This open access book examines the interactions between India’s economic development, agricultural production, and nutrition through the lens of a “Food Systems Approach (FSA).” The Indian growth story is a paradoxical one. Despite economic progress over the past two decades, regional inequality, food insecurity and malnutrition problems persist. Simultaneously, recent trends in obesity along with micro-nutrient deficiency portend to a future public health crisis. This book explores various challenges and opportunities to achieve a nutrition-secure future through diversified production systems, improved health and hygiene environment and greater individual capability to access a balanced diet contributing to an increase in overall productivity. The authors bring together the latest data and scientific evidence from the country to map out the current state of food systems and nutrition outcomes. They place India within the context of other developing country experiences and highlight India’s status as an outlier in terms of the persistence of high levels of stunting while following global trends in obesity. This book discusses the policy and institutional interventions needed for promoting a nutrition-sensitive food system and the multi-sectoral strategies needed for simultaneously addressing the triple burden of malnutrition in India.

Malnutrition is endemic in India. In 2015-16 some 38% of preschool children were stunted and 21% were wasted, while more than half of Indian mothers and children were anemic. There are many posited explanations for the high rates of malnutrition in India, but surprisingly few discuss the role of Indian diets, particularly the affordability of nutritious diets given low wages and the significant structural problems facing India’s agricultural sector. This study was undertaken to address knowledge gaps around the affordability of nutritious diets in rural India. To do so we used nationally representative rural price and wage data to estimate the least cost means of satisfying India-specific dietary recommendations, referred to as the Cost of a Recommended Diet (CoRD), and assess the affordability of this diet relative to male and female wages for unskilled laborers. Although we find that dietary costs increased substantially over 2001-2011 for both men and women, rural wage rates increased more rapidly, implying that nutritious diets became substantially more affordable over time. However, in absolute terms nutritious diets in 2011 were still expensive relative to unskilled wages, constituting approximately 50-60% of male and about 70-80% of female daily wages, and were often even higher relative to minimum wages earned from the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA). Since many poor households have significant numbers of dependents and substantial non-food expenditure requirements, it follows that nutritious diets are often highly unaffordable for the rural poor; we estimate that 45-64% of the rural poor cannot afford a nutritious diet that meets India’s national food-based dietary guidelines. Our results point to the need to more closely monitor food prices through a nutritional lens, and to shift India’s existing food policies away from their heavy bias towards cereals. Achieving nutritional security in India requires a much more holistic focus on improving the affordability of the full range of nutritious food groups and ensuring that economic growth results in sustained income growth for the poor.

The purpose of this Policy Note is to examine the trends in undernutrition in Maharashtra and to document trends and geographic variability in the major determinants of nutrition and the coverage of key nutrition and health interventions. In doing this analysis, we aim to highlight key areas for actions to improve nutrition in Maharashtra.

This open access book provides an evidence-based roadmap for revitalising Indian agriculture while ensuring that the growth process is efficient, inclusive, and sustainable, and results in sustained growth of farmers’ incomes. The book, instead of looking for global best practices and evaluating them to assess the possibility of replicating these domestically, looks inward at the best practices and experiences within Indian states, to answer questions such as -- how the agricultural growth process can be speeded up and made more inclusive, and financially viable; are there any best practices that can be studied and replicated to bring about faster growth in agriculture; does the prior hypothesis that rapid agricultural growth can alleviate poverty faster, reduce malnutrition, and augment farmers’ incomes stand? To answer these questions, the book follows four broad threads -- i) Linkage between agricultural performance, poverty and malnutrition; ii) Analysing the historical growth performance of agricultural sector in selected Indian states; iii) Will higher agricultural GDP necessarily result in higher incomes for farmers; iv) Analysing the current agricultural policy environment to evaluate its efficiency and efficacy, and consolidate all analysis to create a roadmap. These are discussed in 12 chapters, which provide a building block for the concluding chapter that presents a roadmap for revitalising Indian agriculture while ensuring growth in farmers’ incomes.

A notable approach to addressing maternal undernutrition during pregnancy in India in recent years has been the integration of hot-cooked meals (HCM) for pregnant and lactating women together with the provision of other health/nutrition services. Called the One Full Meal (OFM) program, these efforts aim to improve maternal nutrition and health across India by bundling center-based HCM with other nutrition services and behavior change communication implemented through the Integrated Child Development Services (ICDS) scheme. The program is offered at anganwadi centers (AWCs) and has been implemented in eight states in India, including Andhra Pradesh, Chhattisgarh, Gujarat, Karnataka, Maharashtra, Telangana, Madhya Pradesh, and Uttar Pradesh. Although the OFM program has been implemented since 2013, there is limited consolidated insight on its effectiveness or on broader lessons for implementation. The objectives of this evidence review of the OFM program are, therefore, to (1) compare the different state OFM program models on their objectives, implementation elements, cost norms and monitoring mechanisms; (2) develop program impact pathways on the potential ways in which the program could influence intended outcomes; and (3) examine the availability of evidence underpinning the program’s intended pathways to impact.

The evaluation of reproductive, maternal, newborn, and child health (RMNCH) by the Disease Control Priorities, Third Edition (DCP3) focuses on maternal conditions, childhood illness, and malnutrition. Specifically, the chapters address acute illness and undernutrition in children, principally under age 5. It also covers maternal mortality, morbidity, stillbirth, and influences to pregnancy and pre-pregnancy. Volume 3 focuses on developments since the publication of DCP2 and will also include the transition to older childhood, in particular, the overlap and commonality with the child development volume. The DCP3 evaluation of these conditions produced three key findings: 1. There is significant difficulty in measuring the burden of key conditions such as unintended pregnancy, unsafe abortion, nonsexually transmitted infections, infertility, and violence against women. 2. Investments in the continuum of care can have significant returns for improved and equitable access, health, poverty, and health systems. 3. There is a large difference in how RMNCH conditions affect different income groups; investments in RMNCH can lessen the disparity in terms of both health and financial risk.

The purpose of this Policy Note is to examine the trends in undernutrition in Karnataka and to document trends and geographic variability in the major determinants of nutrition and the coverage of key nutrition and health interventions. In doing this analysis, we aim to highlight key areas for actions to improve nutrition in Karnataka.

Hidden hunger has long been an overlooked problem. Vitamin and mineral deficiencies have to be remedied and the availability of calories needs to be increased. As a matter of fact, the number of people who do not have access to a balanced diet has multiplied in rich and poor countries, with lasting consequences for health and well-being. Hidden hunger not only affects childhood growth and cognitive development, but also reduces productivity and well-being later in life, thus keeping the affected population trapped in a circle of poverty and malnutrition. This book illustrates the global fight against hunger by national governments and international organizations. Presented at the Third Hidden Hunger Conference held at the University of Hohenheim in Stuttgart, Germany, it presents a range of strategies being implemented in various regions of the world to improve nutrition quality and combat this international crisis.

The purpose of this Policy Note is to examine the trends in undernutrition in Tamil Nadu, and to document trends in the major determinants of nutrition and the coverage of key nutrition and health interventions. In doing this analysis, we aim to highlight key areas for actions to improve nutrition in Tamil Nadu.

The purpose of this Policy Note is to examine the trends in under nutrition in Rajasthan and to document the trends and geographic variability in the major determinants of nutrition and the coverage of key nutrition and health interventions. In doing this analysis, we aim to highlight the key areas of action to improve nutrition in Rajasthan.