THE STATUS OF NUTRITONAL

INTAKE IN BIHAR

A Report Submitted to the Directorate of Statistics & Evaluation on

‘Nutritional Status of Bihar’, by the students of Tata Institute of Social
Sciences, Mumbai.
 CONTENTS
1. Introduction
2. Nutrition Security
2.1 Consequences of under nutrition
2.2 The Hunger: A reality in Bihar
2.3 India’s rank and State Disparities
3. Trends in Nutritional Status of Bihar
3.1 Trends in calorie consumption in Bihar in comparison with other States
3.2 Trends in protein consumption in Bihar in comparison with other States
3.3 Trends in fat consumption in Bihar in comparison with other States
3.4 Possible reasons of the trend shown in consumption of calories
4. Food security and gender
4.1 (TPDS) Targeted Public distribution System and Food Security
4.2 Debate on poverty and nutrition intake
5. Consumption pattern in Bihar
5.1 Consumption pattern among MPCE classes
5.2 Calorie intake per diem per capita in rural and urban Bihar
6. Nutritional status of children and women
7. Hurdles in achieving the nutritional goals
8. Recommendations
 9.

ACKNOWLEDGEMENT

We would like to express my sincere gratitude to Dr. J.K Sinha, Joint Director, Directorate of
Statistics &. Evaluation, Bihar gave us the opportunity under his valuable guidance for
bringing up this report with his precious suggestions and ideas. His cooperation is highly
recommended for providing continuous guidance and motivation.

The report on the 'Nutritional Intake' in Bihar is based on the analysis of the 61st round of
NSSO data. This report looks substantially into some of the important issues affecting the
nutritional intake of the people in Bihar. It views ‘nutrition’ from a broader development
perspective rather than purely nutrition indicators. It also explores the possibility of a more
effective future direction for nutritional intake in the state.

We are grateful to Mr A K Thakur, Mr Vijay Shanker, Mr P K Choudhary, Mr Vijay Pandey,

Mr Nishit and to all staffs of the directorate, computer centre and library for providing us with
a good environment and facilities to complete this report. We also greatly appreciate the
support of Mr P Jha and Mr Moitra. Our special thanks to Mr Vijay Prakash, Principal
Secretary, Planning & Development, without whom this opportunity might not be available to
us in garnering skills related to analysis and research as an intern.

Finally, an honourable mention goes to our family and friends for their understandings and
supports on us in completing this report. We appreciate the help of all the above mentioned
people without whom this report would not be possible.

Mr. S.Qayam Masumi

Mr. S.M Atiqul Mobin
Mr. Anand Kumar
Mr. Ahmadulbari
 1. INTRODUCTION

Nutrition is inevitable requirement of the each and every individual for survival and
wellbeing. Both the individual development and the development of the state and nation also
is highly dependent on the physical and mental wellbeing which can be attained only when
the adequate nutrition is accessible, affordable and the nutrient requirement is met properly.
The status of nutrition as well connected with the issue of poverty, employment, gender
disparity, water, sanitation facility and other cultural, political and social issues. The modern
state of Bihar came into existence in 1956 and in November 2000 the state of Jharkhand was
carved out of the state of Bihar by transfer of 13 districts to the new state. The remaining 29
districts have been reorganized into 38 districts. Administratively, Bihar now has 9 divisions,
101 subdivisions and 533 community development blocks. There are 130 towns, including
125 statutory towns and 5 census towns, and 45,098 villages, out of which 39,015 are
inhabited. There are 9032 gram panchayats, 7 municipal corporations, 42 municipalities, 3
nagar panchayats, and 853 police stations. The households number 13,744,130, of which
12,407,132 are rural and 1,336,998 are urban. Bihar has a land area of 94,163 sq km, which is
2.86% of the land area of India (3,287,240 sq km). The state’s rural land area is 92,358.40 sq
km (98.08%) and urban land area is 1804.60 sq km (1.92%). Total irrigated land is 4807,000
hectares (1999-2000). The Ganges and its tributaries are the major source of water for the
state. Other major rivers include Gandak, Ghagra, Kosi and Baghmati. The agricultural
economy of the state is characterized predominantly by cash crops such as cotton, hemp, jute,
oilseeds and tobacco. Maize, potato, rice and wheat are the other crops. Litchis, mangoes,
bananas and jackfruit are the main fruits.

There is a direct relation between health and poverty and the overall development of state.
Poverty in its diverse magnitude could be a demonstration as well as a determinant of an
individual’s health as the state of inadequate food availability and nutritional deficiency has a
direct bearing on the morbidity and longevity of people. Other factors affecting the state of
nutrition are like basic amenities like safe water, sanitation, general awareness and most
importantly education contribute to reinforcing poor health and morbidity and leading to
higher mortality levels. High child mortality levels on account of supervening infections,
particularly diarrhoea and other respiratory infections are quite prevalent among people
deprived of these basic amenities of life. These normally seen childhood infections often
aggravate malnourishment. Poor nutritional intake among children further increases the rate
of infections. The major reason for the poor health status in terms of nutritional intake in
Bihar are poverty both human and income. Other root causes are social deprivation, poor
literacy rate among women, the structural inequalities and social stratifications in terms of
caste, class, sex and religion. The per capita net domestic product of Bihar is lowest among all
the Indian states and more than 32% of the state population lives below the poverty line(as per
the 61st Round NSSO survey) second highest in India after Orissa that is (40%). In terms of
literacy rate Bihar has the lowest literacy rate that is 47.0% and lowest female literacy rate of
33.1% among all Indian states and UTs as per the 2001 census.

This report which we can produce with our relentless effort of more than three weeks during
which we had meticulously worked on NSS data avilable to us and related data from other
sources related to nutrition or relevent isues. The report contains facts on nutritional status of
bihar in particula and some camparative figures of other states and the nation. Other then this
we had tried to intrepret the thing to present a holistic picture of the nutrition intake of Bihar
and tried to put forward the realities related to this. Though we had worked to our full
capacity even then we feel that this report is not as good as would have been if we would have
given it more time and effort. This report though can not be considered as the final document
for the policy making but it really we have tried to present a prespective which takes the need
of poor into due consideration and tries to understand the nitty greties related to nutrition
intake in Bihar.

2. NUTRITION SECURITY
Nutrition Security implies physical, economic and social access to balanced diet, clean
drinking water, safe environment, and health care (preventive and curative) for every
individual. Education and awareness are needed to utilise these services. Thus malnutrition
has a complex aetiology and its prevention requires Awareness, and Access to all the above at
Affordable cost. Women’s health, nutrition, education and decision making through
empowerment are important for nation’s nutrition security but remain neglected due to
societal biases. Countrywide diet surveys show that Indian diets are qualitatively more
deficient in vitamins and minerals (hidden hunger) than proteins due to low intake of income-
elastic foods like vegetables, fruits, pulses and foods of animal origin. Nutritious millets are
disappearing. Within the family diet of preschool children are particularly inadequate, due to
ignorance and time constraint on mothers rather than affordability. More than 70% preschool
children consume <50 % of recommended amount (RDA) of iron, vitamin A, and some B
vitamins particularly riboflavin and folic acid.

In India, states like Kerala ,Tamil Nadu, Karnataka, Punjab, Andhra Pradesh have relatively
better nutrition parameters than states with lower nutritional intake like Orissa and Bihar
majorly suggesting that the situation is more complex than mere access to food (calories) or
income, important as they are. Time trends suggest that over the years despite reduction in food
and nutrient intake, nutrition status has shown some improvement, perhaps because of better access to
health care and reduced physical activity. However, there is no reduction in the prevalence or severity
of anaemia. Non-dietary factors also influence nutrition status. Undernutrition reduces immunity and
infections reduce appetite, impair absorption and lead to catabolic losses of precious nutrients. Thus
access to clean environment and drinking water to prevent infections are areas of great concern.
Increasing prevalence of obesity and chronic diseases is due to more sedentary lifestyles, shift to less
fibre, high fat refined carbohydrate diets, stress and addictions. Crowded urban areas leave little space
for physical activity like walking or play even for children. Neither government nor scientists can be
faulted for being silent spectators. Efforts have been made. Food grain (wheat and rice) production
went up markedly and kept ahead of population growth till mid nineties, but has subsequently
plateaued. Unfortunately pulse production has stagnated and per capita availability has declined.
There is erosion in millets production and consumption. Milk and fruit and vegetable production has
increased markedly with India holding 1st and 2nd positions respectively in the world. But that is not
reflected in the diet of the poor people in the Bihar due to poor purchasing power, and lack of
awareness about their nutritional importance. Huge loss of farm produce occurring due to inadequate
post-harvest storage facilities, food processing for value addition and the regular flood.

2.1 Consequences of Undernutrition

Apart from human suffering, malnutrition is one of the major causes of morbidity, mortality,
loss of national productivity and medical expenses. Under nutrition contributes to 60% of
deaths due to infectious diseases like malaria, measles, diarrhoea, pneumonia and perinatal
disorders in preschool children. In India a huge chunk of deaths are due to DALYs
(Disability Adjusted Life Years. The sum of years of potential life lost due to premature
mortality and the years of productive life lost due to disability) lost are due to communicable
diseases, perinatal and maternal conditions and nutritional deficiencies. Children born with
low birth weight remain stunted. Their learning capacity and ability to fight infections is
impaired. Intrauterine malnutrition and consequent low birth weight epigenetically
predisposes to higher body fat and lower muscle mass (the lean fat babies). In later life they
are more susceptible to life-style related chronic diseases like the syndrome
X (diabetes, hypertension, and dyslipidaemia). This trend is of particular concern to a rapidly
developing country like India and states like Bihar where many individuals who are born
with low birth weight due to poverty and maternal malnutrition, shift to affluence and
indulgence later.
2.2 The Hunger: A reality in Bihar

MDG Food and good nutrition are basic human needs, and this is recognized in the first
Millennium Development Goal (MDG)—the eradication of extreme poverty and hunger.
Developing sound ways to monitor progress toward the eradication of hunger is vital to
productive global and national policy discussions about hunger. Three are interlinked
dimensions of hunger—inadequate consumption, child underweight, and child mortality.
Although hunger is most directly manifested in inadequate food intake, over time inadequate
food intake and a poor diet, especially in combination with low birth weights and high rates
of infection, can result in stunted and underweight children. The most extreme manifestation
of continued hunger and malnutrition is mortality (Menon,P; et al;2009).

2.3 India’s Rank and State disparities:

With more than 200 million food-insecure people (FAO 2008), India is home to the largest
number of hungry people in the world. India ranks 66th among 88 countries surveyed on
Global Hunger Index and also Hunger and malnutrition in Indian states are comparable with
hunger and malnutrition in other countries (ISHI, 2009). Hunger indices available for
different states and countries discern very startling facts and give a strong evidence to focus
attention on the problem of hunger and malnutrition at the state and central level. In Bihar the
proportion of population that does not consume an adequate level of calories ;( nearly 50%),
the proportion of underweight children under five years of age ;( nearly 58%
http://www.unicef.org/india/nutrition_4696.htm), and the mortality rate among children under
five years of age ;( 61 per thousand live births. It should be noted that calorie consumption
alone is a conceptually inadequate measure of hunger. Without data on physical activity and
calories expended, it is difficult to truly judge if an individual is undernourished or not.
Percentage population below poverty line and reported hunger in the country are quite
interrelated so these kinds of results are not out of expectation. Though during the period of
1999-2000 to 2004-2005 Bihar had experienced economic growth still the extent of hunger is
on rise. It is indeed alarming that not a single state in India is either low or moderate in terms
of its index score; most states have a “serious” hunger problem, and one state, Madhya
Pradesh, has an “extremely alarming” hunger problem and Bihar's status is of alarming
nature. A closer examination of these states’ past and current investments in social protection,
health, and nutrition programs can help inform the debate about policy instruments to protect
populations against hunger even in the face of poverty. First, economic growth is not
necessarily associated with poverty reduction. Additionally, even if equitable economic
growth improves food availability and access, it might not lead immediately to improvements
in child nutrition and mortality, for which more direct investments are required to enable
rapid reductions. Thus, in addition to wide-scale poverty alleviation, direct investments in
improving food availability and access for poor households, as well as direct targeted
nutrition and health interventions to improve nutrition and mortality outcomes for young
children, will be needed. Investments will be needed to strengthen agriculture, improve
overall food availability and access to all population segments, and to improve child nutrition
and mortality outcomes. Nutrition programs in India are not effectively delivering evidence-
based interventions at scale to vulnerable age groups that need to be reached to ensure rapid
reductions in under nutrition.

3. TRENDS IN NUTRITIONAL STATUS OF BIHAR

 Table- 1 Average per capita intake of calorie, protein and fat per diem over NSS rounds, by major States
Per capita per diem intake of
Calorie (Kcal) Protein (gm) Fat (gm)
according to according to according to
State
27th 38 th 50th 55th 61st 27th 38 th 50th 55th 61st 27th 38 th 50th 55th
round round round round round round round round round round round round round round 61st round
(1972- (1993- (1999- (2004- (1972- (1993- (1999- (2004- (1972- (1993- (1999-
(1983) (1983) (1983) (2004-2005)
1973) 1994) 2000) 2005) 1973) 1994) 2000) 2005) 1973) 1994) 2000)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16)
Rural
Andhra
Pradesh 2103 2204 2052 2021 1995 53.0 56.0 50.8 49.4 49.8 21.0 24.0 27.2 29.5 33.5
Assam 2074 2056 1983 1915 2067 53.0 52.0 49.5 47.7 52.7 15.0 18.0 21.0 22.3 26.7
Bihar 2225 2189 2115 2121 2049 65.0 65.0 60.2 58.7 57.8 17.0 20.0 23.0 26.5 28.4
Gujarat 2142 2113 1994 1986 1923 58.0 59.0 55.6 54.2 53.3 40.0 44.0 47.4 53.8 50.9
Haryana 3215 2554 2491 2455 2226 90.0 78.0 78.4 75.3 69.6 47.0 47.0 53.6 59.1 55.4

Karnataka 2202 2260 2073 2028 1845 57.0 60.0 55.1 54.2 48.8 23.0 26.0 28.6 36.6 33.9
Kerala 1559 1884 1965 1982 2014 38.0 47.0 50.8 52.4 55.4 19.0 32.0 32.7 38.8 40.8
Madhya
Pradesh 2423 2323 2164 2062 1929 68.0 68.0 63.0 58.2 58.8 21.0 25.0 28.3 31.3 35.1
Maharashtra 1895 2144 1939 2012 1933 54.0 62.0 54.8 56.5 55.7 24.0 30.0 33.5 39.7 41.5
Orissa 1995 2103 2199 2119 2023 49.0 51.0 52.7 49.9 48.3 8.0 13.0 14.8 16.3 17.8

Punjab 3493 2677 2418 2381 2240 85.0 79.0 74.7 71.7 66.7 50.0 52.0 59.8 58.7 58.7
Rajasthan 2730 2433 2470 2425 2180 84.0 75.0 79.4 76.9 69.6 46.0 42.0 52.8 53.5 50.9
Tamil Nadu 1955 1861 1884 1826 1842 49.0 47.0 46.8 44.9 44.9 18.0 22.0 24.7 29.5 29.6
Uttar Pradesh 2575 2399 2307 2327 2200 76.0 73.0 70.4 69.7 65.9 28.0 29.0 35.5 37.6 37.5
West Bengal 1921 2027 2211 2095 2070 50.0 52.0 54.8 51.6 52.0 13.0 17.0 21.4 24.2 26.5

all-India 2266 2221 2153 2149 2047 62.0 62.0 60.2 59.1 57.0 24.0 27.0 31.4 36.1 35.5

Urban
Andhra
Pradesh 2143 2009 1992 2052 2000 51.0 50.0 49.6 50.8 50.9 31.0 32.0 34.9 41.5 43.2
Assam 2135 2043 2108 2174 2143 56.0 52.0 53.5 56.5 55.9 25.0 25.0 30.8 38.7 36.8
Bihar 2167 2131 2188 2171 2190 61.0 61.0 61.4 61.0 62.2 25.0 26.0 32.7 34.2 40.4
Gujarat 2172 2000 2027 2058 1991 57.0 55.0 54.9 54.7 57.3 58.0 53.0 57.9 67.0 63.5
Haryana 2404 2242 2140 2172 2033 67.0 67.0 63.6 62.5 60.5 42.0 49.0 49.4 56.3 54.4

Karnataka 1925 2124 2026 2046 1944 46.0 55.0 53.1 53.5 52.2 32.0 36.0 37.6 45.1 43.3
Kerala 1723 2049 1966 1995 1996 44.0 51.0 52.4 55.2 56.7 27.0 38.0 37.0 42.9 44.9
Madhya
Pradesh 2229 2137 2082 2132 1954 61.0 62.0 59.8 60.6 58.2 34.0 36.0 40.3 43.5 43.4
Maharashtra 1971 2028 1989 2039 1847 55.0 56.0 55.5 55.9 52.1 41.0 45.0 47.9 52.6 50.1
Orissa 2276 2219 2261 2298 2139 55.0 56.0 57.2 57.8 55.2 23.0 24.0 28.1 27.4 28.3

Punjab 2783 2100 2089 2197 2150 70.0 63.0 61.8 64.8 63.4 52.0 49.0 53.7 57.9 61.0
Rajasthan 2357 2255 2184 2335 2116 70.0 69.0 66.5 70.4 64.0 47.0 47.0 51.6 61.5 56.4
Tamil Nadu 1841 2140 1922 2030 1935 44.0 45.0 48.7 51.7 49.2 23.0 29.0 33.9 43.2 41.1
Uttar Pradesh 2161 2043 2114 2131 2124 62.0 62.0 63.2 62.0 65.1 35.0 34.0 41.2 45.5 46.1
West Bengal 2080 2048 2131 2134 2011 58.0 55.0 56.6 55.5 55.1 31.0 31.0 34.2 40.2 39.1
all-India 2107 2089 2071 2156 2020 56.0 57.0 57.2 58.5 57.0 36.0 37.0 42.0 49.6 47.5

Source- NSS state samples from 27th, 38th, 50th, 55th & 61st round survey report.
The above table 1 of the NSS state samples from 27th, 38th, 50th, 55th & 61st shows the trend in
consumption of calorie, protein and fat in different states of India. Analysing the status of
Bihar in comparison with other states we came out with the following results as follow:

3.1 Trends in calorie consumption in Bihar in comparison with other states:

Calorie intake in rural Bihar is 2049 as per the 61 st round NSS data (2004-05) that was
2225Kcal in 27th round survey i.e. during 1972-73. The calorie intake as evident from above
has undergone a reduction of 76Kcal i.e. 3%. Similar trend is witnessed in National average
calorie intake both in case of rural and urban. National average per capita per day calorie
intake was 2266Kcal during 1972-73 and reduced to 2047 Kcal during 2004-05. Like Bihar
and India similar trend has been observed in other states also except in states like Orissa,
Maharashtra and Kerala. Especially Kerala had a marked increase in average calorie intake in
rural areas during this period i.e. 1559Kcal during 1972-73 to 2023Kcal during 2004-05.

For Urban Bihar calorie intake shows a marginal increase from 2167Kcal (1972-730) to 2190
Kcal (2004-05). This trend is not in conformity with rural Bihar and also with most of the
states like Punjab, and UP but is similar as evidenced in states like Orissa and Kerala. Kerala
again showing marked increase from 1723 Kcal (1973-73) to 1995 Kcal (2004-05).

3.2 Trends in protein consumption in Bihar in comparison with other

states:

Protein intake also shows more or less similar trend over this period. In rural Bihar the
average consumption of protein was 65.0gms during 1972-73and it reduced to 57.8gms
during 2004-05 survey by NSS. In urban Bihar the average protein intake increased to a
meager amount i.e. from 61.0gms (1972-73) to 62.2gms (2004-05). In case of other states like
Orissa it is evidenced that it has maintained its protein intake constant both in rural and urban
areas. Its protein consumption per capita in rural areas was 49.0gms (1972-73) that rose to
49.9gms (2004-05) and in urban areas this was 55.0gms in 1972-73 and it remained at
55.2gms per capita per day level in 2004-05. While overall the country has shown the
downward trend in average consumption of protein per capita per day some of the states like
Kerala, Karnataka shown a significant increase in protein consumption. Kerala’s protein
average consumption in rural areas has increased from 38.0gms (1972-73) to 55.4gms (2004-
05) and in urban areas the protein consumption in 1972-73 was 44.0gms which rose to
56.7gms in 2004-05. In case of Karnataka the rural average protein consumption has
decreased from 57.0gms (1972-73) per capita per day to 48.8gms (2004-05) per capita per day
and the urban average consumption per capita per day was 46.0gms 1972-73 that rose to
52.2gms (2004-05).
3.3 Trends in fat consumption in Bihar in comparison with other states:

The consumption of fat in both rural and urban areas shows an obverse pattern to the calorie
and protein consumption. In case of Bihar both in rural and urban areas fat increase had
undergone a marked increase. Fat consumption in rural Bihar was 17.0gms in 1972-73 which
become 28.4gms in 2004-05. In urban areas fat consumption was 25.0gms 1972-73 that
become 40.4gms per capita per day in 2004-05. Other states shows similar trends i.e. raise in
the average consumption of fat and not single state had experienced the downward trend.

3.4 Possible reasons of the trend shown in consumption of the calories:

Though real per capita consumption has also grown rapidly, at 2.2% a year in the 1980s, at
2.5% a year in the 1990s, and at 3.9% a year from 2000 to 2005 yet, per capita calorie intake
is declining, as is the intake of many other nutrients; indeed fats are the only major nutrient
group whose per capita consumption is unambiguously increasing. Today, more than three
quarters of the population live in households with per capita calorie consumption below 2,100
per day in urban areas and 2,400 per day in rural areas – numbers that is often cited as
“minimum requirements” in India, (Deaton.et al 2009). As far as Bihar is concerned the trend
of decline in the calorie consumption in the state and the nation is concerned there may be
many reasons for this. One possible but not sufficient condition is that real income over this
span of time has increased for Bihar as well as the nation leading to betterment of nutritional
status, there has been offsetting reduction in calorie requirements due to declining levels of
physical activity and improvement in health environment such as water facility, sanitation,
health care etc.

Also it is needed to be kept in consideration that though the number of calories is important,
so are other factors, such as a balanced diet containing a reasonable proportion of fruits,
vegetables, and fats (not just calories from cereals), and various determinants of the need for
and retention of calories, including activity levels, clean water, sanitation, hygiene practices,
and vaccinations. Because of the made changes due to individual as well policy level efforts
in other factors people are moving from the diet which heavy in calories and rich in fats. This
does not mean that the nutritional status of the people is getting badly effected or leading
towards betterment. Nothing could be a better explanation other than the truth.
Also we would like to point out here that there have been changes in the household
composition due to decrease in the fertility over the period. The reduction in fertility means
that a shorter span of women’s lives is spent in pregnancy or lactation, during which there is a
sharp increase in recommended calorie needs. But it is not clear that most women either in
Bihar or India obtain these extra calories, and we suspect that the saving from this source is
small.

One more possible source of falling calorie requirements is an improved epidemiological

environment, with less exposure to disease and infections. For example, there has been a
major improvement in access to safe drinking water during the last 25 years or so: the
proportion of households with access to piped water has risen sharply across the state and
country also. While piped water is not necessarily safe, much of the increase came from the
construction of hand pumps and tube wells, whose water is usually safe, and certainly safer
than water obtained from rivers, tanks, or open wells. Better water reduces the prevalence of
diseases, especially diarrhoeal disease, and removes a potentially major source of calorie
wastage. Other improvements in the disease environment may also reduce calorific needs. For
instance, child vaccination rates have risen, and child health improves with mother’s
education, which has also risen rapidly in recent years. To the extent that these and other
improvements in the health environment reduce the susceptibility of children (and adults) to
disease and infection, calorie requirements would be reduced.

Another possible source of reduction in calorie requirements is the reduction of activity levels
(especially in rural areas). Aside from reducing exposure to disease, improved access to water
is likely to reduce the energy requirements associated with fetching and carrying water, a
strenuous task (typically assigned to women and children in rural areas). Similarly, the
extension of road coverage and transport facilities has enabled more people to use motorized
transport, and to save some of the energy spent earlier on long walks (another strenuous
activity, especially when it involves carrying heavy loads). The general mechanization of
domestic activities and agricultural work would also contribute to reduced calorie
requirements. For instance, aside from fetching water, rural women used to spend much
energy on grinding flour at home (using heavy stone mills known as chakkis), but today this is
typically done outside the home with energized devices such as mills.

4. FOOD SECURITY AND GENDER

According to NFHS- 3, 2005-06 women whose Body Mass Index (BMI) is below normal is
43 % and men whose BMI is below normal is 28.7 % (figure 1). In urban Bihar this figure is
25.1 % while in rural areas this figure touches 45.9 %. Men in Rural Bihar comprises18.6 %
whose BMI is below normal while in Urban Bihar this figure is 30.9 %. (fig 2. NFHS-3,
Fact Sheet Bihar Provisional data). Within a household, it is known that there are gender
differences in entitlements. Consequently, it is necessary to deal with not just factors
influencing household entitlements, but also those influencing individual entitlements within
the household. Factors of gender differentiation and discrimination come into the picture in
influencing individual entitlements of women and men, girls and boys. Further, there could be
a substantial imbalance between the use of energy and its replacement through food. Given
that women generally work longer hours than men and that women also get less nutrition than
men, this imbalance could itself be a factor in nutritional shortfalls for women.
The pattern of food distribution among family members in households also results nutritional
deficiencies especially in case of women. So socio cultural norms affect the nutrition of
women and female child and cause several health related complexities. When looking at the
data of nutritional intake we must need to look at it with gender dimensions in Indian context.
Figure 1

Figure 2
 In both rural and urban Bihar the percentage of women with BMI below normal is higher
than that of men. The discrimination in food distribution on the basis of gender starts right
from the family which reflects the patriarchal attitude in the society where women and female
child generally have food after feeding all male members of the family. This not only
deprives a female child from nutrition but also affects her growth and development which
capacitate her to deliver healthy child in her adulthood and thus avoiding infant/maternal
mortality.
NFHS – 3 reveals the correlation between nutritional status and status of education among
men and women. There is a direct bearing of education especially of women on health and
nutrition of the family. Men and women with no education comprise 35.7 % and 48.3 %
respectively (as shown in fig 3) whose BMI is below normal in Bihar. Thus the desired goal
of nutrition and food security in Bihar needed to be linked with universalization of education.

Figure 3

Adult literacy especially for women must be ensured since women not only takes care of own
health but she has a responsibility for ensuring nutrition for all members in the family. In
India women are in the center of managing kitchen corner in the house and thus are
responsible for cooking and distributing food in the family. So educating women about
nutrition and health will have manifold effect to ensure nutrition. Education may not be a
kind of formal education but the goal should be bringing awareness among people about
nutrition and health as well as informing them about various government schemes that they
can avail it properly and minimize the manipulation of authorities and middle men.

4.1 Targeted public distribution system and food security

The targeted public distribution system is perhaps one of the biggest food distribution
networks in the world considering the geographical vastness. The state governments have
strived to improve the functioning of PDS but leakages continue for want of community
ownership. The PDS network will contribute effectively in implementation of the national
food security act. The limitation of the PDS is that it works mechanically. Those left in the
process of targeting are not addressed and many deserving families remain without ration
cards.

An analysis of percentage distribution of households by ration card type in major states shows
that in Bihar BPL cards were held by 15 percent of rural households and 4.7 percent of urban
households. Antyodhya card holders formed 2.3 percent of rural and 4.7 percent of urban
households.1

Food subsidies generally involved large transaction costs that gobble funds. There is clearly a
need for reform of TPDS. The focus of reforms can now be shifted to more efficient delivery
systems of public services. It has been recognised that better governance very important for
effective functioning of food based programmes. Social mobilisation, community
participation and decentralised approach are needed. Introduction of food coupons are going
to be a major step toward reform. States like Andhra Pradesh, Rajasthan and recently Bihar
has introduced food coupons and considerable improvements have been reported. It has
helped in reducing the number of bogus ration cards and effective in checking the PDS grains
being diverted to the open market. The basic problem in PDS is lack of public accountability.

4.2 Debate of Poverty and nutritional intake

Poverty line is drawn on the basis of expenditure that is necessary to secure the minimum
acceptable living standard for work and efficiency. In India, the minimum necessary calorie
intake of a person has been put at 2400 calories per capita per day in rural areas and 2100
calories per capita per day in urban areas. The minimum calorie intake for rural areas has
been kept higher than that in the urban areas, as rural people have to put in more physical
effort than those living and working in urban areas. Those who fail to secure the prescribed
calorie intake levels fall below poverty line and are defined as poor. About 63% of total

1 Source: NSS report No. 510, 2004-2005, published in Kurukshetra, March 2011, 14-20
population in Rural areas of Bihar were below the "Normal level of 2700 Kcal calories intake
(Fixed by NSSO) during 61st round. About 78% of Urban Population in Bihar was living
below the normal -Level of Calorie Per Capita intake (2700 Kcal)”.2

The Planning Commission has worked this cost at Rs.229 per capita per month in rural areas
and Rs.264 for urban areas at 1993-1994 prices. The income requirement is estimated to be
higher for urban area than for rural area, because of the relatively higher expenditure in urban
area on food, health, clothing, housing, etc. During 2004-05, the poverty line in our country
as a whole was fixed at Rs.358.03 for rural areas and Rs.540.40 for urban areas, whereas it
was Rs. 356.36 for rural areas and Rs. 461.40 for urban areas in Bihar State (Table-1.2).3

Fundamentally, the concept of poverty is associated with socially perceived deprivation with
respect to basic human needs. These basic human needs are usually listed in the material
dimension as the need to be adequately nourished, the need to be decently clothed, the need to
be reasonably sheltered, the need to escape avoidable diseases, the need to be (at least)
minimally educated and the need to be mobile for purposes of social interaction and
participation in economic activity. Besides it we must need to recognize that deprivation may
indeed exist in non-material dimensions as well, for instance, gender based or caste-based
discrimination.

Socially perceived deprivation can be considered with respect to each individual basic human
need separately, leading to the corresponding concepts of poverty in that domain. However, it
may that not all the basic human needs are independent of each other. Inability to escape
avoidable diseases, for example, may be related to shelter environment with implications for
nourishment and clothing as well. Apart from interdependence, there is no one-to-one
correspondence between any given basic human need and the commodities and services that
satisfy that need. The same commodity or service may serve different basic needs as much as
any given need may be satisfied by different goods and services.

It is commonly believed that agricultural production directly affects food security. Thus
investments in agriculture are important to ensure food security. However, there is an
increasing concern about global food security in future, largely consequent upon growing
resource scarcity and climate change. The increase or even sustenance of the present level of

2 Department of planning and development, directorate of economics and statistics, government of Bihar, Patna

3 Thesis submitted to the University of Agricultural Sciences, Dharwad by Vinodkumar P. Melinamani On

Inter-Linkages Among Agricultural Research Investment, Agricultural Productivity, Poverty And Food And
production is limited by a number of factors – land constraints, water scarcity, and high
energy prices – along with the uncertain effects of climate change, which has been considered
to be one of the areas of greatest uncertainties for agriculture. The combined effects of higher
average temperatures, greater variability of temperature and precipitation, more frequent and
intense droughts and floods and reduced availability of water for irrigation can be devastating
for agriculture.

5. CONSUMPTION PATTERN IN BIHAR

5.1 Consumption pattern among MPCE classes

Table- 2A: Consumption pattern According to Expenditure Class (Rural Area)

MPCE Percentage of Percentage Percentage Calorie intake Protein intake Fat Intake
class household expenditure on expenditure on per diem per (gm) (gm)
food cereals out of capita (kcal)
total food
expense

1 2.14 66.3 30.9 1482 38.8 16.2

2 2.87 65.0 31.6 1669 45.2 17.1

3 7.26 65.4 30.6 1763 52.9 19.4

4 7.33 65.4 30.3 1825 53.6 21.6

5 7.49 65.8 28.7 1962 56.4 25.7

6 10.25 63.4 27.0 2017 61.6 27.4

7 11.75 64.2 24.8 2121 61.7 61.7

8 13.26 60.7 22.4 2209 64.4 34.8

9 15.17 59.7 20.8 2434 70.0 41.3

10 13.89 54.9 17.4 2630 75.9 48.4

11 5.68 47.7 13.8 2759 80.5 55.2

12 2.90 39.6 10.1 2924 81.6 69.1

Source: Department of planning and development, directorate of economics and statistics, government of Bihar, Patna

Table 2B: Consumption pattern According to Expenditure Class (Urban Area)

MPCE Number of Percentage Percentage Calorie Protein Fat

class household expenditure expenditure intake per intake (gm) Intake
on food on cereals diem per (gm)
out of total capita (kcal)
food expense

1 142 67.4 31.2 1610 45.3 19.4

2 190 62.3 24.5 1635 44.7 24.2

3 146 62.9 24.2 1882 54.9 27.8

4 165 59.5 19.6 1943 65.8 32.4

5 168 55.3 17.7 2055 59.0 37.3

6 152 53.8 15.9 2185 63.9 40.1

7 124 49.2 13.9 2276 66.9 43.5

8 109 47.6 12.1 2397 68.1 50.9

9 89 43.5 10.2 2451 71.2 55.1

10 65 44.0 8.0 3888 151.7 75.0

11 16 38.7 7.0 3660 98.3 95.4

12 13 19.2 2.8 3876 100.2 120.3

Source: Department of planning and development, directorate of economics and statistics, government of Bihar, Patna

The pattern of the graph above (figure 4 and 5) clearly depicts that the lower income group
i.e. those households which comes under lower MPCE classes spends large portion of their
income on food. While higher MPCE classes reflect very less percentage expenditure of their
income on food. This shows that people in rural Bihar under low income group have very
less avenues to spend on other needs viz. education. The graph also shows that lower MPCE
 classes spend a larger portion of their food expenditure on cereals. That means in lower
income group people are feeding themselves to satiate their hunger rather than fulfilling
nutritional needs of the body. Households in lower MPCE classes do not pay much heed for
other micronutrients like minerals and vitamins which come from fruits, vegetables, milk and
fish.
In case of lower income group in both rural and urban consumption pattern, it is evident that
there is very less difference in the expenditure on food and cereals in rural and urban
households (see the bar graph of MPCE class 1 in both urban and rural) but when it comes to
higher income group the gap in expenditure on food and cereals can be noticed. In MPCE
class 12 the percentage expenditure on food in rural area is 39.6 % out of which 10.1 % is for
cereals whereas in urban area it reduced to 19.2 % and 2.8 % respectively.

5.2 Calorie intake per diem per capita in Rural and Urban Bihar

The trend in above graph (Figure 6) again has increasing level of calorie intake depending upon the
income group. Higher MPCE classes show higher calorie intake while lower MPCE classes show
non affordability of minimum calorie requirement needs. The difference in rural and urban calorie
consumption level is very discernible through this graph which shows rural urban divide in
nutrition across all MPCE classes. The calorie consumption in rural area is lower than its urban
counterpart across all MPCE classes. Higher Income groups (e.g. MPCE class 10, 11 and 12 in
above graph) in urban area have much better access to nutrition than its rural counterpart. This trend
not only shows the nutritional gap among MPCE classes but also reflect multidimensionality of
poverty where accessibility, affordability, agricultural productivity and availability of livelihoods
options needed to be analyzed contextually.

Protein and fat consumption pattern in Bihar in rural and urban Bihar reflects that in rural
areas protein intake is lower than urban area across all MPCE classes. In urban areas people
have better access to sources of protein like milk and meat while in rural areas there is a
problem of accessibility and affordability. The graph above shows that the difference of fat
and protein intake is less in lower MPCE classes of rural and urban while in higher MPCE
classes the gap of fat and protein intake gram per unit is much higher.
All trends in above graphs show that cereals consumption is generally much higher in the
rural areas than in the urban, mainly due to the higher consumption of rice by the rural
households. The reverse is the case for Meat/Fish/Eggs and Fruits/Vegetables – the
consumption of these items being higher for the urban households. There has been a marked
decline in the consumption of the Cereal items as a whole over the period and there has been
a switch in food preferences towards non Cereal items such as Meat/Fish and
Fruits/Vegetables in both rural and urban areas if we look at past trends in food consumption
pattern in Bihar. Bihar is going through a transition. Many developmental activities are taking
shape to transform Bihar as a progressive state. It is an opportunity for policymakers to
decide the pattern of growth and development of state specially through focusing on
agriculture production and nutritional security for the masses.
 6. NUTRITIONAL STATUS OF CHILDREN AND WOMEN

For children, anthropometric indicators are typically based on age, height and weight. Three
standard indicators are “height-for-age”, “weight-for-height”, and “weight-for-age”. Low
height-for-age is often referred to as “stunting”, low weight-for-height as “wasting”, and low
weight-for-age as “underweight”. Stunting is a cumulative indicator of nutritional deprivation
from birth (or rather, conception) onwards. It is relatively independent of immediate
circumstances, since height does not change much in the short term. Wasting, by contrast is
usually taken to be an indicator of short term nutritional status. “Weight-for-age” can be seen
as a more comprehensive indicator, which captures stunting as well as wasting: both stunted
and wasted children are likely to fall in the “underweight” category. Thus, if a single
“summary” indicator is to be used, weight-for-age would claim special attention.

In many cases, being short or lean is not a serious impairment. However, there is evidence
that pronounced stunting or wasting in childhood is associated with serious deprivations, such
as ill health, diminished learning abilities, or even higher mortality. More precisely, there is a
great deal of variation in the genetic potential of individuals to be small or large, but
nutritional deprivation in early life, resulting in a failure to attain one’s genetic potential, is
likely to cause lasting harm. While genetics are important at the individual level, they are
much less so – and arguably completely unimportant – at the population level, so that
populations with a high fraction of people who are stunted or underweight are populations
where there is evidence of nutritional deprivation.

Having said this, the overall levels of child under nutrition in Bihar (including not only severe
but also “moderate” undernourishment) are still very high, both in absolute terms as well as
relative to other states. Still the percentage of children with anemia is highest in the state and
undernourishment figures are alarming and needs a quick attention. One recent study of
international data concludes that the rate of decline of child under nutrition (based on weight-
for-age) tends to be around half of the rate of growth of per capita GDP (Haddad et al 2003).If
Bihar is indeed growing as fast as is claimed, there are important requirements of better
nutrition that are being held up, and this is in spite of sustained recent improvements in other
important determinants of child nutrition, such as maternal education and the availability of
safe water.
Bihar has the third highest number of malnourished children in India and the percentage of
underweight children increased from 54.3% to 58.4% in the period between 1999 and 2005
which is really a matter of grave concern for the state and for the nation as whole. According
to UNICEF report it is estimated that 8.33% or 9,74,610 children in Bihar are critically and
severely malnourished and are at the risk of dying. The Eleventh five year plan for the state is
to reduce the percentage of underweight children who are below three years from 58.4%
(India - 45.9) to 27.2%. Likewise the anaemia among women is also very high in state that is
68.3% (15 to 49 years of age) where as the national figure is 56.2% so it is also one of the
important task to look upon. The Eleventh Five year Plan also aim at reducing the figure to
31.7% which is not an easy task to cover until and unless the State and other organisation like
ICDS and Aganwadis take effective effort in reducing it by half until the end of the plan. It’s
very important to note that only 9.7% women in Bihar consume iron and folic acid tablets just
for three months or more when they were pregnant last time. The all India figure for this is
22.3% according to NFHS-3. Candies rich in nutrients like vitamin A, folic acid, iron and
vitamin C are being distributed under the programmes running for the cause like ICDS.

SOCIO ECONOMIC INDICATORS OF BIHAR

Table 3.

The nutritional status of children and maternal nutrition is highly connected to each other and
it well reflects in birth weight. First few years after birth is associated with high growth and
nutritional requirements are also very high and generally malnutrition affects severely in the
early two years of life. The most venerable age is the first six months of the life when the
infant is highly dependent on the mother for feeding this period is termed as “period of
perpetual hunger”. According to the Independent Commission of Health in India 1998, the
infection caused a mildly under nourished child doubles in potential to cause death and it
becomes triple for moderately undernourished and may be as many as eight times for severely
undernourished children. According to NFHS data only 4% of children under 3 years are
exclusively breast-fed in Bihar which is far less than the national figure i.e. 55%. Exclusive
breast-feeding of infants less than five months old is also very low in Bihar (27.9%) as
compared to India which is (60%), Breastfeeding and colostrums feeding practices in Bihar
and India for 2005 data is represented in. Table 3A presents data on the nutritional status of
children and married adults in Bihar compared to India. It may be noted that most of the
nutrition-related data are not comparable for NFHS-1.
Nutritional Status of Children and Married Adults in Bihar (%)

Table 3A

Source: Annual Report 2006-2007, Ministry of Health and Family Welfare, Government of
India, New Delhi.

Figures 3B and 3C clearly shows that the nutritional status of children in Bihar continues to
be the worst in India. Different rounds of NFHS surveys shows that the proportion of children
who are stunted decreased steadily with age from NFHS-2 (54.9%) to NFHS-3
(42.3%),whereas the proportion of underweight and wasted children increased (from 19.9%,
NFHS-2 to 27.7%, NFHS-3) up to the age of 12–23 months and then declined significantly at
age 24–35 months over the five years between the two surveys. Undernourishment prevails
equally among the two sexes i.e. boys and girls but girls are slightly more likely than boys to
be underweight and stunted, whereas boys are slightly more likely to be wasted.
Undernourishment generally increases with birth order. Young children in families with four
or more children are nutritionally the most disadvantaged. It is a matter of concern that the
overall level of malnutrition has increased among children in Bihar from NFHS-2 to NFHS-3

Figure 3B. Nutritional status of children in Bihar under 3 years, NFHS-3 and NFHS-2

Figure 3C. Nutritional status of married adults in Bihar, NFHS-3 and NFHS-2

Weight for height ratio is used to calculate several indicators of women’s nutritional status.
An adult’s height is an outcome of several factors, including nutrition during childhood and
adolescence. A woman’s height is indicative of difficulties which the women are going to
suffer at delivery because small size of the body means proportionate size of the pelvis. For
mothers with short stature the chances of having baby of lower weight also multiplies and the
short size is reflective of the economic class of the women to which she belongs and much
extent it also reflects poverty.

Body mass index (BMI) is defined as the weight in kilograms for height in square metres
(kg/m2). This index can be used to assess both thinness and obesity. High level of nutritional
deficiency among women in Bihar is reflected with BMI below normal which is 43%.
Proportion of women with below normal BMI is differential among different income groups.
Women from households with low standard of living are more than two times likely to have a
low BMI than women from households with a high standard of living.

Anaemia is characterized by a low level of haemoglobin in the blood. Anaemia usually

resolves from a nutritional deficiency of iron, folic acid, vitamin B12 and some other micro
nutrients. This type of anaemia is commonly referred to as iron deficiency anaemia. Iron
deficiency is the most widespread form of malnutrition in India and is estimated at 50%
(Sheshadri 1998). Anaemia has a deep effect on the health of women and children and has a
potential to become an important cause of maternal mortality and pre-natal mortality and
results in increased risk of premature delivery and low birth weight babies.As shown in figure
3D the percentage anaemic women in Bihar have increased from 60.4% NFHS-2 to 68.3%
NFHS-3. The prevalence of disease has a relationship with the level of literacy. Anaemia is
relatively high for illiterate women and women belonging to religions other than Hindu or
Muslim, Scheduled Tribe women and self-employed women. The level of anaemia is also
more in pregnant women than non-pregnant women.

Anaemia prevalence in Bihar, NFHS-3 and NFHS-2. Figure 3D

Iodine deficiency: Around sixty six percent population of Bihar is prone to iodine deficiency.
The percentage population using iodine fortified salt is 37.7% which far below than the
national average which is 56.8%. Around one-fourth of the population in the state uses non-
iodized salt which increases the danger of higher incidence of goitre.

Households Reporting Use of SaltTypes in Bihar and India, 2005 (%) Figure 3E

Source - Coverage evaluation Report 2005

To conclude, it is visible from the above illustrations that the level of undernourishment is
high among the adults and especially among women. A large proportion of women is with
below normal BMI and significantly high percentage of married women and pregnant women
are anaemic. Another cause for concern is the increased level of anaemia among children,
married women and pregnant women between NFHS-2 and NFHS-3, which raises issues
related to the effectiveness and access to nutritional services and schemes for children and
pregnant women. Young and married women and women with pregnancy many of whom are
not able to access health care services.
 7. HURDLES IN ACHIEVING THE NUTRITIONAL GOALS
• Nutrition takes a back seat in health and agriculture planning and execution programs
which are the major source of improving nutritional intake among the people.
• The improvement in nutritional intake is not considered as a target or goal by the
government and planning agencies with measurable parameters for monitoring in
programs like National Horticulture Mission and National Rural Health Mission.
• The involvement of rigid and bureaucratic procedure and the top down approach of the
agencies without sensitizing the community and making them involved in the
execution of programs.
• The lack of accountability, governance, transparency, misinterpretation of data and
unfulfilled target are other hurdles in program implementation.
• The lack of awareness among the people and poor significance to nutrition in
academics and other professional sectors. The lack of initiatives like mass awareness
programs in villages and towns.
• The Gender biasness and the ignorance of women and child health issues and
educations.
• The poor coordination and synchronization between the programs and the functioning
of the departments and ministries.
 4. RECOMMENDATIONS

Malnutrition is very well reflected by the indicators such as morbidity and mortality. The
stakeholders recognized young children, adolescents, pregnant and lactating women and
elderly as the most vulnerable. The causes of malnutrition are many the most prominent of
which is poverty and effective panacea would have been equitable development.
Some other measures that should be taken and policies should be directed to keep the
undernourishment eradicated. Here we opine some of them:
1. State should ensure food for all by strengthening different exiting state or national
level schemes and introducing newer ones and also promoting the employment
generating schemes simultaneously.
2. Supplementary feeding should reach all children through existing institutions and
programmes such as Anganwadi and School Mid Day Meal Programmes also better
monitoring system should be evolved to ensure the reach to each and every children in
need.
3. Integrated Child Development Scheme (ICDS) should remain the key strategy. The
current ICDS Scheme should be strengthened into a comprehensive early childhood
care programme improvements in quality and outreach.
4. Policies and schemes should be such that each and every child in the respective states
and country as whole is assured of nutrition, pre-school education and health care and
every working mother should be assured of day care support for young children.
5. Implement preventive measures against epidemics and recurrent infections such as
diarrhoea, cholera, etc. in young children through school health programme.
6. The government should play a more active role in creating awareness for its various
people oriented schemes. Emphasis should be given more on disseminating the
beneficiary messages of the schemes to its target audience through various tools of
communication like community radio, folk songs, theatre and other interactive
medium, so that it ensure more participation of people.
7. Especially abled children with physical and mental challenges should be provided
special nutrition with a flexible partnership approach with the civil society.
8. Among all these food security measures, public understanding of good dietary habits
as suitable to different cultural and economic contexts should be promoted through
appropriate nutrition and education programmes.