Mother’s education & sanitation play an important role in nutrition : Arvind Virmani

26 November 2013 | Column | By Arvind Virmani

Rice and wheat provide just calories and they don’t give nutrition. Within the subsidised price of wheat, people should get the course grain, and then it would be better for them

Malnutrition is a persistent problem in India, though it is often confused with hunger. According to Food and Agriculture Organisation (FAO), about 18% of India’s population was undernourished in 2012. Undernourishment is the main cause of children’s death, and according to United Nations Children's Fund (UNICEF), India houses one-third of stunted/wasted, termed malnourished, children of the world.

What is called malnutrition, I prefer, for accuracy, to call it stunting and wasting of children. It was quite shocking when I came across that 45% of children under three years are stunted, wasted in India. There are two categories we look at, three years and below and five years and below. In both the categories between 45-50% children are stunted.

According to different rounds of National Sample Surveys (NSS), the proportion of households in rural areas, getting enough food every day of the year, increased from 94.5% in 1993-94 to 99.0% in 2009-10. The proportion of rural households, not getting enough food every day, for some months of the year, declined from 4.2% to only 0.9%.

So, this was an incredible puzzle to me. How can you have such a number? One per cent hungry, 25% of poor and almost 50% of the children, it doesn’t matter in which category, are undernourished. Thus, I did this research on interstate and I got to know that sanitation was the most critical factor. Analysis of the state-wise 2004-05 NSS and 2005-06 National Family Health Survey data led to the conclusion that the most important cause of malnutrition in India was the abysmal state of 'public health' in terms of sanitation, pure drinking water and public knowledge about importance of cleanliness and nutrition. Unclean environment generates germs and they affect nutrition as the germs won’t allow absorption of whatever you eat.

This problem is not necessarily restricted to poor people and those living in slums. Even those living in a good house in a proper building may face this problem due to the unclean environment surrounding the home. Monsoon in India adds to this problem as every time there is rain these germs spread all over the place, even good localities. People and children in good houses are also affected by these germs if their environment is not clean and thus the problem of not getting nutrition, despite having proper food intake, occurs. It is more prevalent among children because as one grows, the person develops immunity. But children are more vulnerable and that’s why malnutrition has been defined as stunting and wasting of children.

The second important issue related to malnutrition is supply of wheat and rice at subsidised rates through Public Distribution System (PDS). The PDS has had both positive and negative effects. It was positive at some places and negative in other places.

Everybody feels that rice and wheat is the right diet. But that’s not completely true. Rice and wheat provide just calories and they don’t give nutrition. Those who have dealt with food issues for the last few decades have often cautioned that availability of subsidised wheat and rice has driven out coarse cereals. So, even at the subsidised price of wheat, if people can get the course grain, it would have been better for them.

I tried to introduce coarse cereals in PDS, but what we learnt was that it is very inconsistent with the PDS because the cereals cannot be stored. So there was no way we could have introduced coarse cereals in the PDS. What we suggested could probably be done at the state and local levels, but nobody took it up.

The PDS has one more effect. It has also driven out more nutritious local foods (such as wild berries and roots), which are much better than rice and wheat, from the diet of poor and it might have a negative impact on nutrition. Many people are forgetting their old knowledge and that too is creating a problem. The important thing is coarse cereals and micro nutrients.

After experimenting with the data in my study, the second thing I came to know about the issue was related to the traditional nutrition that gets into people’s staying areas. In old days, people used to stay in the same place for ages and the knowledge gained was passed on, which was useful. It was a culture of its own. Little things were worked out as living together for years brought about a new understanding. Some things which we don’t even know. Unfortunately, that knowledge has gone and has been replaced by the media.

Mother’s education along with sanitation plays an important role in nutrition. Mother’s education and the proportion of household with toilets turned out to be significant. Hence, I came to the conclusion that one of the most crucial thing was having a proper sewage system.

What I recommended on the nutrition front is a public education campaign, which covers basics of cleanliness and nutrition. Basic nutritional training for the public should be started. People should know that they need to be clean. In Mumbai slums everybody is not poor. Many of them earn good but get affected if they are not clean and have no proper sewage. Children should start learning clean habits when they are in school. Otherwise if they don’t learn it in school, they don’t learn it anywhere.

As far as spreading traditional knowledge is concerned, we urban people don’t know how we can revive it. But, if we could collect all those old tales and do a phenomenology that would definitely help.

As far as nutritional companies’ role is concerned, I think the best way is to go back and see how things evolved in developed countries. Companies can be involved in public education campaign. The rich can afford to purchase their products. But not the poor. The education campaign can be done for the have nots.

You are thus helping the poor by educating and propagating health and sanitation, food groups and how important vitamins and minerals are, and provide the products to the rich. That is probably the best way to get involved and show importance of different food groups and health from nutrition point of view.

While studying this issue related to food and nutrition, the most important problem one sees is hunger as nearly 1% of our population is hungry. People may feel that 1% is nothing as it is a very small figure. But that means 12 million people in the country are hungry which is a disgrace.


The Food Security Act is supposed to cover 67% of the population. But one of the most important social problem that comes to mind is the 12 million hungry people. In the 67% of population these 12 million hungry people will be lost. They probably don’t even have ration cards. They don’t access the PDS which is supposed to be for them. Thus the Food Security Act is not going to touch them. Most of these hungry people are in remote rural areas. Hence, what we need is a focussed campaign to eliminate hunger.

The country has PDS since 1950. I did the first study on it and found leakages in transporting food to the people. Now, we are talking of reaching additional 25-50% through Food Security Act when we have not been able to cover earlier 25-30% completely due to leakages.

That brings us to the second obvious issue. Need for improvement in PDS. One should see how the poor, who have to buy foodgrains from PDS, are treated at ration shops. They are at the mercy of shopkeepers and government employees involved in the PDS work. To overcome this problem people need to be empowered. Like bank debit and credit cards, we should give each poor a food debit card or a food credit card. This gives them the right to go to any shop, not only to the PDS shop, and use the card to buy foodgrains. Give them the card and their right to food. If the shopkeeper doesn’t want to give the card holder any food then he won’t get any money. That is empowerment. Credit card companies may be happy to do this almost for free because of greater exposure.

The third problem was poverty. In my 2009 paper, I calculated the amount spent on the three largest ‘Garibi Hatao’ programmes of the Centre and showed that the amount of money is equal to what one would need to bring every person from below the poverty line on the poverty line. I thus concluded that it was not a money problem, but a governance problem. And that was the beginning of Unique Identification (UID). So, in that paper I first suggested we transfer the money.


About the author
Arvind Virmani is an economist who was appointed India's representative to the International Monetary Fund in 2009 for a period of three years. Prior to that, he was the Chief Economic Advisor to the Government of India. During that time Virmani wrote the Economic Survey of India (2008-2009). He published several articles in areas of macroeconomics, growth and finance, international trade & tariffs and international relations. His books include The Sudoku of India’s Growth, From Uni-polar To Tri-polar World: Multi-polar Transition Paradox, Propelling India from Socialist Stagnation to Global Power.

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