malnourished, much higher than the national average of 45% and higher than most poorer states such as Chhattisgarh (53%), Jharkhand (44%), Rajasthan (47%) and Madhya Pradesh (44%). While the situation, improved in 2011-12(from 57% to 34%), it still remains higher than many other states. Moreover, it is important to remember that this number does not take into account children who are not ICDS beneficiaries and thus the situation could in fact be far worse.

Even with regards to adult women malnutrition as per the NFHS-III, 55 % of Gujarati women were anaemic and 2.6% were severely anaemic, worse than all states except Assam and Andhra Pradesh.

I do not deny that like many states the average nutritional intake in Gujarat has been declining in recent years. In fact, in their article on nutrition, Jean Dreze and Angus Deaton refer to a number of puzzling trends which indicate that per capita food consumption in India has been falling as income levels rise. But what is worrying about Gujarat’s data is the fact that in 2009-10, over 60 percent of households in rural areas and over 55 percent in urban areas were below the recommended norm of 2,700 Kcal per day. (66^th round of the National Sample Survey Organisation Report (NSSO), Report No. 540, “Nutritional intake in India”)

Unsurprisingly, these nutritional levels seem to be strongly correlated with poverty. The 66^th round of NSSO maps the per capita per day intake of calories measured in Kcal with the Monthly Per Capita Expenditure (MPCE) and found that in 2009-10, the average daily intake in Gujarat was significantly low for the poorest 10% of households at 1,484 kcal in urban areas and 1,430 kcal in rural areas. For the richest 10% on the other hand, it was nearly double those figures for both urban and rural.

To conclude, the malnutrition data from Gujarat points to the fact that malnutrition is not a middle class phenomenon as has been assumed but rather a serious problem that needs to be actively addressed through targeted government efforts

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[1] 66^th round of the National Sample Survey Organisation Report (NSSO), Report No. 540, “Nutritional intake in India”