Although poor nutritional outcomes among the Indian population are a well-known problem, there is not enough discussion in policy circles on what Indians eat.
For a long time, food security was reduced to satisfying the physical sense of hunger. The quality of food that people consume or the drivers of people’s diets, however, has not been given enough attention in either research or policy. With high levels of anaemia on the one hand and the increasing burden of non-communicable diseases on the other, the need to bring policy attention to dietary diversity is urgent.
Even in the case of addressing child malnutrition, along with other factors such as sanitation, creches for childcare and improved child feeding practices, the quality of children’s diets is an issue. According to the NFHS-5, only 11.3% of children in the age group of six months to two years are fed a ‘minimum acceptable diet’ as defined by the World Health Organisation (WHO). This includes frequency of feeding as well as minimum dietary diversity.
Dietary surveys of the kind that are conducted in many parts of the world are also missing in India – therefore, there is not much data on dietary diversity among the population.
The National Nutrition Monitoring Bureau (NNMB) of the National Institute of Nutrition (NIN) used to conduct dietary surveys but this was stopped around 10 years back. Even when NNMB surveys were conducted, they did not include all the states in the country and had small samples. However, there are reports that a national survey on diets is currently underway.
The National Family Health Survey (NFHS) does include some questions on food consumption, but these are not adequate to give us full information on dietary diversity. While we get a sense of which food groups are included in people’s consumption regularly, this survey does not include any data on the quantities consumed. Therefore, even a spoonful of milk added to a cup of tea every day might be counted as milk being consumed daily.
According to the latest NFHS data, 56.2% of men and 49.6% of women consume fruits at least once a week, and 57.8% of men and 45.1% of women consume eggs at least once a week.
The consumption expenditure survey (CES) of the National Sample Survey Office also gives some information on food consumption. The data from the recent household CES (2022-23) is yet to be analysed for estimating calorie or protein consumption; the data from the report show that the per capita consumption of cereals has been reducing over the years 12.72 kgs per capita per month in 1999-2000 to 9.61 kgs per capita per month in 2022-23.
Although there are issues of comparability across different rounds of the survey, this trend of reducing the quantity of consumption of cereals has been a long-term trend. About 10% of the food budget is spent on cereals in rural and urban areas and about 18% on milk. Vegetables, fruits, ‘egg, fish and meat’ account for a similar proportion of the total spending on food in rural and urban areas (around 9% to 11%).
Illustration: Pariplab Chakraborty
What is striking is that almost 21% of the food budget in rural areas and 27% in urban areas is spent on beverages, refreshments and processed food. This needs to be understood carefully given the harmful effects of consumption, especially of ultra-processed foods.
Analysis of the unit data could give further insights into dietary patterns, however, this is not the same as a dietary survey. The survey basically asks questions on expenditure on food items, which is then used to derive nutritional information at the household level. For instance, if rice was used as an ingredient to make kheer at home, then this would show up as ‘rice’ rather than as ‘kheer’. Information on intra-household distribution is also not available from this survey.
What we do know for sure is that there is a great scope for improvement of dietary diversity. Some information is also available on the drivers of poor dietary diversity, although this needs much more granular research.
For example, the report on State of Food Security and Nutrition in the World, 2024 brought out by a group of UN organisations estimates that 55.6% of the Indian population cannot afford a healthy diet. Affordability is determined by both income levels as well as prices. While we know that a large section of the Indian population earns very low incomes, food prices have been more volatile.
In a recent paper in Economic and Political Weekly, International Food Policy Research Institute (IFPRI) researchers Sudha Narayanan, Kalyani Raghunathan and Anita Cristopher make an argument for computing the cost of health diets (COHD) along with consumer price indices for food (CPI-F).
They show that while these two are correlated, they do not always move in the same direction. The COHD estimates the cost of purchasing the daily recommended quantities of various foods as recommended by the Indian Council of Medical Research (ICMR), from the cheapest source. This would obviously be a better metric to evaluate what people require to meet their health and nutritional needs compared to the CPIs. They could form the basis for calculations of minimum wages, poverty lines and so on.
Along with accurate measurement, policies related to food and nutrition security also need to broaden their emphasis from cereal security to healthy diets. Agriculture policies for food security traditionally focused only on cereals, especially paddy and wheat.
Although there is now some mention of millets, the interventions on pulses and oils are far from adequate. The public distribution system (PDS) also mainly distributes only rice and wheat, although some states have included millets, pulses and/or edible oils.
Even the meals given to children in schools and Anganwadis do not have much diversity in terms of sources of proteins and micronutrients. It is usually rice and dal in some form that children are given across the country, with little addition of vegetables, fruits or animal proteins such as eggs, milk or meat.
On the other end of the spectrum, issues related to the regulation of marketing and sales of processed foods are also important. A shift in attention to improving dietary diversity for all can also be a good segue towards a comprehensive food and nutrition policy based on a ‘food systems’ approach.
Dipa Sinha is a development economist.
