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Nutritional Inequities in Indian Childhood: Socioeconomic Influences and Policy Responses
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  • University: Birmingham City University
  • Country: United Kingdom

Introduction

In this paper, dietary inequalities among Indian children is put under the microscope. This is an issue that goes beyond health and crosses over into social justice, economic growth (Jain & Agnihotri, 2020). This study is set against the paradoxical situation in India, where chronic malnutrition afflicts children despite unprecedented economic prosperity. The report will focus on major policy initiatives and changes in the emphasis of public health.

The purpose is to explore the wider effects of these differences in nutrition on children and society as a whole, while uncovering at the same time what lies behind all this. This paper aims to analyze the source of this public health problem and determine whether government action can resolve these injustices.

The format of the report has been carefully designed, balancing depth and comprehensibility. The report starts off with an overview of the present state of child nutrition in India, followed by statistics and figures from recent years.

Thus a close look at government policies and programs follows, gauging their effectiveness and indicating where implementation or reach falls short. Afterwards the report looks at how other socio-economic factors, such as poverty, education and cultural values affect child nutrition on both sides of those divides. Building thus upon these discoveries, the report finally arrives at a detailed discussion with recommendations for future research and policy.

Topic and Context

Child Malnutrition is a major healthcare and socioeconomic problem in India, and the issue of nutritional differences among children is extremely timely. With troubling statistics and the need for effective policy, this subject has great significance.

 Rate Of Stunting five year old
Figure 1: Rate of stunting in India's under-five-year-old population (2012 and 2022)
(Source: Statista, 2023)


Today India is one of the fastest growing countries in the world. But it is a paradoxical position that while economic progress has been made, it hasn't led to fair nutritional results for all children (Lakshmanasamy and Maya, 2020).

According to the 2023 Joint Malnutrition Estimates (JME) from UNICEF, WHO, and the World Bank, while India's rate of child stunting fell from 48 % in 2006 to 31.7 % in 2022 (UNICEF, 2023). Yet despite this, the incidence of 18.7 % of child wasting, a very severe form of undernutrition, remains too high (UNICEF, 2023).

 prevalence and numbers affected

Figure 2: Prevalence and Numbers Affected
(Source: UNICEF, 2023)


The difference between the availability of nutritious meals and economic capacities is also underscored in the State of Food Security and Nutrition in the World (SOFI) report for 2023. This figure indicates that in 2021, 1.043 billion Indians, or 74.1 % of the total population of India, had no access to a wholesome diet (The Wire, 2023). All the more worrying, given India's huge population and the big influence nutrition has on children's growth and future welfare.

To solve these problems, the Indian government has adopted a number of measures, including the National Food Security Act (NFSA) passed in 2013, which further expanded coverage under existing public food distribution schemes; Mid-day Meal Scheme for schoolchildren; and POSHAN Abhiyaan - or National Mission for Nutrition. However, praise should be given to these programs but one must also consider how deep they go in a land as big and diverse as India.

The other foundation of the arguments made in this paper will be Amartya Sen's 'capability approach,' which develops a classifying system for children on their prospects (of) health, education and wellbeing generally (Williams and Daniel, 2020). The framework is particularly useful for studying the injustices of diets and how they impact children's chances to live a good life.

Besides, the study will take Social Constructionism as a theoretical basis and apply Bronfenbrenner's Ecological Systems Theory to examine these factors. Bronfenbrenner's ecological theory helps us to understand how the different environmental factors, from local up to global--economic states and religious influences factor into practical decision-making. Social constructionism adds deeper insight into social norms as these shape thinking about child nutrition (Evans 2020; Ingram et al., 2019).

The justification for emphasising this subject also corresponds with international obligations such as the Sustainable Development Goals (SDG 2: Zero Hunger, and SDG 3: Good Health and Well-being). India, as a signatory to these goals, must take steps toward eradicating hunger and achieving health for all the country's children (Ranjan, 2021). 

Basically, the urgent need to fight against nutritional inequality among Indian children was in fact why this topic had been chosen. Based on recent data, it will give an in-depth assessment of measures and policies.

It will also draw from relevant conceptual frameworks to come up with a sophisticated understanding of the highly interlinked environment in which many child nutrition factors operate.

This strategy will both show the present state of child nutrition in India, and at the same time stimulate rich discussion on the variety of practical tools for achieving equitable nutrition for every child.

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Critical review of literature 

Historical and Current Research Overview 

India's child nutrition research has gone through a profound transformation over the years, as India's social economy and public health situations have changed. As Karlsson et al. (2021) note, studies of child nutrition in India have previously taken an almost exclusive focus on undernutrition, which is seen in the large numbers of stunted, wasted, or underweight children.

Swaminathan et al. (2019) observe that many studies done in the second half of the 20th century have already pointed out that these problems were everywhere, commonly attributed to lack of access to healthcare, poor sanitation, or poverty.

In this way the research slowly expanded its scope to include malnutrition as well as obesity, given the worsening risk of childhood obesity (Striessnig and Bora, 2020).

The change reflects a global trend, but the double burden of malnutrition whereby under-nutrition and obesity (over-nutrition) coexist in the same households and communities is also a characteristic feature.

The various factors that make up dietary injustice have been explored in a systematic line of research over the past few years. Studies carried out nowadays mostly explore how cultural traditions, educational level, gender, and socioeconomic status affect nutritional outcomes (Bhandari and Gayawan 2022). Furthermore, the effects of urbanisation and changes in lifestyle are also focusing attention on child nutrition.

The trajectory of this research into early childhood malnutrition further indicates that it leads to adult chronic illness, poor cognitive development, and impaired economic output (Shirisha, 2022). And it represents the increasing understanding that nutrition is a complex problem which requires cross-sectoral action of social policies, education and health.

As a result, the discipline of child nutrition research in India has been moving from a narrow focus on direct correspondence with undernutrition toward a more generalized and complex one that includes other social-economic, cultural, and lifestyle factors.

The evolution of research itself mirrors and is mirrored by the continuing attempts to solve the intricate riddle of how to achieve fair nutrition for every child in India.

Theoretical Perspectives 

To understand nutritional disparity, several theoretical perspectives have been taken. Each has a different way of looking at this rather complex problem, particularly for India.

There are a number of theories that consider the many ecological factors that are impacting on a child, from the child's immediate family and school to wider society. The Ecological Systems Theory used by Singh et al. (2020) in their analysis is helpful in identifying all the different ways in which Indian children are influenced by different perspectives such as parents' educational attainment, family income and the overall socioeconomic environment in which they live.

Although this theory provided a complete explanation, in consideration of the different socio-cultural nuances and eating habits of India's various peoples and regions, it has perhaps missed the mark.

Further, behavioural economics offers insight into the choice of a diet. Chen and Antonelli (2020) indicate that culture, money or misinformation can indeed be among poor nutritional decisions. This hypothesis enables to grasp the intricate relationship between dietary choice and economic class in India. On the other hand, an excessive focus on individual choice might divert attention from systemic problems--unequal food distribution and helpless policies.

Another aspect is that the Social Determinants of Health concept studies how various structures and conditions of society-access to healthcare, sanitation or education-affect health. Harris and Nisbett (2021) apply this framework, to illustrate the systemic nature of dietary injustices as also their connection with wider problems such as inequality and poverty. But this way may not catch all the little peculiarities of individual behavior and preferences, which have a profound impact on nutritional status.

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Legislation and Policy Initiatives 

India has taken several legal steps and policy initiatives to reduce the nutritional gap among children, including the National Food Security Act (NFSA) 2013, the Mid-Day Meal Scheme, and the POSHAN Abhiyaan (POSHAN).

The POSHAN Abhiyaan, which was launched in 2018, is intended to produce overall improvements in children's, pregnant women's, and nursing mothers 'nutritional outcomes (Kapur and Suri, 2020). It sets clear objectives for reducing stunting, low birth weight, anaemia and undernutrition. With lofty objectives, the programme has faced problems in reaching the most remote areas and the most backward populations, and even in maintaining quality in India's most advanced states.

Since 1995, children in government and government-aided schools have free lunches under the Mid-Day Meal Scheme (Mirajkar and Narayanaswamy, 2019). Student enrollment and attendance have increased greatly under this programme. But doubts have been raised about the overall effectiveness of the programme; the infrastructure is inadequate, and food delivery uneven, and there have even been questions about the safety and nutritive value of the meals themselves.

Another important programme is the NFSA 2013, which intends to give food grains at subsidised prices to almost two-thirds of India's population (Puri, 2022). It is important to guarantee food security, especially for families with modest incomes. However, its ability to reduce nutritional gaps has been hampered by issues with the distribution system, beneficiary identity, and food grain quality.

Although these programmes show the government's dedication to enhancing child nutrition, administrative, logistical, and infrastructure issues frequently hinder their efficacy.

To have maximum impact, improved infrastructure, comprehensive monitoring and assessment, more cross-agency cooperation, and the active participation of the community are all required. These implementation problems must be resolved to ensure that these programmes are able to provide all children in various parts of India with adequate nutrition.

Recent Developments 

The National Family Health Survey (NFHS), which was conducted recently, the Global Hunger Index, and other studies provide a detailed picture of the nutrition environment in India. They are very insightful, but not quite enough to attack nutritional injustices.

According to the most recent statistics compiled by NFHS, a paradox exists. The fading of childhood stunting and undernutrition has been most apparent in terms of progress. However, regardless of all this the problem remains acute nutritional lack (Maiti et al., 2023).

They also point to the real structural problems that have been present for many years, including high proportions of wasting and anaemia in children. However, there are several weaknesses of the NFHS. Most serious is that the information date has no set time. So at times they will not reflect a complete and objective picture--they have may be late, or else cannot fully show changes brought about by recent policy modifications.

The Global Hunger Index is an important indicator of the state of nutrition in India. The index rates nations by indicators such as undernourishment, stunting, child mortality and child wasting (Patel et al., 2020).

In terms of the Global Hunger Index (GHI) 2023, India is 111th out of 125 countries. It has been a source of concern because it indicates that there is widespread hunger and malnutrition in the country. Nonetheless, the index has been criticized for perhaps losing sight of variations within and between regions, and not taking into account various other contextual elements unique to India, by making the simplistic countrification of complex problems into a single score.

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Implications and Current Relevance 

Dietary inequality among children in India has far-reaching implications for policy, public health, and the social system. It highlights the urgent need for overall policy initiatives aimed at tackling root problems like poverty, health care and education in conjunction with food supplies. In the very diversified socioeconomic environment of India, the problem of undernourishment in children is not just a health issue but also a symbol of social inequality (Yadav and Maurya, 2022).

The nutritional status of India's children has a direct bearing on the country's future human capital and socioeconomic potential as it maintains its place as a major player in the global economy. Therefore, ensuring equal nutrition is crucial for the long-term economic and social growth of the country as well as for the immediate well-being of children.

Synopsis

The literature study emphasises how difficult it is to overcome the gaps in child nutrition in India. It highlights ongoing issues in some areas while revealing progress in others. The main conclusions emphasise the need for integrated strategies that take into account how socioeconomic factors interact with child nutrition.

A dynamic knowledge of the problem is hampered by gaps in the existing literature, particularly with regard to the frequency and area specificity of data collection.  In future research, therefore, more localized studies should be done, and policy success must be carefully assessed. Only in this way can plans be tailored to the different needs of the Indian population.

Development of Argument

This section brings up arguments about the impact of nutritional injustices on the development and general welfare of children in all of India. It argues that these differences seriously impair children's chances of achieving their full potential, not only in the areas of health and education, but also in terms of their overall chances.

The argument will be framed in terms of what has been called the 'capability approach' developed by Amartya Sen. This suggests giving children the means to live happy lives is important. Moreover, social constructionism will be used to understand sociological and cultural factors shaping dietary patterns, while Bronfenbrenner's

Ecological Systems Theory will be used to analyse ecological factors that affect child nutrition. The strategy behind this multi-dimensional analytical approach is to give a complete understanding of the problem and its broader significance.

Analyzing Nutritional Disparities through the Capability Approach 
capability approach 
Figure 3: The Capability Approach
(Source: Prasad, 2018)


The 'capability approach' developed by Amartya Sen is a deep approach to exploring dietary inequalities among Indian children and how these affect the capacities and developmental trajectory of these young people. This method basically says that people's freedom to attain well-being depends on what they can do (their abilities) and become (their accomplishments), both of which are inevitably connected to having access to basic resources, such as food (Williams and Daniels, 2020).

The 'capability approach' clarifies the glaring nutritional differences that exist between various caste, socioeconomic, and regional groups in India. For instance, alarming results from the National Family Health Survey (NFHS) show that children in low-income states and marginalised areas have high rates of stunting, wasting, and underweight.

These diseases indicate a loss of vital abilities in addition to immediate health problems (Raajeswari, 2023). Malnourished children have difficulties developing physically and cognitively, which affects their schooling, productivity, and opportunities for employment in the future.

Sen's theory, which emphasises that development should be measured by the richness of human life rather than just economic growth, is in line with this viewpoint. In a country like India, which has severe economic inequalities, a child's nutritional status very often determines their future prospects and quality of life. (Jose et al., 2020).

Because an undernourished child has a low chance of academic success, this can lead to a vicious circle of poverty, little hope of employment, and a continuance of the problem.

Capability-based approaches make clear the necessity of policies that move beyond a simple distribution of food. Programs like POSHAN Abhiyaan and the Mid-Day Meal Programme are a good start. But it is equally important to make sure that children can consume the nourishment for their overall growth (Kapur and Suri, 2020).

The idea is to widen the scope of child development and integrate dietary programmes with health, education and sanitation efforts. 

Thus, the use of Sen's 'capability approach' to the issue of nutritional injustices in India reveals the close link between children's development of capacities and their nutrition. It points that these differences are not only extremely important from the perspective of public health, but are also prerequisite to achieving fair opportunity for the growth and well-being of all children in India.

Ecological Systems Perspective on Environmental Influences 

 ecological systems theory
Figure 4: Ecological Systems Theory
(Source: Crawford, 2020)


The Ecological Systems Theory proposed by Bronfenbrenner offers a good basis for understanding the different environmental elements that impact on child nutrition in India (Veiga et al., 2022). Therefore, on this theory human development is analyzed in terms of a series of layered environmental systems such as local environment and broader social context.

At its core, the Microsystem, which consists of the immediate environment of the child-the home, the school, and the neighbourhood-is of primary importance. Family has a very large effect on dietary habits in India. Dietary choices are influenced by economic position, parental education, and cultural customs. For instance, in low-income households, when resources are in short supply, it can mean that a meal lacks variety, which can affect a child's diet (Penne and Goedemé, 2021). In addition, some particular cultural customs and beliefs in regard to diet can be right or wrong.

The Mesosystem includes the links between the microsystems, such as the link between home and the school. In India the Mid-Day Meal Scheme represents a school-based type of nutrition programme (Mirajkar and Narayanaswamy, 2019). However, family views and participation in child feeding would appear to affect the effectiveness of these programmes. All of these systems are, after all, inseparable.

The Exosystem is made up of larger social systems (e.g., local government regulations or health services) that affect the child indirectly. Where health services are more accessible and where there is a higher level of community awareness on nutrition, children tend to receive better nutrition results in areas (Shahid et al., 2022). However, in places where these services are limited, children might suffer from nutritional shortcomings.

At the outermost layer lies the Macrosystem, which represents the broader cultural and social values. Indian society and policy are also involved. National Food Security Act and POSHAN Abhiyaan are two major initiatives aimed at reducing overall nutritional inequities (Puri, 2022). But society's ideas of nutrition and health may limit their effectiveness.

The Chronosystem includes the temporal dimension in its formula; it is known that individual and environmental factors change with time and affect growth. India's rapidly changing socioeconomic terrain has given rise to altered dietary patterns due to changes in lifestyle, urbanization, and economic prosperity (Nunes et al., 2020).

Childhood obesity is increasingly a problem in the urban environment.

Indian children's overall development is profoundly affected by these environmental factors. Early life malnutrition can also affect later development, with negative impacts extending to an insufficient cognitive function, stunted growth and a heightened susceptibility to chronic illnesses. It is also significant to society as a whole, for the future economic productivity of children themselves and their education.

In essence, applying Bronfenbrenner's Ecological Systems Theory to Indian children's nutrition illustrates the interrelationship of multiple factors. It portrays the requirement of a multi-layered therapy based on emotional, social and environmental conditions as well as immediate nutritional needs.

Social Constructionism and Cultural Influences on Nutrition 

 social constructionist model
Figure 5: Social Constructionist Theory Model
(Source: Sabatier, 2019)


Social constructionism as a theory suggests that one's view of the world is formed by social interaction and cultural norms (Ingram et al., 2019). Looking at things from this vantage point can give a sense of how social structures and cultural settings shape nutrition habits, attitudes or tastes. These all have a great effect on the health and nutrition of children in India.

An important area where Social Constructionism becomes essential is its gendered perspective on nutrition. In many Indian households one can observe a significant imbalance in how nourishing food is allocated, with men often receiving preferential treatment, especially in patriarchal households (Niehof, 2019). Children are also victims of gender-based discrimination, which has a negative effect on the nutritional status of girls and places them at higher risk of malnutrition.

The dietary habits and nutrition are intimately intertwined with the texture of the social and cultural life of India, a land of cultural variety. Apart from being purely utilitarian, these customs do carry social, cultural, and religious connotations.

For instance, the broad spread of vegetarianism in many parts of India, the origin of which lies in religion and culture, has an impact on children 'eating habits (Chouraqui et al., 2021). Although vegetarian diets can be nutritionally adequate, it is very difficult to get enough protein, especially in lower class households, where it is not always possible to obtain a variety of protein sources.

Further, social class and economic status exert a great influence on dietary preferences and nutritional quality. With higher-income families having greater access to a greater variety of foods and better absorption of nutrients, children in these families tend to eat a more balanced diet (Auer et al., 2023). Yet financial constraints among lower-income groups usually means a narrow range of foods, which in turn affects the nutritional condition of children.

The culture of eating has evolved greatly with urbanisation and globalisation, as shown in the increase in consumption of processed food and fast food, especially in big cities (Kumar et al., 2022). But this departure from traditional eating customs has led to increased numbers of overweight children and the health problems associated with obesity. It has been shaped by international food fashions and a shifting lifestyle.

Also, both education and the media influence how people understand nutrition. Due to the education and publicity efforts, sections of the more urban and educated parts of society have slowly begun to change their food choices (Boccia and Punzo, 2021). Bridge between tradition and change Traditional beliefs and practices still exist in communities with limited access to education and media, therefore targeted nutritional education and awareness programmes are necessary.

Basically, social constructionism provides a conceptual framework for understanding how cultural ideals and beliefs shape eating habits and attitudes in India. These social and cultural factors are important in affecting children's eating habits and, ultimately, their nutrition. These long-established cultural and social influences, which are still very much alive today, must be taken into account to develop effective nutritional interventions aimed at the various needs and circumstances of the Indian population.

Critique of Current Policies and Interventions 

POSHAN Abhiyaan is a major initiative aimed at improving nutritional outcomes, particularly among disadvantaged communities (Kapur and Suri, 2020). It fits Amartya Sen's approach of the Capability Approach. However, a large number of implementation issues-little outreach, little understanding-raise doubts about how well it will really influence children's abilities. This means that the programme must make sure it has a strong presence among vulnerable and marginalized groups in order to remedy these imbalances.

The Mid-Day Meal Scheme, another important intervention, provides nutritious meals to school-age children (Mirajkar and Narayanaswamy, 2019). This, while it doesn't make much of a contribution compared with Bronfenbrenner's Ecological Systems Theory, it still can do a lot to fill an immediate nutritional void. 

Similarly, the National Food Security Act (NFSA) is a legal measure designed to assure food security for every citizen of this country and particularly children (Puri, 2022). This is consistent with the social justice ideals inherent in the Capability Approach, which focus on the importance of reducing inequalities and providing avenues to enable people to lead lives of dignity. Nonetheless, the NFSA's effectiveness is compromised by implementation issues such as targeting and exclusion errors. 
United Nations Convention on the Rights of the Child (UNCRC)

The UNCRC is a global agreement on all issues relating to children's civil, political, economic, social, health and cultural rights. It is believed to be a comprehensive declaration of children's rights, covering many aspects of the child's life and well-being. But almost all the nations of the world, including India, have signed and ratified it.

Another strong characteristic of the UNCRC is that it stresses the children's right to life, to survival and to development (Babu and Sugumar, 2023). The convention's stipulations make it abundantly clear just how important it is that children have adequate food, proper medical care, and conditions of living compatible with the treatment of childhood.

The principles of the UNCRC are also entirely consistent with a number of national programs and policies in India intended to improve child nutrition. Agarwal and Chanda (2022) point out that India has a whole series of laws and programs to deal with children's nutritional problems. These programs show the efforts that are being made to safeguard children's right to health and an adequate standard of living as guaranteed by the UN Convention on the Rights of the Child.

An example is India's Integrated Child Development Services (ICDS) programme, which, in line with the goals of the UNCRC, promises to go a long way toward realizing children's right to nutritional security (Garg, 2023). Meals, pre-school education and primary health care are provided for children under six and their mothers under this programme. Moreover, the Mid-Day Meal Scheme, one of the world's largest school feeding programs, aims to improve children's nutrition as well as boost school attendance.

These policies and programmes show that India is striving to bring its practices into line with UNCRC standards, and is recognizing the right of children to development and nutrition. However, there are still many shortcomings remaining in such areas as targeting the weakest populations, rolling out programmes, and resource allocation. To fully implement the UNCRC's targets on childhood nutrition, India faces next the following challenges.

Conclusion

This paper offers a solid review of the significant issue of nutritional inequality among children in India. The paper begins with some background information, pointing out that in India, this is a very paradoxical position. As for addressing this issue from the point of view of social justice, economic development it emphasizes the need to carefully analyze the basic causes, to evaluate the effects of policies, and to look into the reasons for this public health problem's continued existence.

The literature analysis provides some interesting information about the development of child nutrition research in India. It places particular emphasis on the shift from a narrow focus on undernutrition to the consideration of the complex relationships between these determinants. Some mention also is made of the long-term impact of malnutrition on cognitive development and economic output.

Through an examination of legislation and policy initiatives from a variety of theoretical perspectives, the government's determination to resolve nutritional inequalities is clearly apparent. But importantly, it also points up the challenges of implementation that need to be overcome if such programmes are to be more effective.

The important impact of dietary injustice on public health, policy, and social well-being is highlighted in the report's conclusion. It stresses that cross-sectoral policy must take cultural considerations, environmental impact and socioeconomic factors into account. Such differences reflect social injustice as well as a health problem. Apart from the children 'short-term welfare, talking to them is a must for the country's long-term social and economic development.
 

Recommendations

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