‘Same indicators for all’

Interview with Laura Reiner, Project Head, Global Hunger Index.

The Indian government says there is an effort to tarnish India’s image.

Not at all. The GHI is compiled by technical experts using published data from internationally recognised organisations and published in a peer-reviewed report each year. It is produced using the same standards and the same four indicators for all countries: undernourishment, child stunting, child wasting, and child mortality. Taken together, they reflect deficiencies in quantity (calories) as well as in quality (micronutrients). Our job is to measure long-term hunger in all countries that meet our inclusion criteria and where we have sufficient data. Our vision is to achieve “Zero hunger by 2030”.

The government says that the questions asked to calculate the GHI scores do not take into account the efforts it has made for nutritional support and food security.

The GHI is data-based and there are no special questions for any country.what our long-term measurements clearly show: Since 2000, India has made substantial progress, but there are areas of concern, particularly regarding child nutrition. At 19.3 per cent (latest published data), India has the highest child wasting rate of all countries covered in the GHI. This rate is higher than the 17.1 per cent in 1998-1999.

It is argued that the GHI is not reflective of the hunger status and that other determinants such as sanitation, genetics, drinking water, and utilisation of food intake have to be considered.

We want to measure hunger in its complexity, and we measure outcomes and not inputs. That is why we use the four internationally recognised scientific indicators. The prevalence of undernourishment is recognised as one indicator for SDG 2.1 on ensuring access to safe, nutritious, and sufficient food for all. Child stunting and wasting are recognised as indicators to track progress on SDG 2.2 on ending all forms of malnutrition. Undernutrition is the result of inadequate intake of food in terms of either quantity or quality, poor utilisation of nutrients due to infections or other illnesses, or a combination of these immediate causes. These, in turn, result from a range of underlying factors, including household food insecurity; inadequate maternal health or childcare practices; or inadequate access to health services, safe water, and sanitation.

Finally, we include child mortality, listed as SDG 3.2., for reducing preventable deaths of children under five years of age.

There are accusations that the sample size of 3,000 is very small.

This accusation refers to “Prevalence of Undernourishment”. This indicator is calculated by FAO experts using several factors. Given their competence and long-standing experience, we are convinced that their sample sizes and methodologies are state-of-the-art. The prevalence of undernourishment takes into account the distribution of calorie intake in the population as estimated through official consumption surveys conducted by governments. Where governments have not provided consumption survey data, this aspect is updated using the FIES survey data. India has not collected and disseminated a household consumption survey since 2011.

Does food insecurity contribute to stunting?

Stunting is a result of multiple factors, but food insecurity also contributes to it in multiple ways. Food security has four dimensions: Food availability, meaning the availability of sufficient quantities of food of appropriate quality, supplied through domestic production or imports; food access; the utilisation of food through adequate diet, clean water, sanitation and health care; and food stability.

It has been argued that all three indicators of child health are related to poor food intake but none of them is solely determined by hunger.

It is not credible. It is important to consider why three out of four indicators used in the calculation of the GHI relate to children. Children are particularly vulnerable to nutritional deficiencies. The most critical time for good nutrition is the 1,000-day window between the mother’s pregnancy and a child’s second birthday.

health of children is neither scientific nor rational, the Ministry says.

The Ministry found the report disconnected from reality and unmindful of the government’s efforts to ensure food security during the pandemic. The statement included a long list of food security interventions by the Narendra Modi government.

No other country has objected to the methodology (see interview) in the survey. The report does not deny that hunger is multidimensional, and in fact, the authors point out that inadequate calorie intake is one dimension of the problem.

WHAT GOVERNMENT DATA SHOW

Government data from the National Family Health Surveys (NFHS), including the latest round (2019-21), show that while stunting has decreased, wasting is more or less stagnant. In India’s most populous State, Uttar Pradesh, only 6.1 per cent of the children in the 6-23 months age group receive an adequate diet, according to NFHS-5. Stunting in the State has decreased from 46.3 per cent (NFHS-4) to 39.7 in the latest round; there is no improvement in the wasting rates, and severe wasting has risen. Nearly 32.1 per cent of (623 months) children are underweight and 66.4 per cent children are anaemic.

At the all-india level, things are not significantly better. A Press Information Bureau release in December 2021 stated that nationally “anaemia among women and children continues to be a cause of concern”. Close to 50.4 per cent of women in the 15-49 age group are anaemic. Child nutrition indicators, however, have shown a slight improvement nationally. Stunting has declined from 38 to 36 per cent, wasting from 21 to 19 per cent.

Clearly, the government’s own data made correlations between nutrition and indicators of stunting, wasting, and underweight children. There was also a correlation between maternal health and nutrition and child health and nutrition. There were, undeniably, other determinants but they were not as significant as adequate nutrition in determining rates of stunting, wasting, low body weight and mortality.

Frontline reached out to Laura Reiner, head of the GHI project. She said well-recognised studies showed that child malnutrition and mortality data were extremely sensitive indicators of the nutrition of the whole population (see interview).

About the GHI methodology, she said: “These are internationally recognised standards for measuring hunger. We pull all of our GHI data from internationally recognised organisations that use the highest scientific practices to collect data. Of course, we can only work with what governments feed in or what is collected by the United Nations. And we apply the same standards everywhere.”

Stunting in children, she said, was associated with impaired motor and cognitive development. “India has made significant progress in the fight against hunger since 2000, but the regression or stagnation that has occurred in child wasting cannot be denied and must be acknowledged,” she said.

THE GLOBAL PICTURE

The report says global progress against hunger has stagnated in recent years and the problem has worsened in many countries. In 44 countries, hunger levels are “serious” or “alarming”, and in 22 others the GHI scores have plummeted since 2014. POU had declined between 2000 and 2017, after which it increased sharply. Stunting and underfive mortality has decreased, but wasting levels are stagnating.

There are inter-country variations. Low and middle income countries (LMICS) took a major hit during the pandemic as fuel prices rose, supply chains got disrupted, and inflation became the norm. Twothirds of survey respondents from 18 LMICS reported that their household food quantity had diminished and over half reported that their food quality had declined.

According to the Food Price Index of the FAO, in February 2022 global food prices reached the highest levels since the first FPI in 1990. High food prices were found to disproportionately affect poorer households because they had to spend more on food. Region-wise, hunger levels in South Asia and Africa were labelled as “serious”.

The report says that child wasting is an outcome of low birth weight of babies and insufficient weight gain of mothers during pregnancy. India, Pakistan, and Afghanistan had child stunting rates between 35 to 38 per cent.

While conflict is the likely reason for food insecurity south of the Sahara, in East Africa it is extended drought on account of climate change. In West Asia, North Africa, Latin America, and the Caribbean, hunger levels are not serious but the trends are troubling. East and South Asia are doing better, but there are countries where one or the other indicator shows worrying trends. Europe and Central Asia have the lowest GHI score for any region, but in five Central Asian countries hunger levels range from alarming to serious.

Since 2014, hunger has increased in 20 countries with moderate, serious or alarming GHI scores for 2022. Not all countries have high values for all indicators. For instance, Timor Leste with a GHI score considered “serious” has the highest levels of stunting in the world; India has the highest rates of wasting at 19.3 per cent, while Haiti and the Democratic People’s Republic of Korea have high undernourishment rates. Nigeria has the second highest child mortality rate after Somalia. Thirteen of 32 countries that showed improvement are in Europe and Central Asia and five in Latin America and the Caribbean.

In India there are gaps in the data made available by the government. The findings of the National Consumption Expenditure Survey 2017-18 have not been released.

The GHI and similar reports are occasions to introspect, more so when the findings correspond with India’s own health and nutrition surveys. m