A ‘women-centric’ approach for gains in nutrition

India has won significant battles against malnutrition. Unlike a few decades ago, instances of severe malnutrition such as kwashiorkor and marasmus are now rare. Latest figures from the National Family Health Survey revealed that there has been a ten percentage point decline in stunting from about 48 per cent in 2005-06 to 38.4 per cent in 2015-16. However, national figures mask regional variations. On the one hand, there are states like Kerala and Goa which have a low burden of undernutrition. On the other hand, there are states like Bihar, Uttar Pradesh, and Madhya Pradesh which have a high incidence of undernutrition.

Within the states also, there is considerable variation. Despite stunting levels in Odisha being 34.1 per cent (also known as “high prevalence”) certain districts such as Cuttack (15.3 per cent) and Puri (16.1 per cent) are among the top 10 “low stunting level” districts in the country. Similarly, in Karnataka, districts like Mandya have stunting rates as low as 18.6 per cent while others like Koppal have levels as high as 55.8 per cent. However, overall India’s record in addressing undernutrition has been much poorer when compared to other countries in South Asia such as China, Thailand, and Vietnam. Thus, the war against undernutrition is hardly over and meeting the World Health Assembly targets will be an uphill task for India. Moreover, the problem of undernutrition in India coexists with the problem of overweight and obesity and associated non-communicable diseases for a small section of the population which is affluent. The Observer Research Foundation and the Bill and Melinda Gates Foundation organised a consultation on malnutrition with some of the best experts in the country to explore the reasons behind India’s poor performance in addressing undernutrition and suggest appropriate policy interventions.

Although India has a plethora of policies and schemes to reduce undernutrition, there has been a basic flaw in our approach. The discourse on undernutrition in India has been “food-centric” or in recent years, “ICDS centric”. Social determinants of undernutrition have largely been ignored, particularly, the role of women. India needs a more “woman-centric” approach towards tackling undernutrition for it is not food but birth which determines whether a child will be stunted or not. In Purnima Menon’s words, “the biggest risk factor for being stunted is who you are born to”. Stunted children are born to mothers who are also stunted, uneducated, and not empowered enough to take care of their children. Therefore, nutrition policies must try to address the key determinants of undernutrition such as women’s body mass index, women’s education, early marriage, and access to ante-natal care.

A multi-sectoral approach towards nutrition is the need of the hour because narrow departmentalism has been a critical constraint in case of India. It is important to understand that nutrition does not belong to any one ministry. Nutrition outcomes tend to be better in areas where public investments have also been made in primary education and health centres along with nutrition interventions.

Amarjeet Sinha, secretary, ministry of rural development, stressed that a whole range of initiatives: better sanitation, clean drinking water, and trained rural medical practitioners are required in Indian villages for better nutrition. China offers a good example for India. In China, there was a dramatic reduction in child undernutrition and infant mortality between 1949 and 1979. Not one but a number of initiatives were behind China’s success.

First, the green tea kettle in school enforced the habit of making everyone drink boiled water. Public health facilities were improved through immunisation against diseases and training of traditional doctors. Lessons must also be learnt from better performing states and districts of India. Sinha also underscored the role that communities play in improving the nutritional status of the population by highlighting the successes of women’s self-help groups in states like Tamil Nadu.

Moreover, over half of the Indian population is deficient in micronutrients. This is mainly because of a cereal-based diet. Carbohydrates account for over 80 per cent of the diet along with small portions of fat. The bulk of the population is completely deficient in proteins and micronutrients. Thus, promoting dietary diversity through nutrition literacy and widening of the food basket under the public distribution is of utmost importance.

Here are four recommendations for India. Firstly, nutrition policies must take into account the role of social factors, particularly gender inequality. It will be next to impossible to address the challenge of undernutrition without addressing the key issues of early marriage, lack of control over child birth, and poor health of mothers.

Most nutrition interventions must be targeted to two age groups: children between 0-1,000 days and adolescent girls. This is so because the first 1,000 days are crucial for the baby. Undernutrition during this period can have profound implications on the development of the baby into a healthy adult. Similarly, it is important to target adolescent girls because they are likely to be the future mothers. Second, to address the issue of diabetes and micro-nutrient deficiency, it is important to invest in improving nutrition literacy in India. Thirdly, the basket under public distribution system must be widened to include pulses, and processed fruits and vegetables to ensure dietary diversity. Lastly, linking agriculture to nutrition is critical. Farmers must be encouraged to produce nutritious crops and vegetable not only for the market but also for household consumption.

This article originally appeared in The Asian Age

I really need to be sent off for re-education

I really need to be packed off for re-education. I am finding myself to be quite unsuitable to live in ‘modern’ India. My education, a PhD in economics from Jawaharlal Nehru University (Oops!) has rendered me completely incapable of understanding what the hell is happening in this country. A very highly qualified woman scientist, Medha Khole (we routinely complain that there aren’t many women in STEM) working for the Meteorological Department in Pune had filed a police complaint against her domestic help for hiding her caste and her marital status. In her police complaint, she said she needed a Brahmin married woman, whose husband is alive, to cook food at her house for religious ceremonies. Wow. I mean really…Wow. I am not oblivious to India’s reality. I know discrimination on the basis of caste and gender is quite common in India even among the so called educated urban elite. Most Brahmins do not eat food prepared by dalits especially during religious ceremonies. I am also aware of the discrimination that exists on the basis of gender. Married women whose husbands are alive and have borne sons are on top of the social hierarchy. What went against her the cook was not only the fact that she was not a Brahmin but also that she had lost her husband. As an informed social scientist, I am aware of the low status of widows in India but what astonishes me is that she went a filed a police complaint! I mean, just what happened to the good old Indian hypocrisy? Such a blatant caste and gender discrimination! Hail our education system. One can actually become a scientist without knowing anything about the struggle against caste and gender discrimination and the Indian constitution. Just what kind of educated women is this system creating? 

The story doesn’t end there. Apparently there is an organization called the Akhil Bhartiya Brahmin Mahasabha which decides to support her. A certain Mr Dave from Akhil Bharatiya Brahmin Mahasabha, speaks in her favour and feels that she has every reason to feel cheated because her family tradition goes back to 80 years. He also insists it is the government which is keeping the caste system alive through reservations in government jobs. The solution according to him lies in getting rid of the reservation system. I mean really, just what weed are all these people smoking???

There really is no point in educating women if they have to grow up to be like Medha Khole. We also don’t need any more women in science who have an unscientific mindset. I am more ashamed to know that a widow had to lie about her caste and marital status to earn a livelihood. This is really a denial of the right to life. But then scientists like her who spent hours mugging theorems and formulae and conducting experiments inside laboratories are not as vella as us social scientists are. They really don’t care about India’s constitution anyway. They have better things to do. But Mr Dave is actually right. There should be no reservations in jobs. And here by jobs I mean, not only the government jobs which he and other upper caste snobs of his ilk aspire for, but also the kind of jobs that poor dalit widows apply for. There should be no reservation for jobs to clean, cook etc even in religious places and ceremonies.

Do I make sense? No? I definitely do need re-education. I want to know where Ms Khole and Mr Dave studied.

China’s rapid growth in Africa: Lessons for India

China’s rising economic interest in Africa has caught the attention of scholars, journalists, and policy makers all over the world. Although the literature on China’s role in Africa has proliferated remarkably, most studies present a dichotomous understanding of China’s role in Africa, either as a ‘threat’ or as an ‘opportunity’. In fact, some scholars have even labelled Chinese economic engagement with Africa as the ‘new scramble’ for African resources. On the other hand, there are scholars, who regard China as the new economic frontier which is making a great contribution towards African development. Within India, many experts routinely emphasise the need for India to counter China’s growing influence on the African continent by building closer links with Africa. Others have expressed concerns over ‘China’s deep pockets’ and India’s inability to match China’s soft loans for infrastructure. Sadly, there is very little Indian scholarship devoted to the issue of China-Africa relations. Given the importance of both China and Africa for India, this is indeed quite disappointing.

This article tries to highlight some features of Chinese economic engagement with Africa which are often ignored by Indian scholars.

Firstly, Chinese economic engagement with Africa is not limited to resources. Although trade in resources such as crude oil and copper account for the bulk of trade between China and Africa and China has sanctioned infrastructure for resource loans worth billions of dollars to countries resource-rich countries such as like Angola and Democratic Republic of Congo, it would be wrong to dismiss China’s growing economic engagement with Africa purely as a means of acquiring resources. There are many African countries which lack resources, yet their economic ties with China are growing like never before. Ethiopia, an agricultural country in East Africa, is a case in point. The Ethiopian case completely rebuts the argument that China’s interest in Africa is limited to resources. Bilateral trade between Ethiopia and China grew at a rate of 63 per cent per annum between 2002 and 2012 and currently China is the country’s largest export destination. It is interesting to note that sesame seeds, a product, which has been, introduced in Ethiopia recently, accounts for about 85 per cent of the exports to China followed by leather and leather goods. Moreover, contrary to the belief that only oil producers like Nigeria, Angola, Sudan, and Equatorial Guinea, have been major recipients of Chinese soft loans, Ethiopia has also received huge volumes of Chinese loans for infrastructure. According to figures from China Aid Data, the total value of Chinese official financial flows to Ethiopia was about US$ 3.6 billion in 2012. Ethiopia has also been a major recipient of Chinese foreign direct investments. Chinese investment in Ethiopia is dominated by the private sector and is primarily directed towards the manufacturing sector, particularly the leather sector.

Secondly, China is making a huge economic impact on Africa through trade, development finance, and investment flows. Demand for African exports was one of the most direct channels through which China penetrated Africa. Chinese demand had a huge quantitative impact on most African countries and led to an unparalleled growth in exports from countries such as Angola, Democratic Republic of Congo, and Ethiopia. In fact, Chinese demand was significant enough to affect world prices, and led to improvements in terms of trade for these countries. Therefore, the emergence of China as the main export destination played an important role in reviving their economies during the 2000s. Sub-Saharan Africa’s exports to China grew remarkably from 2000 onwards, at a compound annual growth rate of over 22 per cent and by 2013, it exceeded sub-Saharan Africa’s exports to the United States.

Indian experts rarely regard Africa as a market for Indian manufactured products and prefer to focus on India’s long-term commitment to African development, development cooperation initiatives like Indian Technical and Economic Cooperation (ITEC) and Lines of Credit (LoCs) as well as the need for African votes for a permanent seat in the United Nations. On the other hand, China has effectively penetrated the African market. Imports from China overtook the US in 2004 and by 2013; China’s share in sub-Saharan Africa’s imports was about 14 per cent. There was a dramatic growth in imports of Chinese manufactured goods early 2000s onwards and China is now sub-Saharan Africa’s largest source of manufactured products. There was a dramatic growth in Chinese manufactured exports to countries such Angola and Democratic Republic of Congo, countries known for the huge ‘infrastructure for resource’ loans from the Chinese Export Import Bank. In 2009, China accounted for just 2.9 per cent of Angola’s manufactured imports but by 2013, China replaced Portugal as the largest source of manufactured goods for Angola with a share of 38.9 per cent. Similarly, Democratic Republic of Congo’s imports of manufactured goods from China have grown tremendously and China now accounts for over a quarter of the country’s manufactured imports. Ethiopia’s case is particularly unfortunate because India has lost market share to China. In 2000, India was the largest exporter of manufactured goods to Ethiopia with a share of 19.1 per cent followed by China at 13.1 per cent. However, China overtook India in 2003 and by 2012, it accounted for over 31 percent of Ethiopia’s manufactured imports, whereas India’s share declined to 14.9 per cent. China currently accounts for over 50 per cent of Ethiopia’s imports of leather manufactures, textile yarn and fabrics, and cork and wood manufactures and nearly 90 percent of Ethiopia’s footwear imports.

Similarly, Chinese investment flows to Africa have also increased rapidly in recent years. According to the World Investment Report 2016 published by United Nations Conference on Trade Development (UNCTAD), China was the fourth largest investor in Africa in 2014. China’s foreign direct investment stock increased more than three-fold from USD 9 billion in 2009 to USD 32 billion in 2014 and China overtook South Africa as the largest investor from a developing country in the region. While most of the Chinese investments in Africa are indeed led by large state owned enterprises which typically invest in infrastructure and resource sectors, increasingly a large number of private Chinese enterprises have also set up operations in many African countries. Scholars like Jian-Ye Wang and Jing Gu assert that increasingly it is the Chinese private sector, rather than government ministries, which is the leading China’s economic intercourse with Africa. Chinese private sector enterprises typically invest in the manufacturing and service sectors.

Proximity to Europe and access to cheap labour are important pull factors in the case of African countries like Ethiopia. The presence of India’s private sector has also grown very rapidly but the actual volume of Indian investments in Africa is much less than reported by the Indian media. This is largely because the bulk of the Indian investments in Africa are directed towards Mauritius, a tax haven, and is round-tripped back to India.

However, the most striking feature of China-Africa relations is the unprecedented growth of official finance from China to Africa. Although conceptual differences make comparisons between Chinese development finance and official development assistance from Organisation of Economic Cooperation and Development (OECD) countries difficult, many estimates suggest that Chinese financial flows to sub-Saharan Africa are now comparable in scale to traditional Official Development Assistance (ODA) from OECD countries. Chinese finance is predominantly channeled through China’s Export Import Bank in the form of concessional loans for infrastructure development. Chinese companies are also building vital infrastructure including, dams, ports, roads, railways, and bridges in Africa. According to a study by the World Bank, over thirty five African countries have engaged with China on infrastructure finance deals. Given sub-Saharan Africa’s critical shortage of infrastructure, this is China’s biggest contribution towards African development. Indian LoCs are largely directed towards infrastructure development in Africa, but it is quite clear that India cannot match China in terms of scale. Therefore, India’s development cooperation must be directed towards a few niche areas. India also needs to ensure better implementation of its lines of credit which often suffer from project delays.

In a nutshell, potential gains from closer economic ties between India and Africa have not been realised fully. To revive its manufacturing sector and create jobs for the youth, India needs a more active strategy to expand its manufacturing sector. India’s ailing manufacturing sector really can’t afford to ignore the Africa’s growing middle class. Secondly, given that India can’t match China’s deep pockets, its development cooperation must be more strategic. India needs to focus on a few niche areas and ensure better implementation.
(Originally published in China Chronicles, ORF)