Malnutrition in Odisha

20 Malnutrition in Odisha Sanjukta Das, Reader, P.G. Department of Economics, Sambalpur University, Jyoti Vihar, Sambalpur (Odisha) ABSTRACT This paper makes a comparative analysis of child malnutrition in Odisha with other states. It also makes an attempt to explore the causes of high level of malnutrition in Odisha. It also uses the district level data to understand the problem more in detail. Finally it linked malnutrition to poverty and food insecurity. Keywords Malnutrition, underweight, stunting, poverty, food insecurity INTRODUCTION Every household and society desires/aspires to have a good standard of living for its members and more specifically for the children, its future generation. By good living standard it means in general a healthy and disease free long life, with at least a minimum level of knowledge and awareness; and a level of income, which guarantees at least a minimum decent standard of living. Households and society plan their resources; evaluate their performance in the achievement of this desired objective. Accordingly, plans and programmes are designed and evaluation studies are made. In spite of the concerted efforts, Odisha has not been able to reduce its level of poverty and malnutrition to a satisfactory level. According to the report based on data of NSS 55th Round, 48.03 percent of the rural and 42.5 percent of the urban population of Odisha are below the poverty line. Similarly 54.4 percent of the children below five years of age are found to be malnourished (NNMB Report 2000-01). There are states like Kerala and Tamil Nadu with even higher level of malnutrition in 1975 (NNMB Survey Report) who have successfully reduced the level of malnutrition to much lower levels, (i.e. 28.8 and 39.0 percent respectively). But the progress of Odisha in the reduction of malnutrition is quite unsatisfactory during the same period. In this paper an attempt is made to analyze the different aspects of malnutrition prevailing among the children of Odisha. Side by side the situations of six other states, where NNMB surveys are conducted are presented to give a comparative picture of Odisha vis-à-vis other states. We also make an attempt to study the factors related to malnutrition. MALNUTRITION, ITS MEANING AND CONCEPT There is no universally accepted meaning of malnutrition. Very often the terms malnutrition and under nutrition are used interchangeably, though there is a thin line of demarcation between the two. Some use under nutrition to mean the energy or calorie deficiency, while others take protein-energy malnutrition (PEM) to mean it. In contrast to it malnutrition is expected to mean deficiencies in all types of vitamins and minerals. In this way it becomes more a techno-medical phenomenon. But it has both economic causes and consequences. In general, all these deficiencies (both under nutrition and malnutrition types) are found to exist simultaneously with poverty. And in this paper we have used these terms interchangeably. The costs of malnutrition, both human and economic are well recognized. Studies reveal a very high human as well as economic cost of malnutrition to the societies particularly to the low-income countries. Pelletier et al (1994) estimated 2.8 million child deaths each year. 51 percent of these child deaths in the low-income Asian countries are owing to malnutrition. Estimates of the global burden of diseases in 1993 (WB 1993) attributed 20-25 percent of the burden of diseases among children to undernutrition. Among the studies relating to economic costs of malnutrition, Horton (1999) s, Alderman et al. (1995) s and Ross and Horton (1998) s are important Horton summaries the estimates of the loss of labour productivity owing to the various types of malnutrition. It is stated that as high as 17 percent of loss of labour productivity accrue owing to iron deficiency. Proteinenergy malnutrition (PEM) and iodine deficiency each causes 10 percent reduction of labour productivity individually. Realizing the serious implication of malnutrition both on the present as well as on the future generations a number of attempts are made both at the national as well as international level to estimate the level of malnutrition of different countries. In India NFHS as well as DNP and NNMB surveys are conducted for that purpose. At the international `level UNDP, UNICEF etc. have their own estimates. For the purpose of policy intervention these studies are found to be very useful. There are two sets of measurements that can be used to compare the incidence of malnutrition: (i) The food supply-based estimates emanating from FAO, (ii) The other uses anthropometric data on children and adult (adopted by WHO). FAO s calculations of under nutrition are based on the productions and net imports.

21 Per capita availability of food (converted into calories in individual countries,) depends on its own production and net imports). Distribution of these available calories across the households is estimated from household food surveys. This method has serious limitations arising either from the under-estimation of per capita food availability, or from the differential calorie requirements of individuals. In underdeveloped countries poor people depend on subsistence cultivation, the products of which escape market and GDP calculation (Heston, 1994). Moreover, calorie requirements of people depend on the age, sex, and the type of activities they do. Estimation of food calorie requirement based on the average calorie norm (of 2400 kcal for rural and 2100 kcal for urban areas) is expected to yield erroneous results (Hayter and Henry, 1994; Svedberg, 2001). Moreover, according to Amartya Sen, food consumption is only one determinants among many on nutrition. Consumption cannot readily be identified with what human beings get out of consumption. Anthropometric data measuring malnutrition also suffer from various limitations. Critics like Payne etc. raise objections to the use of the mean weight, height data of the developed countries norm. According to them because of the adaptation phenomenon, use of such norm would result in the overestimation of the problem. Moreover, anthropometrics is very often to be influenced by genetic factors. However, recent research also shows that the average height and weight of the children of the well-to-do families of the under-developed countries (UDCs) are found to be almost at par with those of the developed countries. UNDP also in its various Human Development Reports (HDRs) have used the standard deviation measure of underweight, stunting calculation for both the developed and under-developed countries. Hence in this paper we also have used the anthropometric measure of malnutrition as they are considered to be more objective and comparable. The state, Odisha with a very high level of poverty and undernutrition is regularly being surveyed by National Nutrition Monitoring Bureau since 1975. The National Family Health Surveys also provide data Odisha s level of malnutrition. In this paper using the information on malnutrition prevailing in the state vis-à-vis of other states is analysed. Here we emphasize mainly the child malnutrition. Malnutrition among the adults; especially women are also examined as a supportive explanation of child nutrition. Because a malnourished mother is very likely to give birth a malnourished child. ODISHA S LEVEL OF MALNUTRITION- A NATIONAL COMPARISON Difference in the sources and methodology of data, restrict the trend analysis of the malnutrition to a large extent. Only data collected with same methodology can be used for that. Accordingly we present the data in three separate tables parts- a, b and c of Table-1, each part has inside data comparability. But among the three parts data comparability is absent. However, these three parts of Table-1 give a comparative picture of Odisha vis-à-vis other states. Here the percentage of underweight children is taken as the measure of malnutrition. From part A according to the NNMB repeat surveys the level of malnutrition in Odisha remains within the range of (54-58) percent, which implies that more than half of the children of Odisha are malnourished. Another notable point regarding malnutrition in Odisha its relative position during the period has deteriorated. While in 1975, it was 5.9 percent points below the national average; in 1996 it was 4.0 points above the national rate, which indicates the state s failure to reduce the level. In fact, in 1975 among all states covered under NNMB survey, Odisha was at the bottom in malnutrition. Kerala, the state, which is well referred at present in many aspects like education, health, even nutrition, was above Odisha, with a 2.2 percent point higher level of malnutrition. Table 1. Level of Malnutrition among the States (In Percentage) A B C States 1975 1988 1996 1996 2000-01 1992-93 1998-99 M F Kerala 56.8 34.0 27.1 34.4 34.2 28.8 28.5 26.9 Tamil Nadu 59.6 50.0 36.4 40.9 39.7 39.0 48.2 43.9 Karnanaka 64.3 57.1 51.6 55.6 51.1 47.6 54.3 43.9 Andhra Pradesh 61.5 51.8 54.7 48.6 49.6 39.9 49.1 37.7 Maharashtra 71.4 55.3 57.2 52.7 55.6 52.2 54.2 49.6 Gujarat 68.1 58.8 63.7 74.2 61.8 48.9 50.1 45.1 Odisha 56.6 57.3 54.5 55.1 51.4 54.4 53.3 54.5 All (India) 62.5 52.5 50.5 47.71 53.4 47.0 Source: NNMB Repeat Surveys, Source:NNMB Surveys, Source: NFHS I and II.

22 In the reduction of malnutrition Odisha is at the bottom during this period of 20 years with a decline of only 2.1 percent points. In contrast to it Kerala has reduced the same by as high as 29.7 percent points during the same time. In fact, it has been able to reduce malnutrition by more than 50 percent. In Tamil Nadu also malnutrition rate has declined by more than 23 percent points. From Part-B it is seen that in the year 1996, Odisha was third from the top among these seven states both in male and female malnutrition. But its position deteriorated in 2000-01. In this year it occupied the first position, indicating the worst situation among the states in malnutrition. It is clear that during 1996-2000 all the states except Odisha have been able to reduce the level of malnutrition. In Madhya Pradesh also (not presented here in Table-1) malnutrition has increased during the period by more than seven percent points, the reason of which has to be found out. In Odisha the level has just stagnated. Part C of table-1 is based on the data of NFHS, which took children of <4 years in NFHS-1 and those of <3 years in NFHS-II in measuring underweight. In NFHS-I Odisha was found just below the national average with 53.3 percent of underweight children. But its position has deteriorated both in the absolute as well as in the relative terms in 1998-99. Its deterioration was more in the relative sense while the national level malnutrition was reduced by 6.4 percent points. Odisha gained (which actually means its deterioration) by 1.2 percent points during the period. Among these seven states its position was third from top in 1992-93 which shifts to the top in 1998-99 implying the deterioration of the situation of the state. The above studies thus, indicate a very high percentage of underweight children in Odisha. It also indicates a fact that from the bottom position Odisha is likely to attain the top one in the near future which should be a matter of serious concern. Table 2. Percentages of Moderately and Severely Stunted Children States 1992-93 1998-99 Kerala 27.4 21.9 Tamil Nadu -- 29.9 Karnataka 47.6 36.6 Andhra Pradesh -- 38.6 Maharashtra 48.5 39.9 Gujarat 48.7 43.6 Odisha 48.2 44.0 All India 52.0 45.5 Source: NFHS-I and II Note: Indicates data non-availability While underweight measures both the long term as well as short term deprivations, stunting indicates the problem of linear growth (Physical) of the children, which occurs as a long-term phenomenon. For this we use the NFHS data only. Table-2 gives the comparative picture of Odisha visà-vis other states. Here we stick our analysis to the states used in Table-1 only. Table-2 shows that in the country as a whole the percentage of stunted children was reduced from 52.0 to 45.5 percent a gain of 6.5 percent points. None of the states in Table-2, however, did not show stunting > 50 percent in both the years though, their percentage of stunting ranges from 27.4 percent of Kerala to 48.7 percent of Gujarat in 1992-93. Odisha s situation was very much similar to those of Gujarat and Maharashtra. But as per NFHS-II, even if Odisha s situation is improved its situation by reducing the level of stunting to 44.0 percent which is lower by 3.8 percent points from that in 1992-93, its position vis-à-vis with other states under study deteriorated. Among the seven states Odisha s level of stunting was found at the top even if it was marginally below the national average. During this period its reeducation in stunting is found the lowest in this table. Karnataka was found with highest rate of reduction i.e., by 11 percent points. The country as a whole also experienced a reduction by 6.5 percent points. Thus, Table-2 shows the less intensive efforts made by Odisha (compared to other states) in the reduction of long term / chronic under nutrition. Low weight for height is known as wasting. Any short term (or temporary) or seasonal malnutrition are being captured by this measure. Using the data of NFHS, the situation of Odisha is compared vis-à-vis with other states. Table-3 shows the percentages of wasted children in 1992-93 and 1998-98 of Odisha and other states. One important feature of the wasting data vis-à-vis underweight and stunting is: low percentages of wasting compared to the other two types of undernutrition measures. As we know that underweight is the product of both the chronic as well as temporary deprivation (stunting and wasting), its magnitude will be higher. So similarly wasting is the product of stunting and inverse of underweight. Hence, its magnitude is lower as a part of underweight and stunted children are not wasted. It is found that Odisha was above the national average in both the times. Another notable point is clear from the table: while the percentage of stunting is declining for the country as a whole, it is increasing for the state, Odisha. Its increase during the period is as high as 3 percent points, even higher than that of Karnataka, the state, which also experienced a rise in stunting. From the states under our consideration only Kerala and Gujarat have experienced decline in stunting. High percentage of stunting in both the surveys in Odisha indicates the severity of nutrition problem, which are seasonal in nature. In Odisha agriculture being the main source of livelihood for the people, the seasonal nature of agriculture hurts

23 people mainly during the lean season and thus the high percentage of wasted children. Table 3. Percentage of Wasted Children States 1992-93 1998-99 Kerala 11.6 11.1 Tamil Nadu -- 19.9 Karnataka 17.4 20.0 Andhra Pradesh -- 9.1 Maharashtra 20.2 21.2 Gujarat 18.9 16.2 Odisha 21.3 24.3 All India 17.5 15.5 Source: NFHS I & II Note: implies data non-availability ANEMIA AMONG THE CHILDREN Anemia among the children indicates their poor nutritional status. Taking iron-deficiency among children of (6-35) months NFHS-II provides state level data for the different states. Table-4 presents situation of Odisha in this regard vis-à-vis with other states. It is found that in the country approximately three out of four children are found to be with some type of anemia. Table 4, Anemia Among the Children (In Percentage) States Any Moderate Severe Anemia Anemia Anemia Kerala 43.9 18.9 0.5 Tamil Nadu 69.0 40.2 6.9 Karnataka 70.6 43.3 7.6 Andhra 4.4 72.3 44.9 Pradesh Maharashtra 76.0 47.4 4.4 Gujarat 74.5 43.7 6.7 Odisha 72.3 43.2 2.9 All India 74.3 45.9 5.4 Source: NFHS-II Except the state Kerala all others have anemia of some type as high as 70 percent or more. In this context Odisha s position is not more severe than that of others. Not a single factor can be sighted against such high anemia cases. For example lack of immunization is supposed to influence to a great extent this high level of anemia. Therefore, Odisha and Gujarat with the very high percentage (i.e., 66 percent) of children not fully vaccinated in 1998-99 are expected to have high level of anemia. But Tamil Nadu, Karnataka, Maharashtra with higher percentages of children fully vaccinated (i.e. 78.2, 60.0, and 78.2 percent respectively) also possess high degree of anemia which indicates the role of other factors in anemia also. MALNUTRITION AMONG WOMEN Children s malnutrition especially that of the infants is likely to be affected by the mother s malnutrition. An unhealthy mother is very likely to give birth to an unhealthy child and because of her malnourishment she will not be able to nourish her child properly in feeding and other cares. To see the link between the child s and mother s malnutrition we first make an attempt to see the women s nutritional status. Here we use the body-massindex (BMI) and chronic energy deficiency (CED) to analyse the nutritional status of women. Table 5. Percentage of Women Under nourished States Women BM < 18.5 kg/m 2 in 1998-99 Kerala 18.7 Tamil Nadu 29.0 Karnataka 38.8 Andhra Pradesh 37.4 Maharasthra 39.7 Gujarat 37.0 Odisha 48.0 All India 35.8 Note: Ever married women who are not pregnant nor had delivery during the last two months are considered here. Source: NFHS II BMI measures weight (in kg.) per unit height (squared metres). It is used in the case of women as an indicator of nutrition. BMI less than 18.5 Kg/m 2 is considered to be the case of chronic energy deficiency. Table-5 shows the percentage of women with less than 18.5 Kg/m 2 BMI. It is observed that none of the states except Kerala and Tamil Nadu considered here has BMI deficiency equal to or less than the national average of 35.8 percent. But Odisha is found to be at the top with a very high percentage of women with less than the normal BMI. In fact, among all the states of the country it is at the top followed by West Bengal and Maharashtra. High BMI deficiency of the women may be because of the poor medical attention and low and improper diet of the women. Poverty and sociocultural factors are mainly responsible for such high BMI deficiency. In the rural area women generally do not take various types of food, mainly non-vegetarian food owing to the cultural factors. Similarly during the period of scarcity they reduce the quantity and frequency of their diet due to the cultural factors known as maternal buffering (Swaminathan, 2003). The high BMI deficiency among the adult women in Odisha is also found in the NNMB survey, 2000-01. It is found that among the adult women, deficiency was as high as 46 percent which is 6.7 percent points higher than the national average (i.e. pooled data of the states covered). Impact of cultural factors on the high BMI deficiency of women is clearly reflected from the fact that both the pool data and data of Odisha

24 reveal higher BMI deficiency for women than that for men, (combined BMI deficiency was 38.6 percent for Odisha and 37.4 for the pool data). NNMB 1996 reveals different degrees of BMI deficiency of the states. Severe form of chronic energy deficiency (CED) is categorized as CED-III, the moderate as CED-II and mild as CED-I are estimated for different states. These are presented in Table-6. Like Table-5 it also presents a very high level of CED deficiency among women in the states. Table 6. Different Degrees of Energy Deficiency (In percentage) Among Women States CED III CED II CED I CED Total Kerala 6.9 7.6 18.7 33.2 Tamil Nadu 6.2 9.3 21.8 37.3 Karnataka 11.4 14.7 27.7 53.8 Andhra 24.1 49.4 13.4 11.9 Pradesh Maharashtra 12.3 12.3 26.4 51.0 Gujarat 14.2 13.7 25.2 53.1 Odisha 9.2 11.4 36.7 57.3 Source: NNMB Survey Report-1996 The state Kerala as in the NFHS so in NNMB survey also remains at the bottom with 33.2 percent level of CED deficiency. But one interesting thing is: even if Odisha is at the top in total CED deficiency, in severe and moderate deficiency, it is not at the top. In CED III it is just above Kerala and Tamil Nadu, the two states which have been able to reduce their malnutrition to a very low level. Similarly in moderate degree of deficiency also Odisha is only above the said two states. Others have higher percentage of energy deficiency of these two types. It is only mild CED in which Odisha is at the top. More than one third of its ever married women (excluding the pregnant and the nursing mothers with kids up to the age of 2 months) are found to be with mild degree of energy deficiency. This implies that socio-cultural factors are more responsible than the economic factors like income or standard of living (as used in NFHS reports) in creating energy deficiency among the women of Odisha. The correlation between women s energy deficiency and children s deficiency in weight and height is studied. Close association of CED of women and child malnutrition (underweight anemia etc.) are found. The relation of CED of the third degree is found to more strongly correlated with the variables indicating child malnutrition. For example the value of correlation coefficient (r) of CED III of women in 1996 with child anemia in 1998 is 0.776 (significant at.05 level), with underweight in 1996 is 0.909 (significant at 0.01 level), with stunting in 1998 is 0.942 (significant at 0.01 level). Similarly, mother s shortfall of BMI index in 1998 level with stunting in 1998 is found to be highly correlated (with the value of r=0.930, significant at 0.01 level. However, wasting of children is not found to be significantly correlated with mother s deficiency or body mass index even if these variables found to be moving in the same direction. Not only mother s energy deficiency results in child malnutrition, mother s educational status also has an influence over it. Educated mothers are expected to be more well aware of the good child care practices. The impact of mother s education on the reduction of child malnutrition is well established. In Latin America, completing 12 years of education protects 80 percent of young people against poverty (ECLAC, 1992). NFHS also indicates the close association of child malnutrition and mother s education. According to NFHS-II in Odisha around 96 percent of the illiterate mothers have underweight children of the severe or moderate type while 59 percent of the mothers with middle school completed, have such type of underweight children. It is again reduced for the mothers with at least high school completion; only 45 percent of them have underweight children. Similarly mothers with less educational status are also found in greater proportion with other types of child deprivations. For example, 73 percent of illiterate mothers have stunted children while only 28 percent of the high school completed mothers have such children. As in stunting so in wasting also the role of mother s education is well reflected. While 74 percent of illiterate mothers have wasting children, only 23 percent of the mothers with at least High School completion have such type of children in Odisha. MALNUTRITION IN DIFFERENT REGIONS AND DISTRICTS OF ODISHA The studies analysed above give the state average data, which fail in helping the state government s proper fund allocation among the districts for the reduction of malnutrition. District level data are required for that purpose. From time to time some micro studies are done by different individuals and institutions to study some aspects of malnutrition of certain areas/ some socioeconomic groups. Using that information a broad idea of the status of the state can be framed. Malnutrition as a function of food insecurity, lack of knowledge of good childcare practice and prevalence of disease and morbidity is expected to have regional dimension. Educationally advanced (relatively) coastal districts with the relatively low poverty ratio and safe sources of drinking water (tap, tube well and hand pumps) are expected to have low level of malnutrition compared to the other districts of the state. Lack of district level data hinders such analysis to a great extent. However, some micro studies undertaken by a few individuals and

25 institutions are used here to show the existence of malnutrition in different pockets. Pathi et al. (2003) in a study of the block of Khallikote, a coastal rural block of Odisha found more than 60 percent of the children below 6 months of age and more than 65 percent of the children above 6 months and below 12 months of age are malnourished. They use underweight as a measure of malnutrition. From their study it is clear that lack of good childcare practice is the main reason of such high level of malnutrition. It is found from that study that beneficial effects of exclusive breast feeding for the child below 6 months and of partial breast feeding for the child of 6-12 months are not known to most of the illiterate mothers. G.P. Chhotray (unpublished observation) in a perspective study of four primitive tribes Bonda, Diyadi, Juanga and Kutia Kandha of Odisha found the high prevalence of severe malnutrition (based on Gomez classification) among the children. It was found that the rates of severe malnutrition among the children of those tribes were 16, 19, 25 and 26.6 percent respectively. Severe, moderate and mild anemia as per WHO s classification were found to be in the range of 0.6 to 2.3 percent, 7.4 to 13.6 percent and 30.7 to 48.2 percent respectively among these people. Majority of these anemic are found to be of iron deficiency type. Regional Medical Research Centre (RMRC), Bhubaneswar in a study on the tribals of Mayurbhanj and Sundargarh, found malnutrition among the primitive tribes was as high as 68 percent. These two districts are tribal dominated (Balgir, 1999). Among the primitive tribes like Langia Soura and Kutia Kandha of Rayagada district, chronic energy deficiency (CED) was found to be more than 88 percent (Bulliya et al. 2001). Mahapatra et al (1996-97) also found higher incidence of malnutrition among the primitive tribes than that of the other tribes of Odisha. Odisha Vision 2010 also recognizes the high incidence of malnutrition in the tribal districts of the State. In a study conducted by M.S. Swaminathan Foundation and financed by World Food Programme, New Delhi (2002), found higher level of malnutrition among the tribal dominated districts than that among the others. Out of the four districts Kendrapara, Kalahandi, Koraput and Mayurbhanj, (which it took for its study) it found highest level of malnutrition among the tribal dominated districts. Using underweight measure among the children below three years and children of 3-6 years it was observed that Kalahandi had the highest and Kendrapara the lowest percentage of underweight children for both the groups. In the group (0-3) Kalahandi had 33.62 percent and Kendrapara 26.44 percent underweight children. Similarly in the age group (3-6), Kalahandi had 31.18 and Kendrapara 23.99 percent underweight children. Mayurbhanj and Koraput also had higher percentage of underweight children for both the groups than the state average. Besides these, reportings of the frequent occurrence of hunger and starvation deaths in KVK districts in various news papers and magazines indicate the prevalence of malnutrition in its severe form in the state. However, in the absence of systematic study of the problem in these areas as well as in other parts of the state it is very difficult to give a comprehensive socio-economic, regional and gender dimension of malnutrition. This requires research work on the field. However, with the available scarce data the prevalence of higher level of malnutrition among the people of the tribal dominated hilly districts of the state can be concluded. Analogously the lower level of malnutrition among the people of the plain and coastal districts may be assumed. POVERTY AND MALNUTRITION An extensive empirical literature shows that poverty (low income) is the crucial determinant of hunger and malnutrition. This has been demonstrated in numerous cross- country (as well as cross household ) studies. The relationship between income and child nutrition can be explained in two ways: (i) With the higher per capita income households can exert stronger effective demand for essential private consumption goods, including nutritionally better food. (ii) Higher GNP or consumption means higher revenues and expenditures. To the extent that these expenditures finance 1 public investment and consumption in health and nutrition related services, there should be a positive effect on child nutritional status (Svedberg, 2000, ch. 15; Smith and Hadded, 2002; Hadded et al. 2003). However, in many cross-country as well as cross- state variation in the prevalence of child malnutrition is not explained by the differences in per capita income. For example, in Jamaica only 4.4 percent of the children are stunted, while 25-30 percent children are stunted in Albania, Peru and Philippines, countries in the same per capita income bracket in 1998-2002. In India also states like Kerala and Karnataka have similar levels of per capita income. But the percentages of children of below three Kalahandi, Balangir and Koraput district of undivided 13 districts of Odisha For a recent-contribution to the large literature based on cross-household data, see Haddad et.al(2003)

26 years of malnourished category ones are 27 for Kerala but 44 for Karnataka. Odisha and Maharashtra report similar levels of malnutrition, but Maharashtra s per capita income is almost three times higher than that of Odisha. The relationship between poverty (income poverty) and malnutrition is also not straightforward. Most of the Sub- Saharan African countries report higher levels of income poverty than India even though levels of child malnutrition in India are significantly higher than in Sub Saharan Africa. At the country level also, similar cases are there. For example, Haryana (35%) and Assam (36%) reported similar levels of child malnutrition despite the fact that in 1993-94, only 25 percent of Haryana s population lived below the poverty line as against 41 percent in Assam. POVERTY AND MALNUTRITION IN ODISHA Using the available information on poverty and child malnutrition an analysis of these two is done. Table-7 presents malnutrition (child underweight) and poverty (i.e. HCR) of Odisha for different years. In the absence of matching year we took the years very close to each other. Similarly in the absence of data of malnutrition by same organization for the required years we use the data of different organizations of the required years. It is observed from the table that poverty is consistently declining with the passage of time (may be owing to the economic growth and the various poverty alleviation programmes of the government). But the percentage of child malnutrition does not show such trend. It is rather fluctuating systematically (Of course in the absence of the data for more number of years this cannot be said emphatically). Another important is: while poverty is reduced by more than 20 percent points during the time of 25 years, malnutrition has declined by only 2 percent points, as has been already mentioned that Odisha has been transformed from the lowest malnourished state to the highest malnourished state in the course of a quarter century. This is mainly owing to the fact that other states have made specific attempts to reduce malnutrition directly (as in Tamil Nadu), while in Odisha even if programmes under ICDS are going on, but regular monitoring of Tamil Nadu (Under World Bank Project) type are not taking place. Moreover, there are many loopholes in the programme implementation. Another important fact may be said about the difference in the decline in the malnutrition and poverty is the difference in the fertility among the rich and poor households. The high crude birth rate among the poor households accompanied by the low crude birth rate among the rich households might be resulting in the higher proportion of malnourished children in the child population group. The decline in the share and/or number of poor households may not be able to reduce the proportion of malnourished children from that age group. Of course, in the absence of data this hypothesis cannot be established. This requires further study. Table 7. Poverty and Malnutrition in Odisha Mal nutrition ( In percentage) Poverty *(In percentage) Year Under weight HCR (Rural) Year = -2 SD 1975 56.6 ** 1973-74 69.07 1988 57.3 ** 1987-88 59.14 1992-93 53.3 @ 1993-94 49.0 1998-99 54.5 @ 1999-00 48.03 Source: *: NSSO Reports, **: NNMB Survey, @: NFHS-I &-II FOOD SECURITY AND MALNUTRITION Nutritional status of households depends on its command over food and intra-household food distribution. While the former is a product of household food security, the latter depends on individual s food security (i.e. his access to food within the family). In addition to the lack of adequate and balanced food, malnutrition also depends on diseases, poor food absorption, lack of knowledge of good nutrition and sanitation. In this section we emphasize only on the food security. According to Odisha Human Development Report, 2004, a high level of poverty, a large tribal population living in remote areas with poor connectivity, and periodic recurrence of drought, and floods (sometimes in different parts of the state) give rise to a situation of chronic and endemic food security. National Sample Surveys also reveal households food in-security. Using the household s own perception of food adequacy (i.e. two square meals a day) it studies the situations of different states of the country. In both the 50 th and 55 th rounds of NSS Odisha was found with high percentage of food inadequate households. Its relative position deteriorated in 1999-2000 compared to 1993-94. In the 50 th round Kerala (in both rural and urban), and Karnataka (in rural) had higher percentage of food inadequacy than Odisha. But within a period of five years they managed to reduce their household food inadequacy, but in Odisha it was possible for the urban households only. Rural households food inadequacy increased from 5.6 to 8.0 percent. In fact, Odisha occupies the second position from the top in the percentage of rural households, not having enough food every day. Food inadequacy was mainly from the months June to September. However, this food adequacy takes into account only the bare minimum (i.e. without taking nutritional context into account) for the survival. Using the information of its surveys, NSSO has published reports (on 50 th and 55 th Rounds) on nutritional intake in India indicating the calorie deficiency of the households.

27 According to these reports percentage of households with less than 90% of calorie norm (of 2700 Kcal) in rural areas of Odisha has increased from 30.9 to 37.3 percent and has declined in the urban areas from 27.6 to 26.1 percent. Among the states we have considered in this paper, Odisha was found at the bottom both in rural and urban areas in both the surveys. Table- 8 presents the calorie deficiencies of the households of these states in 50 th and 55 th Round of NSS. Table 8. Percentage of Households Below 90 % Calorie Norm. States 1993-94 1999-2000 Rural Urban Rural Urban Kerala 45.7 47.6 44.3 43.4 Tamil Nadu 51.3 42.9 56.8 47.4 Karnataka 42.7 44.7 48.4 43.3 Maharashtra 49.7 45.9 35.9 43.5 Andhra Pradesh 40.9 48.1 43.5 43.2 Gujarat 46.4 40.0 47.0 41.8 Odisha 30.9 27.6 37.3 26.1 India 36.9 41.6 40.9 41.1 Note: Calorie Norm 2700K calorie Source: Nutritional Intake in India, (1993-94) & (1999-94), NSSO, Govt. of India, New Delhi Low calorie deficiency (relatively) and high level of malnutrition of Odisha vis-à-vis other states apparently makes the link between them weak. But the basic difference between these two data sets is : while nutritional deficiency measured by underweight, stunting etc. or anemia use individual as the unit of study, calorie deficiency use household as the unit. The fact may be that a household may not be calorie deficient, but some members of the same household may be suffering from calorie deficiency, because of socio-cultural reasons, which are not being captured in the household level data. Besides, the other factors of malnutrition like poor food absorption, lack of knowledge of good nutrition, sanitation etc. may be resulting in the high level of malnutrition of Odisha. Moreover, the household s allotment of food and other resources to women and children, depending on their culture, and the knowledge of good child care practice are more determining factors (A.K. Shiva Kumar, in Little magazine, Vol.-II, issue 6 ) M.S. Swaminathan undertook a study on food insecurity status of Odisha. Using a very comprehensive measure consisting of 19 indicators it was found that Odisha is coming under the category of severely food insecured region. Lack of adequate livelihood opportunity and susceptibility to vulnerability to natural disasters are the factors behind it (Food Insecurity Atlas 2001). Odisha is a state with various types of natural calamities. Frequent occurrences of flood, drought and famine in Odisha force people to adopt various types of risk coping mechanisms. A study (2002) conducted by M.S. Swaminathan Foundation financed by World Food Programme in four districts Kalahandi, Koraput, Mayurbhanj and Kendrapara found various (food deficit) coping strategies adopted by the poor households. Restricting the quantity and frequency of eating, borrowing of food or money, changing consumption pattern (eating inferior grains etc.) and maternal buffering are some of the classic cases of coping mechanism (Odisha HDR, 2004). Household food insecurity and women s reduction of quality and quantity of intake as a method of coping mechanism might be resulting in the high level of malnutrition among women and children. Government is supporting food security through programmes like (a) subsidised distribution of food grains, (b) nutrition provision through Anganwadis and (c) Food for Work programmes. In addition, grain banks have also emerged as people s intervention to cope food insecurity in some parts of the State (Odisha HDR, 2004). All these are short-term interventions. But for chronic insecurity and undernutrition from which Odisha is suffering, augmentation of income through generation of additional and steady employment is required. REFERENCES [1] Balgir, R.S. (1999), Physical growth, health and nutritional status of Ashram School Children. Annual Report, 1998-99, RMRC, Bhubaneswar. [2] Bulliaya, G., S.S.Mohapatra, A.S. Kerketta, R.K. Das and P.K. Jangid, Assessment of Health and Nutritional Profile among the elder by population of Odisha Primitive Tribes, Annual Report 2000-01, RMRC, BBSR. [3] Chhatray, G.P. (2003), Health Status of Primitive Tribe of Odisha ICMR Bulletin, Vol.33 No 10. [4] Govt. of Odisha (2005), Human Development Report 2004, Planning Commission, New Delhi. [5] Govt. of Odisha- Odisha Vision 2010 A Health Strategy: Odisha State Integrated Health Policy, Strategies and Action Points, Dept. of Health Family Welfare, Bhubaneswar. [6] Haddad, L,.E.S: Gillespie, (2003) The Double Burden of Malnutrition in Asia, causes, consequences and solutions, Sage Publication, New Delhi. [7] Haddad, L., H. Alderman, S. Appleton, Y. Younas (2003), Reducing Child Undernutrition: How far does Income Growth Take Us? World Bank Economic Reviews, 17(1): 107-31. [8] N.S.S.O. (1993-94), Reported Adequacy of Food Intake in India: 1993-94. 50 th Round (July 1993 to June 1994), Department of Statistics, New Delhi. [9] N.S.S.O. (1999-2000) 55 th Round (July 1999- June 2000).

28 [10] N.S.S.O.(1993-94) Nutritional Intake in India: 1993-94. [11] NNMB, NIN(2002) Diet and Nutritional Status of Rural Population. [12] Osmani, S.R.(1997) Poverty and Nutrition in South Asia, Nutrition Policy Paper 16, ACC/SCN, WHO. [13] Pathy, S. (2003), Destitution, Deprivation and Tribal Development EPW, Vol. XXXVIII No. 27. [14] Planning Commission, Govt. of India (2002), National Human Development Report OUP, New Delhi. [15] Shiv Kumar, A.K. Child Malnutrition: Myths and Solutions, Little Magazine Vol. II: Issue 6. [16] Svedberg, P. Hunger in India: Facts and Challenges, Little Magazine Vol. III: Issue 6. [17] Svedberh, Peter (2000), Poverty and Under Nutrition, Theory, Measurement and Policy, OUP, New Delhi. [18] Svedberh, Peter (2004 a), Has the Relationship between Child Under Nutrition and Income Changed?