# **1. Introduction**

India is in the curious position of having very high levels of malnutrition despite large stocks of food-grains resulting from increased agricultural productivity. Moreover, the country experienced rapid economic growth during the 1990s, but this was accompanied by very modest declines in child malnutrition. Estimated levels of moderate or severe under-nutrition among children below age 3 were 52 percent in 1992, and 47 percent in 1998.<sup>1</sup> There are two factors responsible for this outcome. A significant proportion of the population remains unable to buy enough food. And the whole population is vulnerable to ⎯ becoming malnourished due to exposure to diseases in particular diarrheal diseases and parasitic infections resulting from poor sanitation and living conditions ⎯ and malnutrition in turn increases future susceptibility to disease.<sup>2</sup> These synergies take a heavy toll in labor productivity and outlays on health care, as well as mortality.<sup>3</sup> To ameliorate the situation, the government of India has developed several major programs for increasing access to food. One approach is through price controls: for example, the Public Distribution System<sup>4</sup> makes some staple foods such as food-grains and sugar available at controlled prices through “fair-price shops”. Another thrust has been through income support: such as a range of food-for-work programs and employment guarantee programs, where people are paid (often in foodgrains) for working on building or maintaining public infrastructure.<sup>5</sup> A third approach has been to directly feed children: this includes mid-day meal programs for school-going children, and nutrition supplementation programs. By far the biggest nutrition supplementation program is the Integrated Child Development Services (ICDS).

The ICDS program aims to provide child growth monitoring, supplementary feeding, and pre-school education to young children, along with some basic health services to young children, pregnant women and lactating mothers. With support from UNICEF and other donors, it has emerged from small beginnings in 1975 to become India’s flagship program in these areas. The program has expanded rapidly: the number of blocks covered rose from 33 in 1975, to 4,200 around 2000, and over 5,500 in 2003<sup>6</sup> . During the 1990s,

> 1 IIPS 2000: Table 7.17 and Figure 7.3. The Government of India (1999) estimated that 33% of newborns were of low birthweight, constituting 35% of the total low birthweight children in the developing world (Department of Women and Child Development, cited in Greiner and Pyle, 2000.) 2 See for example Esrey et al.1990, and Scrimshaw and SanGiovanni 1997.

> 3 There is a large literature on this, but see the review and analysis in Behrman et al. 2004.

4 Initiated under wartime rationing during the Second World War, this has expanded greatly thereafter (Nawani 1994).

5 Over the years, these programs have been variously re-named and re-structured, including into the National Rural Employment Program and the Rural Landless Employment Guarantee Program, which were merged in 1989 into the Jawahar Rozgar Yojana and as of 2001 re-formulated into the Sampoorna Grameen Rozgar Yojana. Sources: Government of India, Planning Commission (no date), and Government of India, Ministry of Rural Development (no date).

> 6 Greiner and Pyle 2000:5, Government of India 2000, and Parliament of India 2003.

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