NSF National Seminar On Malnutrition Report

POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY
ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGEINE POVERTY LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGEINE POVERTY LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION ILLITERACY POVERTY LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGEINE POVERTY LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD POVERTY ILLITERACY
NATIONAL SEMINAR ON UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGEINE MALNUTRITION : ISSUES AND CONCERNS
A REPORT
Narotam Sekhsaria Foundation
LIVELIHOOD HYGIENE
EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGEINE POVERTY LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH
MALNUTRITION : ISSUES AND CONCERNS

Report on the National Seminar held on 11 - 12 January 2010, Mumbai Jointly organised by Narotam Sekhsaria Foundation, PG Department of Economics, SNDT Women's University, Mumbai and Directorate of Health Services, Maharashtra State
Mumbai
Documented by: Lakshmi Menon Layout by: Anita Rajagopalan Cover Design by: Anita Rajagopalan Printed by: Prime Printers
Narotam Sekhsaria Foundation, 2010
Narotam Sekhsaria Foundation 102 Maker Chambers III, 10 Floor Nariman Point, Mumbai 400021 Tel. (91-22) 22824589 Website: www.nsfoundation.co.in
th
CONTENTS
Foreword Abbreviations
4 5
SECTION I - Introduction
Background Objectives Participants Programme
8 9 9 9
SECTION II - Proceedings
Day 1 Presidential address Welcome address Keynote address Chief guest's address Panel presentations and discussion Vote of thanks Day 2 Session 1:Political economy of malnutrition Session 2:Effects of malnutrition on mortality and morbidity: national profile and regional; rural-urban; caste, class, gender, ethnicity and religious variations Session 3:Discourse on micronutrient deficiencies, food and nutrition supplements Session 4:Policy, schemes and programmes concerning nutrition: role of the government and NGOs Valedictory Address
12 13 14 17 22 29
30 34
39 43 46
SECTION III - Recommendations

Recommendations Sustainable solutions
48 51
ANNEX
Annex 1 - Programme Schedule Annex 2 - List of Participants
56 57
FOREWORD
The current economic recession and rising inflation brings to fore the urgency to deal with the issue of malnutrition in India. We felt it necessary to hold a national seminar to understand the issue in all its complexities. We also thought it useful to work with the academia and the state health department. Thus the National Seminar, Malnutrition in India: Issues and Concerns was co-organised with the Post-Graduate Department of Economics, SNDT Women's University, Mumbai and the Directorate of Health Services, Maharashtra State. The participants included students and faculty members, government health officials, NGOs and community-based organisations and activists who have been working on development issues, especially on poverty, health and malnutrition. The issues that were brought up and discussed were multi-disciplinary, covering economic aspects, nutrition and health and human rights, and also focused on marginalised groups like the scheduled castes and tribes, people living below the poverty line, religious minorities and vulnerable groups such as women and children. This report covers the proceedings of the Seminar in detail. Section I gives the background, objectives and outline of the Seminar's programme. Section II includes the inaugural programme in detail, such as the keynote address and the chief guest's address which set the tone and direction for the Seminar. The panel presentations and the discussion which followed too have been covered in detail. The presentations of the four sessions on the second day have been condensed; the full presentations are available in a compact disc which accompanies this report. As there were 30 presentations , many speakers did not have sufficient time for full presentation. That there was inadequate time for a meaningful discussion in each session is deeply regretted. Session III of this report includes recommendations gleaned from the presentations of the keynote speaker, the chief guest, panel speakers as well as other presenters. The recommendations will help future action plans. I thank Prof. Dr. Vibhuti Patel for guiding the Foundation in conceptualising and executing the idea the Foundation put forth to her, the Directorate General of Health Services for being co-organisers, for sharing Government interventions to tackle malnutrition and for deputing staff members to participate in the discussion.
Padmini Somani Director Narotam Sekhsaria Foundation Mumbai
Foreword
Abbreviations
Adv. ASHA BMI BPL BV CD CESCR DGHS FAO GDP ICDS ICESCR ICMR ICU ID IDD IGIDR IGNOU IIPS IMR INGO IPR MDG MDMP MMR MNCs NBSAP NFHS NGO NNMB NRHM NSS NMIMS NSF PDS PEM Advocate Accredited Social Health Activist Body Mass Index Below Poverty Line Biological Value Calcium Deficiencies Committee on Economic, Social and Cultural Rights Directorate General of Health Services Food and Agriculture Organization Gross Domestic Product Integrated Child Development Scheme International Covenant on Economic, Social and Cultural Rights Indian Council of Medical Research Intensive Care Unit Iron Deficiency Iodine Deficiency Disorder Indira Gandhi Institute of Development Research Indira Gandhi National Open University International Institute for Population Sciences Infant Mortality Rate International Non-Governmental Organisation Intellectual Property Rights Millennium Development Goal Mid-day Meal programme Maternal Mortality Rate Multinational Companies National Biodiversity Strategy and Action Plan National Family Health Survey Non-governmental Organisation National Nutrition Monitoring Bureau National Rural Health Mission National Sample Survey Narsee Monjee Institute of Management Studies Narotam Sekhsaria Foundation Public Distribution System Protein Energy Malnutrition
Abbreviations
PIL PRIs PUCL RCH RDA SHGs SGRY SRS THR TRIPS UNICEF VAD WHO
Public Interest Litigation Panchayati Raj Institutions Peoples Union of Civil Liberties Reproductive and Child Health Recommended Daily Allowance Self Help Groups Sampoorna Gramin Rozgar Yojna Sample Registration System Take-home Rations Trade-Related Aspects of Intellectual Property Rights United Nations Children Fund Vitamin A Deficiency World Health Organization
Abbreviations
SECTION I - Introduction
Background Objectives Participants Programme 8 9 9 9
Malnutrition: Issues and Concerns
Section I
Background
Malnutrition, in children as well as adults, continues to be a major problem in India. About 60 million children in India are malnourished and almost 50 per cent of the Indian women and 44 per cent of the men are undernourished. The prevalence of undernutrition and malnutrition in India is amongst the highest in the world, almost twice that in SubSaharan Africa, a region that is despoiled by internal wars, famines and the spread of AIDS. The National Family Health Survey (NFHS-3) also found high levels of anemia among women and children. Both malnutrition and anemia have increased among women since NFHS-2 in 1988-99. As per the India Hunger Index Report twelve states in India fall under the 'alarming' category and one state Madhya Pradesh falls under the 'extremely alarming' category and twelve other states fall in 'serious' category. Disaggregated data reveals that socio-economically disadvantaged groups across geographical regions are most at risk of malnutrition. The prevalence of undernutrition is higher in rural areas (50 per cent) than in urban areas (38 per cent); higher among scheduled castes (53.2 per cent) and scheduled tribes (56.2 per cent) than among other castes (44.1 per cent). The proportion of underweight is higher (60 per cent) amongst the lowest wealth quintile. There is also large inter-state variation in trends in under nutrition. In India, six states account for almost 43 per cent of all underweight children. In states like Maharashtra, Orissa, Bihar, Madhya Pradesh and Rajasthan at least one in two children are underweight. Nutrition divide which exists between the different economic quintiles is increasing at a rapid pace. Chronic undernutrition has exposed the country to deficiencies and pandemic anemia. Lack of access to clean The 50th Round of the National Sample Survey (NSS) in 1993-94, drew attention to the fact that the country doesn't have a comprehensive programme to address the nutrition situation in India. The public distribution system (PDS) is the only programme and it has a limited impact. The NFHS Anemia can lead to reduced productivity, greater susceptibility to infections, and slow recovery from infections. Among women, poor pregnancy can increase the risk of obstructed labour, low-birth-weight babies, postpartum hemorrhage and other complications. More than drinking water, sanitation and access to sustained livelihoods has compounded the problem. A myriad of factors contribute to malnutrition situation in India. Food insecurity, inappropriate infant and young-child feeding and caring practices, exposure to infections, micronutrient deficiencies, chronic illnesses, and lack of access to health care are some of the contributors to this malady.
one-third of the married women and men are too thin, according to the body mass index (BMI), an indicator derived from height and weight measurements. In India and most of South Asia the nutritional paradox lies in the coexistence of grain mountains and hungry millions. Considering its impact on health, education and productivity, persistent undernutrition is a major obstacle to human development and economic growth in the country; especially among the poor and the vulnerable, the prevalence of malnutrition is the highest.
2 survey (1998-99) also showed that the
nutrition situation in the country had not improved and that urban poor and rural areas were still at risk.
Section 1: Introduction
Malnutrition: Issues and Concerns The country's main early child development intervention, the Integrated Child Development Services (ICDS), has been in existence for the past three decades but it has not succeeded in making a noteworthy dent in child nutrition. Government interventions in addressing the issue of undernutrition have been skewed towards food-based interventions and other determinants of malnutrition have been completely neglected. The civil society has reacted rather sharply to this issue. Their initiatives in giving shape to democratic practices such as monitoring government programmes like ICDS and Public Interest Litigation (PIL) at the Rajasthan High court and finally the Right to Food Campaign have at least pressured the government to make some commitments. In spite of the magnitude of the problem, the issue of malnutrition has not received enough attention in public debates and electoral politics. The media has also only highlighted the sensational aspect of the issue. Given the complexity and magnitude of problem, it is imperative that civil society and academia strive to understand the issues and promote the participation of all important stakeholders. As a step forward in this direction, Narotam Sekhsaria Foundation (NSF) together with the Post-Graduate Department of Economics, SNDT Women's University, Mumbai, and the Directorate of Health Services, The highlight was the keynote address by Prof. Dr. Veena Shatrugna, former Deputy Director and Head, Clinical Division, National Institute of Nutrition, Hyderabad, and Consultant, Indian Institute of Public Health, Hyderabad. The Right to Health was the theme of the address by the chief guest, Adv. Anand Grover, UN Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Mental and Physical Health. This was followed by a panel discussion on Discourse on Nutrition and Malnutrition. The four panel members were Prof. Dr. Sumati Kulkarni, Retired Professor, International Institute for Population Sciences (IIPS), Mumbai, Prof. Dr. Sulabha Parsuraman, Prof., IIPS, Mumbai, Prof. Dr. The Seminar was inaugurated with a Presidential address given by Prof. Dr. Vibhuti Patel, Professor and Head, PG Department of Economics, SNDT Women's University. Prof. Dr Chandra Krishnamurthy, Hon. Vice Chancellor, SNDT Women's University, Mumbai was unable to attend. and 4. Help build partnerships for further action. Participants Over 150 participants attended this national seminar. They included 90 from the academic field and about 55 from non-governmental organisations (NGOs). The participants were from Andhra Pradesh, Delhi, Gujarat, Jharkhand, Karnataka, Maharashtra and Punjab. Some government officials from the Maharashtra State Health Department also attended the seminar. (See Annex 2 for List of Participants) Programme
Maharashtra organised a two-day national-level seminar titled Malnutrition: Issues and Concerns. Objectives The objectives of the seminar were to: 1. Bring to focus the magnitude of the problem of malnutrition 2. Understand the complexity of the issue 3. Bring together the Government, civil society and academia on a common platform to discuss the issue,
Sangita Kamdar, Prof. of Economics, Narsee Monjee Institute of Management Studies (NMIMS), Mumbai, and Dr. Srijit Mishra, Associate Prof., Indira Gandhi Institute of Development Research (IGIDR), Mumbai.
The 2nd day of the seminar was organised according to four themes in four sessions: 1. Political economy of malnutrition 2. Effects of malnutrition on mortality and morbidity: national profile and regional; rural-urban; caste, class, gender, ethnicity and religious variations
3. Discourse on micronutrient deficiencies, food and nutrition supplements 4. Policy, schemes and programmes concerning nutrition: role of the Government and NGOs Thirty presentations were made on these four themes. (See Annex for Programme Schedule)
10
SECTION II - Proceedings
Day 1 Presidential address Welcome address Keynote address Chief guest's address Panel presentations and discussion Vote of thanks Day 2 Session 1:Political economy of malnutrition Session 2:Effects of malnutrition on mortality and morbidity: national profile and regional; ruralurban; caste, class, gender, ethnicity and religious variations Session 3:Discourse on micronutrient deficiencies, food and nutrition supplements Session 4:Policy, schemes and programmes concerning nutrition: role of the government and NGOs Valedictory Address 30 34 12 13 14 17 22 29
39 43
46
Section II : Proceedings - Day 1

Day 1, 11 January 2010
Leni Chaudhuri, Programme Manager, NSF, welcomed the participants and chaired the first day's sessions. Also welcoming the participants, Prof. Dr. Vibhuti Patel explained that the PG Department of Economics of the SNDT University, Mumbai has focused on development economics through its teaching programmes and research, curricular, co-curricular and extracurricular activities and responded to major economic challenges in the country. Leni Chaudhuri
Presidential Address
several anti-poverty programmes from the fifth Five Year Plan (1974-79) onwards. Development economists world over had been seriously debating the food first policy. But they talked only about macro-economic food security and did not highlight nutrition security. The human development approach popularised by Prof. Amartya Kumar Sen avers that nutrition affects development as much as development affects nutrition. Visionary leaders like MGR who started a mid-day meal programme in Tamil Nadu 40 years back, believed in this.
Prof. Dr.Vibhuti Patel
Around
52 per cent of the women and 74 per cent of the
In her presidential address, Prof. Dr. Vibhuti Patel gave an introduction to the topic of malnutrition and put it in the larger social and economic context. She pointed out that malnutrition was a multidimensional problem linked with purchasing power, social behaviour, livelihood sources and survival struggles, equity and equality, human rights and dignified life. Malnutrition indicated deficit, excess or imbalance of one or more than one essential nutrients/ calories. Morbid obesity could be as devastating as acute malnutrition. Debates in the 1970s, between Prof. Dandekar and Rath versus Prof. Sukhatme and these three stalwarts of Pune School of Economics versus Prof. Minhas brought the issue of calorie intake centre stage. As a result, ensuring 2100 calories for the urban poor and 2300 calories for the rural poor guided
children were victims of undernutrition, a silent catastrophe. The gap between the overfed population crowding the gymnasiums and underfed millions groping for food in the empty cans and garbage was widening. Women and children suffered due to self-denial, learning to live with far less food and nutrition than what the body needed. Women-headed households suffered the most. So many illnesses among poverty-ridden people were linked to malnutrition. If we deconstructed the infant mortality rate (IMR), one-eighth of the child deaths were of tribal children. Gender inequality in nutrition was a norm in India. Because state policies focused on reproductive and child health (RCH), elderly women and adolescent girls got neglected in nutrition programmes. Recent studies had shown that Indian adolescent boys were also facing moderate malnutrition.
12
Presidential Address
Markets were aggravating malnutrition. There were also other controversial issues such as chemicalisation of food and the use of biotechnology for food and nutrition security. There was a need to examine the India Micronutrient Investment Plan proposed by the international nongovernment organisation, Micro-nutrient Initiatives and the Government of India (2007-2011).
Welcome Address
Various nutrition-deficiency diseases like night-blindness (Vitamin A deficiency or VAD), goitre (iodine deficiency or IDD), iron deficiency (ID), protein energy malnutrition (PEM) and calcium deficiency (CD) needed urgent attention or else the demographic dividend will become a demographic catastrophe. Padmini Somani, Director, NSF, pointed out that the Foundation focused on education, health and livelihood issues and explained the reason for holding this seminar. As the Foundation was still new to the issue, there was need for In this context, she pointed out that it was encouraging to receive papers from scholars working in different parts of India examining malnutrition from an inter-disciplinary perspective - economics, sociology, anthropology, home science, health science, and nutrition science. better understanding especially the complexities of malnutrition. It was also interested in knowing the government perspective and building up partnership with academia and activists.
Padmini Somani
Prof. Dr. Patel was also happy at the proactive participation of implementing agencies such as the Directorate of Health Services of the Government of Maharashtra. She concluded her address thanking NSF and specially Padmini Somani, Leni Chaudhuri and Anushakti Tayade for collaborating with SNDT University and for supporting this important event.
13
Keynote address
the colonial government was forced to set up a department with nutrition experts to address questions of hunger. The first book The Nutritive value of Indian foods and the planning of satisfactory diets reflects the confidence of science. It came up with calorie requirement of different population classified into sedentary, moderate and heavy workers based on the nature of work and activity. The text clearly states that ... it is important to plan a diet which first provides foods rich in vitamins, minerals, proteins, iron and other nutrients and then fill the calorie gap with cereals, potatoes, sugar etc.
Prof. Dr.Veena Shatrugna
In her keynote address, Prof. Dr. Veena Shatrugna focused on the reasons for the massive nutritional deficiencies in the country. At any given point around 50 per cent of the children in India were starving, because of poverty and nonavailability of food or absence of foods appropriate for children. Even if they were not starving, children had multiple nutrient deficiencies; this was given an exotic name, hidden hunger, which was nothing but multiple vitamin and mineral deficiency. India was one of the first underdeveloped countries in the world to address the problem of hunger by releasing a document which addressed calorie requirements for Indians based on the occupation of the person. British experts had analyzed and given nutritive value to over 300 foods in 1937 itself (government publication, Health Bulletin No.23 (5), 1937,1st edition). It was recognised by then that some foods like cereals, potatoes, sugar, etc. were a concentrated source of calories, but most other foods contained multiple nutrients such as proteins, vitamins and minerals and also calories, etc. During the famines in the 1940s and the Second World War, the colonial government in India did not have a department of food. Because of the need to dispatch food to the war front, in the midst of food shortage and famine,
This simple rule was quickly forgotten by the late 1940s and 50s. Attempts were made to justify cereals as a good source of most nutrients. It was well known that the proteins from cereals and pulse are different from the proteins found in foods such as egg, milk, meat, and fish. eggs meat. Cereal proteins were of a poor quality or of low biological value (BV) when compared with animal proteins such as milk, eggs meat. It was obvious that cereal proteins did not support children's optimum growth and development or help pregnant and lactating women. Using calculations and adjustments for differences in BV, nutritionists stated that perhaps a combination of cereals and pulse proteins came close to the animal protein value, but certainly animal protein was the standard. Despite this knowledge, most nutritionists over time advised cereal pulse proteins, thus denying Indian children good quality proteins from milk and eggs. After independence, nutrition researchers came up with new ideas. For instance, Dr. Patwardhan set aside concerns for good quality proteins when he said that consuming a typical Indian cereal pulse diet would provide adequate proteins. He ended up endorsing and promoting a vegetarian diet, despite the fact that Indians had different food habits such as those who ate eggs, meat, pork, beef, even insects and wild animals.
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He recommended that people eat cereal and pulse protein in a ratio of 2:1 at every meal, that is, for every 100g of cereal, a person must consume at least 20g of pulse in the same meal for the protein to be of some value. This prescription was an attempt to homogenise the diet of the whole nation. He of course did not try to find out the number of Indians who could afford and scientifically eat this cereal-pulse combination. The biological value of proteins was important. Animal proteins were the closest to the proteins which humans can utilise. Egg protein was a standard with a BV of 100; milk protein came very close to egg protein while pulses and cereals had a BV of 65 and soyabean only 45. Nutrition scientists in India had been concerned with the cost of milk, eggs and meat, and have stated that the people could not afford it. They spent the better part of their careers convincing the government that milk consumption could be minimised or done away with. During the famine of the 1960s, giants in nutrition research came up with the theory that the protein gap was a myth. They said that they found that when people ate enough cereals they got to consume sufficient protein - 100 g of rice had 6-8 g of protein, and a person eating 350-400g of cereal was bound to get 24-30g of protein The scientists had forgotten about the BV or even the cereal- pulse protein ratio by then. The traditional cereal-pulse diet of the Indian upper class/ upper caste was recommended for adequate protein-calorie consumption. This diet consisted of rice, dal, pulses, vegetables, spices, curd and a sweet, but the poor ate only cereal with chillies and tamarind water; their diet consisted of bajra roti and chutney which had calories and fibre. If foods rich in proteins and vitamins were not included in the diet, the calories merely got converted into fat. In the 1960s, the country was asking children from a poor background to also eat a cereal-pulse diet, in effect asking
children to make sacrifices for the nation and not to desire milk, curd, chocolate, etc. To get their proteins, the children would have to eat more cereals. Top nutrition researchers did not sit back and reflect on the fact that children would not be able to eat more of the same cereal. It was well known that at least 30-40 per cent of children's calorie intake must be derived from fat, but children were already consuming 80 per cent of the calorie from cereals. A child could not get adequate calories from cereals even if she ate the whole day (1 g of cooked cereals provided only 0.5 to 1 calorie.) It is well known that many middle class mothers added dollops of ghee in their children's diet. It made sense because 1 g of ghee gave 9 calories, 1g of carbohydrate gave 4 calories. To put on the required weight and height, children's diet should contain good-quality protein and 30-40 per cent of calories from fat. Though many studies pointed to the importance of highquality protein and fat for children's growth, it was believed that the country could not afford milk and so studies were conducted with groundnut cake instead. Then protein
sources with anti-nutrients such as soya bean were being used in the ICDS programme. People with cardiac diseases were advised to use soya bean to lose weight, but soya bean was being given to undernourished children to gain weight and was also included in the ICDS programme. The bureaucracy used calories and calorie norms to calculate poverty. Cereals became a proxy for calories; it was simple calculating below poverty line (BPL) families based on calories. Wages too were based on calorie norms. Many school lunch programmes did not include eggs, instead they have bananas notwithstanding the fact that eggs and bananas were not the same. This had resulted in creating a Hindu cereal-consuming vegetarian nation. The micronutrient lobby had taken advantage of the nation's calorie-centred (read cereal-centred) consumption pattern.
15
The multi-million dollar micronutrient industry had identified hidden hunger as a problem, and was lobbying with the government to endorse fortification of different foods to sell their products - pills containing vitamins, iron and zinc to people subsisting on pure cereal calories. Instead of ensuring that people had access to adequate intake of nutritive food rich in proteins, minerals and vitamins, like fruits, vegetables, meat, eggs and milk, the government was encouraging industry to give people cereals fortified with iron and zinc.
severe under nutrition.
Chief Guest's Address
In Gujarat, wheat flour was being fortified with iron, despite the fact that wheat is rich in phytates which inhibit iron absorption. [Phytates are phosphorus compounds found primarily in cereal grains, legumes, and nuts. They bind with minerals such as iron, calcium, and zinc and interfere with iron absorbtion]. Furthermore, the marketing of
Adv. Anand Grover
The chief guest Adv. Anand Grover's address was titled, Malnutrition and Achieving the Right to Health.
fortified wheat flour, was pushing small enterprises such as chhakis (small flour mills) out of business.
To start with, Adv. Grover said he was happy that there were academics at this seminar. He was also happy that the presidential address was critical of the academics because they accepted the situation as it was, and that was unacceptable; this was the first message for the seminar not only for academics, but also for all individuals who were conscientious about the right to food. People tended to be comfortable as the Home Minister (who Adv. Grover met recently) said and who also publicly acknowledged that the economic liberalisation of the early 1990s had not benefited the poor, in fact it had widened the disparity between the rich and the poor. Prof. Shatrugna had correctly said that the path this country had taken to accommodate itself to this economic situation was by forcing food styles on people. It was distressing that vegetarianism and cereal foods had become the norm, and poor people and tribal people who thrive on non-vegetarian food had to suffer.
The WHO recommendation for children stated that :

30-40 per cent of calories
must come from fats (low
volumes and energy densities);

Vitamin A, calcium, and iron must come from milk, egg,
flesh foods, vegetable, fruit, etc. ( which also contribute additional calories); and
Cereals and pulses must be used to bridge the calorie gap.
However in India, the whole picture was reversed. As a result of the cereal load, only 30 per cent of the children had adequate calories and this has resulted in massive mineral and vitamin inadequacy. This now had a diagnosis which sounds like a disease micronutrient deficiencies.
Obviously children (and even adults) could not afford the recommended nutrient-rich foods. More than 50 per cent of children were underweight and short. Research showed that children's bodies were shrinking to cope with such
Adv. Grover's special message was to fight for holistic and wholesome foods and accessibility to food. He pointed out
17
that the right to health is impacted by accessibility to food. His address focused on six main points: 1. International instruments, 2. Rights-based approach to health and nutrition, 3. Intellectual property rights, 4. Constitutional and legal provisions, right to food as human right, and 5. The way forward.
The General Comment No. 14 adopted by the Committee on Economic, Social and Cultural Rights (CESCR), 22nd Session, Geneva in 2000, noted that the State parties are under immediate obligation to guarantee that the right to health care is exercised without discrimination, and that concrete steps are taken towards full realisation, with emphasis on vulnerable and marginal groups. It also called for reducing maternal and infant mortality, ensuring environmental and industrial hygiene, and controlling
1. International instruments The right to health was covered by the following international instruments:
Universal Declaration of Human Rights, Art. 24 International Convention on the Elimination of All
epidemic and occupational and providing health care services. The governments are obliged to respect, protect and fulfill the health rights of every individual; the citizens have the right to availability, accessibility, acceptability and quality goods and services (i.e. access to nutrition, special provisions for vulnerable groups).
Forms of Racial Discrimination, Art. 5(e)(iv) 1965

Convention on the Elimination of All Forms of
Discrimination against Women (CEDAW, Art. 11(1)(f), 12, 14(2)(b) 1979)

Convention on the Rights of the Child, Art (24) 1989 International Convention on the Protection of the Rights
The State should also respect, protect and fulfill the right to health which extended to the underlying determinants of health, including social and environmental factors. These determinants impacted health care needs and health care delivery. Malnutrition was a leading cause of child mortality, and Intellectual Property Rights (IPR) limiting biodiversity compromise availability of essential medicines and nutritional resources. The right to food was a key environmental determinant as food was necessary in both achieving and maintaining good health. Achieving nutritional sustainability is a prerequisite of achieving health sustainability.
of All Migrant Workers and Members of their Families , Arts. (28, 43 (e), 45(c)
Convention on the Rights of Persons with Disabilities ,
Art. 25 (2006)
The Charter of Fundamental Rights of the European
Union (2000)
European Convention of the Protection of Human
Rights and Fundamental Freedoms (1950)
Another important international instrument is Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), 2000 on the Right to Health states The right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
The right to food was a right under international law which indicates specifically production, conservation and distribution making full use of technical knowledge. Prof. Shatrugna was right when she said that technical progress did not mean putting micronutrient into foods separately. Lawyers have been using this phrase in a not so knowledgeable way. With regard to food cases, the lawyers
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were only concerned about determining workers wages as per calorie requirements of 2000 calories per person per day; they were not concerned about the basis of this data. Right to food is key environmental determinant and if the right to food is not realised in the way Prof. Shatrugna has mentioned, the right to health will not be realised either.
Accountability was important but rarely exercised. It was a popular belief that accountability is ensured in a democracy. Yet India is at the bottom of the list when it came to poverty and hunger. However the government tried to explain otherwise by juggling statistics. It was very shameful that India had high levels of malnutrition, infant, child and maternal morbidity and mortality rates. Lawyers,
2. Rights-based approach to health and nutrition Adv. Grover pointed out that a rights-based approach to health and nutrition should be non-discriminative, transparent, participatory, proportionate, accountable and be monitored. It should meet the targets set for the Millennium Development Goal (MDG) # MDG 1.
nutritionists, academics and individuals should make it clear to the government that such poor development indicators were not acceptable. To be involved in social action, it was necessary to be caring, mindful of people's distress, and understand their pain and suffering. For instance, during the struggle of pavement dwellers in the early 1990s, Adv. Grover too had middle class prejudices. But because he was taking up the PIL cases of pavement dwellers, he visited the families, interacted with them and
1 to eradicate
extreme poverty and hunger. India was far from achieving
The State had the obligation of making food accessible to people without discrimination. Pushing cereals down poor people's throats is discriminatory as it becomes a caste and class issue; the right to food should also look at issues of inequality; as women had to sacrifice for their husbands and children, they eat last and the least amount of food. The needs of food-exporting and food- importing countries have to be taken into account for equitable access to food and food supplies. India, China and European countries were buying large tracts of land in Africa, not caring about the effect on African people. Were they being treated in an equitable manner? Similarly, it was necessary to question if SC/ST and poor people in India were treated in an equitable manner. A look at the data on undernutrition showed that India has yet to realise the right to food. Progress could be said to be achieved when greater number of people enjoy high levels of nutrition. Furthermore there is no transparency in government policies. There should be participation of people who were affected by government decisions and policies. People should aggressively articulate their views for people-centred policies.
created a bond with them. In doing so, he was able to understand their problems and suffering. Hence it was necessary for academics to bond with the people, understand their problems, and take action, otherwise the dry statistics they collected would have no meaning and there would be no change.
3. Intellectual property rights The issue of patents too affected the right to food. The Trade-Related Aspects of Intellectual Property Rights (TRIPS) extended protection to micro-organisms, nonbiological and microbiological processes and plant varieties. Patents were granted for drugs, medicines and agrochemicals. Strong IPR law severely limited sustainable food production, and thus was at the root of malnutrition. Examples of patenting which compromised India's biodiversity included: Indian basmati rice variety by Rice Tech (US), Nap Hal wheat by Monsanto (European Patent Office), entire gene sequences of rice by Syngenta (Switzerland), and medicinal properties of turmeric, neem, jamoon, bitter gourd and such other Indian varieties and
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the associated knowledge, by US and European multinational companies (MNCs). People must oppose such measures which made profit at the cost of people's health. It was advisable to link with other organisations and put international pressure on the government.
d. Preventing government officials and employees from taking any action that could be construed as involving a conflict of interest in so far as it might be hostile to the right to food e. Ensuring that any interaction with the commercial food sector on matters of food policy or nutrition-related
4. Constitutional and legal provisions There were also Constitutional and legal provisions for the right to food in India.
Article 21 of the Indian Constitution articulates the right
schemes is accountable and transparent. Transparency should be ensured through public hearings, public notice of interaction and disclosure of records
to health: No person shall be deprived of his life or personal liberty except by procedure established by law. Article 47 articulates the right to food and its relationship to health: The state shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties.
5. Right to food as human right The above-mentioned provisions of the draft Right to Food Act were critical in protecting the human rights to food and health. The connection between nutrition and public health outlined in the draft Right to Food Act makes restrictive IPR law in the realm of biodiversity a matter of international human rights law. Protections under international human rights law must be based on community action in order to
The Draft Right to Food Act (June 2009) states:It is imperative to create and enforce legal entitlements and obligations to ensure that every person is assured physical, economic and social access to adequate food with dignity as is necessary to lead an active and healthy life. The right to food and IPR is contained in Chapter VIII (Section 24.8) on Prevention of commercial interference of the Right to Food Act (2009):
work towards MDG
1 to eradicate extreme poverty and
hunger. Using human rights will help sustain the right to food movement.
6. The way forward Community involvement was the key to moving forward:
Families, especially farmers, should not remain objects of
the interventions but become the subjects and the controlling factors in the process
a. Banning and preventing the promotion of baby foods for infants at any level with the public, with professionals or using any media b. Banning and preventing commercial promotions targeted at public health professionals and health workers c. Refraining from any partnership with the commercial food sector for either design or implementation of nutrition-related schemes
It was important to engage civil society, not just NGOs. Building capacities of the community so that they could
participate in decision-making, monitoring the progress of the interventions, and holding governments accountable
The community must be empowered with information
information about their rights and the government's policies and progress of implementation of the policies and programmes
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Despite having strong jurisprudence on the right to health and right to food by way of constitutional and legal provisions, it was not articulated politically in the manner it should be; it was subverted by policies being introduced through conspiracies. The MNC lobby was good at influencing Indian bureaucrats. India has a vibrant civil society which was able to demand the right to food law. Though still in the formative stage, it had important provisions on the right to health. There was an urgent need to push this agenda forward and make sure it was not merely an IPR issues but issues that Prof. Shatrugna talked about so as to realise the right to food and right to health.
per year per person. Many people died as they could not afford the expensive drug. By early 2000, a strong people's movement forced CIPLA to sell the drug at US$ 350 per person per year. It was not IPR that prevailed in this case but the right of the people to healthy life. The same action could be undertaken to prevent farmers' suicide, malnutrition deaths in Melghat and also to make the government responsible for providing good quality food and for people to have easy access to sanitation and drinking water and healthcare facilities.
Adv. Grover concluded expressing his happiness that this seminar had tied up with the academics and advised the
In 1990s, when the world was reeling under HIV-AIDS, the drug to treat the disease then cost more than US$ 10,000
people in the academia to collaborate with NGOs to make the government listen.
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Panel Presentation and Discussion

The next session, Panel Discussion chaired by Prof. Shatrugna had four presentations. They include the following: a) National Family Health Survey 2, b) Nutrition in India Salient Findings from National Family Health Survey 3, c) Can a Malnourished India Race to the Top of the World?, and d) Agrarian Distress, Food Security and Malnutrition 1.National Family Health Survey 2 by Prof. Dr. Sumati Kulkarni, Retired Professor, IIPS, Mumbai
But South Asian purchasing power was higher ; agricultural performance, per capita and daily energy supply were also higher in South Asia. Another argument was that the predominant vegetarian diet of Indians was the cause of malnutrition. However, most Indians consumed milk and milk products and ICDS programmes provided dietary supplements to children. He concluded that cause for the difference was the lower social status of women in South Asia. In India, one third of babies were underweight at birth, in Bangladesh, one half of babies were underweight at birth, but in Africa only one sixth of babies were under weight at birth. Birth weight was the single most important predictor of malnutrition.
Traditionally, in a patriarchal society, the neglect of women from childhood through adolescence and during pregnancy, led to anemia and to low birth weight of babies. These children grew into adults and the same cycle continued. Hence it was important to go beyond food security issues and examine such deep-rooted social issues.
Prof. Dr.Sumati Kulkarni
Prof. Kulkarni focused on NFHS 2 as she was its All India Coordinator. She pointed out that in the first national survey (NFHS 1) conducted in 1992-93, nutrition data was collected from representative sample of women and children. Many estimates were given by background characteristics of age, education, and standard of living to know the prevalence of malnutrition in different groups.
NFHS 1 which was done in 1992-93 relied on survey using height and weight measurements with children. The NFHS
2, conducted in 1998-99, had wider scope. Field tests

covered women aged 15 to 49 years ever married and children up to three years. Infant practices were covered including breastfeeding and supplementary feeding practices. Dietary patterns of women covered what food and how often they consumed. Malnutrition among children
In 1997, Dr. Ramalingam Swamy talked about a South Asian enigma: while 30 per cent of African babies were malnourished, 50 per cent of South and South East Asian babies were malnourished. Such a high rate of malnutrition in a region where development was higher than in Africa was surprising. He tried to examine the causes for the higher malnutrition in South Asia. Was it poverty?
was measured by height for age for linear growth and and chronic malnutrition, weight for height and weight for age for chronic and acute malnutrition and acute undernutrition.
Malnutrition among children: The WHO standards were comparable to Indian children. In India nearly half the children were under weight, and 16 per cent were wasted.
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A study of 58 developing countries showed that India was high on the list with high malnutrition.It is a matter of serious concern that malnutrition had a negative correlation with standard of living; even in urban areas and also in households with high standards of living, onefourths of children were malnourished. Lifestyle and inappropriate cooking practices were some of the causes identified. NFHS-2 found that despite a strong preference for male children, there was no evidence that girls in the age group 0-3 years were more malnourished than boys. The extent of undernourished children was less among children aged six months, maximum malnourishment was between 1 and 2 years. This had important policy implications because ICDS programmes covered children aged 5-5 years. Thus we see that data can speak if we look with a proper mindset.
that Punjab too was in this category. One of the reasons could be that in Punjab children were fed large quantities of milk, which was not conducive to iron absorption. In Kerala and Nagaland, 44 per cent of the children were anaemic, and in Rajasthan, 10 per cent were severely anaemic.
Malnutrition among women: In India, 52 per cent of the women had anaemia. Many women had body mass index lower than 18. One third women in the age group of 15 years and 49 years had chronic anaemia. There was chronic energy deficiency in Orissa and Bihar. Chronic energy deficiency was also high in West Bengal, Maharashtra and Karnataka. Some data was intriguing: malnutrition was lowest in Arunachal Pradesh, Punjab, Kerala and Goa. The consumption of milk, fruits, eggs, chicken and fish was less likely to cause this problem of chronic energy deficiency. At
There was high malnutrition in Bihar, UP, Rajasthan and Orissa. But it was surprising to find high levels of malnutrition even in developed states, like West Bengal, Maharashtra and Gujarat. Kerala and Goa have less malnutrition.
the same time, 11 per cent of the women suffered from obesity with BMI of over 25 and this problem was mostly found in Punjab and Delhi. The sample, taking into account all sections of society, shows that 35 per cent of the women have high anaemia, 15 per cent moderate anaemia and 2 per cent severe anaemia. Sixty-five per cent of the schedule tribe
There were many indicators of malnutrition. Improper feeding practices were the cause of malnutrition among children of age group of 0-3 years. Exclusive breastfeeding was very important but only 55 per cent of the children below four months breastfed exclusively. WHO recommended exclusive breastfeeding without even water up to six months. Only one third of the children received supplementary foods. Information about appropriate feeding practices needed to be disseminated well.
women and women from poor households had anaemia. Anaemia was low among Jain and Sikh women. Fifty per cent of women from Assam, Meghalaya, and Arunachal Pradesh had anaemia which was surprising because these were meat and fish-eating communities. Apart from poverty and dietary patterns, diseases such as diarrhoea and respiratory illnesses affected (depleted) nutrition supply. Disease management was important as also
nutritional and health care of adolescent girls and pregnant and lactating women.
Anemia was another indicator of malnutrition; 74 per cent of the children six months to 3 years were anaemic. Of these 33 per cent had mild anaemia, 46 per cent had moderate and 5 per cent had severe anaemia. It was also surprising
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2.Nutrition in India Salient Findings from National Family Health Survey 3 by Prof. Dr. Sulabha Parasuraman, Professor, IIPS, Mumbai
3. Can a Malnourished India Race to the Top of the World? by Prof. Dr. Sangita Kamdar, Professor (Economics), NMIMS, Mumbai
Dr. Sulabha Parasuraman
Dr. Sangita Kamdar
Prof. Dr. Parasuraman gave a detailed presentation of the National Family Health Survey-3 (NFHS-3) which was conducted in 2005-06, focusing on child and adult nutritional status and issues. She concluded with the following points:
Prof. Dr. Kamdar's presentation provided a link between poverty and nutrition. The definition of poverty line often relied on the expenditure necessary to obtain a certain minimum amount of food or nutrient basket. But there was no strong relation between an increase in income and an increase in nutrition. Increased income might not translate
Children in India suffered from some of the highest
into increased calorie consumption. She therefore pointed out that direct nutrition supplements may have a far greater impact on undernutrition than an increase in income. The positive link between poverty and under nourishment was established through work capacity. A state of good nourishment was desirable as it meant more stamina, physical and mental health and higher resistance to illness; it raises work capacity and hence the ability to earn What were the implications of undernourishment among the people for India's growth potential? India had been growing rapidly since the introduction of economic reforms. The growth in the working age population had been cited as one of the factors that led to a sustained economic growth of 9 per cent in recent years.
levels of stunting, wasting and underweight in the world, and the situation has not improved much
Anaemia levels among children were very high and it
had actually increased since NFHS-2

Most recommended infant and young child feeding
practices were widely ignored by parents

The ICDS programme, which had been in operation for
more than 30 years, had not been able to reduce malnutrition to acceptable levels in any state
The adult population suffered from a dual burden of
undernutrition and overweight/ obesity

Almost half the number of women and more than 40 per
cent men in most population subgroups were either too thin or too fat.
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The 'demographic dividend' was the increase or the bulge in the working-age population. The Indian population in the 15-24 years age group grew from around 175 million in 1995 to 210 million in 2005. In 2020, the average Indian would be only 29 years old, compared with 37 in China and the US, 45 in West Europe and 48 in Japan. This trend was seen as significant on the grounds that what mattered was not the size of the population, but its age structure. For the demographic dividend to take shape and contribute meaningfully to economic growth, there was need to ensure that this workforce was 'employable'. Education and training for imparting skills was necessary to reap the demographic dividend. Health and nutrition were needed to improve labour productivity. Malnutrition had substantial economic costs: productivity losses to individuals were estimated at more than 10 per cent of lifetime earnings, and gross domestic product (GDP) lost to malnutrition ran as high as 2 to 3 per cent. The Government's policy responses to malnutrition were to improve access to food through the public distribution system (PDS), income support such as food-for-work programmes and employment guarantee schemes where people were paid often in food grains for working on public projects; food programmes for young children through mid-day meal schemes and nutrition supplementation programmes such as the Integrated Child Development Services (ICDS) and basic health services to young children, pregnant women and lactating mothers. Prof. Kamdar concluded by explaining that it was not poverty (and the resultant lack of food) alone that caused malnutrition. Evidence showed that the damage from malnutrition occurred either when the child was in the womb or in the first two years of life, and much of the
impairment of brain development and future productivity in these early periods of life was irreversible. Therefore supplementary feeding through school feeding programmes for nutritional purposes was often too late and too little as there was always a budget constraint on nutritional programmes.
She made the following recommendations: There is a very clear need to focus on the very young Public policy needs to promote healthy nutrition practices during pregnancy and the first two years of life it should promote and support traditional practices such as adequate rest during pregnancy and breast feeding. An information campaign is needed Need to support fortification of commonly consumed foods with micronutrients such as iodine, iron, vitamin A and zinc and encourage women to take iron supplements during pregnancy.
4. Agrarian Distress, Food Security and Malnutrition by Dr. Srijit Mishra, IGIDR, Mumbai
Dr. Srijit Mishra
Dr Mishra's presentation focused on the agrarian crisis, its adverse impact on nutrition and the social and economic situation of farmers.
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He said there were two dimensions to the agrarian crisis: 1. The agrarian (livelihood) crisis which threatened the livelihood of farmers (particularly small and marginal farmers). It could cause displacement of people 2. The agricultural (developmental) crisis which lay in the neglect of agriculture (designing of programmes and allocation of resources). It could cause displacement of ideology. The number of poor and undernourished farmers had increased significantly. Further there had been a decline in food production, in yield, prices and employment which had contributed to rural distress provoking farmers' suicides. Climate change impacts were a cause for concern: it would cause an increase in temperature, decrease in the number of monsoon days, and an increase in the intensity of rainfall and the frequency/intensity of cyclonic storms. Crop yield was likely to decrease and hunger risk would increase. Government interventions had been mainly in the form debt waiver, which was merely a book-keeping exercise that at best would reduce the mental burden for loan from formal sources. It did not necessarily lead to an increase in investment for production. This intervention raised two questions of equity: 1) across regions/states and 2) across size-class of farmers. Debt waiver did not give credit guarantee for non-willful default. Instead innovations were required at technological and institutional levels. Technological innovations included, community-managed sustainable agriculture, nonpesticide management, botanical extracts as a last resort, farmer field schools (FFS) and use of local resources. Institutional innovations included FFS and self help groups (SHGs).
Dr. Mishra concluded with the following recommendations :
remarks and
Risk mitigation interventions need to go beyond suicides
and debt waivers. It should address yield, price, credit, income, weather and other uncertainties
There is need to spruce up of public investments that will
increase returns to cultivation. Skill enhancement and linking of opportunities to local resources are required to increase income from non-farm avenues
Success of the credit and input markets require effective
regulation
Interventions should encourage technological and
financial products that would reduce costs while increasing returns

Institutions that can organise farmers are required.
Q&A/Discussion Q. Kamini Kapadia said that most of the analysis had been about undernourishment. Community workers need to look at differentials between malnourishment and undernourishment. They needed a sharper analysis in terms of nourishment for which population and seeing disaggregated data in relation to malnourishment and undernourishment would help get a sharper picture of the situation. Some of the speakers had used the term interchangeably and some of them had used it specifically. A. Prof. Shatrugna answered that this demand was legitimate. Undernourishment was increasing and it is also necessary to focus on obesity among the rich and middle class. It cannot be treated as a homogenous whole. It is necessary to acknowledge that there were three Indias the very rich, the middle class and the very poor. While the middle class was getting into a trap of obesity, the very poor suffered low BMI.
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Prof. Dr. Kulkarni said undernourishment was the result of inadequate intake of food. There were many questions that needed to be asked: did women consume milk and milk products and other foods? There was malnourishment among children and it was necessary to examine the
Q. Venkat pointed out that in rural areas, the spending pattern had changed with priority given to mobile phones and television, and he said there was need to educate people. A. Dr. Mishra said that people's movement was required for consumer education and good health and nutritional practices. Q. Prof. Savaddati posed three questions: 1) How reliable was the NFHS data? What measures were taken for error margins as accurate data was important to bring about changes in policies and programmes. 2) She requested Prof. Dr. Kamdar to clarify her statement that there was no link between economic development and nutrition. She said that there was a definite link that without economic development and with increasing purchasing power there was need for education which should be implemented in the next phase. 3) Why had Dr. Mishra not mentioned the role of malnutrition in farmers' suicide. A. Prof. Dr. Parasuraman answered that the NFHS studies were reliable. She pointed out that when she mentioned a percentage she spoke only in approximate terms. When she said 52 per cent it may not be exactly 52 per cent but thereabouts. Research surveys provided statistics for policy makers and administration to take appropriate action. She pointed out that malnutrition and undernutrition were treated separately. She had mentioned sub groups under malnutrition and undernutrition. It was important to ensure that the programmes were relevant and that they reached the right groups the lowest strata of society. Prof.
dietary patterns of children who were breastfed and not given supplementary food. Q. Dr. Santosh Chowdhury who worked in the rural areas and among tribal people said that there was malnutrition in rural Maharashtra and in tribal areas. Farmers were selling cows despite their usefulness. There was a need to improve the traditional culture. Not much importance was given to agriculture. In urban areas dietary patterns and lifestyle had changed and the problem there is of obesity. A. Dr. Mishra said the solution was in appropriate interventions. He related the experience of the Society for the Elimination of Rural Poverty in Andhra Pradesh. The intervention for livelihoods was started by local self help groups working at village, taluka levels. The government officials too believed in self empowerment and supported and facilitated the people's initiative. So there was a structure at village, district levels for facilitators and also structure for the people's involvement at village and district levels. Alternative technology was being used for cultivation and local resources including cows were used in cost-effective ways. Alternative institutional structure, such as in Nagpur, helped to scale up agricultural production.
Q. Preeti Singh wanted to know how to make the urban poor and rural people aware of nutrition issues. She pointed out the need to pay attention to education of the poor and disadvantaged and give them information on nutrition.
Dr. Kulkarni added that those interested may look up her article on care taken to provide reliable data in the Economic and Political Weekly special issue on NFHS-2 for article written by her with title, NFHS-2 - the Inside Story: Inputs and Processes.
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Prof. Dr. Kamdar responded to Prof. Savaddati's query that education was necessary but was not sufficient. Q. Bandu Sane of Melghat regretted that farmers' suicides continued to rise. When they questioned the authorities about malnutrition deaths (in Melghat) they were told that the matter was in the court. When the bureaucrats were not interested in solving the problems, how could a change be brought about in people's lives? A. Dr. Mishra replied that the agricultural production pattern was changing - if a farmer uses his field to grow one crop, say cotton, then if the crop failed, he had nothing to live on, nothing to feed his family. The farmers' suicide was a symptom of a larger crisis. For every one farmer who committed suicide there were several thousands who were in distress. Hence there was need to look at the larger picture and to seek solutions to the problems in a holistic way. Q. Dr. Ratnavalli wanted to know if Prof. Dr. Shatrugna's slide on relation between mother and daughter was based on generational study. A. Prof. Shatrugna said that there was no disparity between NFHS data and National Nutrition Monitoring Bureau (NMNB) data, which was from 10 states in northern India. She pointed out that while she admired the commitment to figures/statistics, when half the country was starving it hardly mattered if the malnutrition rate was 62 per cent or 58 per cent. She said that India was blessed with a good crop of groundnuts which had lot of oil, and was high in protein which could be easily processed and should be used more than soya. Soya was difficult to process and the process destroyed the nutrients. Its fibre content was high which inhibited absorption of other nutrients.
Though it had a role in managing cardiovascular diseases and might help in menopausal problems, it was also known to be responsible for breast cancer. America rejected soya for these reasons and also because it caused allergies. Soya oil had high fatty acids and was very low in proteins. In answer to Dr. Ratnavalli's query, Prof. Shatrugna said that in India, the average height had remained the same in the last 60 years. Genetics came into play once the maximum potential was reached. Food, medicine and high quality protein are required for proper growth. She further said that it was not a good idea to pick up a concept that was developed for another discipline and mix it in nutrition. Short was not beautiful, one must have normal weight for height. Cardiovascular disease, hyper tension, and diabetes set in early in short people as weight was distributed around a short height; that was why weight for height was developed. It is necessary to have normal weight for height. But 35 per cent of Indians do not have normal weight for height. This measurement was also being used for children which was wrong as children had the potential to grow taller. With these words, Dr. Shatrugna closed the session on panel discussion.
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Vote of Thanks
Dr. Ruby Ojha gave the vote of thanks on behalf of the Post-Graduate Department of Economics, SNDT Women's University. She was happy that the National Seminar on Malnutrition: Issues and Concerns organised by Narotam Sekhsaria Foundation, the PG Department of Economics, SNDT Women's University and the Directorate of Health Services, Maharashtra State, Mumbai on 11-12 January 2010 at SNDT Women's University, Churchgate Campus, Mumbai went off smoothly. She thanked Prof. Vibhuti Patel the Director of PG Dept of Economics who ably guided the team. She also thanked the following people:
Prof. Dr. Chandra Krishnamurthy, the Honorable Vice Chancellor, SNDT Women's University, Mumbai, who could not
be present, for her encouragement and support
Dr. Madhu Madan, Registrar of SNDT University for granting permission to hold this event and for making available university infrastructure
Padmini Somani, Director, Narotam Sekhsaria Foundation, Mumbai for co-organising and supporting the seminar Leni Chaudhuri and Anushakti Tayade, programme officers from NS Foundation for meticulously designing and
executing the seminar

Prof. Dr. Veena Shatruguna, Former Dy. Director & Head Clinical Division, National Institute of Nutrition, Hyderabad
and Consultant, Indian Institute of Public Health, Hyderabad for keynote address
Adv. Anand Grover, UN Special Rapporteur on the right of everyone to the enjoyment of highest attainable standard of
mental and physical health for the Chief Guest's address Dr. S.K. Dakhure, Director, Health Services, Government of Maharashtra who made a special effort to involve the Government of Maharashtra it his crucial event, but who could not be present at the seminar
Participants of the Panel Discussion on Discourse on Nutrition and Malnutrition: Prof. Dr. Sumati Kulkarni, Retired
Professor, IIPS, Mumbai, Prof. Dr. Sangita Kamdar, Professor of Economics, NMIMS, Mumbai, Prof. Dr. Sulabha Parsuraman, Professor, IIPS, Mumbai and Srijit Mishra, Associate Prof., IGIDR
Chairpersons: Prof. Dr. Veena Shatrugna, Prof. Pushpa Savaddatti, Professor, Karnataka University, Dharwar; Dr Veena
Devasthali, Reader, PG Dept of Economics, SNDT Women's University, Mumbai; Dr. Sunita Kaistha, Reader, Jesus and Mary College, University of Delhi and Prof. Dr. Vibhuti Patel
Dr. S.V. Rathod, Consultant of National Rural Health Mission, Maharashtra for his valedictory address. All the participants who made presentations SNDT University teaching staff, Geeta Shah and Dr. Rekha Talmaki of SNDT UG College for their valuable suggestions SNDT University PGSR office staff, Mr. Mohanan, Accounts Officer Mr. Rajendra Vategaonkar and the non-teaching staff
of PF|GSR office for their technical support

The staff of Narotam Sekhsaria Foundation Student volunteers for their assistance All the participants of the seminar
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Day 2 - 12 January 2010 SESSION I - Political Economy of Malnutrition Chairperson: Prof. Pushpa Savaddati, Professor, Karnataka University, Dharwar Prof. Dr. Savaddati thanked Prof. Dr. Vibhuti Patel for inviting her to participate in this seminar and introduced the topic of the first session. She pointed out there were six presenters and each presenter had eight minutes to present which allowed 10 minutes for discussion.
Dr. Pushpa Savaddati
1. Malnutrition: A serious concern towards young India by Dr. K. Srinivasa Rao, Sr. Faculty, PG Dept. of Commerce, Vivek Vardhini (AN) College, Hyderabad, Andhra Pradesh. Dr. Rao pointed out that malnutrition was a multidimensional problem because it was related to the process of socio-political transformation like social behavior, household livelihood, state services, equality and human rights with dignity. India had a higher prevalence of child malnutrition, as manifested in stunting and underweight, than any other large country and was home to about onethird of all malnourished children in the world in early 2000. There were, however, substantial inter-state differences in child malnutrition and also in the progress made in overcoming the problem since the early 1990s. Therefore it was necessary to have the multi-sectoral view of nutrition security, defining it as physical, economic and social access to, and utilisation of an appropriate, balanced diet, safe drinking water, environmental hygiene and primary health care for all. The persistence of widespread malnutrition might seem surprising considering the recent overall shining performance of the Indian economy. The cost in terms of health, well-being and economic development was tremendous. Between 1993 and 2006, net state domestic product per capita nearly doubled in the wake of 4.5 per cent average annual growth.
The presenter identified various social and economic effects of malnutrition and examined the existing measures to overcome the problem. He also made recommendations for sustainable economic and appropriate social development programmes to achieve inclusive growth, which included expanding and improving nutrition education, providing clean drinking water and addressing non-food factors. 2. The Political Economy of Malnutrition in India: the need to move towards the paradigm of food sovereignty by Dr. Vanmala Hiranandani, Reader-cumDeputy Director, Center for the Study of Social Exclusion and Inclusive Policy, SNDT Women's University, Juhu Campus, Mumbai. This paper pointed out that poverty and food insecurity were viewed as the main causes of malnutrition; yet, structural causes of poverty and hunger had received inadequate attention. Therefore, a food-centered approach to nutrition had dominated policy-making. In postindependent India, food subsidies, supplementary food, health and nutrition education, pre-school education, and health services had characterised government approaches to tackle the problem. Despite these efforts, undernutrition remained a silent catastrophe in India; a UNICEF survey of 2009 revealed that 52 per cent of women and 74 per cent of children were anaemic.
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Dr. Hiranandani argued that malnutrition, food insecurity and poverty were inherently political issues. She pointed out that the limitations of the concept of food security that was congruent, for instance, with a market-oriented economy in which people ate McDonald's burgers, while the fast food chain extinguished the livelihoods of small-scale farmers and ravaged the planet by its ecological footprint. She therefore emphasised the need for a paradigm of food sovereignty that counteracted neo-liberal notions on food as a commodity, rather than a right. Food sovereignty, put forth by Via Campesina, the largest international farmers' association, focused on protecting and sustaining rural and urban livelihoods. The presentation emphasised the need for agricultural production for subsistence and local markets rather than for the production of cash crops that destroyed the food security of millions of farming families in India. Food sovereignty also brought gender justice and protected the livelihoods of indigenous populations (e.g. adivasis) within its ambit. Thus, the paper concluded that food sovereignty was a much-needed alternative that must be made the cornerstone of policy-making to eliminate malnutrition and hunger. 3. Neo urbanisation - A saga of desire,
The presenter, viewing the situation as a social activist, raised such pertinent questions as, had migration helped? Had awareness about facility of health and education resulted in the access to health and education? What had happened to community life? Though women were more visible now than before, it was important to find out what professions they were in and what were their responsibilities; and importantly, what was the state of their health and nutrition? 4. Political Economy of Hunger by ManiMala, Delhi This presentation made in Hindi, brought to fore the issue of chronic hunger in villages and cities of India. The presenter described it as one of intense avoidable suffering: of self-denial, of learning to live with far less than the body needs. State authorities continued to regard starvation as a temporary aberration caused by rainfall failures rather than as an element of daily lives. The authorities continued to craft minimalist responses, to spend as little money as was absolutely necessary to keep people threatened with food shortages alive. The duties of State officials were not legally binding, in ways that they could not be punished for letting citizens live with and die of hunger. The government programmes were woefully inadequate to address destitution; in fact, they tended to be blind to or in denial of the fact that large numbers of people lack even the elementary means and power to survive with dignity. The presentation urged the State to acknowledge the conditions of malnutrition, identify people threatened by them, and address and prevent the enormous suffering, sickness and death caused by malnutrition. 5. Malnutrition among Adivasis of Maharashtra by Shubhangini A. Joshi, Lecturer, SNDT Women's University, Juhu Campus, Mumbai. The presentation gave a background of the situation of
displacement and deprivation by Adv. Shalini Mathur, Lucknow This paper looked at the phenomenon of urbanisation in post-globalised India, which had led to further deprivation of the poor, especially the women. Neo-liberalisation had replaced socialistic ethos and has created a false sense of hope. While open market and availability of more goods in the market place have increased the level of desire yet decreasing purchasing power has not only increased huge disparity but also has caused emotional upheavals related to migration which meant displacement.
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adivasis in Maharashtra. Adivasis comprised 635 tribes among 5653 distinct communities of India. Despite being skilled craftspeople and knowledgeable about animals and plants of forests, they were being pushed to the brink of survival. Displaced from their homes, denied basic human rights, they faced a relentless cycle of abject poverty, deprivation and hunger, leading to malnutrition among adivasis, the worse-affected were their children. In 2001, more than 8000 children up to 6 years died in the tribal belt of Maharashtra due to malnutrition. A Government survey reported that 86 per cent of the families were food deficient, 78 per cent per cent did not have enough food for six months in a year; 65 per cent of the tribal children were undernourished and 83 per cent were anaemic. In 1994, 89 per cent of rural population had a calorie intake of less than 2400. Melghat and Nandurbar reported high rates of infant mortality rate (IMR) with oneeighth of the total child deaths were those of tribal children. The presenter pointed out that the problem of malnutrition among the adivasis was not a medical one but was related to social and political-economy. A strong political will was required to bring the adivasis into the mainstream of society. It was also necessary to restore their livelihoods and ensure food security and stability so as to save the vulnerable adivasi tribes from becoming extinct. 6. Prevalence of malnutrition in India: a disturbing phenomenon by Dr. Ruby Ojha, PG Economics Dept., SNDT Women's University, Mumbai. This presentation pointed out that mere economic development or increased food production did not by itself necessarily ensure nutrition for all. Using extensive data from NFHS 2 and 3, it showed the effects of malnutrition: nutritional status of children (stunted, wasted and underweight), nutritional status of urban and rural adults
both undernutrition and obese; prevalence of anaemia in India; correlation between prevalence of anaemia and development indicators; correlation between child malnutrition and development indicators. The paper emphasised the need to tackle the problem of nutrition both through direct nutrition intervention for especially vulnerable groups as well as through development policies, which would create conditions for improved nutrition. Economic growth alone, though impressive, would not reduce malnutrition sufficiently to meet the nutrition target. If this was to be achieved, difficult choices about how to scale up and reform existing nutrition programmes or introduce new ones have to be made by the Government and other agencies involved in nutrition in India. Q &A/Discussion
1. Dr. Alex George pointed out that Dr. Srinivas Reddy's paper only examined food-related aspects of malnutrition. He said that non-food issues need to be examined. His presentation did not provide link between water and sanitation and malnutrition. For instance, if a child was suffering from diarrhea, the absorption of nutrition will not take place. Dr. Reddy answered that water and sanitation were environmental issues. Environment should be protected and unless issues of
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sanitation and water were addressed, it would aggravate malnutrition and health problems. Environmental issues could not be separated from malnutrition and his paper dealt with both. 2. Prof. Dr. Vibhuti Patel asked Dr Shubangini Joshi what kind of royalty was she expecting for the tribal community Dr. Shubangini Joshi expecting. Dr. Joshi replied that she expected royalty for forest areas which were used for national parks and wild life sanctuaries; a portion of the income should be given to the tribal community as compensation for taking away their land and livelihood. They should also be compensated adequately for the industrial development projects that come up in the forest land inhabited by the tribal people. 3. A query was made about there being no data regarding the diet of the tribal people and this affected welfare programmes. The discussion involved the following: data on tribal diet was available in national institutes in Hyderabad and Nagpur. These institutes conducted annual surveys on the tribal consumption patterns in rural and urban areas and this data was made available to the Planning Commission for necessary action. Unfortunately the surveys were stereotype and there was no improvement on consumption patterns of the tribal people. Subhangi Joshi responded that there was no data available on the tribal nutritional status. The details of calories, proteins, fat in the food tribals consumed were not listed. She had come across calorie deficit, types of hunger but there was no data specifically about the nutritional intake of any particular tribe. Prof. Dr. Shatrugna said the diet survey was usually on amount of food eaten by the family or a person, the
nutritive value of rice, wheat and converted to nutrients. However tribal food was not analysed. She pointed out nutritionists were programmed only to analyse cereals, pulses, vegetables, fruits. There was very little analysis on non-vegetarian food. But tribal people ate roots, birds, insects, snakes. As a result the survey data was not comprehensive. Even tubers, roots and other forest products eaten by tribals do not have botanical names and are not documented. Preeti Singh pointed out that there was a wide variation between tribals in different areas such as in Andaman Islands and those in Jharkhand. Shubangi responded that her paper was specifically on tribals of Maharashtra and that she did not do a comparative study of tribals in other states. 4. In a comment to Vanmala, Radha Holla said that the word access had been co-opted by neoliberals to mean access through market using money. It was equivalent to the co-option of the word choice in reproductive rights. Choice in developed countries now meant choice between abortion and non-abortion. In developing countries, choice was about choice of contraceptives; there was no other choice. She pointed out that the word, access should not be allowed to reach the point choice had reached. It is necessary to reclaim the word access to mean Right to food and bring it back into civil society dialogue. 5. Another issue raised was that the paradigm of development needed to change. 6. One participant said that the issue of malnutrition was in programmatic mode. Why was the ICDS programme treated as if it was a disease like TB and malaria programmes? Why should a demand be made of something that already existed? But water had been privatised, and soon it would be the turn of fresh air
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to be privatised. So right to food should not be compartmentalised into PDS, ICDS. He asked if political mileage was being gained by providing food to people, which was in fact people's basic right. 7. Bandu Sane of Melghat pointed out that to enable better studies it was necessary to go the villages and understand the real situation and problems people face;
only then could appropriate solutions be found. 8. Another comment made was that there was enough food grains but people were unable to purchase food grains. Prof. Sadavatti summed up the session with a brief outline of each presentation. She thanked all presenters and the participants for their contribution to the discussion.
Day 2 - 12 January 2010 SESSION 2 - Effects of Malnutrition on Mortality and Morbidity: National profile and regional; rural-urban; caste, class, gender, ethnicity and religious variations Chairperson: Dr. Veena Devasthali, PG Economics Department, SNDT Women's University, Mumbai Dr. Devasthali regretted the lack of time and said that chairpersons have the unenviable task of keeping to time especially in this session which had 10 presentations. The topic of this session covered a wide range and it would be interesting to hear the full presentations, but because of severe time constraints, she urged the presenters to confine their presentations to seven minutes each.
1. Migrant women labour malnutrition and poverty: A case study by Dr. Preeti Singh, Associate Professor, Jesus and Mary College, New Delhi This presentation was a study on 40 Rajashthani migrant women labourers in three construction sites in Delhi. On an average each family had four undernourished children having a daily intake of less than five hundred calories each. The women were working for survival. They earned Rs. 90 per day as casual labourers for about 20 days in a month. The men lazed around, drank alcohol or were unemployed. The women were frail and emaciated but they had to pick up heavy building material. They were not given food, shelter, clothes or medical facilities. They were breastfeeding children aged up to 5 and 6 years. The family ate rice/roti mixed with water and achaar (pickles) given by affluent
families. The methodology adopted was to observe the families and their work. Each woman was interviewed individually and also in a group. Time was also spent with the children in informal interaction for gathering information. Remedial situation for these families was taken up through a small group. Recommendations include overtime wages for migrant workers and provisions for facilities such as bathrooms, basic education, nutrition education through charts, BPL identification cards to benefit PDS. 2. Malnutrition among rural tribal women: A socioeconomic study in Jharkhand state by Dr. Renu Dewan, Reader in Psychology, Ranchi Women's College, Ranchi University, Jharkhand
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This presentation stated that nutrition was a basic determinant of health. Malnutrition was one of the most devastating problems worldwide and was inextricably linked with poverty, lack of development, education, awareness, self assertiveness, etc. In India, gender inequality in nutrition was present from childhood to adulthood. Here the basic health condition of tribal women and girls in Jharkhand was very poor - 72.9 per cent women and 82.40 per cent children had anaemia. The literacy rate of tribal women was 39.38 per cent and that of tribal men was 67.94 per cent. While Jharkhand was rich in natural resources like minerals, forests, fountains, mountains and industries, people lived in poverty and penury. According to the Government estimates, around 23.22 lakh families in rural Jharkhand live below poverty line, out of which 8.79 lakh belong to schedule tribes.
More than half of the girls and two-third of the boys aged 1519 suffered from undernutrition. Adults too suffered from malnutrition. Around one-third of the adults were too thin. Undernutrition was very common among adults in rural areas and SC/ST women. Anaemia was a real problem among women and children in Karnataka: 70 per cent of the children (6-59 months) were anaemic, 52 per cent of the women had anemia, and 63 per cent of the pregnant women were anaemic. Though the government of Karnataka spent huge amount of money annually on health programmes of women and children, the nutritional scenario in the state was still worrying. The presentation concluded stressing on the need to find out the efficacy of various programmes run by the government.
4. Dietary intake and nutritional status of the tribal 3. Malnutrition in Karnataka State by Prof. Pushpa M. Savadatti, Post Graduate Dept of Economics, Karnataka University, Dharwad, Karnataka State Gujarat had 15 per cent tribal population. Despite the This presentation provided details of food consumption patterns in Karnataka which revealed that cereals and millets were the main food items, and that foods that were rich in vitamins, minerals and protein were consumed in lesser quantities. The nutritional status in the state revealed that nearly 50 per cent of the children in Karnataka suffer from malnutrition. Children's malnutrition status in the state indicated that around 44 per cent of the children under age five were stunted or too short for their age, due to undernourishment. As a result of malnutrition, one in 28 children in the state died before his/her first birthday. One in 18 children died before reaching age five. Infant mortality in rural areas was higher than the urban areas. Undernutrition was also serious among teenagers in the state. relative prosperity of the state, the tribal people had poor nutritional status. Using the data from NFHS and the National Nutrition Monitoring Bureau (NNMB), this paper discussed the nutritional intake and its linkages, impacting upon the health status of the tribal population of Gujarat. It was observed that there was considerable decline in the food intake of the community across the age groups and sexes over the years. Nearly one-fourth population was protein-calorie deficient. The resultant impact was reflected in increasing trend of poor nutritional indicators and higher vulnerability of the population to morbidity. The presentation stated that the situation called for a proper look into the various nutritional programmes and sincere interventions to improve the nutritional status of the tribal population. population of Gujarat by Dr. Ratnawali, Asst. Professor, Centre for Social Study, Surat, Gujarat
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5. A Study on the health status of tribal women: Problems and practical solutions by Poonam Singh and Sushma Singh, P.N. Doshi Women's College, Ghatkopar and JVM College of Arts, Com & Sc. , Airoli, Navi Mumbai This presentation discussed the study conducted to examine the problems of monitoring health status of tribal women, Warli and Kokni tribes of Koknipada, Thane (W) in Maharashtra. This presentation stated that in order to improve the health status of the tribal women, the health care delivery should be designed for each specific tribal group to cater to their specific needs and problems by ensuring their personal involvement. It pointed out the need for a region-specific study of tribal women, for better understanding of their lives and problems so that planning welfare programmes would be more meaningful, significant and effective. The following were some recommendations for strategies based on the study:
Formulating realistic development health plans based on
This presentation threw light on the health status of tribals in Thane District of Maharashtra, where more than 75 per cent tribal people resided. The study reported that the health condition of tribal population had not only not improved but was in fact deteriorating. They lived below the poverty line and were undernourished or malnourished. The presentation pointed out that the Scheduled Tribe population in Maharashtra was 73.18 lakhs, i.e. 9 per cent of the population of the state with 47 tribes. They were vulnerable because of their geographical location and also because they were unable to demand their rights. They had lost access to forest produce and were not able to increase the productivity of their lands through water and other resources. Thane district was home to four different tribal groups, the Katharis, Koknas, Kolis and the Warlis. The Warlis were more sensitive to nutrition and health issues because of their vegetarian diet, they depended on the forest and the forest produce. Children below age five suffered from hunger and malnutrition. In the forest belt of Jowhar, Mokhada and Wada Taluka, the tribal population was shrinking and it is a serious issue. The politicians blamed it on the tribal social mores and not on the
needs of tribal women.

Promoting
nutritional and health education among
working, lactating and pregnant tribal women. Encouraging healthy nutrition through local produce and local recipes
Imparting health education by local tribal women with
administration. But the inadequacies of the government administration too were responsible. Some other issues include: why did the government not prevent child marriages? Why were the tribal women not attended to during child birth? Why did they have go to witch-doctors?
guidelines provided by health functionaries.

Training tribal girls as "dais"/nurses. Maintaining a health card for each tribal family
7. Effect of income level on nutritional status of rural pregnant women by Tejashree L. Shende, Dept of Home Science, Women's College of Home Science & B.C.A, Loni, Maharashtra
containing vital information like blood group status, haemoglobin level, genetic disorders.
6. Health Status of Tribal People in Thane District, Maharashtra by Dr. Rekha Talmaki, S.N.D.T. Arts Commerce and Science College for Women, Mumbai This presentation provided the results of a study undertaken to assess the association between socio-
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Malnutrition: Issues and Concerns economical and dietary factors with anaemia prevalence, in which 100 pregnant women from rural areas of Rahata taluka district Ahmednagar were selected randomly.
Women. The presentation raised serious concerns regarding malnourishment among urban women belonging to Muslim community in Mumbra Kausa. It also aimed at estimating the expenditure on health and food for the
Information was collected through self-structured questionnaire and 24-hour dietary recall method. The results showed that among the selected pregnant women, 11 per cent belonged to low-income and 89 per cent to middleincome group respectively. Almost all women had three meals pattern a day. The quality of the diet was better among the middle-income women than among the lowincome women. The mean nutritional intake of the low income of pregnant women was below minimum nutritional requirements of Recommended Daily Allowance (RDA) as compared to middle-income group. Results indicated that in low-income group pregnant women, 45.5 per cent suffered from moderate anaemia and 54.5per cent suffered from mild anaemia. There were no cases of severe anaemia and none were in normal Hb group. In the middle-income group no one suffered from severe anaemia. Only 10.11 per cent of the pregnant women suffered from moderate anaemia while 44.94 per cent suffered from mild anaemia and 44.94 per cent of pregnant women in middle-income group showed normal Hb level.
Muslim community. The paper also discussed the issue of political economy of malnourishment. It pointed out that malnourishment and poverty went hand in hand, especially for Muslim women who had low literacy and minimal opportunities for productive work due to lack of training and cultural practices. Mumbra-Kausa had peculiar history of predominantly Muslims who settled in this part of the city after 2001 following the anti-Muslim riots and attacks on Muslims. The preliminary findings of the study were that families had no steady income, no permanent shelter to prove their economic status, and single, divorcee and deserted women were unable to prove they belonged to below poverty line. Their life was a struggle due to biases and anti-Muslim feelings of the administration. The management of solid waste, drainage facilities was dismal, causing disease. People in this locality had poor access to public health care due to lack of adequate hospitals and inefficient facilities, and they were forced to depend on private hospitals. As a result, people suffered severe indebtedness.
8. Malnourishment of Muslim women: Case study of Mumbra Kausa by Swatija Manorama and Farhat Ali, CAFYA: a project to monitor Sachar Recommendations and Status of Muslim Women, Mumbai This presentation gave the preliminary findings of the research study done by CAFYA a coalition of five organisations: Centre for Enquiry Into Health and Allied Themes (CEHAT), Awaz-e-Niswan, Forum Against Oppression of Women, Youth for Unity and Voluntary Action (YUVA) and Akshara. The CAFYA project monitors Sachar Recommendations and the status of Muslim 9. Assessment of and correlation between nutrient intake dietary pattern and anthropometric parameters among college going day scholar girls and hostel girls in the city of Mumbai by Twinkle N. Thakkar, S.V.T. College of Home Science, S.N.D.T.
University, Juhu Campus Mumbai. Ms Thakar presented the results of a study conducted to: i) assess, compare and correlate the dietary pattern, nutrient intake and anthropometric measures a among college going day scholar girls and hostel girls in Mumbai
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city; ii) study their macronutrient and micronutrient discrepancies in the die; and iii) to study their health related problems. The study revealed the incidence of poor quality of diet in college students. It pointed out the need to target first-year college students for interventions designed to increase their daily intakes of fruit, non-fried vegetables, low-fat dairy, and whole grains. 10. A Study of causes and effects of malnutrition on mortality and morbidity by Sharvari Kulkarni, Dept of Mathematics and Meghana Shinde, Dept. of English, Model College, Dombivli East, Mumbai This presentation described the problems caused by malnutrition, such as, deficiency diseases like rickets, complaints with NFHS data. It was difficult to decide which data to rely on. night blindness, anemia, goiter (iodine deficiency) kwashiorkor (protein deficiency). The presentation also pointed out that while the main cause of malnutrition was lack of food and poor quality of diet, there were other related causes leading to malnutrition and morbidity. They were: illiteracy, low standard of living, lack of medical facilities, no proper sanitation, perennial unemployment, lack of infrastructure, early marriage, drought and famine, wrong government policies and debt. Q&A/Discussion
2. Alex George of Save the Children, New Delhi, pointed out that the NFHS study had one lakh sample which was highly inadequate even for IMR. So he suggested using the Sample Registration System (SRS) data conducted annually with a bigger sample size. SRS data was available for 2008 and also for 2009. He further illustrated that when NFHS data was broken down by states, it came to only 7000 households per state, except in UP where they had a bigger sample. NFHS was probably popular because it was promoted by the government. The discussion on this asserted that the SRS data too could be used. Dr. Ratnawali said SRS data was problematic because it could not be relied on as in the case of maternal mortality. There were no such complaints with NFHS data. It was difficult to decide which data to rely on.
3. Another question was if there were legal provisions and government programmes to protect migrant workers. Legal provisions and government programmes such as ESIS and PF were available in the organised sector but such provisions were not available in unorganised sector. 4. To a question about the source of data on child marriage in Melghat, the speaker answered that it was taken from a local newspaper, Lok Prabha, Sept 2009 issue.
1. A question was posed to Dr. Rekha Talmaki to provide statistics on malnutrition in other grades. Dr. Talmaki replied that the data was taken from Dr. Takale's research study, which took into consideration 5,600 babies and concluded that less than 1000 babies were in normal category; 10 per cent were in Grade I category of malnutrition which is mild malnutrition, 29 per cent in Grade II moderate malnutrition, 32 per cent in Grade III- severe malnutrition and 18 per cent in Grade IVacute malnutrition.
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Day 2 - 12 January 2010 SESSION 3 - Discourse on micronutrient deficiencies, food and nutrition supplements Chairperson: Dr. Sunita Kaistha, Reader, Jesus and Mary College, University of Delhi
Dr. Sunita Kaistha
1.Markets and malnutrition: Reinforcing the hunger bazaar by Radha Holla, Campaign Coordinator, Breastfeeding Promotion Network of India (BPNI), Delhi Almost 50 per cent of children under five in India were suffering from under nutrition. Undernutrition was primarily caused by lack of food, which in turn was the result of structural problems such as lack of access to food, unemployment, and destruction of livelihoods as well as lack of knowledge of the right kinds and right quantities of foods to consume. The presentation made the following observation: malnutrition problems deepened as food was increasingly becoming a tool of gaining wealth and power. Food for health and nutrition became food as a commodity for trade. The answer to hunger was increasingly presented as a glamorised quick fix - a mix of chemicals in the name of food. Little attention was paid to inequities that deny people access to food. Helping the rise of corporate food power was reductionist science that reduces food into its chemical components from breastmilk to artificial milks, from butter and cream to Omega 3 and other fatty acids, from millets and cereals to artificial food fortification. The chemicalisation of food as the answer to hunger diverted attention away from the real causes of hunger and malnutrition, and paved the way for short-term remedies: remedies that have long-term health implications and which destroyed people's control over decisions of what to eat and how to access it. The presentation also included
several sustainable solutions to tackle and prevent malnutrition. (See section III-Recommendations)
2. Invisible Economic Burden of Hidden Hunger by Dr. G. Subbulakshmi, Ex-Director, Dept of PG Studies and Research in Home science, SNDT Women's University, Mumbai Dr. Subbulakshmi shared her experiences as a nutritionist. She said that she had worked in rural areas, tribal areas and in urban slums and her experiences showed that food-based approach is only a preventive measure. For curative measures supplementation was requried. As mentioned by Prof. Dr. Shatrugna in her keynote address, food-based approach of wholesome food should be aimed for. Unfortunately supplementation was needed where severe malnutrition had to be treated and if haemoglobin was very low (below 10) then it became irreversible, hence the need for supplementation. A normal person could remain healthy by eating a good balanced diet. She said she was interested in traditional food ingredients which were therapeutic in nature such as haldi, ginger, ajwain and some sources of unconventional sources which could be used to treat health problems. These needed to be tracked and made available to people as wholesome food rather than identifying and isolating the ingredient and making it a pharmaceutical product.
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Many companies talked about social upliftment and wanted to allocate funds for such work. Academics were unable to continue with their research due to lack of funds in academic institutions. If Roche, a pharmaceutical company, was willing to fund academicians' research, she said there was nothing wrong. But the funders had to be sincere and the researchers should not be biased in giving a positive report because they were funding the research. She did not think there was a problem in getting money from companies for that and nutritionists, food technologists, social workers, community workers have to work together. There was also the problem of PDS where the food grains and other items were not available. Her work in Mumbai, Hyderabad and other cities revealed that poor people were exchanging their ration card with upper class people to buy sugar as it provided energy. Thus it is necessary to educate people and examine teaching methods in colleges of home science. She then related her experience of a teaching
socioeconomic status. Poor people were more likely than others to suffer from micronutrient malnutrition. The
economic burden of micronutrient deficiencies had been estimated to be around 10 million in terms of "healthy life years" lost in India each year. The main focus should be on ensuring women and female adolescents and children achieved the various micronutrient goals. Investing in female nutrition through educational programmes would reduce the cost of micronutrient deficiencies. 3. Micronutrient malnutrition in India by Geeta Shah, S.N.D.T. College of Arts and S.C.B College of Commerce and Science, Mumbai This paper pointed out that India had the highest number of malnourished people, and child malnutrition rate was unacceptably high. One-third of approximately two billion people suffering from vitamin and micronutrient deficiency were in India. Micronutrients were required in small quantities and were responsible for vital functions of the human body. Micronutrient malnutrition had been a persistent problem in India, and as recent data suggested, some forms of micronutrient malnutrition were reaching their peak. The Indian Government was committed to prioritise and work
method used by preparing 114 small messages on nutrition for children to take home. Children also shared other children's messages and gave these messages to their mothers, aunts, grandmothers and other family members. The result could be seen in their lunch boxes which then had more nutritious snacks.
While Dr. Subbulakshmi shared her experiences, her power point presentation was displayed. It covered the following points: vitamin and mineral deficiencies are both highly prevalent in developing countries. In developing countries, it was thought that intakes of expensive animal-derived foods were the only way to good health. On the other hand, over nutrition and obesity and the related health problems in well developed nations were also well known. Moreover, there was great awareness that vegetarianism was the main solution to these problems. Low micronutrient intakes were mostly influenced by customs and traditions and
toward resolving micronutrient malnutrition. The Indian Micronutrient Investment Plan for 2007 - 2011 was proposed by the Micronutrient Initiative, an international non-government organisation working in collaboration with the Government of India. The presentation examined the magnitude of the problem, the initiatives taken by the government to tackle it and the results obtained with those efforts; to consider newer options and commitments required that were available for tackling the problem of micronutrient malnutrition.
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4. A Midterm review of Project SARAS, a foodbased micronutrient supplement trial by Dr. Ramesh D. Potdar, Centre for the Study of Social Change (CSSC), Mumbai Dr. Potdar presented the mid-term review of the 'Project Saras' for discussion and suggestions. The project was a randomised controlled in poor slum undernourished women in Bandra East in Mumbai, to determine whether daily consumption of green leafy vegetables, fruit and milk from at least three months prior to conception, and throughout pregnancy, would improve maternal micronutrient status, reduce pregnancy risks, improve neonatal weight, infant survival, growth, cognitive development and reduce metabolic and cardiovascular risk factors. In the project, 5122 eligible women were randomised, stratified by age and body mass index, and received colourcoded identity cards before supplementation. Thirty recipes (test and control) of several local snacks like samosas, were offered to women as one daily snack, six days per week, at 45 distribution centres, eating directly observed by project clerks, and recorded. It studied women's last menstrual period dates, women missing two periods were given a urine pregnancy test, and if positive, they were studied further. All babies were measured within 72 hours post-delivery with repeat development records at one, three, six and 12 months, and every year subsequently. The trial aimed to study approximately 1,500 pregnancies. To date, the study covered 1034 pregnancies and 858 deliveries and infants have been followed up.
This presentation dealt with the problem of overnutrition causing obesity. The presenter defined obesity as a generalised accumulation of excess fat in the body leading to more than 20 per cent of the desirable weight. Obesity had reached epidemic proportions in India in the 21st century, with morbid obesity affecting 5 per cent of the country's population. Lifestyle changes and intake of high calorie food were among the causes associated with morbid obesity. The presentation pointed out that the formulation of a broad food policy that encompassed both undernutrition and overnutrition, was the only answer to this problem. 6. Malnutrition in Maharashtra by Bandu Sane, Khoj, Melghat, Maharashtra Bandu Sane made a heart-rending presentation appealing to participants to help identify strategies to solve the problem of malnutrition deaths, which continued despite court interventions and widespread media coverage. His paper pointed out that every year, around two lakh children died of malnutrition in Maharashtra. Around 10,000 children died in Melghat area of Amravati district alone. In 1993 journalist/activist Sheela Barse filed a Public Interest Litigation (PIL) in Nagpur bench of Mumbai High Court to bring the Government's attention to the severity of the problem. Two more petitions were filed and between 2004 2005, the media played a significant role in drawing attention to malnutrition deaths in Melghat. Through a suo moto petition the case was transferred to Mumbai High Court and an order for establishing a Malnutrition Control Committee to reduce child deaths in the tribal areas was passed. Fresh petition was filed in 2007 to highlight the
5. Obesity a reflection of malnutrition -- A growing concern by Manjusha Bhakay, Sr. Lecturer, Dept. of Food Science and Nutrition, SMRK. BK. AK Mahila Mahavidyalaya , Nashik, Maharashtra
increasing deaths of mothers and children in Melghat, and the Mumbai High Court, Nagpur bench passed 19-pointsorder which were never implemented.
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Following the setting up the Rajmata Jijau Mother and Child Health and Nutrition Mission at Aurangabad, two reports were submitted to the Government and many health officials and politicians had visited the area. During the period 1993-March 2009, some attempts were made to address the problem, but the short-sighted measures only provided temporary solutions. It was shocking that there was no infrastructure even after several petitions on 27 issues. There had been no integration between ICDS and National Rural Health Mission (NRHM), nor there been registration of birth, deaths and marriages.
The animal products content in diet was low partly because a large section of people were vegetarian. The presentation examined the link between nutrition and labour productivity, and malnutrition and GDP. It
identified a nutrition strategy consisting of four important complements: supplementation, food fortification, bio fortification and dietary management, and concluded with suggestions for an action plan.
Q&A/Discussion
One participant requested Geeta Shah to give the sample 7. Micronutrient Deficiency's Effects on Indian size of the study or the percentage of people suffering from malnutrition. As this was a very specific question, the Economy by Dr. Daksha Dave
chairperson , Dr. Sunita Kaistha suggested that the person Dr. Dave presented the results of a study which aimed to: 1) analyse the micronutrient malnutrition in India, 2) evaluate micronutrient deficiencies effects on Indian Economy, and 3) suggest some strategies for improvement of micronutrient malnutrition. The presentation pointed out that the micronutrient deficiency was wide spread in India, and that a large number of the people were exposed to micronutrients malnutrition because their diet, though adequate, was not balanced. The Indian diet was heavily weighted in favor of carbohydrates, with less consumption of animal products and vegetables and more of cereals and sugar. who raised this query collected a copy of the paper from the seminar organisers, and this was agreed to. Due to severe time constraints, the chair person closed this session.
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Malnutrition: Issues and Concerns Day 2 - 12 January 2010 SESSION 4 - Policy, schemes and programmes concerning nutrition: Role of Government and NGOs Chairperson: Prof. Dr. Vibhuti Patel, Professor and Head, PG Department of Economics, SNDT Women's University, Mumbai, Prof. Vibhuti Patel explained that this session had seven presentations on government initiatives. She said that the seminar got serious hearing from representatives of Government of Maharashtra. There were some gaps as revealed in Swatija's paper regarding the situation of in which Muslims were living. The Maharashtra government had earmarked Rs 299 crores for Ministry of Minority Affairs, not a single rupee was utilised and only two months left to spend it. This was reported as headline news in local
Prof. Dr. Vibhuti Patel
newspapers. However, she acknowledged that other departments had been proactive so far as public private partnership was concerned.
As the seminar programme was lagging behind, presenters were allowed only three minutes for each presentation.
1.Government schemes and programmes concerning nutrition by Dr. Suhas V. Ranade, Asst. Director, Family Welfare, Directorate General of Health Services (DGHS) Maharashtra
Some of the specific
programmes included: the
Navsanjeevani Yogana to tackle malnutrition and infant deaths especially in tribal area, the Matrutav Anudan Yogana for antenatal care for tribal women; the Janani Suraksha Yogana programme for SC/ST and BPL people to reduce IMR and MMR; the Pada Swayamsevak, in which local volunteers from the pada were selected and trained to improve liaison between villagers and health institutions; the Bharari Phatak programme which had honorary mobile doctor with two paramedical, equipped with vehicle and medicines, to provide medical services in remote tribal area, and activities carried out were examining and treating antenatal and postnatal care and children 0-6 yrs, examining and treating , and referral for children in Grade
Dr. Suhas V. Ranade
This presentation gave an insight in to the Government's various malnutrition programmes. It pointed out that cultural and social factors were causing malnutrition. Various factors influenced child malnutrition and steps to check malnutrition were taken by the government at the levels of pregnancy, child delivery, postnatal care, child care, adolescent care, community nutrition programmes.
III and Grade IV category of malnutrition, and examining of ashram schools; Child Treatment Camps to treat severe acute malnutrition among children. Other activities which were carried out in the tribal areas to improve health status of the children, included: pediatric ICU, warm room at PHC, use of Boko peti, referral for seriously ill Anganwadi children, and appointment of accredited social health activists (ASHA).
43
2. Food security and nutrition security in India: Need for reappraisal of the policy by Swati Vaidya, Dept. of Economics, Smt. B. M. Ruia Girls' College, Gamdevi, Mumbai The paper pointed out that the advent of global food crisis had seriously threatened the macro-economic food security situation in India. Achieving food security at macro-level meant that there was enough food stock available for the people, but this did not guarantee entitlement of food to each household or to each member in every household. The macro-economic food security made no mention of nutrition security. For instance, the available diet might consist of only carbohydrates, causing undernutrition or malnutrition though there was no widespread hunger and starvation. The paper further described the macro-level evidence on food security, hunger, starvation deaths and examined the extent of malnourishment in India. It reviewed the policy measures that aim to provide poor people with food, as an entitlement. It also described the political economy of
But from the beginning of the fifth Five Year plan (1974-79), the combating malnutrition became a national priority to improve the nutritional status of the vulnerable section of the society viz. women and children. The paper pointed out the need to tackle the problem of malnutrition both through direct nutrition intervention for specially vulnerable groups as well as various development policy instruments which will create conditions for improving nutrition status. 4. Impact of Mid Day Meal programme on
educational and nutritional status: A way to inclusive growth By Prof. P. Malyadri, Head Dept. of Commerce, Vivekananda Government College, Hyderabad
This paper attempted to investigate the impact of the Mid Day Meal programme (MDMP) on education, health and nutrition in two districts of Andhra Pradesh and also made some suggestions for preparation of nutritious and economical MDMP programme for sustainable development in education, health and nutrition to accomplish inclusive growth.
nutrition security in the light of changing dynamics of maintaining food security in times of the global food crisis; the diversion of agricultural land to non-agricultural use due to aggressive industrialisation. The paper also It pointed primary education was boosted by massive programmes like Sarva Siksha Abhiyan, which aimed to provide easy access to all children especially those who were involved in physical labour, street children, migrant children. Despite this, parents were unable to send their children to school due to their poor economical status. 3. Intervention programmes to combat The Government of Andhra Pradesh had addressed this fundamental problem by implementing the midday meal scheme that provides children with at least one nutritionally adequate meal a day. This programme was known to lead to higher attention spans, better concentration, and improved class performance. malnutrition by Beauty Gogoi, Research and Teaching Assistant, Indira Gandhi National Open University (IGNOU), New Delhi This paper stated that nutrition affected development as much as development affected nutrition. Till the end of the fourth Five Year plan (1969-73), India's main emphasis was on the aggregate growth of the economy.
reviewed the indigenous agriculture methods and their role in achieving nutrition security.
44
It also provided parents with a strong incentive to send children to school, thereby encouraging enrollment and reducing absenteeism and dropout rates. School meal programmes supported health, nutrition, and education goals and consequently had a multi-pronged impact on a nation's overall social and economic development. 5. Women's work and family well-being by Dr. Sunita Kaistha, Reader, Jesus and Mary College, University of Delhi This presentation examined the impact of social protection/inclusion measures including providing midday meals at school, child care support for working women and cash transfer programs especially for visits to health centres on children's health, education and nutrition. It pointed that working women, including those who were forced to work to make ends meet or otherwise, were unable to reconcile their responsibilities of work and child care. It argued that in view of the close relationship
disorders (IDD), Vitamin A deficiency (VAD) and anaemia. Besides, fluorosis was also prevalent, and lathyrism was localised to certain regions. The Nutrition Cell in the Directorate General of Health Services provided technical advice on all matters related to nutrition. The State nutrition divisions, set up in 17 States and Union Territories, assessed the diet and nutritional status in various groups of population, conducted nutrition education campaigns, and supervise supplementary feeding programme and other ameliorative measures. Surveys conducted by State nutrition divisions and National Nutrition Monitoring Bureau (NNMB) under the Indian Council of Medical Research (ICMR) revealed that malnutrition and other deficiency disorders were found more in young children, and among pregnant and lactating women.
7. The Primacy of Malnutrition, Education and MDGs by Madhulika Sharma, Junior Research, Dept. of Education & Community Service, Punjabi University,
between women's earning and children's well-being, social inclusion measures mentioned above which increased Government policies to improve nutritional status and education were linked to achieving the Millennium Development Goals 1 and 2. This paper stated that the challenge was in bringing universal socio-educational revolution to check malnutrition, and suggested that immediate priority should be given to formulate a set of effective mechanisms at national level to reduce malnutrition keeping in mind the objectives of MDGs. It recommended bridging the gap between government mechanisms and NGOs and curbing malnutrition in targeted rural and urban areas. There was no time for Q&A/Discussion.
women's access to better- paying jobs were likely to have positive implications for children's well- being specially health and nutrition through its income effect. As food was more likely to fall under the control of women within the household than cash, it would benefit the entire household specially children. Moreover, with increasing 'feminisation of poverty', with less food to go around, it was invariably the women who gave up their food to feed the family. 6. Current nutrition programmes in India by
Nitinkumar H. Umraniya, Lecturer, Chitrini Women's College of Education, Prantij, Dist.: S.K. (Gujarat) This paper described nutritional programmes in India. It pointed out that the nutritional problems in India were protein energy malnutrition (PEM), iodine deficiency
45
Valedictory Address by Dr. N. J. Rathod, Consultant, National Rural Health Mission
Dr Rathod concluded his valedictory address by urging everyone to take responsibility in order to combat malnutrition and related problems.
Closing ceremony
Padmini Somani of Narotam Sekhsaria Foundation gave a concluding speech. She said that the Malnutrition Seminar was indeed very enlightening. She said malnutrition was a multi dimensional problem and must be tackled from all angles. She was impressed by the presentations and the
Dr. N.J. Rathod
range of issues brought out. She hoped to work with members of the academia on malnutrition. She invited participants to contact the Foundation with comments, suggestions and also proposals for plan of action so as to work together. She acknowledged that Leni had suggested the need to discuss malnutrition from NGO perspective and also to get experts to talk in an academic atmosphere.
Dr. Rathod stated that malnutrition was a global problem. The poor and disadvantaged population suffered from malnutrition. Affluent societies face the problem of overnutrition. People's movement would be a useful to identify malnutrition and bring it to the notice of the concerned authorities for appropriate interventions. He suggested the following points that needed to be
Certificates of attendance were then distributed. Ms Somani thanked Dr. Rathod and Dr. S.V. Ranade, Asst. Director of Family Welfare, DGHS, Maharashtra for giving
considered when dealing with malnutrition:
Breastfeeding should be encouraged. It should be
the valedictory address and a presentation on various government initiatives respectively and also Dr. Dakure of DGHS for his cooperation. She also thanked Prof. Dr. Vibhuti Patel of SNDT Women's University and her NSF team mates Leni, Anushakti, Leela from the Accounts and Administrative department and other office staff.
initiated
Routine immunisation is required to maintain
nutritious status of children

Children should be sent to anganwadi and also mothers
should go there
Safe drinking water should be provided Anaemia among adolescent girls and women should be
prevented/corrected
Iodide salts should be made available Early marriage should be discouraged as it is related to
low birth weight of children

Women should be trained in correct child feeding
practices
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SECTION III - Recommendations

Recommendations Sustainable Solutions 48 51
Section III : Recommendations

Several recommendations were made in various presentations. These recommendations are categoried under broad subjects for easy reference, which include the following:1) Awareness raising, 2) Peoples participation, 3) Government programmes, 4) Government policies, 5) Vulnerable groups6) Tribal upliftment, 7) Migrant workers 8) Micronutrient deficiency, and 9) Sustainable solutions for battling malnutrition. 1. Awareness raising Collaborate with the academia and NGOs to act on the
Improve nutrition education and raise awareness on
Raise awareness in schools and colleges about the
importance of physical activity

Provide nutritional information also for the educated
and wealthy groups of people

Provide nutrition education/awareness for vulnerable
groups
2. People's participation
malnutrition problem
Build a strong peoples movement and participate
nutrition and healthy living

Importance of nutritive value of food and ensure that
actively Use the UN procedure to bring about change Involve self-help groups in malnutrition programmes Popularise local nutritious snack food such as, idli, dosa, thepla, dhokla and thalipeeth instead of burgers, pizzas and pasta Increase female literacy and female autonomy, especially in rural areas
children get adequate food rich in proteins, minerals, iron and zinc
Encourage people to consume milk, eggs, meat which are
sources of animal protein

Create awareness on breastfeeding and young child
feeding practices
Raise awareness on problems of obesity and its
prevention
Raise awareness on personal and environmental
3. Government Programmes
Require better co-ordination and implementation of
hygiene
Involve television, radio and other powerful media to
government programmes
Review and revive existing programmes and policies Introduce
spread the message of healthy diet and living

Awareness raising for specific groups
Make it mandatory for schools to provide nutrition
programmes which will:
i) administer
regularly 2 doses of vitamin A to all children under 5 years of age, ii) administer iron tablets to all pregnant women and lactating mothers, and iii) administer iron tablets to at least 70 per cent of adolescent girls in rural areas
Encourage women to practise sustainable agriculture Encourage capability approach to development
education for students and parents

Increase awareness of teenagers and young adults on
daily intakes of fruit, vegetables, non-fried food, lowfat dairy and whole grains. To avoid junk food such as vada pav, burgers, pizza, and sweetened carbonated drinks
Incorporate National Biodiversity Strategy and Action Plan (NBSAP) to reduce poverty, encourage female
48
autonomy and improve nutrition security

Ensure that social protection measures/ programmes
Prevent malnutrition by providing food not
micronutrients
Promote healthy nutrition practices during pregnancy
recognise women's dual roles

Frame programmes without further burdening
and the first two years of life; it should promote and support traditional practices such as adequate rest during pregnancy and breastfeeding
Develop parks, jogging tracks & playgrounds for
mothers. Mothers must be intertwined with those of their children

Intervention programmes for farmers
physical activity
Formulate a national strategy on agricultural and food
Introduce risk mitigation programmes for farmers which will go beyond suicides and debt. It should address yield, price, credit, income, weather and other uncertainties
prices
Put tax on fatty foods Provide subsidy on fruits and vegetables
Spruce up of public investments that will increase returns to cultivation. Skill enhancement and linking of opportunities to local resources are required to increase income from non-farm avenues 5. Vulnerable Groups
Take steps to increase the capacity of vulnerable
groups to earn more and have access to food

Link nutrition with health care, water supply and
Introduce effective regulation of credit and input markets
sanitation services and PDS at community as well as household levels

Entrust SHGs with monitoring of nutrition programme Ensure that foodgrains are available food through PDS
Establish institutions that can organise farmers Encourage technological and financial products that would reduce costs while increasing returns
on fixed dates of the month. Relaxation norms for

Programmes for preschool children and mothers

setting up fair price shops may increase the coverage and distribution in the future.
Ensure transparency in distribution and proper
Improve the quality of ICDS services Ensure regular monitoring of the ICDS programmes Involvement of mothers in anganwadi activities Continue Mid Day Meals programmes because they have positive impact on annual school enrolment, daily school attendance, and has employment implications for women
targeting of PDS
Involve private sector in storage and transport Provide rationed supply of pulses and edible oil at
subsidised rates to the poorest, landless families only under PDS
4. Government Policies
Plan food policies with focus on nutritive value of
6. Tribal Upliftment
Ensure strict measures to prevent malnutrition deaths
food and not to calories

Provide cereals at low cost, so that people's money can
among tribal women and children in Melghat

Formulate realistic development health plans based
be spent on other foods, as a large portion of wages is spent on cereals rice and wheat
on needs of tribal women
49
Promote nutritional and health education among
Provide door-to-door health and nutrition services Government to display political will and ensure that
lactating and pregnant tribal women

Encourage tribal women to address their own
maximum benefits are realised through NRHM by: - using people's participation as a basis for increased - greater accountability - enhanced service delivery
nutritional needs through a better utilisation of locally available, nutritious food.

Train tribal women to impart health education Train tribal girls and women as "dais"/nurses Maintain a health card for each tribal family where vital
7. Migrant workers
Issue identification cards Issue BPL status & Allotment of PDS cards Have mobile dispensaries at construction sites Have part time schools at construction sites Participation of NGOs Ensure that employers provide snacks and tea Provide nutritional education Ensure overtime wages for extra hours of work Provide bathrooms and toilet facilities Provide basic education to coolies and their children Provide social security and safety net for good nutrition
information like blood group status, haemoglobin level, genetic disorders

Give royalty to be given to Adivasis for the use of forests
for national parks, wild life sanctuaries

Redistribute land Give rights of ownership in forest produce Ensure decent wages Plan community-based programmes Undertake analysis of institutional, systemic and
structural issues causing malnutrition in adivasis

Conduct authentic, systematic and continuous field
research in food habits of tribals

Ensure that health interventions take in to
8. Micronutrient deficiencies
Make it mandatory for universal double fortification of
consideration tribal culture, and tribal perspectives.

Empower tribal women socially, economically and
salt with iodine and iron

Motivate industry to promote fortification of at least 50
politically
Train anganwadi workers to record the causes of
per cent of marketed wheat flour, bread, biscuits, milk, edible oil, sugar and tea, with relevant fortificants and take steps to facilitate fortification.
malnutrition properly
Fully utilise Government-allotted funds for tribal
welfare
Improve education status of tribals Reduce vitamin deficiency by systematic use of crops
growing in their area, e.g. ragi or nachni and neera drink have high levels of proteins and iron
Document medicinal plants which are found in the
forests
Improve facilities for transport and communications
and healthcare
Make available drinking water and sanitation facilities
50
Sustainable solutions The following recommendations were made for battling malnutrition by Radha Holla, BPNI, New Delhi
1. Universalised maternity entitlements. Women need adequate nutrition and care, including health care, during pregnancy, after delivery and when they breastfeed. They need skilled counselling and support to begin breastfeeding within the first hour. During the six months of exclusive breastfeeding, they need to stay close to their children, at the risk of losing their wages. Therefore it is necessary to have maternity entitlements that include:
Compensation for staying home to breastfeed the very
young child at the risk of losing wages or affecting their economic status, on the lines of the Dr.Muthulakshmi Reddy Maternity Benefit Scheme in Tamil Nadu, where
Radha Holla
women are given cash support of Rs 1,000 per month for six months starting from the 7th month of pregnancy, for care during pregnancy and after delivery.
Adequate nutrition during pregnancy and lactation,
Children need adequate quantities of wholesome, diverse foods to grow and develop in the best manner possible. These foods should meet their requirements of various nutrients, as well as calories. Nearly 70 per cent of India's children do not get as many calories as they need or the diverse foods required to meet their micronutrient needs. The following are recommendations for sustainable solution to prevent and tackle malnutrition:
including good quality supplementary nutrition for pregnant and lactating mothers through the ICDS
Adequate access to quality health care services Adequate access to skilled counselling and support for
early initiation of breastfeeding and exclusive breastfeeding.
Sustainable solutions for children
As a result of the Right to Food Campaign and the Peoples Union of Civil Liberties (PUCL) cases filed as part of the campaign, the Supreme Court of India gave some landmark orders: provision of hot cooked meals in schools and in the ICDS, and banning of contractors from the schemes. This was intacit recognition that replacing hot cooking meals with packaged foods does not ensure improvement of malnutrition.
2. Exclusive breastfeeding for children up to six months. ICDS and the health system should mainstream providing skilled counselling and support for women to practice exclusive breastfeeding for six months through adequate training of frontline workers such as ASHA, anganwadi workers and ANMs. Mitanins in Chhattisgarh have shown the way.
3. Skilled counselling and nutritional support for children However, much more needs to be done. In the context of dealing with malnutrition in children, the following strategies need to be adopted: under three. Children require solid foods that are caloriedense, including fats, after six months of age (complementary feeding).
51
Nutritious and carefully designed take-home rations (THR) based on locally procured food should be provided as supplementary nutrition for children in this age group. Currently THRs are in the form of just grain this is inadequate. Also, THRs must be combined with nutrition counselling and nutrition and health education sessions for mothers and family members to ensure that children of this age group are given appropriate and adequate foods at home. Further, skilled counselling is also required to educate the family on the psycho-social and learning needs of the child. 4. Pre-school and hot, cooked meals for all children in the age group of 3 years 6 years. Preschool education is very significant in helping children to prepare for formal schooling. Preschool education assists children both to enter school and to remain in the system. The ICDS must provide a centre-based play-school facility at the anganwadi with the worked trained in conducting preschool activities.
need to be breastfed on demand. Children 6mths-3 years of age need 5-6 small but nutritious and energydense meals a day. Children 3-6 years of age need 3-4 small but nutritious meals a day.
Existing crche schemes such as the Rajiv Gandhi Crche Scheme and provision for crches under the NREGA must also be expanded and strengthened.
6. Second anganwadi worker for ICDS centres. Adequate care of children under three, which includes skilled counselling on breastfeeding, nutrition and learning needs, combined with effective preschool education for children aged 3-6 years cannot be achieved without the involvement of two anganwadi workers (along with the anganwadi helper). The availability of at least two anganwadi workers at each anganwadi centre would make it possible for one of them to concentrate on providing the home-based services, while the other can provide centre-based activities such as pre-school.
For these children a culturally acceptable, varied, adequate, energy meal that has multiple nutrients including micronutrients like Vitamin A and Zinc must be provided at the Anganwadi centre.
7. Convergence between the Health and the Women and Child Development Department at all levels including provisioning of basic health care services including Nutritional Rehabilitation Centres for highly malnourished children. Regular interventions like
5. Day care centres or crches. Women across the country work long hours at paid and unpaid work, often starting to work very soon after delivery. They need support to provide adequate care and attention to their children. They need safe places or crches, close to their work sites, run by trained workers, where they can keep their infants, and where their older children will receive hot cooked meals and health care.
health screening and referral, growth monitoring, immunisation and de-worming must be carried out by the ICDS and health department together.
There are several factors that affect the nutritional status of children, including food and health factors. Tackling malnutrition effectively will require that the health department and the ICDS work together at all levels.
Crches must be designed to meet the varying needs of children of different age groups. Infants 0-6 months
52
8. Investing in the ICDS workforce through training and capacity building. The training programmes should recognise pre-school education and nutrition counselling as essential components. Within the overall framework, training curriculum, material and approaches should be developed in a decentralised manner, to be appropriate to the specific state/district level.
participatory
planning,
community
ownership,
responsiveness to local circumstances, and the involvement of Panchayati Raj Institutions (PRIs). Key decisions, including decisions on recruitment and transfers should be taken locally. Procurement of food should be done at the village level without private contractors, as the Supreme Court has ordered. Medicine kits and pre-school kits should be procured locally. Monitoring and evaluation should also be
9. Building in a comprehensive monitoring and evaluation system. A more robust, regular and independent
carried out at the block and district level with the active involvement of PRIs.
monitoring and evaluation system, where workers are not forced to under-report malnutrition is needed. As things stand, the most reliable source of information on child nutrition is the National Family Health Survey (NFHS). However, the NFHS surveys have been conducted at intervals of 6-7 years. Further, these surveys are too small to produce nutrition indicators at lower levels of aggregation than the State level (e.g. the district level). Ideally, NFHS-type surveys should be conducted every five years on a scale that would allow the estimation of district-level health and nutrition indicators, and every year on a smaller scale. At the very least, national NFHS-type surveys should be conducted at intervals no larger than three years. Expert scrutiny of this issue is urgently required. 1. Safeguard the rights of local food producers and communities to the land, water and biodiversity, to produce diverse foods and be paid fairly for their produce. Production of staple foods for basic needs should have priority over production for exports. 2. Ensure livelihoods for all who can work, particularly in the unorganised sector, at wages that are adequate to sustain life and their nutritional well being with dignity. 3. Universalise public distribution system based on A high-level overseeing mechanism should be created which will serve as a strategic oversight, technical support and ensure convergence and accountability in the range of interventions concerned with child nutrition. nutritional norms of above 2400kcal/person/day as well as the adequate protein and all nutrients, and accessed through diverse foods such as millet, pulses, dairy products, fruit and vegetables. 4. Maintain the price of basic foods like oil, grain, milk, pulses, vegetable and eggs at levels that people can afford 10. Improving governance and involving communities. Decentralisation is the key to reducing corruption. A decentralised approach is required, fostering to buy. 5. Ensure that any food or ingredient introduced in public food and public health programmes undergoes strict In addition to the above, the government must ensure the following in order to maintain food security and thereby reduce malnutrition and micronutrient deficiencies. Other sustainable solutions
53
holistic independent scientific assessment and is subject to regulation. No new chemical, industrial additive or fortified food or therapeutic food should be introduced in the public health and public food programmes till all conditions of providing adequate food and water are in place. 6. Ensure access to safe and adequate water as a public good. 7. Ensure independent and unbiased research by providing public funds. The source of funding for research studies which are used for programme inputs should be verified to ensure that there is no conflict of interest.
8. Ensure that international bodies are not used to undermine food sovereignty and nutrition security. All interactions of government with any international or commercial body should be transparent and subject to democratic scrutiny. No industry representative should be in government delegations for any international negotiations such as CODEX. There should be no direct or indirect commercial participation in health, food and nutrition related policies at all levels of governance nationally.
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Annex
Annex 1 - Programme Schedule Annex 2 - List of Particpants 56 57
Annex 1 - Programme Schedule

Programme : 11th January, 2010
1.30 p.m to 2.00 p.m: Registration 2.00 p.m to 3 p.m : Inaugural Function Welcome: Ms. Padmini Somani, Director, Narotam Sekhsaria Foundation, Mumbai. Key Note Address: Prof.Dr. Veena Shatrugna, Former Dy. Director & Head Clinical Division, National Institute of Nutrition Hyderabad and Consultant Indian Institute of Public Health, Hyderabad. Presidential Address: Prof. Dr. Chandra Krishnamurthy, Hon. Vice Chancellor, SNDT Women's University, Mumbai. Chief Guest Address: Adv. Anand Grover, UN Special Rapporteur on the Right of Everyone to the Enjoyment of Highest Attainable Standard of Mental and Physical Health
3 p.m. to 3.30 p.m. Tea/Coffee Break
Panel Discussion: Discourse on Nutrition and Malnutrition 3.30 p.m. to 5.00 p.m. Speakers: Prof. Dr. Sumati Kulkarni, Retired Professor, IIPS, Mumbai Prof. Dr. Sulabha Parsuraman, Professor, IIPS, Mumbai Prof. Dr. Sangeeta Kamdar, Prof. & Head, Economics, NMIMS Deemed Univ., Mumbai Dr. Srijit Mishra, Associate Professor, IGIDR, Mumbai
Programme: 12th January, 2010

10 am to 4.00 p.m Technical sessions Paper Presentation & Discussion Session 1 - Political Economy of Malnutrition Session 2 - Effects of Malnutrition on Mortality and Morbidity: National profile and regional; rural-urban; caste, class, gender, ethnicity and religious variations Session 3 - Discourse on micronutrient deficiencies, food and nutrition supplements Session 4 - Policy, schemes and programs concerning nutrition: Role of Government and NGOs
4.00 p.m. to 4.30 p.m. Valedictory Session
Annex - Programme Schedule
56
Annex 2 - List of Participants

Speakers
1. Prof. Dr. Veena Shatrugna, Consultant, Indian Institute of Public Health, Hyderabad (veenashatrugna@yahoo.com) 2. Adv. Anand Grover, UN Special Rapporteur on the Right of Everyone to the enjoyment of the highest attainable standard of mental and physical health (anandgrover@gmail.com) 3. Dr. N. J. Rathod, Consultant, National Rural Health Mission 4. Prof. Dr. Sumati Kulkarni, Retired Professor, International Institute for Population Sciences (IIPS), Mumbai, (sumati2610@gmail.com) 5. Prof. Dr. Sulabha Parsuraman, Prof, IIPS, Mumbai (sulabhap@rediffmail.com) 6. Prof. Dr.Sangita Kamdar, Prof. of Economics, Narsee Monjee Institute of Management Studies (NMIMS), Mumbai, (sangitask@gmail.com) 7. Dr. Srijit Mishra, Associate Prof., Indira Gandhi Institute of Development Research (IGIDR), Mumbai (srijit@igidr.ac.in)
Paper Presenters
1. Dr. Suhas V. Ranade, Asst. Director, Family Welfare, Directorate General of Health Services (DGHS) Maharashtra, Mumbai 2. Dr. K. Srinivasa Rao, Sr. faculty, PG Dept. of Commerce, Vivek Vardhini (AN) College, Hyderabad 3. Dr. Sunita Kaistha, Associate Professor, Jesus and Mary College, University of Delhi (skjmc@rediffmail.com) 4. Sharvari Kulkarni, Dept of Mathematics, Model College Dombivli (E), Mumbai (rams128@yahoo.co.in) 5. Meghana Shinde, Dept. of English, Model College, Dombivli (E), Mumbai (meghna-shinde@yahoo.com) 6. Dr. Preeti Singh, Associate Professor, Jesus and Mary College, University of Delhi (preetisingh15@gmail.com) 7. Dr. Ratnawali, Assistant Professor, Centre for Social Study, Surat, Gujarat (sinha_ratnawali@yahoo.com) 8. Manjusha Bhakay, Sr. Lecturer, Dept. of Food Science And Nutrition, SMRK.BK.AK Mahila Mahavidyalaya, Nasik., Maharashtra ( manjushabhakay@gmail.com) 9. Dr.Ramesh D.Potdar, Centre for the Study of Social Change (CSSC), Mumbai. (rdpotdar@snehamrc.com) 10. Nitinkumar H. Umraniya, Chitrini Women's College of Education, Tal. Prantij, Dist.: S.k. (Gujarat.) (nitu_umr@yahoo.com) 11. Madhulika Sharma, Junior Research Fellow, Dept. of Education & Community Service, Punjabi University, Patiala, Punjab (madhulikasharma24@gmail.com) 12. Geeta Shah, S.N.D.T. College of Arts and S.C.B College of Commerce and Science, Mumbai (gnshah9@hotmail.com) 13. Tejashree L Shende, Dept of Home science, Women's College of Home Science & B.C.A, Loni, Maharashtra. (tejashree.2050@gmail.com)
Annex 2 - List of Participants
57
Malnutrition: Issues and Concerns 14. Dr. Renu Dewan, Reader in Psychology, Ranchi Women's College, Ranchi University, Jharkhand (renudewan2001@yahoo.com) 15. Swatija Manorama, CAFYA, Mumbai. (cafyaindia@gmail.com) 16. Farhat Ali, CAFYA, Mumbai. (cafyaindia@gmail.com) 17. Dr. Vanmala Hiranandani, Reader-cum-Deputy Director, Center for the Study of Social Exclusion and Inclusive Policy, SNDT Women's University, Juhu, Mumbai. (vanmala_hi@yahoo.com) 18. Radha Holla, Campaign Coordinator,IBFAN Asia/BPNI, Delhi (radhahb@yahoo.com) 19. Shalini Mathur, Lucknow, Uttar Pradesh. (Shalinilucknow@yahoo.com) 20. Swati Vaidya, Dept. Of Economics,Smt. B. M. Ruia Girls' College, Gamdevi, Mumbai. (swachar@gmail.com) 21. Beauty Gogoi, Research and Teaching Assistant, IGNOU, New Delhi (beauty.gogoi@ignou.ac.in) 22. Dr. G. Subbulakshmi, Consultant, Impact India Foundation, Mumbai (subbulakshmiji@gmail.com) 23. ManiMala, Delhi (mani9000@hotmail.com) 24. Prof. P.Malyadri, Head Dept. of Commerce, Vivekananda Government College Vidyanagar, Hyderabad , Andhra Pradesh. (drpm16@yahoo.co.in) 25. Twinkle N. Thakkar, College of Home Science, S.N.D.T. University Juhu , Mumbai (twinklethakker@gmail.com) 26. Poonam Singh, PN Doshi Women's College, Ghatkopar. Mumbai (punam_singh1985@yahoo.com) 27. Sushma Singh, JVM College of Arts, Commerce & Science, Airoli. Mumbai 28. Prof. Pushpa M. Savadatti, Post Graduate Dept of Economics, Karnataka University, Dharwad, Karnataka (pmsavadatti@gmail.com) 29. Bandu Sane, Khoj Melghat , Maharashtra (khojmelghat@gmail.com) 30. Shubhangini A, Joshi, Lecturer, Dept. Food Technology, P.V. Polytechnic, SNDT Women's University, Juhu ,Mumbai (shubha.joshi@gmail.com) 31. Rekha Talmaki, S.N.D.T. Arts Commerce and Science College for Women, Mumbai 32. Dr. Daksha Dave, SNDT University, Mumbai
Annex - List of Participants
58
Organisers
Narotam Sekhsaria Foundation 1. Padmini Somani, Director (admin@nsfoundation.co.in) 2. Leni Chaudhuri, Programme Manager (leni.chaudhuri@nsfoundation.co.in) 3. Anushakti Tayade, Project Officer (anu.tayade@nsfoundation.co.in)
SNDT Women's University 1. Prof. Dr. Vibhuti Patel, Head, PG Economics Department, Director PGSR, SNDT Women's University, Mumbai. (vibhuti.np@gmail.com) 2. Dr. Veena Devasthali, Reader, PG Economics Department, SNDT Women's University, Mumbai (veena.devasthali@gmail.com) 3. Dr. Ruby Ojha, Reader, Dept. of Economics, PGSR, SNDT Women's University, Mumbai (Ojha.ruby@gmail.com)
59
List of Participants
No. 1. 2. Name Saurandi Vaidya Kishor P. Kadam Organisation Shramjeevi Sanghatan SNDT College of Arts & SCB College of Com. & Sci., Churchgate, Mumbai PVDT College of Edn. for Women, SNDT Womens University, Mumbai. State Bureau of Nutrition, Public Health Dept., Govt. of Maharashtra. kishopp_kadam@rediffmail.com Email
3. 4.
Dr. Kalpana Modi Rajaram Rokade
kalpana.modi@gmail.com rajaram.rokade@yahoo.com
5. 6. 7.
Dr. R. D. Patil Bandya L.Sane Mr. Phad Sanjay Phulchand Ms. Reena Mary George Keda V. Deore Mr. Kishan Choure Dr. Ruby Ojha Dr. K. S. Ingole Dr. Arvind S.More. Dr. Alex George Dr. Ramesh Bansod Dr. Nini Gulla Radha Merchant Bhavisha Sanadhya Snehal Kulkarni Prof. D. D. Jadhav Bhatia Hospital St. Jude St. Jude PGSR Dept. of Sociology, SNDT Univ., Mumbai P.V.D.T College of Education, Mumbai Vidhayak Sansad PGSR Eco. Dept., SNDT Womens Univ. Mumbai. Dept. of Economics PGSR, SNDT University ADHO, Health Dept., Zilla Parishad, Nashik, Maharashtra. Save the Children, New Delhi ADHO, Camp, Dharni, Zilla Parishad, Amaravati. kisanraochoure@yahoo.com ruby_ojha@indiatimes.com ksingole@indiatimes.com arvind.supadeemore@gmail.com a.george@savethechildren.in drramesh355@yahoo.co.in ninigulla@gmail.com radhamerchant@gmail.com bsanadhya@gmail.com sach31_sam@rediffmail.com Khoj Melghat Dept. of Economics, PGSR, SNDT Womens Univ. Churchgate, Mumbai. khojmelghat@gmail.com sanjayphad@gmail.com
8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
marygeorge66@yahoo.com
60
No. 21. 22. 23. 24.
Name Vaishali Wankhede Sumati Shinde Surekha Gaikwad Pratibha Loke
Organisation Dept. of Sociology Dept. of Eco. G. E. I. S. Mahila Mahavidyalaya, Dombivali Dept. of Eco. G. E. I. S. Mahila Mahavidyalaya, Dombivali Physics, Dept, G. M. D. Arts, B. W. Commerce & Science College, Sinnar Dist., Nashik BUILD, Mumbai Masum, Pune Mumbai SNDT College of Arts, Com., Sci. for Women, Churchgate. Bal Asha Trust, Anand Niketan, Dr. E. Moses Road, Mahalaxmi, Mumbai . Ambuja Cement Foundation Apnalaya, Mumbai JSA, Mumbai Aga Khan Health Service India SNDT college of Arts, Com. & Sci. for Women, Churchgate, Mumbai. P. V. D. T. College of Education, SNDT Univ. for Women, Mumbai P. V. D. T. College of Education, SNDT Univ. for Women, Mumbai Observer Research Foundation J. N. U., New Delhi TISS, Mumbai S. N. D. T. College of Arts & S. C. B. College of Com. Sci., Mumbai
Email vaishali_nm@yahoo.com
25. 26. 27. 28. 29.
A. DSouza Dr. Ankita Srivastava Dr. Vivek Korde Dr. Rekha K.Talmaki Jayashree Gadapa
ankitasrivastava@gmail.com drvivekkorde@yahoo.com rekhatalmaki@yahoo.co.in balashaoffice@gmail.com
30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40
Pradnya Shinde Dnyaneshwar Tarwade Kamini Kapadia Dr. Padma Shetty Sajeda Shaikh Prin. Dr. Kute Meena Prakash Varsha Raj Dr. Ritu Khatri Dr. Vaibhao Ambhore Rajani C. Patak
pradnya.shinde@ambujacement .com health@apnalaya.org kamini.kapadia@gmail.com smp@akhsi.org
kute.manish@gmail.com pvdt college@gmail.com varsha.raj@orfonline.org dr_ritukhatri@yahoo.co.in vaibhao.ambhore@gmail.com
61
No. 41.
Name Mr. Nilkanth Waghmare
Organisation S.N.D.T. College of Arts & Commerce. P.V.D.T. College Dr. B. M. Nanavati College of Home Science P.V.D.T. College, Mumbai K.Rangoonwala Foundation (India) Trust, Mumbai. S.V.U. College of Home Sci., S.N.D.T. Univ. Mumbai. S.N.D.T. College of Arts & Com. Mumbai. P.V.D.U. College of Education S.N.D.T. Univ. Mumbai - 20. S.N.D.T. College of Arts & SCB Com. S.N.D.T. College of Arts & SCB Com. Sneha, Mumbai Reliance Foundation S.N.D.T. College S.N.D.T. College S.N.D.T. College S.N.D.T. College of Arts & SCB College of Com. & Sci.
Email
42. 43. 44. 45.
Dr. Hansa A. Dave Dr. Mehta Meena B. Dr. Subhash Waghmare Sarika Dinkar
hansa.dave@yahoo.co.in bipin_281050@yahoo.com 16drwaghmare@gmail.com assist@rangoonwala.org
46. 47. 48. 49. 50 51. 52. 53. 54. 55. 56. 57. 58. 58. 59. 60. 61.
Madhuri Nigudkar Prajakta Bhadgaonkar Bhupendra Uttam Bansod. Suhas Chavavan Bhavna P. Mehta Sushma Shende Chandrika Bahadur Vaijanath G Suryawanshi Mankare D. Raghunath Putul Sathe Namrata Gawkar Ravindra Hande Harsha Chopra Devi Shiva Shankaran Sarah Preeti Naik Mahesh Rajguru
rvnigud@gmail.com prajaktabhad@yahoo.com bbhupen2007@gmail.com mumbai_suhas@yahoo.com
sushma@snehamumbai.org chandrika_bahadur@mail.com
dnyaneshwar21@gmail.com putulsathe@yahoo.co.in namg@gmail.com ravi_hande2001@yahoo.com
CSSC, Mumbai CSSC, Mumbai
harsha_c3@yahoo.com devi_480@rediffmail.com sk@mrc.soton.ac.uk
CSSC, Mumbai Rangoonwala Foundation
preetiadekar@yahoo.com mahesh.rajguru@gmail.com
62
No. 61 62. 63. 64 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. 77. 78. 79.
Name Mahesh Rajguru Sonal Shukla K. Venkat Dr. Santosh Kanchan S. Chavan Prof. B. M.Jani Ram Pradhan Prashant Kamble Ramesh Gaikwad Dr. Harshita R. Mehta Sonali Wadke Hajare Bangar Macchender Suryakant Asha Sonawane Vidya D.Gaikwad Rohini Kor Kartiki Jadhav Deepali Gaikwad Dr. Madhuri Sutey Prabhakar Nair
Organisation Rangoonwala Foundation Vacha, Mumbai Bhaktivedanta Hospital Bhaktivedanta Hospital S.N.D.T. Juhu Rajkot S.N.D.T. University S.N.D.T. University, Mumbai S.N.D.T. Gaikwad University S.N.D.T. University Staff S.N.D.T. Univ. Churchgate. P.V.D.T. College, SNDT Univ., Churchgate, S.N.D.T. College, Churchgate, Mumbai. S.N.D.T. College, Churchgate, Mumbai S.N.D.T. College, , Churchgate, Mumbai S.N.D.T. College, Churchgate, Mumbai. S.N.D.T. College, Churchgate, Mumbai S.N.D.T. College, Churchgate, Mumbai Institute for Community Organisation & Research (ICOR), Mumbai S.N.D.T.College, Churchgate, Mumbai
Email mahesh.rajguru@gmail.com vachamail@gmail.com vraj108in@yahoo.co.in santoshchoudhari@yahoo.co.in
janibsllenshha@yahoo.com
80. 81 82. 83.
Savita Tayade Pandurang Barkale Dr. Amin Kaba Manisha Rao
Aga Khan Health P. G. Dept. of Sociology, SNDT Univ. manisharao@hotmail.com
63
No. 84. 85. 86. 87. 88. 89. 90. 91. 92. 93. 94. 95.
Name Tanuja Palav Sayali Nanavare Aarti Shidruk Pradeep Shinde Sudha Kashelikar Dinesh Mishra Sejal K.Sota Meher Jyoti Sangle Hume, Nilesh Suresh Garud Dr. Rohini Sudhakar Anita H. Panot
Organisation S.N.D.T. University Vikas Adhayan Kendra, Malwani, Mumbai Vikas Adhayan Kendra, Malwani, Mumbai Mumbai Mobile Creche AIILSG Bandra, Mumbai Yuva, Mumbai S.N.D.T. College, Churchgate. History Dept., SNDT, Churchgate English Dept, SNDT, Churchgate Lecturer in B. V. A. (Dra & Ptg), S.N.D.T., Churchgate. Dept of Community Ed., SNDT Univ. College of Social Work, Nirmala Niketan, 38, Marine Lines, Mumbai - 20. Foundation For Medical Reasearch, 84A, R. G. Thadani Marg, Worli, Mumbai - 400 018. Apnalaya, Mumbai Population First P. D. Karkhanis Arts & Com. College Ambarnath. Consultant Vacha Apnalaya, Mumbai Siddharth College, Mumbai. Kotak Education Foundation Chetanas College of Eco., Bandra (East). Sneha, Mumbai
Email
rcuesaiilsg@yahoo.co.in dinesh.m@yuvaindia.org
nilubhan_aim@rediffmail.com
rohiniksudakar@gmail.com anitapanot@hotmail.com
96.
Dr. Tannaz Birdi
fmr@fmrindia.org
97. 98. 99.
Varsha Parchure Meenal Gandhe Pratibha Agarwal
varsha.parchure@gmail.com meenal.g@populationfirst.org
100. 101. 102. 103. 104. 105. 106.
Jayeeta Choudhury Sabina Yeasmin Leena Joshi Jyoti R. Parulkar Grazilia Almeida Naresh R. Bodkhe Ankur Singh Chavhan
jayeetachoudhury@gmail.com sabina_yeasminn@yahoo.com director@apnalaya.org
drgrazilia@gmail.com nareshbodkhe@gmail.com singhankur04@yahoo.co.in
64
No. 107.
Name Sanjay P. Shedmake
Organisation PVDT College of Education, Mumbai. Dept. of Economics , S.N.D.T. University Dept. of Economics SNDT Univ. Dept of Management Studies, Bedekar College, Thane (W) GIMS College, Hotel Management, Andheri
Email ucofed@rediffmail.com
108. Shubha Sharma 109. Jyoti Gaikwad 110. 111. Leena Singh Avnish Agarwal
gaikwadjyoti29@gmail.com
112. Dipti Bharadwaj
65
POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGEINE POVERTY LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGEINE POVERTY LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGEINE POVERTY LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HEALTH SANITATION EDUCATION was established in 2002 by Mr. Narotam Sekhsaria as a ILLITERACYinitiative to focus on Narotam Sekhsaria Foundation RURAL LIVELIHOOD HYGIENE POVERTY not for profit UNEMPLOYMENT FOOD
education, health and livelihood. The FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD POVERTY ILLITERACY UNEMPLOYMENT Foundation supports charitable and philanthropic initiatives but also partner with HYGIENE
EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION ILLITERACYThe Foundation believes that if each HEALTH has access to health care and to pursue a meaningful education and through it POVERTY UNEMPLOYMENT FOOD individual SANITATION EDUCATION RURAL LIVELIHOOD HYGEINE LIVELIHOOD opportunity for livelihood, ILLITERACY UNEMPLOYMENT FOOD forward. The SANITATION EDUCATION RURAL an HYGIENE POVERTY this is the only way that India will truly move HEALTH Foundation strives to partner with initiatives which believe in the same goals and contribute towards their realization UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT learning and innovative education models. It FOOD HEALTH SANITATION EDUCATION career professionals through its fellowship program, supports initiatives of mass FOOD HEALTH SANITATION EDUCATION RURAL public health infrastructure and institutionsILLITERACY UNEMPLOYMENT supports community health initiatives, strengthens LIVELIHOOD HYGIENE POVERTY and encourages private charitable initiatives in health care. It partners with initiatives which provide opportunities for capacity building and LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL skill
training for employment. HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD In pursuing the above goals the Foundation nurtures meritorious students through the scholarship program, supports mid quality of life of those living on the edges of society, recognizing innovation and preserving the traditional culture and art forms.
government and private developmental enterprises. It works towards promoting excellence among individuals, improve the
POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGEINE POVERTY LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH

NSF National Seminar On Malnutrition Report

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POVERTY ILLITERACY UNEMPLOYMENT FOOD HEALTH SANITATION EDUCATION RURAL LIVELIHOOD HYGIENE EDUCATION RURAL LIVELIHOOD HYGIENE POVERTY

Narotam Sekhsaria Foundation

MALNUTRITION : ISSUES AND CONCERNS

Narotam Sekhsaria Foundation, 2010

SECTION III - Recommendations

Padmini Somani Director Narotam Sekhsaria Foundation Mumbai

Malnutrition: Issues and Concerns

2 survey (1998-99) also showed that the

Malnutrition: Issues and Concerns

Malnutrition: Issues and Concerns

Section II : Proceedings - Day 1

Prof. Dr.Vibhuti Patel

52 per cent of the women and 74 per cent of the

Section II : Proceedings - Day 1

Malnutrition: Issues and Concerns

Section II : Proceedings - Day 1

Malnutrition: Issues and Concerns

Prof. Dr.Veena Shatrugna

Section II : Proceedings - Day 1

Malnutrition: Issues and Concerns

Section II : Proceedings - Day 1

Malnutrition: Issues and Concerns

severe under nutrition.

Chief Guest's Address

The WHO recommendation for children stated that :

must come from fats (low

volumes and energy densities);

Section II : Proceedings - Day 1

Malnutrition: Issues and Concerns

Forms of Racial Discrimination, Art. 5(e)(iv) 1965

Discrimination against Women (CEDAW, Art. 11(1)(f), 12, 14(2)(b) 1979)

Rights and Fundamental Freedoms (1950)

Section II : Proceedings - Day 1

Malnutrition: Issues and Concerns

extreme poverty and hunger. India was far from achieving

Section II : Proceedings - Day 1

Malnutrition: Issues and Concerns

work towards MDG

1 to eradicate extreme poverty and

Section II : Proceedings - Day 1

Malnutrition: Issues and Concerns

Section II : Proceedings - Day 1

Malnutrition: Issues and Concerns

Panel Presentation and Discussion

2, conducted in 1998-99, had wider scope. Field tests

Section II : Proceedings - Day 1

Malnutrition: Issues and Concerns

Section II : Proceedings - Day 1

Malnutrition: Issues and Concerns

Dr. Sulabha Parasuraman

Dr. Sangita Kamdar

Children in India suffered from some of the highest

had actually increased since NFHS-2

practices were widely ignored by parents

undernutrition and overweight/ obesity

Section II : Proceedings - Day 1

Malnutrition: Issues and Concerns

Dr. Srijit Mishra

Section II : Proceedings - Day 1

Malnutrition: Issues and Concerns

Dr. Mishra concluded with the following recommendations :

Risk mitigation interventions need to go beyond suicides

financial products that would reduce costs while increasing returns