In India, 22,000 women die every year due to severe anemia. Anemia in pregnant women causes 20 per cent of infant mortality. Despite such alarming figures, policymakers in India have not given this aspect of nutritional anemia (caused due to iron deficiency) the priority it deserves. Despite the World Health Organization (WHO) declaring anemia as one of the top 10 serious health problems in the world, policymakers continue to see anemia as a 'women's problem'.

It is this view that has not only compromised women's health but productivity as well. Incredible as it may seem, India loses one per cent of its annual economic growth due to anemia alone, according to a study conducted by UNICEF and Micronutrient Initiative (an international NGO) in 2004. Such huge economic losses result from human resource depletion linked to ill-health, reduced intellectual capacity and early death.

How can developing countries, including India, address nutritional deficiencies? What are the areas that need greater priority? How can interventions be improved to counter the problem? These were some of the issues addressed by a regional consultation on maternal and child nutrition in Asia, held in Delhi recently. Organized by the United Nations World Food Program (UNWFP), in collaboration with the Department of Women and Child Development (DWCD), the meet emphasized that unless all aspects of malnutrition - including anemia - were prioritized, it would continue to ravage women and children.

"Just three Asian countries - India, Bangladesh and Pakistan - account for half the underweight children in the world. It is a reflection of the poor nutritional status of mothers prior to birth, often prior to conception. High levels of anemia contribute to appalling levels of maternal mortality and even to adult female mortality unassociated with births," said Dr Patrick Webb, chief of nutrition at UNWFP.

The main objective of the meet, said Webb, was to expose policymakers to the information available so that they could use it to formulate strategies to deal with the problem. "We have to change the perception that anemia is a woman's issue, just as we have to try to demonstrate the economic pain (referring to the economic losses in GDP) of malnutrition to garner the resources to do what needs to be done. At a time when countries like Italy and Britain are getting their economic growth up above two per cent per annum, there are countries in Asia 'hemorrhaging' two per cent growth every year because of anemia." This is a huge loss, Webb points out.

"But what is worse is that when anemia is compounded by other nutritional deficiencies, the impact can be higher than two per cent of the GDP. No country can afford it, especially developing countries," he contended. The 2 per cent loss is based on productivity losses and wage losses arising from low Labour participation, which is due to absenteeism linked to ill-health.

Institutions like WHO, Micronutrient Initiative, and Food and Agriculture Organization have found that low weight and height among adults is linked to reduced output and wages. (In fact, an increase of one per cent in caloric intake among Brazilians consuming only 1,700 kcal per day - well below the minimum required - resulted in a close to 2 per cent increase in income through higher productivity.)

Studies conducted by the World Bank have shown that the economic costs of not addressing malnutrition can be substantial. Economist Harold Alderman, who has researched direct and indirect links between nutrition, physical productivity, cognitive development and schooling, has found countries that successfully implement nutritional programmes stand a better chance of improving their rates of growth.

"If malnutrition is not addressed in early childhood, subsequent interventions or economic prosperity will, at best, only partially reverse the consequences. Furthermore, the commonly held belief that nutrition programmes are welfare interventions that use resources that could probably be used to raise national incomes, is a myth. Instead, investments in nutrition are among the most profitable," Alderman pointed out at the meet.

This is also what DWCD discovered during its 1996 study, conducted to assess the economic loss arising out of malnutrition. This study revealed that the cost of malnutrition was between 3 and 9 per cent of the GDP in 1996. More importantly, it found that the cost of treating malnutrition was 27 times higher than the investment required for its prevention.

Although India has initiated several programmes to address the malnutrition problem, DWCD officials admit that there is no universal system of monitoring the nutrition situation in the country. According to Chaman Kumar, Joint Secretary, DWCD, the mandate of the nutrition policy and the National Nutrition Mission was to narrow the existing gaps between policy and implementation. He said that since nutritional deficiency disorders affected productivity and translated not just into a vicious circle of poverty and malnutrition but also poor national development, efforts were being made to institutionalize nutrition monitoring.

"There are more that 41.4 million children who are being targeted by the Integrated Child Development Scheme (ICDS). However, malnutrition continues unabated despite expansion in the ICDS program. Nutritional anemia due to iron and folic acid deficiency is prevalent not only among pregnant women but also in infants and adolescent girls. Our goal is to reduce the prevalence of anemia by 25 per cent and that of moderate/severe anemia by 50 per cent by 2007," said Kumar.

This is an ambitious goal. DWCD statistics indicate that the percentage of anemia among pregnant women is 74.3 per cent, 77.7 per cent in lactating mothers and 68.6 per cent in adolescent girls.

In most Indian homes, not only are women the last to eat but the poor quality and quantity of what they eat undermines their health. Women's food insecurity perpetuates the cycle of malnutrition and ill-health for several generations.

What is worrying is that India has the dubious distinction of being far ahead of its neighbors as far as numbers of maternal deaths from severe anemia is concerned. (While the figure stands at 22,000 for India, in Bangladesh, it is 2,800 and only 820 in China.) UNWFP estimates show that while India loses one per cent of its GDP, Bangladesh loses 0.9 and China only 0.2 per cent.

How can India reverse this trend? Agriculture expert M S Swaminathan contended that there has to be a paradigm shift from the conventional definition of food security: from simply providing food to people to providing safe drinking water and a balanced diet that addressed nutritional deficiencies.

He said that if the community was given the responsibility of managing its nutrition needs, the needy could be targeted better. "We should be able to achieve freedom from absolute hunger by August 15, 2007. But what is equally important is that nutritional balance should also be achieved." 

It is this view that has not only compromised women's health but productivity as well. Incredible as it may seem, India loses one per cent of its annual economic growth due to anemia alone, according to a study conducted by UNICEF and Micronutrient Initiative (an international NGO) in 2004. Such huge economic losses result from human resource depletion linked to ill-health, reduced intellectual capacity and early death. 

How can developing countries, including India, address nutritional deficiencies? What are the areas that need greater priority? How can interventions be improved to counter the problem? These were some of the issues addressed by a regional consultation on maternal and child nutrition in Asia, held in Delhi recently. Organized by the United Nations World Food Program (UNWFP), in collaboration with the Department of Women and Child Development (DWCD), the meet emphasized that unless all aspects of malnutrition - including anemia - were prioritized, it would continue to ravage women and children.

"Just three Asian countries - India, Bangladesh and Pakistan - account for half the underweight children in the world. It is a reflection of the poor nutritional status of mothers prior to birth, often prior to conception. High levels of anemia contribute to appalling levels of maternal mortality and even to adult female mortality unassociated with births," said Dr Patrick Webb, chief of nutrition at UNWFP.

The main objective of the meet, said Webb, was to expose policymakers to the information available so that they could use it to formulate strategies to deal with the problem. "We have to change the perception that anemia is a woman's issue, just as we have to try to demonstrate the economic pain (referring to the economic losses in GDP) of malnutrition to garner the resources to do what needs to be done. At a time when countries like Italy and Britain are getting their economic growth up above two per cent per annum, there are countries in Asia 'hemorrhaging' two per cent growth every year because of anemia." This is a huge loss, Webb points out. 

"But what is worse is that when anemia is compounded by other nutritional deficiencies, the impact can be higher than two per cent of the GDP. No country can afford it, especially developing countries," he contended. The 2 per cent loss is based on productivity losses and wage losses arising from low Labour participation, which is due to absenteeism linked to ill-health. 

Institutions like WHO, Micronutrient Initiative, and Food and Agriculture Organization have found that low weight and height among adults is linked to reduced output and wages. (In fact, an increase of one per cent in caloric intake among Brazilians consuming only 1,700 kcal per day - well below the minimum required - resulted in a close to 2 per cent increase in income through higher productivity.) 

Studies conducted by the World Bank have shown that the economic costs of not addressing malnutrition can be substantial. Economist Harold Alderman, who has researched direct and indirect links between nutrition, physical productivity, cognitive development and schooling, has found countries that successfully implement nutritional programmes stand a better chance of improving their rates of growth.

"If malnutrition is not addressed in early childhood, subsequent interventions or economic prosperity will, at best, only partially reverse the consequences. Furthermore, the commonly held belief that nutrition programmes are welfare interventions that use resources that could probably be used to raise national incomes, is a myth. Instead, investments in nutrition are among the most profitable," Alderman pointed out at the meet.

This is also what DWCD discovered during its 1996 study, conducted to assess the economic loss arising out of malnutrition. This study revealed that the cost of malnutrition was between 3 and 9 per cent of the GDP in 1996. More importantly, it found that the cost of treating malnutrition was 27 times higher than the investment required for its prevention.

Although India has initiated several programmes to address the malnutrition problem, DWCD officials admit that there is no universal system of monitoring the nutrition situation in the country. According to Chaman Kumar, Joint Secretary, DWCD, the mandate of the nutrition policy and the National Nutrition Mission was to narrow the existing gaps between policy and implementation. He said that since nutritional deficiency disorders affected productivity and translated not just into a vicious circle of poverty and malnutrition but also poor national development, efforts were being made to institutionalize nutrition monitoring.

"There are more that 41.4 million children who are being targeted by the Integrated Child Development Scheme (ICDS). However, malnutrition continues unabated despite expansion in the ICDS program. Nutritional anemia due to iron and folic acid deficiency is prevalent not only among pregnant women but also in infants and adolescent girls. Our goal is to reduce the prevalence of anemia by 25 per cent and that of moderate/severe anemia by 50 per cent by 2007," said Kumar.

This is an ambitious goal. DWCD statistics indicate that the percentage of anemia among pregnant women is 74.3 per cent, 77.7 per cent in lactating mothers and 68.6 per cent in adolescent girls. 

In most Indian homes, not only are women the last to eat but the poor quality and quantity of what they eat undermines their health. Women's food insecurity perpetuates the cycle of malnutrition and ill-health for several generations.

What is worrying is that India has the dubious distinction of being far ahead of its neighbors as far as numbers of maternal deaths from severe anemia is concerned. (While the figure stands at 22,000 for India, in Bangladesh, it is 2,800 and only 820 in China.) UNWFP estimates show that while India loses one per cent of its GDP, Bangladesh loses 0.9 and China only 0.2 per cent.

How can India reverse this trend? Agriculture expert M S Swaminathan contended that there has to be a paradigm shift from the conventional definition of food security: from simply providing food to people to providing safe drinking water and a balanced diet that addressed nutritional deficiencies.

He said that if the community was given the responsibility of managing its nutrition needs, the needy could be targeted better. "We should be able to achieve freedom from absolute hunger by August 15, 2007. But what is equally important is that nutritional balance should also be achieved."