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 LIVELIHOOD HYGIENE






NATIONAL SEMINAR ON MALNUTRITION : ISSUES AND CONCERNS

A REPORT

Narotam Sekhsaria Foundation

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

© Narotam Sekhsaria Foundation, 2010

Narotam Sekhsaria Foundation th

102 Maker Chambers III, 10 Floor

Nariman Point, Mumbai – 400021

Tel. (91-22) 22824589

Website:

Printed by: Prime Printers

www.nsfoundation.co.in

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

3Session :Discourse on micronutrient deficiencies, food and

nutrition supplements

4Session :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

Padmini Somani

Director


Mumbai

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.

Foreword 4

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


Public Distribution System

Protein Energy Malnutrition

Abbreviations

Abbreviations 5

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 6

SECTION I - Introduction

Background

Objectives

Participants

Programme

8

9

9

9

Section I

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 Sub-

Saharan Africa, a region that is despoiled by internal wars,

famines and the spread of AIDS. The National Family

3)Health Survey (NFHS- also found high levels of anemia

among women and children. Both malnutrition and anemia

have increased among women since NFHS- in 1988-99. As 2

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

5higher in rural areas ( per cent) than in urban areas (38 0

53per cent); higher among scheduled castes ( per cent) .2

5and scheduled tribes ( 6.2 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

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.

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, post-

partum hemorrhage and other complications. More than

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.

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 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.

Malnutrition: Issues and Concerns

Section 1: Introduction 8

Background

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,

Maharashtra organised a two-day national-level seminar

titled “Malnutrition: Issues and Concerns”.

Objectives

T h e o b j e c t i v e s o f t h e s e m i n a r w e r e t o :

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,

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

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.

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.

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.

Section 1: Introduction 9


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,


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 1: Introduction

SECTION II - Proceedings

Day 1

Presidential address

Welcome address

Keynote address

Chief guest's address

Panel presentations and discussion

Vote of thanks

12

13

14

17

22

29

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

30

34

39

43

46

Presidential Address

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

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.

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

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.

Section II : Proceedings - Day 1 12

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 extra-

curricular activities and responded to major economic challenges in the country.

Section II : Proceedings - Day 1


Leni Chaudhuri

Prof. Dr.Vibhuti Patel

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 non-

government organisation, Micro-nutrient Initiatives and

the Government of India (2007-2011).

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.

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.

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.

Welcome Address

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

better understanding especially the complexities of

malnutrition. It was also interested in knowing the

government perspective and building up partnership with

academia and activists.

13


Padmini Somani


Keynote address

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 non-

availability 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,

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”.

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.


14Section II : Proceedings - Day 1

Prof. Dr.Veena Shatrugna

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

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 high-

quality 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

H i n d u c e r e a l - c o n s u m i n g v e g e t a r i a n n a t i o n .

The micronutrient lobby had taken advantage of the

nation's calorie-centred (read cereal-centred) consumption

pattern.

children to make sacrifices for the nation and not to desire



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.

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

fortified wheat flour, was pushing small enterprises such as

chhakis (small flour mills) out of business.

The WHO recommendation for children stated that :

Ÿ 30-40 per cent of calories must come from fats (low

volumes and energy densities);

Ÿ Vitamin A, calcium, and iron – must come from milk, egg,

flesh foods, vegetable, fruit, etc. ( which also contribute

additional calories); and

Ÿ 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

severe under nutrition.

Chief Guest's Address

The chief guest Adv. Anand Grover's address was titled,

“Malnutrition and Achieving the Right to Health”.

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.

Adv. Grover's special message was to fight for holistic and

wholesome foods and accessibility to food. He pointed out



Adv. Anand Grover

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.

1. International instruments

The right to health was covered by the following

international instruments:

Ÿ Universal Declaration of Human Rights, Art. 24

Ÿ International Convention on the Elimination of All

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

Ÿ Convention on the Elimination of All Forms of

Discrimination against Women (CEDAW, Art. 11(1)(f),

12, 14(2)(b) 1979)

Ÿ Convention on the Rights of the Child, Art (24) 1989

Ÿ International Convention on the Protection of the Rights

of All Migrant Workers and Members of their Families ,

Arts. (28, 43 (e), 45(c)

Ÿ Convention on the Rights of Persons with Disabilities ,

Art. 25 (2006)

Ÿ The Charter of Fundamental Rights of the European

Union (2000)

Ÿ 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”.

that the right to health is impacted by accessibility to food. 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

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).

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.

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



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.

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) # 1 to eradicate

extreme poverty and hunger. India was far from achieving

MDG 1.

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.

were only concerned about determining workers wages as 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,

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

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, non-

biological 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



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.

4. Constitutional and legal provisions

There were also Constitutional and legal provisions for the

right to food in India.

Ÿ Article 21 of the Indian Constitution articulates the right

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.

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):

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

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

schemes is accountable and transparent. Transparency

should be ensured through public hearings, public

notice of interaction and disclosure of records

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

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:

Ÿ Families, especially farmers, should not remain objects of

the interventions but become the subjects and the

controlling factors in the process

Ÿ It was important to engage civil society, not just NGOs.

Ÿ Building capacities of the community so that they could

participate in decision-making, monitoring the progress

of the interventions, and holding governments

accountable

Ÿ 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



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.

In 1990s, when the world was reeling under HIV-AIDS, the

drug to treat the disease then cost more than US$ 10,000

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

people in the academia to collaborate with NGOs to make

the government listen.



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

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.

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?

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.

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

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.

Section II : Proceedings 22Section II : Proceedings - Day 1


Prof. Dr.Sumati Kulkarni

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, one-

fourths 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.

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.

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.

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

A study of 58 developing countries showed that India was 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

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

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.



2.Nutrition in India Salient Findings from

National Family Health Survey 3 by Prof. Dr.

Sulabha Parasuraman, Professor, IIPS, Mumbai

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:

Ÿ Children in India suffered from some of the highest

levels of stunting, wasting and underweight in the world,

and the situation has not improved much

Ÿ Anaemia levels among children were very high and it

had actually increased since NFHS-2

Ÿ Most recommended infant and young child feeding

practices were widely ignored by parents

Ÿ 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

Ÿ The adult population suffered from a dual burden of

undernutrition and overweight/ obesity

Ÿ Almost half the number of women and more than 40 per

cent men in most population subgroups were either too

thin or too fat.

3. Can a Malnourished India Race to the Top of the

World? by Prof. Dr. Sangita Kamdar, Professor

(Economics), NMIMS, Mumbai

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

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.



Dr. Sulabha Parasuraman Dr. Sangita Kamdar

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 Mishra's presentation focused on the agrarian crisis, its

adverse impact on nutrition and the social and economic

situation of farmers.

Section II : Proceedings 25


Section II : ProceedingsSection II : Proceedings - Day 1

Dr. Srijit Mishra

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, non-

pesticide 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 remarks and

recommendations :

Ÿ Risk mitigation interventions need to go beyond suicides

and debt waivers. It should address yield, price, credit,

income, weather and other uncertainties

Ÿ 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

Ÿ Success of the credit and input markets require effective

regulation

Ÿ Interventions should encourage technological and

financial products that would reduce costs while

increasing returns

Ÿ 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 dif ferentials 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.



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

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.

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.

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”.



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.



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:

Ÿ Prof. Dr. Chandra Krishnamurthy, the Honorable Vice Chancellor, SNDT Women's University, Mumbai, who could not

be present, for her encouragement and support

Ÿ Dr. Madhu Madan, Registrar of SNDT University for granting permission to hold this event and for making available

university infrastructure

Ÿ Padmini Somani, Director, Narotam Sekhsaria Foundation, Mumbai for co-organising and supporting the seminar

Ÿ Leni Chaudhuri and Anushakti Tayade, programme officers from NS Foundation for meticulously designing and

executing the seminar

Ÿ 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

Ÿ 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

Ÿ 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

Ÿ 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

Ÿ Dr. S.V. Rathod, Consultant of National Rural Health Mission, Maharashtra for his valedictory address.

Ÿ All the participants who made presentations

Ÿ SNDT University teaching staff, Geeta Shah and Dr. Rekha Talmaki of SNDT UG College for their valuable suggestions

Ÿ 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

Ÿ The staff of Narotam Sekhsaria Foundation

Ÿ Student volunteers for their assistance

Ÿ All the participants of the seminar


Section II : ProceedingsSection II : Proceedings - Day 1 29

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 multi-

dimensional 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 one-

third 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-cum-

Deputy 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 post-

independent 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.

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

Section II : Proceedings - Day 2 30



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,

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.

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



35adivasis in Maharashtra. Adivasis comprised 6 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

7were food deficient, 8 per cent per cent did not have

5enough food for six months in a year; 6 per cent of the tribal

3 children were undernourished and 8 per cent were

9 anaemic. In 1994, 8 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 one-

eighth 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

3from NFHS 2 and , 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

32



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



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,

w h i c h w a s i n f a c t p e o p l e ' s b a s i c r i g h t .

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.


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 socio-

economic study in Jharkhand state by Dr. Renu

Dewan, Reader in Psychology, Ranchi Women's College,

Ranchi University, Jharkhand

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 in-

equality 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.

3. Malnutrition in Karnataka State by Prof. Pushpa M.

Savadatti, Post Graduate Dept of Economics, Karnataka

University, Dharwad, Karnataka State

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.

More than half of the girls and two-third of the boys aged 15-

19 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

population of Gujarat by Dr. Ratnawali, Asst. Professor,

Centre for Social Study, Surat, Gujarat

Gujarat had 15 per cent tribal population. Despite the

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.



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:

Ÿ Formulating realistic development health plans based on

needs of tribal women.

Ÿ Promoting nutritional and health education among

working, lactating and pregnant tribal women.

Encouraging healthy nutrition through local produce and

local recipes

Ÿ Imparting health education by local tribal women with

guidelines provided by health functionaries.

Ÿ Training tribal girls as "dais"/nurses.

Ÿ Maintaining a health card for each tribal family

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 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

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?

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

This presentation provided the results of a study

undertaken to assess the association between socio-



economical and dietary factors with anaemia prevalence, in

which 100 pregnant women from rural areas of Rahata

taluka district Ahmednagar were selected randomly.

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 middle-

income 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 low-

income 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.

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

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

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.

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



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

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 IV-

acute malnutrition.

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.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

3butter and cream to Omega 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.


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

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

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

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

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.



4. A Midterm review of Project SARAS, a food-

based 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 colour-

coded 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.

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

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

increasing deaths of mothers and children in Melghat, and

the Mumbai High Court, Nagpur bench passed 19-points-

order which were never implemented.



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.

7. Micronutrient Deficiency's Effects on Indian

Economy by Dr. Daksha Dave

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.

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

size of the study or the percentage of people suffering from

malnutrition. As this was a very specific question, the

chairperson , Dr. Sunita Kaistha suggested that the person

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.



1.Government schemes and programmes

concerning nutrition by Dr. Suhas V. Ranade, Asst.

Director, Family Welfare, Directorate General of Health

Services (DGHS) Maharashtra

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.

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

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).


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

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.

Prof. Dr. Vibhuti Patel

Dr. Suhas V. Ranade

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

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

reviewed the indigenous agriculture methods and their role

in achieving nutrition security.

3. Intervention programmes to combat

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.

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.

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.

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.



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 mid-

day 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

between women's earning and children's well-being, social

inclusion measures mentioned above which increased

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

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,

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.



Valedictory Address by Dr. N. J. Rathod, Consultant,

National Rural Health Mission

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

considered when dealing with malnutrition:

Ÿ Breastfeeding should be encouraged. It should be

initiated

Ÿ Routine immunisation is required to maintain

nutritious status of children

Ÿ Children should be sent to anganwadi and also mothers

should go there

Ÿ Safe drinking water should be provided

Ÿ Anaemia among adolescent girls and women should be

prevented/corrected

Ÿ Iodide salts should be made available

Ÿ Early marriage should be discouraged as it is related to

low birth weight of children

Ÿ Women should be trained in correct child feeding

practices

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

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.

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

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.



Dr. N.J. Rathod

SECTION III - Recommendations

Recommendations

Sustainable Solutions

48

51

Section III : Recommendations 48

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

Ÿ Improve nutrition education and raise awareness on

nutrition and healthy living

Ÿ Importance of nutritive value of food and ensure that

children get adequate food rich in proteins, minerals,

iron and zinc

Ÿ Encourage people to consume milk, eggs, meat which are

sources of animal protein

Ÿ Create awareness on breastfeeding and young child

feeding practices

Ÿ Raise awareness on problems of obesity and its

prevention

Ÿ Raise awareness on personal and environmental

hygiene

Ÿ Involve television, radio and other powerful media to

spread the message of healthy diet and living

Awareness raising for specific groups

Ÿ Make it mandatory for schools to provide nutrition

education for students and parents

Ÿ Increase awareness of teenagers and young adults on

daily intakes of fruit, vegetables, non-fried food, low-

fat dairy and whole grains. To avoid junk food such as

vada pav, burgers, pizza, and sweetened carbonated

drinks

Ÿ Raise awareness in schools and colleges about the

importance of physical activity

Ÿ Provide nutritional information also for the educated

and wealthy groups of people

Ÿ Provide nutrition education/awareness for vulnerable

2. People's participation

• Collaborate with the academia and NGOs to act on the

malnutrition problem

Ÿ Build a strong people’s movement and participate

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

3. Government Programmes

Ÿ Require better co-ordination and implementation of

government programmes

Ÿ Review and revive existing programmes and policies

Ÿ Introduce 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

Ÿ Encourage women to practise sustainable agriculture

Ÿ Encourage capability approach to development

Ÿ Incorporate National Biodiversity Strategy and Action

Plan (NBSAP) to reduce poverty, encourage female

Section III : Recommendations


groups

autonomy and improve nutrition security

Ÿ Ensure that social protection measures/ programmes

recognise women's dual roles

Ÿ Frame programmes without further burdening

mothers. Mothers must be intertwined with those of

their children

Intervention programmes for farmers

Ÿ Introduce risk mitigation programmes for farmers

which will go beyond suicides and debt. It should

address yield, price, credit, income, weather and other

uncertainties

Ÿ 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

Ÿ Introduce effective regulation of credit and input

markets

Ÿ Establish institutions that can organise farmers

Ÿ Encourage technological and financial products that

would reduce costs while increasing returns

Programmes for preschool children and mothers

Ÿ Improve the quality of ICDS services

Ÿ Ensure regular monitoring of the ICDS programmes

Ÿ Involvement of mothers in anganwadi activities

Ÿ Continue Mid Day Meals programmes because they

have positive impact on annual school enrolment, daily

school attendance, and has employment implications

for women

4. Government Policies

Ÿ Plan food policies with focus on nutritive value of

food and not to calories

Ÿ Provide cereals at low cost, so that people's money can

be spent on other foods, as a large portion of wages is

spent on cereals – rice and wheat

Ÿ Prevent malnutrition by providing food not

micronutrients

Ÿ 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 breastfeeding

Ÿ Develop parks, jogging tracks & playgrounds for

physical activity

Ÿ Formulate a national strategy on agricultural and food

prices

Ÿ Put tax on fatty foods

Ÿ Provide subsidy on fruits and vegetables

5. Vulnerable Groups

Ÿ Take steps to increase the capacity of vulnerable

groups to earn more and have access to food

Ÿ Link nutrition with health care, water supply and

sanitation services and PDS at community as well as

household levels

Ÿ Entrust SHGs with monitoring of nutrition programme

Ÿ Ensure that foodgrains are available food through PDS

on fixed dates of the month. Relaxation norms for

setting up fair price shops may increase the coverage

and distribution in the future.

Ÿ Ensure transparency in distribution and proper

targeting of PDS

Ÿ Involve private sector in storage and transport

Ÿ Provide rationed supply of pulses and edible oil at

subsidised rates to the poorest, landless families only

under PDS

6. Tribal Upliftment

Ÿ Ensure strict measures to prevent malnutrition deaths

among tribal women and children in Melghat

Ÿ Formulate realistic development health plans based

on needs of tribal women



Ÿ Promote nutritional and health education among

lactating and pregnant tribal women

Ÿ Encourage tribal women to address their own

nutritional needs through a better utilisation of locally

available, nutritious food.

Ÿ Train tribal women to impart health education

Ÿ Train tribal girls and women as "dais"/nurses

Ÿ Maintain a health card for each tribal family where vital

information like blood group status, haemoglobin level,

genetic disorders

Ÿ Give royalty to be given to Adivasis for the use of forests

for national parks, wild life sanctuaries

Ÿ Redistribute land

Ÿ Give rights of ownership in forest produce

Ÿ Ensure decent wages

Ÿ Plan community-based programmes

Ÿ Undertake analysis of institutional, systemic and

structural issues causing malnutrition in adivasis

Ÿ Conduct authentic, systematic and continuous field

research in food habits of tribals

Ÿ Ensure that health interventions take in to

consideration tribal culture, and tribal perspectives.

Ÿ Empower tribal women socially, economically and

politically

Ÿ Train anganwadi workers to record the causes of

malnutrition properly

Ÿ Fully utilise Government-allotted funds for tribal

welfare

Ÿ Improve education status of tribals

Ÿ 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

Ÿ Document medicinal plants which are found in the

forests

Ÿ Improve facilities for transport and communications

and healthcare

Ÿ Make available drinking water and sanitation facilities

Ÿ Provide door-to-door health and nutrition services

Ÿ Government to display political will and ensure that

maximum benefits are realised through NRHM by:

- using people's participation as a basis for increased

- greater accountability

- enhanced service delivery

7. Migrant workers

Ÿ Issue identification cards

Ÿ Issue BPL status & Allotment of PDS cards

Ÿ Have mobile dispensaries at construction sites

Ÿ Have part time schools at construction sites

Ÿ Participation of NGOs

Ÿ Ensure that employers provide snacks and tea

Ÿ Provide nutritional education

Ÿ Ensure overtime wages for extra hours of work

Ÿ Provide bathrooms and toilet facilities

Ÿ Provide basic education to coolies and their children

Ÿ Provide social security and safety net for good nutrition

8. Micronutrient deficiencies

Ÿ Make it mandatory for universal double fortification of

salt with iodine and iron

Ÿ Motivate industry to promote fortification of at least 50

per cent of marketed wheat flour, bread, biscuits, milk,

edible oil, sugar and tea, with relevant fortificants and

take steps to facilitate fortification.



Sustainable solutions

The following recommendations were made for battling

malnutrition by Radha Holla, BPNI, New Delhi

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:

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.

However, much more needs to be done. In the context of

dealing with malnutrition in children, the following

strategies need to be adopted:

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:

Ÿ 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

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.

Ÿ Adequate nutrition during pregnancy and lactation,

including good quality supplementary nutrition for

pregnant and lactating mothers through the ICDS

Ÿ Adequate access to quality health care services

Ÿ Adequate access to skilled counselling and support for

early initiation of breastfeeding and exclusive

breastfeeding.

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

under three. Children require solid foods that are calorie-

dense, including fats, after six months of age

(complementary feeding).



Radha Holla

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.

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.

5. Day care centres or crèches. 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 crèches, 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.

Crèches must be designed to meet the varying needs of

children of different age groups. Infants 0-6 months

need to be breastfed on demand. Children 6mths-3

years of age need 5-6 small but nutritious and energy-

dense meals a day. Children 3-6 years of age need 3-4

small but nutritious meals a day.

Existing crèche schemes such as the Rajiv Gandhi

Crèche Scheme and provision for crèches 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.

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

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.



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.

9. Building in a comprehensive monitoring and evaluation

system. A more robust, regular and independent

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.

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.

10. Improving governance and involving communities.

Decentralisation is the key to reducing corruption. A

decentralised approach is required, fostering

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

carried out at the block and district level with the active

involvement of PRIs.

Other sustainable solutions

In addition to the above, the government must ensure the

following in order to maintain food security and thereby

reduce malnutrition and micronutrient deficiencies.

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

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

to buy.

5. Ensure that any food or ingredient introduced in public

food and public health programmes undergoes strict



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.

Annex


Annex 2 - List of Particpants

56

57

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:

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,


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

Adv. Anand Grover, UN Special Rapporteur on the Right of Everyone to the

Enjoyment of Highest Attainable Standard of Mental and Physical Health

Annex - Programme Schedule 56



Speakers

1. Prof. Dr. Veena Shatrugna, Consultant, Indian Institute of Public Health, Hyderabad ([email protected])

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 ([email protected])

3. Dr. N. J. Rathod, Consultant, National Rural Health Mission

4. Prof. Dr. Sumati Kulkarni, Retired Professor, International Institute for Population Sciences (IIPS), Mumbai,

([email protected])

5. Prof. Dr. Sulabha Parsuraman, Prof, IIPS, Mumbai ([email protected])

6. Prof. Dr.Sangita Kamdar, Prof. of Economics, Narsee Monjee Institute of Management Studies (NMIMS), Mumbai,

([email protected])

7. Dr. Srijit Mishra, Associate Prof., Indira Gandhi Institute of Development Research (IGIDR), Mumbai

([email protected])

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 ([email protected])

4. Sharvari Kulkarni, Dept of Mathematics, Model College Dombivli (E), Mumbai ([email protected])

5. Meghana Shinde, Dept. of English, Model College, Dombivli (E), Mumbai ([email protected])

6. Dr. Preeti Singh, Associate Professor, Jesus and Mary College, University of Delhi ([email protected])

7. Dr. Ratnawali, Assistant Professor, Centre for Social Study, Surat, Gujarat ([email protected])

8. Manjusha Bhakay, Sr. Lecturer, Dept. of Food Science And Nutrition, SMRK.BK.AK Mahila Mahavidyalaya, Nasik.,

Maharashtra ( [email protected])

9. Dr.Ramesh D.Potdar, Centre for the Study of Social Change (CSSC), Mumbai. ([email protected])

10. Nitinkumar H. Umraniya, Chitrini Women's College of Education, Tal. Prantij, Dist.: S.k. (Gujarat.)

([email protected])

11. Madhulika Sharma, Junior Research Fellow, Dept. of Education & Community Service, Punjabi University, Patiala,

Punjab ([email protected])

12. Geeta Shah, S.N.D.T. College of Arts and S.C.B College of Commerce and Science, Mumbai ([email protected])

13. Tejashree L Shende, Dept of Home science, Women's College of Home Science & B.C.A, Loni, Maharashtra.

([email protected])

Annex 2 - List of Participants 57

Annex 2 - List of Participants


14. Dr. Renu Dewan, Reader in Psychology, Ranchi Women's College, Ranchi University, Jharkhand

([email protected])

15. Swatija Manorama, CAFYA, Mumbai. ([email protected])

16. Farhat Ali, CAFYA, Mumbai. ([email protected])

17. Dr. Vanmala Hiranandani, Reader-cum-Deputy Director, Center for the Study of Social Exclusion and Inclusive

Policy, SNDT Women's University, Juhu, Mumbai. ([email protected])

18. Radha Holla, Campaign Coordinator,IBFAN Asia/BPNI, Delhi ([email protected])

19. Shalini Mathur, Lucknow, Uttar Pradesh. ([email protected])

20. Swati Vaidya, Dept. Of Economics,Smt. B. M. Ruia Girls' College, Gamdevi, Mumbai. ([email protected])

21. Beauty Gogoi, Research and Teaching Assistant, IGNOU, New Delhi ([email protected])

22. Dr. G. Subbulakshmi, Consultant, Impact India Foundation, Mumbai ([email protected])

23. ManiMala, Delhi ([email protected])

24. Prof. P.Malyadri, Head Dept. of Commerce, Vivekananda Government College Vidyanagar, Hyderabad , Andhra

Pradesh. ([email protected])

25. Twinkle N. Thakkar, College of Home Science, S.N.D.T. University – Juhu , Mumbai ([email protected])

26. Poonam Singh, PN Doshi Women's College, Ghatkopar. Mumbai ([email protected])

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

([email protected])

29. Bandu Sane, Khoj Melghat , Maharashtra ([email protected])

30. Shubhangini A, Joshi, Lecturer, Dept. Food Technology, P.V. Polytechnic, SNDT Women's University, Juhu ,Mumbai

([email protected])

31. Rekha Talmaki, S.N.D.T. Arts Commerce and Science College for Women, Mumbai

32. Dr. Daksha Dave, SNDT University, Mumbai

58Annex - List of Participants


Organisers


1. Padmini Somani, Director ([email protected])

2. Leni Chaudhuri, Programme Manager ([email protected])

3. Anushakti Tayade, Project Officer ([email protected])

SNDT Women's University

1. Prof. Dr. Vibhuti Patel, Head, PG Economics Department, Director PGSR, SNDT Women's University, Mumbai.

([email protected])

2. Dr. Veena Devasthali, Reader, PG Economics Department, SNDT Women's University, Mumbai

([email protected])

3. Dr. Ruby Ojha, Reader, Dept. of Economics, PGSR, SNDT Women's University, Mumbai

([email protected])

Annex - List of Participants 59




List of Participants

No. Name Organisation Email

1. Saurandi Vaidya Shramjeevi Sanghatan

2. Kishor P. Kadam SNDT College of Arts & [email protected] SCB College of Com. & Sci., Churchgate, Mumbai

3. Dr. Kalpana Modi PVDT College of Edn. for Women, [email protected] SNDT Women’s University, Mumbai.

4. Rajaram Rokade State Bureau of Nutrition, [email protected] Public Health Dept.,

Govt. of Maharashtra.

5. Dr. R. D. Patil

6. Bandya L.Sane Khoj Melghat [email protected]

7. Mr. Phad Sanjay Dept. of Economics, PGSR, [email protected] Phulchand SNDT Women’s Univ. Churchgate, Mumbai.

8. Ms. Reena Mary George [email protected]

9. Keda V. Deore P.V.D.T College of Education, Mumbai

10. Mr. Kishan Choure Vidhayak Sansad [email protected]

11. Dr. Ruby Ojha PGSR Eco. Dept., [email protected] SNDT Women’s Univ. Mumbai.

12. Dr. K. S. Ingole Dept. of Economics [email protected] PGSR, SNDT University

13. Dr. Arvind S.More. ADHO, Health Dept., Zilla Parishad, [email protected] Nashik, Maharashtra.

14. Dr. Alex George Save the Children, New Delhi [email protected]

15. Dr. Ramesh Bansod ADHO, Camp, Dharni, [email protected] Zilla Parishad, Amaravati.

16. Dr. Nini Gulla [email protected]

17. Radha Merchant Bhatia Hospital [email protected]

18. Bhavisha Sanadhya St. Jude [email protected]

19. Snehal Kulkarni St. Jude [email protected]

20. Prof. D. D. Jadhav PGSR Dept. of Sociology, SNDT Univ., Mumbai




21. Vaishali Wankhede Dept. of Sociology [email protected]

22. Sumati Shinde Dept. of Eco. G. E. I. S. Mahila Mahavidyalaya, Dombivali

23. Surekha Gaikwad Dept. of Eco. G. E. I. S. Mahila Mahavidyalaya, Dombivali

24. Pratibha Loke Physics, Dept, G. M. D. Arts, B. W. Commerce & Science College,

Sinnar Dist., Nashik

25. A. D’Souza BUILD, Mumbai

26. Dr. Ankita Srivastava Masum, Pune [email protected]

27. Dr. Vivek Korde Mumbai [email protected]

28. Dr. Rekha K.Talmaki SNDT College of Arts, Com., Sci. [email protected] for Women, Churchgate.

29. Jayashree Gadapa Bal Asha Trust, Anand Niketan, [email protected] Dr. E. Moses Road, Mahalaxmi, Mumbai .

30. Pradnya Shinde Ambuja Cement Foundation pradnya.shinde@ambujacement .com

31. Dnyaneshwar Tarwade Apnalaya, Mumbai [email protected]

32. Kamini Kapadia JSA, Mumbai [email protected]

33. Dr. Padma Shetty Aga Khan Health Service India [email protected]

34. Sajeda Shaikh SNDT college of Arts, Com. & Sci. for Women, Churchgate, Mumbai.

35. Prin. Dr. Kute P. V. D. T. College of Education, [email protected] SNDT Univ. for Women, Mumbai

36. Meena Prakash P. V. D. T. College of Education, pvdt [email protected] SNDT Univ. for Women, Mumbai

37. Varsha Raj Observer Research Foundation [email protected]

38. Dr. Ritu Khatri J. N. U., New Delhi [email protected]

39. Dr. Vaibhao Ambhore TISS, Mumbai [email protected]

40 Rajani C. Patak S. N. D. T. College of Arts & S. C. B. College of Com. Sci., Mumbai




41. Mr. Nilkanth Waghmare S.N.D.T. College of Arts & Commerce.

42. Dr. Hansa A. Dave P.V.D.T. College [email protected]

43. Dr. Mehta Meena B. Dr. B. M. Nanavati College [email protected] of Home Science

44. Dr. Subhash Waghmare P.V.D.T. College, Mumbai [email protected]

45. Sarika Dinkar K.Rangoonwala Foundation [email protected] (India) Trust, Mumbai.

46. Madhuri Nigudkar S.V.U. College of Home Sci., [email protected] S.N.D.T. Univ. Mumbai.

47. Prajakta Bhadgaonkar S.N.D.T. College of Arts & Com. [email protected] Mumbai.

48. Bhupendra Uttam P.V.D.U. College of Education [email protected] Bansod. S.N.D.T. Univ. Mumbai - 20.

49. Suhas Chavavan S.N.D.T. College of Arts & [email protected] SCB Com.

50 Bhavna P. Mehta S.N.D.T. College of Arts & SCB Com.

51. Sushma Shende Sneha, Mumbai [email protected]

52. Chandrika Bahadur Reliance Foundation [email protected]

53. Vaijanath G Suryawanshi S.N.D.T. College 54. Mankare D. Raghunath S.N.D.T. College [email protected]

55. Putul Sathe S.N.D.T. College [email protected]

56. Namrata Gawkar S.N.D.T. College of Arts & SCB [email protected] College of Com. & Sci.

57. Ravindra Hande [email protected]

58. Harsha Chopra CSSC, Mumbai [email protected]

58. Devi Shiva Shankaran CSSC, Mumbai [email protected]

59. Sarah [email protected]

60. Preeti Naik CSSC, Mumbai [email protected] 61. Mahesh Rajguru Rangoonwala Foundation [email protected]



No. Name Organisation Email 61 Mahesh Rajguru Rangoonwala Foundation [email protected]

62. Sonal Shukla Vacha, Mumbai [email protected]

63. K. Venkat Bhaktivedanta Hospital [email protected]

64 Dr. Santosh Bhaktivedanta Hospital [email protected]

65. Kanchan S. Chavan S.N.D.T. Juhu

66. Prof. B. M.Jani Rajkot [email protected]

67. Ram Pradhan S.N.D.T. University 68. Prashant Kamble S.N.D.T. University, Mumbai

69. Ramesh Gaikwad S.N.D.T. Gaikwad University

70. Dr. Harshita R. Mehta S.N.D.T. University

71. Sonali Wadke Hajare Staff S.N.D.T. Univ. Churchgate. 72. Bangar Macchender P.V.D.T. College, Suryakant SNDT Univ., Churchgate,

73. Asha Sonawane S.N.D.T. College, Churchgate, Mumbai.

74. Vidya D.Gaikwad S.N.D.T. College, Churchgate, Mumbai

75. Rohini Kor S.N.D.T. College, , Churchgate, Mumbai

76. Kartiki Jadhav S.N.D.T. College, Churchgate, Mumbai.

77. Deepali Gaikwad S.N.D.T. College, Churchgate, Mumbai

78. Dr. Madhuri Sutey S.N.D.T. College, Churchgate, Mumbai

79. Prabhakar Nair Institute for Community Organisation & Research (ICOR), Mumbai

80. Savita Tayade S.N.D.T.College, Churchgate,

Mumbai 81 Pandurang Barkale

82. Dr. Amin Kaba Aga Khan Health

83. Manisha Rao P. G. Dept. of Sociology, SNDT Univ. [email protected]




84. Tanuja Palav S.N.D.T. University

85. Sayali Nanavare Vikas Adhayan Kendra, Malwani, Mumbai

86. Aarti Shidruk Vikas Adhayan Kendra, Malwani, Mumbai

87. Pradeep Shinde Mumbai Mobile Creche

88. Sudha Kashelikar AIILSG Bandra, Mumbai [email protected]

89. Dinesh Mishra Yuva, Mumbai [email protected]

90. Sejal K.Sota S.N.D.T. College, Churchgate. 91. Meher Jyoti Sangle History Dept., SNDT, Churchgate 92. Hume, Nilesh English Dept, SNDT, Churchgate [email protected]

93. Suresh Garud Lecturer in B. V. A. (Dra & Ptg), S.N.D.T., Churchgate.

94. Dr. Rohini Sudhakar Dept of Community Ed., [email protected] SNDT Univ.

95. Anita H. Panot College of Social Work, [email protected]

Nirmala Niketan, 38, Marine Lines, Mumbai - 20.

96. Dr. Tannaz Birdi Foundation For Medical Reasearch, [email protected] 84A, R. G. Thadani Marg, Worli, Mumbai - 400 018.

97. Varsha Parchure Apnalaya, Mumbai [email protected]

98. Meenal Gandhe Population First [email protected]

99. Pratibha Agarwal P. D. Karkhanis Arts & Com. College Ambarnath.

100. Jayeeta Choudhury Consultant [email protected]

101. Sabina Yeasmin Vacha [email protected]

102. Leena Joshi Apnalaya, Mumbai [email protected]

103. Jyoti R. Parulkar Siddharth College, Mumbai.

104. Grazilia Almeida Kotak Education Foundation [email protected]

105. Naresh R. Bodkhe Chetana’s College of Eco., [email protected] Bandra (East). 106. Ankur Singh Chavhan Sneha, Mumbai [email protected]




107. Sanjay P. Shedmake PVDT College of Education, Mumbai. [email protected]

108. Shubha Sharma Dept. of Economics , S.N.D.T. University

109. Jyoti Gaikwad Dept. of Economics SNDT Univ. [email protected]

110. Leena Singh Dept of Management Studies, Bedekar College, Thane (W)

111. Avnish Agarwal GIMS College, Hotel Management, Andheri

112. Dipti Bharadwaj















































Narotam Sekhsaria Foundation was established in 2002 by Mr. Narotam Sekhsaria as a not for profit initiative to focus on

education, health and livelihood. The Foundation supports charitable and philanthropic initiatives but also partner with

government and private developmental enterprises. It works towards promoting excellence among individuals, improve the

quality of life of those living on the edges of society, recognizing innovation and preserving the traditional culture and art forms.

The Foundation believes that if each individual has access to health care and to pursue a meaningful education and through it

an opportunity for livelihood, this is the only way that India will truly move forward. The Foundation strives to partner

In pursuing the above goals the Foundation nurtures meritorious students through the scholarship program, supports mid

career professionals through its fellowship program, supports initiatives of mass learning and innovative education models. It

supports community health initiatives, strengthens public health infrastructure and institutions and encourages private

charitable initiatives in health care. It partners with initiatives which provide opportunities for capacity building and skill

training for employment.

with initiatives which believe in the same goals and contribute towards their realization

NSF National Seminar on Malnutrition Report

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