After each visit to a PDS outlet, Shantama sits on the balcony of her home in a village in Shikabalapur, Karnataka, picking out crusts, rocks and other impurities. The slightly discolored grains of rice you throw out are fortified with nutrients, but she doesn’t know it.
In an effort to counteract malnutrition, the Union government has introduced rice fortified with iron, folic acid and vitamin B12 in the country.
Like Shantama, many in her village do not know what rice to eat. They are unaware of the debate around immunization and the risks it can pose to people with certain diseases.
With a monthly income of 9,000 rupees and a family of four to take care of, Shantama admits that PDS provides rice and ragi, but it is not enough. “Can we go to sleep with only rice in our stomachs? We need to spend money on vegetables, oil, sugar and pulses,” she says.
Nearly 71 percent of India cannot afford healthy meals, according to a 2022 report from the Food and Agriculture Organization (FAO). The diet becomes prohibitively expensive when it costs more than 63 percent of a person’s income. India is worse than countries like China (12%) and Brazil (19%).
A study by the Center for Science and Environment found that 1.7 million people in India die each year from diseases caused by poor nutrition. These numbers only show that the country’s food programs need to start tackling food insecurity, rather than focusing solely on food security.
Malikarjun, an agricultural worker in Chikkabalapur, says the recent rise in food prices means his family is shopping for vegetables and meat less times a week. Fruits not included. With no land to grow vegetables, we are forced to buy what we cannot afford. We are just starting to eat less vegetables.
About 60 percent of Indians receive food grains through the public distribution system – the majority of states are supplied with rice and wheat. While a heavy cereal program may meet calorie requirements, it masks a serious nutritional deficiencies.
The Green Revolution increased the country’s dependence on grain. The over-cultivation of cash crops and the decline of millet contributed to the crisis. There is a need to immediately diversify food crops.
This is evident in the nutritional status of ration card holders who score poorly across all indicators. A 2019 study by a private consulting firm assessed nutritional gaps in households that consumed food grains obtained through PDS.
The study revealed that all the beneficiaries – men, women, pregnant and lactating women and children – had low levels of macro- and micro- and essential nutrients. This included serious deficiencies in protein, fat, calcium, iron and folic acid.
The study shows that only 18 percent and 20 percent of the protein needs of men and women are met by government programmes. Pregnant and lactating women and children who benefit from nutritional supplementation through Integrated Child Development Services (ICDS) performed relatively better. However, at least 50 percent of their protein needs are not yet met.
Why do these programs fail to address food insecurity? Experts say the problem is a lack of dietary diversity.
“We only provide people with grains. The body needs more than just carbohydrates – it needs pulses, legumes, eggs, oil and meat. It needs variety,” says Dr. Veena Chatrujna, former deputy director of the National Institute of Nutrition in Hyderabad. Of the 20 micronutrients that the body needs.
Most micronutrients are naturally available in legumes, vegetables, fruits, dairy products, eggs, meat products, and oils, which are still out of reach for many underserved communities.
“Although the PDS is a jurisprudence of food, many people, including the government, consider it a charitable initiative. They believe that something is better than PDS,” says Dr. Vandana Prasad, a Delhi-based pediatrician and public health expert. no thing”.
Experts say it’s natural to crave variety. To satisfy these cravings, many people have become dependent on crackers, chips, and other ultra-processed foods. “My baby would cry if I didn’t give him some rice, so I ended up buying biscuits or chips with his food,” says Geetha (name changed), a construction worker in Bengaluru.
Excessive intake of these easily available snacks along with a diet rich in grains can lead to obesity and cause non-communicable diseases such as diabetes and high blood pressure. India already has a diabetes problem of epic proportions, with 74.2 million infected. It was only surpassed by China.
Diets rich in grains can also mask malnutrition and prevent people from seeking treatment. “Several studies prove that the effects of undernourishment are severe, affecting thinking, intelligence, cognition and daily activities,” says Dr. Prashant N.S., Associate Director of the Institute of Public Health, Bengaluru.
According to the World Bank, India loses up to $12 billion annually due to vitamin and mineral deficiencies.
The newest “magic solution” for anemia caused by malnutrition is rice fortification. In his Independence Day address last year, Prime Minister Narendra Modi announced that the rice provided under all schemes would be fortified by 2024.
The move was not well received by experts, doctors and nutritionists, who questioned the evidence, efficacy and ethics behind the decision.
Evidence supporting the effectiveness of fortification in treating anemia is ambiguous. An RTI query submitted to the Indian Council of Medical Research-National Institute of Nutrition (ICMR-NIN) found that both fortified rice and regular rice in midday meals had a similar effect on reducing anemia.
Contemporary research also calls into question the requirement for iron requirements in the past. “The daily requirement of iron as a nutrient was thought to be very high (before 2020). One cannot counter this with a normal diet. Like this,” says Dr. Anura Korbad, Professor of Physiology and Nutrition at St. John’s Medical College, Bengaluru. The situation raises the need to fortify the diet.” In 2020, new research revealed that a regular and varied diet can adequately meet iron requirements.
Focus on the individual
For those with vitamin and mineral deficiencies, a clinical approach is vital. The PDS, designed to account for households as units rather than as individuals, is insufficient to address malnutrition. “A case management approach is the right way to address undernutrition. Clinical intervention, with physicians who can monitor doses, says Kavitha Koruganti, of the Alliance for Sustainable and Inclusive Agriculture (ASHA), who was part of a recent fact-finding visit to Jharkhand on rice fortification. On and off, safe.
The fact-finding report noted that fortified rice can be dangerous for people with thalassemia, sickle cell anemia, malaria, tuberculosis and even those suffering from severe acute malnutrition. Even people who have a genetic trait and do not have a clinical disease can absorb excess iron and be at risk.
“This is only a small amount of the population. The program will benefit the majority,” explains Kapil Mohan, Additional Chief Secretary for Food and Civil Supplies, Karnataka.
It is unclear whether patients with thalassemia and sickle cell anemia were informed when they were provided with the fortified rice. There is also uncertainty as to whether alternative options will be available to them at PDS centres.
In a conversation with DH, the PDS dealer, on condition of anonymity, said that there are no media campaigns about fortified rice in Chikkaballapur. “Vendors like me attended an information session conducted by the district commissioner. I only explain to consumers when they ask me about the immunization process,” he says. The vast majority do not ask.
The lack of an effort to raise awareness is a serious violation of the rights of citizens to make informed choices. Citizens should have the first say in what they consume. It shouldn’t dictate their food choices. “The government should take a collaborative approach,” says Dr. Prasad.
There is also a tendency to attach the concept of “impurity” to eating meat. There is a tendency towards a vegetarian system that proves to be discriminatory towards minorities, tribalism, and scheduled caste societies. For example, traditionally many marginalized communities consume beef which is a cheap and nutritious source of protein and iron,” says Dr. Prasad. However, there are restrictions on beef consumption in 20 out of 28 states.
Meat products have a high biological value, as they are rich in protein, iron, vitamin B12, zinc, selenium and phosphorous. Nutrition experts have long advocated the inclusion of eggs in midday meals due to their high protein, vitamin and mineral content.
A mother in Bengaluru who receives eggs for her five-year-old daughter through ICDS, “My daughter goes to Anganwadi to get eggs. She can eat anything with eggs,” she says. However, in a country with meat-eating 70 percent of the population, only 13 states and 3 union territories serve eggs at midday meals.
Even Karnataka, which started serving eggs in seven districts recently, came out with a national education policy position paper proposing a ban on eggs and meat at midday meals. It claims to lead to “lifestyle disorders”.
Associating morality with food and nutrition can be extremely harmful. “People are free to use religion as a justification for their food choices but not to prove them to others,” says Dr. Prasad.
“Food cultures have evolved over long periods. Kitchens were once nutritious places because of the many types of grains, meats, vegetables and fruits,” says Coroganti.
An inclusive diet is inseparable from agricultural diversity. Local food crops, such as millet, fell off the farms after the Green Revolution. The lack of crop diversity, due to the rapid expansion of commercial and cash crops, has contributed to poor diets.
Dr. Corbad concludes that “a serious effort must be made to diversify the food basket in India, and to protect farmers who grow diverse foods, rather than just grains.”
Without sufficient evidence and stakeholder participation, the fortified rice project becomes a one-size-fits-all solution. This ignores cultural diversity and dietary requirements.
The right way forward is to adopt a decentralized collaborative approach. There is a need to enable citizens to make informed choices. Communities have the right to access and consume diverse foods through the public distribution system that makes this possible.