By Bhogtoram Mawroh
Malnutrition in Meghalaya has been a persistent problem over the years. The most recent National Family Health Survey (NFHS-5) has reiterated the challenges the state faces regarding child and maternal health. Under the indicators for child feeding practices and nutritional status, two key metrics—children aged 6-23 months receiving an adequate diet and children under 5 years who are stunted (height-for-age)—show figures higher than the national average: 29% and 46%, respectively. Another serious issue is anaemia among children and adults. All five indicators in this category—children aged 6-59 months who are anaemic (<11.0 g/dl), non-pregnant women aged 15-49 years who are anaemic (<12.0 g/dl), pregnant women aged 15-49 years who are anaemic (<11.0 g/dl), all women aged 15-49 years who are anaemic, and all women aged 15-19 years who are anaemic—report figures that are almost or more than 50%. This means that around half or more of the children and women are anaemic, which is a very worrying finding.
One of the widely used policies employed by the government of India to tackle the problem of malnutrition is large-scale food fortification of grains, oil, salt, and other staples. This approach dates back to the early years of independence, beginning with the fortification of vanaspati oil with vitamin A and salt with iodine. Recently, this approach has gained momentum with the introduction of universal distribution of fortified rice through the Public Distribution System (PDS), midday meals, and the Integrated Child Development Scheme. However, this approach has not been without its flaws.
Last year, The Reporters’ Collective, a publication that reports on public issues, published a three-part story on fortified rice supplied through the PDS. This policy has its roots in a speech given by Prime Minister Narendra Modi during Independence Day, in which he announced that more than half of Indians would be fed rice fortified with micronutrients by 2024 to eradicate anaemia. The three-part series revealed that the Modi government rushed this policy despite warnings from internal and external experts regarding the adverse effects of feeding fortified rice to people, particularly children. It was also revealed that at least six international organizations found their way into an Indian government agency to influence decisions and open the Indian market to global suppliers and manufacturers of premixes used to produce the artificial fortified rice kernel, which represents an annual business opportunity of Rs 1,800 crore. This raises many questions about the health risks and intentions behind the policy. Now, questions are being raised as to whether fortified rice can actually solve the problem of malnutrition.
A recent news report in the Economic Times mentioned a 2024 EAC-PM working paper by Mudit Kapoor et al., titled “Changes in India’s Food Consumption and Policy Implications,” which uses data from the Household Consumption Expenditure Survey 2022-23 and NFHS-5 (2019-21). The paper found that, irrespective of the consumption of fortified cereals, anaemia prevalence was higher in states with lower dietary diversity of iron-rich foods among both children and women. It highlighted the example of Rajasthan, where, despite the average iron intake being the highest among households due to the consumption of fortified cereals, the prevalence of anaemia was also very high. The study indicated that Rajasthan had the lowest dietary diversity for sources of iron and the poorest average iron intake when fortified cereals were excluded (since 84% of iron was from fortified cereals). The conclusion was that a diverse diet, rather than fortified foods, is a better way to reduce anaemia.
Dietary diversity is based on the principle that different foods are sources of various macro and micro nutrients, so a diverse diet best ensures nutrient adequacy. One way to assess this is by measuring the number of different food groups consumed over a 24-hour period. A food group is defined as a collection of food items that have similar caloric and nutrient contents. The FAO (Food and Agricultural Organisation) has identified ten of these groups: (1) starchy staples—grains, white roots, tubers, and plantains; (2) pulses (beans, peas, and lentils); (3) nuts and seeds; (4) dairy; (5) meat, poultry, and fish; (6) eggs; (7) dark green leafy vegetables; (8) other vitamin A-rich fruits and vegetables; (9) other vegetables; and (10) other fruits.
There are two important things to remember regarding food groups: consumption of different food items from the same group will not provide additional benefits, and an individual must consume at least five food groups in a day to ensure dietary diversity. For example, eating rice and potatoes, which are part of the starchy staple group, will not increase nutritional benefits; instead, one of them should be replaced by items from another group, such as dark green leafy vegetables or vitamin A-rich fruits and vegetables. Only then is nutrient adequacy ensured, and the threat of malnutrition tackled. This also emphasizes the importance of food production practices. Farming practices that focus on monoculture will find it difficult to ensure dietary diversity, as crops from this system are mostly meant for sale and not for consumption (e.g., broom, arecanut, etc.). On the other hand, a mixed cropping system is much more favorable for achieving the outcome of a diversified diet. In this respect, the farming systems practiced by the indigenous communities of Meghalaya, particularly jhum or shifting cultivation can be of tremendous importance.
An upcoming book chapter titled “The Importance of Shifting Cultivation for Food Biodiversity and Diversifying Diets in Northeast India,” to be published in the book – Farmers’ Innovation and Best Practices by Shifting Cultivators in Asia-Pacific, applies the concept of food groups to assess the diversity of food plants found in jhum or shifting cultivation areas. The first volume of the book is already out, and the second volume, which includes this particular chapter, will be released by the end of the year. The book is being published by CABI, which is known for producing high-quality, rigorously peer-reviewed interdisciplinary research focused on global agriculture, food security, forestry, and environmental and social sciences. The findings of this chapter, authored by NESFAS (North East Society for Agroecology Support), are very important in the discussion on leveraging agriculture to combat malnutrition in the state.
This study selected two villages from the Mawkynrew block, namely Khapmaw and Rasong, to assess different land uses—jhum plots, home gardens, terrace farming, and forests—as sources of food groups for dietary diversity. The study focused only on plant-based food groups, with animal-based food groups (dairy, eggs, meat, poultry, and fish) not included. Farmers from both Khapmaw and Rasong identified more than 200 food plants spread across all seven plant-based food groups. What was particularly impressive was the huge diversity of starchy staples identified by the community, which included different varieties of millet, sweet potato, cassava, Job’s tears, taro, potato, and maize. This included Raishan (Digitaria cruciata), a millet species endemic to the Khasi Hills. More than 60 fruits were identified, while the number of food plants under dark green leafy vegetables and other vegetables also exceeded 50 in some cases. Among the different land uses, jhum plots were found to be the most diverse.
Jhum is practiced by all households in both villages, and at least half—often much more than half—of the food plants from the categories of ‘starchy staples,’ ‘pulses,’ and ‘vitamin-A-rich plants’ are found in jhum fields. The jhum-sourced staples include nearly all varieties of cassava, taro, sweet potatoes, maize, Job’s tears, millets, and potatoes. Various beans and legumes make up the important ‘pulses’ from jhum fields, while the key ‘vitamin-A-rich plants’ include papaya, mangoes, pumpkins, tree tomatoes (Solanum betaceum), and carrots. Locally important plants from the remaining food groups grown in jhum fields include cucumbers, bitter eggplants, and gourds from ‘other vegetables’; sesame and perilla from ‘nuts and seeds’; and local vegetables such as mustard greens, sweet potato leaves, and the locally named jali and jarem. Many fruit trees also grow spontaneously in jhum fields or along the field margins. These include bananas, box myrtle, lychees, jackfruit, guavas, plums, oranges, and star fruit (Averrhoa carambola).
The availability of all the food groups makes jhum the most important food-producing system in the study communities, in terms of both absolute quantity and nutritional diversity. This diversity is found across the seasons as well: a minimum of three food groups are present in any particular season. From the perspective of food diversity, home gardens (kper) are the only other system that can rival jhum, since it also provides all food groups. Many of the crops found in jhums are also grown in kper. However, an average jhum plot is a little less than half a hectare, while a kper is much smaller. Production from jhum is therefore much higher than that from kper. Thus, although both systems provide nutritional diversity, without jhum, households would find it difficult to achieve food security.
This discussion on the relationship between dietary diversity and agriculture becomes very important in light of the news that on September 24, 2024, the Meghalaya government signed a Memorandum of Understanding (MoU) with the Bill and Melinda Gates Foundation (BMGF) to collaborate on improving the population health outcomes of the state, particularly related to maternal and newborn health, family planning, nursing education, and agriculture and livestock development. Among the key areas in which BMGF intends to provide technical and financial support are maternal health, anaemia, childhood wasting, and malnutrition. Regarding agriculture and livestock development, the emphasis is on building value chains and supporting small farmers in the state of Meghalaya.
Although the news report does not provide many details, it appears that the link between dietary diversity, nutrition, and the role of agriculture in combating malnutrition has not received due attention. This would be a significant mistake and a missed opportunity for the government to leverage agriculture to combat malnutrition. The state is fortunate that jhum is still an important farming system practiced by many communities. This gives Meghalaya and the villages where jhum is practiced an advantage, as they do not have to depend on sources beyond the community to achieve dietary diversity. Support is needed to increase productivity and address issues of pests and crop loss, particularly due to climate change. The project can design activities to resolve these issues; however, it cannot be denied that there is an immense opportunity to leverage agriculture to combat malnutrition in the state. Hopefully, this opportunity will not be missed; otherwise, the project might fall short of its intended outcome of improving health for the citizens of the state. If that happens, it would be a matter of great shame.
(The views expressed in the article are those of the author and do not reflect in any way his affiliation to any organisation or institution)