In the recent past, there has been a renewed discussion around nutrition in India.  A few months ago, the Ministry of Health and Family Welfare had released the National Health Policy, 2017.[1]  It highlighted the negative impact of malnutrition on the population’s productivity, and its contribution to mortality rates in the country.  In light of the long term effects of malnutrition, across generations, the NITI Aayog released the National Nutrition Strategy this week.  This post presents the current status of malnutrition in India and measures proposed by this Strategy.

What is malnutrition?

Malnutrition indicates that children are either too short for their age or too thin.[2]  Children whose height is below the average for their age are considered to be stunted.  Similarly, children whose weight is below the average for their age are considered thin for their height or wasted.  Together, the stunted and wasted children are considered to be underweight – indicating a lack of proper nutritional intake and inadequate care post childbirth.

What is the extent of malnutrition in India?

India’s performance on key malnutrition indicators is poor according to national and international studies.  According to UNICEF, India was at the 10th spot among countries with the highest number of underweight children, and at the 17th spot for the highest number of stunted children in the world.[3]

Malnutrition affects chances of survival for children, increases their susceptibility to illness, reduces their ability to learn, and makes them less productive in later life.[4]   It is estimated that malnutrition is a contributing factor in about one-third of all deaths of children under the age of 5.[5]  Figure 1 looks at the key statistics on malnutrition for children in India.

Figure 1: Malnutrition in children under 5 years (2005-06 and 2015-16)

NFHS Survey

Sources: National Family Health Survey 3 & 4; PRS.

Over the decade between 2005 and 2015, there has been an overall reduction in the proportion of underweight children in India, mainly on account of an improvement in stunting.  While the percentage of stunted children under 5 reduced from 48% in 2005-06 to 38.4% in 2015-16, there has been a rise in the percentage of children who are wasted from 19.8% to 21% during this period.[6],[7]  A high increase in the incidence of wasting was noted in Punjab, Goa, Maharashtra, Karnataka, and Sikkim.[8]

The prevalence of underweight children was found to be higher in rural areas (38%) than urban areas (29%). According to WHO, infants weighing less than 2.5 Kg are 20 times more likely to die than heavier babies.2  In India, the national average weight at birth is less than 2.5 Kg for 19% of the children.  The incidence of low birth-weight babies varied across different states, with Madhya Pradesh, Rajasthan and Uttar Pradesh witnessing the highest number of underweight childbirths at 23%.[9]

Further, more than half of India’s children are anaemic (58%), indicating an inadequate amount of haemoglobin in the blood.  This is caused by a nutritional deficiency of iron and other essential minerals, and vitamins in the body.2

Is malnutrition witnessed only among children?

No.  Among adults, 23% of women and 20% of men are considered undernourished in India.  On the other hand, 21% of women and 19% of men are overweight or obese.  The simultaneous occurrence of over nutrition and under-nutrition indicates that adults in India are suffering from a dual burden of malnutrition (abnormal thinness and obesity).  This implies that about 56% of women and 61% of men are at normal weight for their height.

What does the National Nutrition Strategy propose?

Various government initiatives have been launched over the years which seek to improve the nutrition status in the country.  These include the Integrated Child Development Services (ICDS), the National Health Mission, the Janani Suraksha Yojana, the Matritva Sahyog Yojana, the Mid-Day Meal Scheme, and the National Food Security Mission, among others.  However, concerns regarding malnutrition have persisted despite improvements over the years.  It is in this context that the National Nutrition Strategy has been released.  Key features of the Strategy include:8

  • The Strategy aims to reduce all forms of malnutrition by 2030, with a focus on the most vulnerable and critical age groups. The Strategy also aims to assist in achieving the targets identified as part of the Sustainable Development Goals related to nutrition and health.
  • The Strategy aims to launch a National Nutrition Mission, similar to the National Health Mission. This is to enable integration of nutrition-related interventions cutting across sectors like women and child development, health, food and public distribution, sanitation, drinking water, and rural development.
  • A decentralised approach will be promoted with greater flexibility and decision making at the state, district and local levels. Further, the Strategy aims to strengthen the ownership of Panchayati Raj institutions and urban local bodies over nutrition initiatives.  This is to enable decentralised planning and local innovation along with accountability for nutrition outcomes.
  • The Strategy proposes to launch interventions with a focus on improving healthcare and nutrition among children. These interventions will include: (i) promotion of breastfeeding for the first six months after birth, (ii) universal access to infant and young child care (including ICDS and crèches), (iii) enhanced care, referrals and management of severely undernourished and sick children, (iv) bi-annual vitamin A supplements for children in the age group of 9 months to 5 years, and (v) micro-nutrient supplements and bi-annual de-worming for children.
  • Measures to improve maternal care and nutrition include: (i) supplementary nutritional support during pregnancy and lactation, (ii) health and nutrition counselling, (iii) adequate consumption of iodised salt and screening of severe anaemia, and (iv) institutional childbirth, lactation management and improved post-natal care.
  • Governance reforms envisaged in the Strategy include: (i) convergence of state and district implementation plans for ICDS, NHM and Swachh Bharat, (ii) focus on the most vulnerable communities in districts with the highest levels of child malnutrition, and (iii) service delivery models based on evidence of impact.

[1] National Health Policy, 2017, Ministry of Health and Family Welfare, March 16, 2017, http://mohfw.nic.in/showfile.php?lid=4275

[2] Nutrition in India, Ministry of Health and Family Welfare, 2005-06, http://rchiips.org/nfhs/nutrition_report_for_website_18sep09.pdf

[3] Unstarred Question No. 2759, Lok Sabha, Answered on March 17, 2017, http://164.100.47.190/loksabhaquestions/annex/11/AU2759.pdf

[4] Helping India Combat Persistently High Rates of Malnutrition, The World Bank, May 13, 2013, http://www.worldbank.org/en/news/feature/2013/05/13/helping-india-combat-persistently-high-rates-of-malnutrition

[5] Unstarred Question No. 4902, Lok Sabha, Answered on December 16, 2016, http://164.100.47.190/loksabhaquestions/annex/10/AU4902.pdf

[6] National Family Health Survey – 3, 2005-6, Ministry of Health and Family Welfare http://rchiips.org/nfhs/pdf/India.pdf

[7] National Family Health Survey – 4 , 2015-16, Ministry of Health and Family Welfare, http://rchiips.org/NFHS/pdf/NFHS4/India.pdf

[8] National Nutrition Strategy, 2017, NITI Aayog, September 2017, http://niti.gov.in/writereaddata/files/document_publication/Nutrition_Strategy_Booklet.pdf

[9] Rapid Survey On Children, Ministry of Women and Child Development, 2013-14, http://wcd.nic.in/sites/default/files/RSOC%20National%20Report%202013-14%20Final.pdf

India has been in lockdown since March 25, 2020.  During this time, activities not contributing to the production and supply of essential goods and services were completely or partially suspended.  Passenger trains and flights were halted.  The lockdown has severely impacted migrants, several of whom lost their jobs due to shutting of industries and were stranded outside their native places wanting to get back.  Since then, the government has announced relief measures for migrants, and made arrangements for migrants to return to their native place.  The Supreme Court of India, recognising the problems faced by migrants stranded in different parts of the country, reviewed transportation and relief arrangements made by the government.  On June 9, the Court directed central and state governments to complete transportation of remaining stranded migrants and expand focus of relief measures to facilitate employment for returning migrants.  In this blog, we highlight some facts about migration in India, summarise key relief measures announced by the government and directives issued by the Supreme Court for the migrant population in relation to the lockdown.

Overview of Migration

Migration is the movement of people away from their usual place of residence, across either internal (within country) or international (across countries) borders.  The latest government data on migration comes from the 2011 Census.  As per the Census, India had 45.6 crore migrants in 2011 (38% of the population) compared to 31.5 crore migrants in 2001 (31% of the population).   Between 2001 and 2011, while population grew by 18%, the number of migrants increased by 45%.  In 2011, 99% of total migration was internal and immigrants (international migrants) comprised 1%.[1] 

Patterns of migration

Internal migrant flows can be classified on the basis of origin and destination.  One kind of classification is: i) rural-rural, ii) rural-urban, iii) urban-rural and iv) urban-urban.  As per the 2011 census, there were 21 crore rural-rural migrants which formed 54% of classifiable internal migration (the Census did not classify 5.3 crore people as originating from either rural or urban areas).  Rural-urban and urban-urban movement accounted for around 8 crore migrants each.   There were around 3 crore urban-rural migrants (7% of classifiable internal migration).

Another way to classify migration is: (i) intra-state, and (ii) inter-state.  In 2011, intra-state movement accounted for almost 88% of all internal migration (39.6 crore persons).1 

There is variation across states in terms of inter-state migration flows.  According to the 2011 Census, there were 5.4 crore inter-state migrants.  As of 2011, Uttar Pradesh and Bihar were the largest source of inter-state migrants while Maharashtra and Delhi were the largest receiver states.  Around 83 lakh residents of Uttar Pradesh and 63 lakh residents of Bihar had moved either temporarily or permanently to other states.  Around 60 lakh people from across India had migrated to Maharashtra by 2011. 

Figure 1: Inter-state Migration (in lakh)

image 

Note: A net out-migrant state is one where more people migrate out of the state than those that migrate into the state.  Net in-migration is the excess of incoming migrants over out-going migrants.   

Sources: Census 2011; PRS.

Reasons for internal migration and size of migrant labour force

As of 2011, majority (70%) of intra-state migration was due to reasons of marriage and family with variation between male and female migrants.  While 83% of females moved for marriage and family, the corresponding figure for males was 39%.  Overall, 8% of people moved within a state for work (21% of male migrants and 2% of female migrants). 

Movement for work was higher among inter-state migrants- 50% of male and 5% of female inter-state migrants.  As per the Census, there were 4.5 crore migrant workers in 2011.  However, according to the Working Group Report on Migration, the Census underestimates the migrant worker population.   Female migration is recorded as movement due to family since that is the primary reason.  However, many women take up employment after migrating which is not reflected in the number of women moving for work-related reasons. [2]  

According to the Economic Survey, 2016-17, Census data also underestimates temporary migrant labour movement.  In 2007-08, the NSSO estimated the size of India’s migrant labour at seven crore (29% of the workforce).  The Economic Survey, 2016-17, estimated six crore inter-state labour migrants between 2001-2011.  The Economic Survey also estimated that in each year between 2011-2016, on average 90 lakh people travelled for work. 

Figure 2: Reasons for intra-state migration 

image

Sources: Census 2011; PRS.

Figure 3:Reasons for inter-state migration 

Sources: Census 2011; PRS.

Issues faced by migrant labour

Article 19(1)(e) of the Constitution, guarantees all Indian citizens the right to reside and settle in any part of the territory of India, subject to reasonable restrictions in the interest of the general public or protection of any scheduled tribe.  However, people migrating for work face key challenges including: i) lack of social security and health benefits and poor implementation of minimum safety standards law, ii) lack of portability of state-provided benefits especially food provided through the public distribution system (PDS) and iii) lack of access to affordable housing and basic amenities in urban areas. 2    

Poor implementation of protections under the Inter-State Migrant Workmen Act, 1979 (ISMW Act) 

The ISMW Act provides certain protections for inter-state migrant workers.  Labour contractors recruiting migrants are required to: (i) be licensed, (ii) register migrant workers with the government authorities, and (iii) arrange for the worker to be issued a passbook recording their identity.  Guidelines regarding wages and protections (including accommodation, free medical facilities, protective clothing) to be provided by the contractor are also outlined in the law. 

In December 2011, a report by the Standing Committee on Labour observed that registration of workers under the ISMW Act was low and implementation of protections outlined in the Act was poor.   The report concluded that the Central government had not made any concrete and fruitful efforts to ensure that contractors and employers mandatorily register the workers employed with them enabling access to benefits under the Act.  

Lack of portability of benefits

Migrants registered to claim access to benefits at one location lose access upon migration to a different location.  This is especially true of access to entitlements under the PDS.  Ration card required to access benefits under the PDS is issued by state governments and is not portable across states.  This system excludes inter-state migrants from the PDS unless they surrender their card from the home state and get a new one from the host state.  

Lack of affordable housing and basic amenities in urban areas

The proportion of migrants in urban population is 47%.1  In 2015, the Ministry of Housing and Urban Affairs identified migrants in urban areas as the largest population needing housing in cities.  There is inadequate supply of low-income ownership and rental housing options.  This leads to the spread of informal settlements and slums.  The Prime Minister Awaas Yojana (PMAY) is a central government scheme to help the economically weaker section and low-income group access housing.  Assistance under the scheme includes:  i) slum rehabilitation, ii) subsidised credit for home loans, iii) subsidies up to Rs 1.5 lakh to either construct a new house or enhance existing houses on their own and iv) increasing availability of affordable housing units in partnership with the private sector.  Since housing is a state subject, there is variation in approach of States towards affordable housing.2 

Steps taken by the government with regard to migrant labour during the lockdown

During the lockdown, several inter-state migrant workers tried to return to their home state. Due to the suspension public transport facilities, migrants started walking towards their home state on foot.  Subsequently, buses and Shramik special trains were permitted by the central government subject to coordination between states.[3],[4]  Between May 1 and June 3, more than 58 lakh migrants were transported through specially operated trains and 41 lakh were transported by road.  Measures taken by the government to aid migrants include-

Transport:  On March 28, the central government authorised states to use the State Disaster Response Fund to provide accommodation to traveling migrants.  States were advised to set up relief camps along highways with medical facilities to ensure people stay in these camps while the lockdown is in place.  

In an order issued on April 29, the Ministry of Home Affairs allowed states to co-ordinate individually to transport migrants using buses.  On May 1, the Indian Railways resumed passenger movement (for the first time since March 22) with Shramik Special trains to facilitate movement of migrants stranded outside their home state.  Between May 1 and June 3, Indian Railways operated 4,197 Shramik trains transporting more than 58 lakh migrants.  Top states from where Shramik trains originated are Gujarat and Maharashtra and states where the trains terminated are Uttar Pradesh and Bihar.[5]  Note that these trends largely correspond to the migration patterns seen in the 2011 census data.  

Food distribution:  On April 1, the Ministry of Health and Family Affairs directed state governments to operate relief camps for migrant workers with arrangements for food, sanitation and medical services.  On May 14, under the second tranche of the Aatma Nirbhar Bharat Abhiyaan, the Finance Minister announced that free food grains would be provided to migrant workers who do not have a ration card for two months.  The measure is expected to benefit eight crore migrant workers and their families.   The Finance Minister also announced that One Nation One Ration card will be implemented by March 2021, to provide portable benefits under the PDS.  This will allow access to ration from any Fair Price Shop in India.  

Housing:  The Aatma Nirbhar Bharat Abhiyaan also launched a scheme for Affordable Rental Housing Complexes for Migrant Workers and Urban Poor to provide affordable rental housing units under PMAY.  The scheme proposes to use existing housing stock under the Jawaharlal Nehru National Urban Housing Mission (JnNURM) as well as incentivise public and private agencies to construct new affordable units for rent.  Further, additional funds have been allocated for the credit linked subsidy scheme under PMAY for middle income group. 

Financial aid:  Some state governments (like BiharRajasthan and Madhya Pradesh) announced one-time cash transfers for returning migrant workers.  UP government announced the provision of maintenance allowance of Rs 1,000 for returning migrants who are required to quarantine. 

Directions by the Supreme Court

The Supreme Court reviewed the situation of migrant labourers stranded in different parts of the country, noting inadequacies and lapses in government response to the situation.  

  • On May 26, the Court issued an order to the central and state governments to submit a response detailing all measures taken by the respective governments for migrant labourers.  
  • On May 28, the Court provided interim directions to the central and state/UT governments for ensuring relief to the migrant workers: i) no train or bus fare should be charged to migrant workers, ii) free food should be provided to stranded migrants by the concerned State/UT government and this information should be publicised, iii) States should simplify and speed-up the process of registration of migrants for transport and those registered should be provided transportation at the earliest and iv) the state receiving migrants should provide last-mile transport, health screening and other facilities free of cost. 
  • Reiterating their earlier directions, on June 5 (full order issued on June 9), the Supreme Court further directed the Central and state/UT governments to ensure: i) transportation of all stranded workers wanting to return to their native place is completed within 15 days, ii) identification of migrant workers is immediately completed and the process of migrant registration be decentralised to police stations and local authorities, iii) records of returning migrant labourers are kept including details about place of earlier employment and nature of their skills, and iv) counselling centres are set-up at the block level to provide information about central and state government schemes and other avenues of employment.  The Court also directed the state/UT governments to consider withdrawal of prosecution/complaints under Section 51 of Disaster Management Act filed against migrant labourers who allegedly violated lockdown orders. 

 

[1] Census, 2011, Office of the Registrar General & Census Commissioner, Ministry of Home Affairs.

[2] Report of Working Group on Migration, Ministry of Housing and Urban Poverty Alleviation, January 2017, http://mohua.gov.in/upload/uploadfiles/files/1566.pdf.

[3] Order No. 40-3/2020-DM-I (A), Ministry of Home Affairs, April 29, 2020, https://prsindia.org/files/covid19/notifications/4233.IND_Movement_of_Persons_April_29.pdf

[4] Order No. 40-3/2020-DM-I (A), Ministry of Home Affairs, May 1, 2020, https://prsindia.org/files/covid19/notifications/IND_Special_Trains_May_1.jpeg

[5] “Indian Railways operationalizes 4197 “Shramik Special” trains till 3rd June, 2020 (0900hrs) across the country and transports more than 58 lacs passengers to their home states through “Shramik Special” trains since May 1”, Press Information Bureau, Ministry of Railways, June 3, 2020, https://pib.gov.in/PressReleseDetail.aspx?PRID=1629043