Dietary Diversity, Nutrition and Food Safety S. Mahendra Dev and Vijay Laxmi Pandey 1 Introduction India is faced with a triple burden of malnutrition, viz., under-nutrition, micronutrient deficiency and over-nutrition. In 2017, about 68.2% of the total death of children under-5, was due to malnutrition in India (LANCET, 2019). The prevalence of stunting among children under-5 was high at 34.7% during 2016–18 (MoHFW, 2019). The body mass index of 23% of women aged 14–49 was below normal in 2015–16 (NFHS, 2017). Moreover, two-thirds of India’s population is estimated to be micronutrient deficient (Rao et al., 2018), which exists despite impressive economic growth (6% in 2018–19), a high level of food grain production and an increase in per capita net availability of food grains (GoI 2020). However, there has been a significant decline in the percentage of the population below the poverty line (Tendulkar method) from 37.2% in 2004–05 to 21.9% in 2011–12 (GoI, 2013).1 Along with undernutrition, overweight and obesity have emerged as severe public health problems leading to non-communicable diseases (NCD). In 2017, about 63% of deaths in India were attributable to NCDs (WHO, 2018). It is vital to address malnutrition challenges, especially in children and women, to ensure proper cognitive growth, overall health and productivity. 1 The government has not released the latest 2017–18 consumer expenditure data due to comparison problems. S. Mahendra Dev · V. L. Pandey (B) Indira Gandhi Institute of Development Research, Gen. Vaidya Marg, Goregaon (East), Mumbai 400065, India e-mail: vijay@igidr.ac.in S. Mahendra Dev e-mail: profmahendra@igidr.ac.in © The Author(s) 2022 R. Chand et al. (eds.), Indian Agriculture Towards 2030, India Studies in Business and Economics, https://doi.org/10.1007/978-981-19-0763-0_3 39 40 S. Mahendra Dev and V. L. Pandey Sustainable Development Goal (SDG)–2 aims to end hunger, achieve food security, improve nutrition and promote sustainable agriculture. Dietary patterns influence the production portfolio and sometime lead to environmental degradation. Food production is one of the major causes of global environmental change (Lancet, 2019). Therefore, interventions are needed to secure a sustainable diet that delivers food and nutrition security for all in a manner that does not compromise future generations’ ability to ensure food and nutrition security (HLPE, 2014). The present paper aims to study dietary pattern and malnutrition trends, impact of different food and nutrition security interventions. The issues related to healthy diets and food safety are discussed and pathways for a safe and healthy diet to achieve nutritional security in India are suggested. 2 Changing Dietary Pattern Consumption expenditure on different food groups and intake of calorie, protein and fat is studied using the National Sample Survey (NSS) 50th, 61th and 68th rounds.2 National Family Health Survey second, third and fourth rounds (NFHS2, NFHS-3 and NFHS-4) are used for understanding the trends in micronutrient consumption. Comprehensive National Nutritional Survey (CNNS) for the period 2016–18 (MoHFW, 2019), has also been referred for the latest available data on consumption pattern and nutritional status among the children and adolescents. 2.1 Consumption Expenditure on Food and Non-food Groups The monthly per capita consumption expenditure (MPCE) has increased (in real terms) from INR 943 to INR 1287 in rural areas and from INR 1608 to INR 2477 in urban areas during 1993–94 to 2011–12. A steady decline in the percentage of food consumption expenditure in rural and urban areas was observed with steeper decline in urban areas than that in the rural areas (Fig. 1a, b). This decline is in line with Engel’s Law, that the proportional share of food expenditure declines in the household budget with increase in income as shown in Fig. 2. Over time, India’s food basket has also got transformed. There are changes in the dietary pattern in rural and urban areas as per capita monthly consumption of edible oils, vegetables, egg, fish and meat has almost doubled from 1993–94 to 2011–12. Consumption of pulses remained nearly stagnant while of cereals reduced in the same period (Table 1). The dominance of cereals in total expenditure has also significantly decreased even among the poorest in rural and urban areas (Fig. 3a, b). A decline 2 As National Statistical Office (NSO) has not released the 2017–18 consumer expenditure survey results, we could analyse consumption expenditure data only up to 2011–12. The uniform reporting period is being used from NSS reports of these rounds. Dietary Diversity, Nutrition and Food Safety 41 a 64.3 65.6 64 non-food expenditure 63.2 55 35.7 34.4 36 36.8 53.6 45 46.4 48.6 51.4 Percentage expenditure Percentage expenditure b food expenditure food expenditure 60 59.1 40 40.9 non-food expenditure 61.5 59.3 57.5 56.4 54.7 45.3 43.6 40.7 42.5 38.5 Year Year Percentage expenditure Fig. 1 a Food and non food expenditure: rural area (per cent). b Food and non food expenditure: urban area (per cent). Source NSSO (2013) 70 60 50 40 30 20 10 0 MPCE Class Rural Urban Fig. 2 Share of food in consumption expenditure (per cent) for different income class (2011–12). Source NSSO, 2013 Table 1 Per capita per month consumption of different food components Year Cereals (kg) Pulses (kg) Edible oils Vegetables (kg) (kg) Milk (litre) Egg (No.) Fish and meat (kg) 1993–94 13.4 0.76 0.37 2.71 3.94 0.64 0.26 2004–05 12.12 0.71 0.48 2.92 3.87 1.01 0.30 2011–12 11.22 0.78 0.67 4.33 4.33 1.94 0.50 10.6 0.86 0.56 2.91 4.89 1.48 0.34 Rural areas Urban areas 1993–94 2004–05 9.94 0.82 0.66 3.17 5.11 1.72 0.37 2011–12 9.28 0.9 0.85 4.32 5.42 3.18 0.57 Source NSSO 1996, NSSO 2007, NSSO 2014 42 S. Mahendra Dev and V. L. Pandey a beverages etc, Areas 4.2 50 7.7 3.3 4.4 9.5 3.8 20 10 24.3 4.2 7.9 3.3 3.7 8.8 3.8 22.3 sugar 4.5 8 3.3 4.6 8.5 3.1 18.1 0 5.8 6.7 3.6 3.8 9.1 3.1 12.1 vegetables, fruits &nuts egg, fish & meat edible oil percentage expenditure Percentage expenditure 60 30 beverages etc, 60 salt & spices 70 40 b 50 salt & spices 7.2 6.4 40 30 20 10 milk & products 8.2 3.4 4.4 9.8 sugar 6.2 7.1 7.5 3.1 3.1 6.7 2.7 3.5 7.9 2.1 3 8.7 2.8 14.1 12.4 10.1 vegetables, fruits &nuts egg, fish & meat 5.7 2.8 2.7 7.8 2.1 7.4 edible oil milk & products 0 pulses & products Year pulses & products cereals &products cereals &subsitute Year Fig. 3 a Percentage expenditure on different food components in rural areas. b Percentage expenditure on different food components in urban areas in expenditure towards cereals reflects Bennett’s Law, which suggests that with the increase in income, diets get more diversified and move away from staple grains. However, in the same period, share of expenditure on non-staples, pulses and pulses products, milk and milk products also decreased in both the areas. The spending on meat, egg and fish and beverages increased in the rural areas from 1993–94 to 2011–12 (Fig. 3a). 2.2 Calorie Intake Trends A significant decline in the share of expenditure on cereals, main constituents and major energy source of Indian diet (Fig. 4a), in the food budget is observed, and evidence showed that it is possibly due to lifestyle changes, urbanization, b 80 70 60 50 71.01 67.54 64.16 61.1 58.52 56.08 55.01 51.64 40 Rural Urban Year Share of cereals (Percentage) Share of cereals(Percentage) a 80 70 69.42 60 59.41 50 66.37 56.16 62.45 53.69 Rural Urban 40 1993-94 2004-05 2011-12 Year Fig. 4 a Share of cereals in total calorie intake. b Share of cereals in total protein intake Fig. 5 Trend in calorie intake (Kcal) in rural and urban areas Calorie (Kcal) Dietary Diversity, Nutrition and Food Safety 43 2200 2100 Rural PCC 2000 Urban PCC 1900 1993-94 2004-05 2011-12 Year mechanization, dietary diversification, etc. (Deaton & Dreze, 2009; Pingali et al., 2019). The calorie intake was lower than the recommended guidelines of 2100 kcal in urban and 2400 kcal in rural areas in 1993–94, and it further declined by 2011– 12 (Fig. 5). The calorie intake improved in both the areas in 2011–12, compared with 2004–05 due to better coverage of the public distribution system (Srivastava & Chand, 2017) and increased income. Recommended calorie intake guidelines were revised and lowered to 2090 kcal per person per day in urban areas and 2155 kcal per person per day in rural areas by Indian Council of Medical Research. Even with the revised guidelines, average calorie consumption was below the norms in rural and urban areas. However, it was above the revised norms in the highest 50 and 60% of the MPCE classes in rural and urban areas, respectively (Fig. 6a, b). The average calorie consumption of the poorest and the richest class in rural and urban areas is significantly different, though, the gap has narrowed in both rural and urban areas (Fig. 6a, b). The Gini coefficients of inequality in calorie intake reduced from 0.16 to 0.13 in rural areas and 0.18 to 0.14 in urban areas (Srivastava & Chand, 2017). This improvement might be attributable to better food access because of increased income and better coverage of government food subsidy programme. In the higher decile classes (5th decile class and above), calorie intake reduced in both the areas, and the highest decline is in the richest decile. According to Deaton and Dreze (2009), the calorie Engel curve’s downward shift is due to lower calorie a b 3500 4000 Calorie (Kcal) Calorie (Kcal) 3000 5000 2500 2000 1500 1000 3000 2000 1000 0 0-5 5-10 10-20 20-30 30-40 40-50 50-60 60-70 70-80 80-90 90-95 95-100 0 1993-94 MPCE Class 2004-05 2011-12 0-5 5-10 10-20 20-30 30-40 40-50 50-60 60-70 70-80 80-90 90-95 95-100 500 MPCE Class 1993-94 2004-05 2011-12 Fig. 6 a Per capita per day intake of calorie (Kcal) in rural areas in different MPCE class. b Per capita per day intake of calorie (Kcal) in urban area in different MPCE class 44 S. Mahendra Dev and V. L. Pandey Table 2 Average number of meals consumed by the households outside the house in last 30 days Year Free meals Meals on payment Rural Urban Rural Urban 1993–94 6 7 1 4 2004–05 11 8 1 3 2011–12 13.7 8.05 1.44 5.45 Source NSS reports requirements, mainly associated with better health and lower activity levels. The calorie consumption decreases even when there is undernutrition. However, number of meals taken outside the house is increasing (Table 2), and calorie consumption calculations ignore these consumed calories. The share of cereals in total energy intake is highest for lowest decile class in 2011–12 (Fig. 7a, b). This indicates poor diet quality of households in lower decile classes than the higher decile classes. According to dietary guidelines, balanced diet should have 50–60% of total calories from carbohydrates, about 10–15% from proteins and 20–30% from fats (NIN, 2011). EAT-LANCET norms suggest that total calories from cereals should be about 32.44% for a healthy diet (Willett et al., 2019). These evidence clearly show that Indian diets are unhealthy across all the income classes as contribution of cereals in calorie intake is quite high. The highest contribution in calorie intake after cereals was oil and fats, with 9.01% in rural areas and 12.2% in urban areas in 2011–12 (Table 3). The increase in the share of oils and fats from 1993–94 to 2011–12 was 3.7% point in rural areas and a 3.4% point in urban areas. However, the share of vegetables and fruits in total calorie intake has declined despite their increased consumption, both in rural and b 90 90 80 Share of cereals (Percentage) Share of cereals (Percentage) 80 70 60 50 40 30 20 10 0 70 60 50 40 30 20 10 0-5 5-10 10-20 20 - 30 30-40 40-50 50-60 60-70 70-80 80-90 90-95 95-100 0 1993- 94 MPCE class 2004-05 2011-12 0-5 5-10 10-20 20 - 30 30-40 40-50 50-60 60-70 70-80 80-90 90-95 95-100 a 1993- 94 MPCE class 2004-05 2011-12 Fig. 7 a Share of cereals in total calorie intake (Rural). b Share of cereals in total calorie intake (Urban) Dietary Diversity, Nutrition and Food Safety 45 Table 3 Percentage of calorie consumption from food groups other than cereals Roots & tubers Sugar & honey Pulses, nuts & oilseeds Veg & fruits Meat, eggs & fish Milk & milk products Oils & fats Misc food, food products & beverages Rural 1993–94 2.65 4.8 4.92 2.02 0.68 6.15 5.34 2.41 2004–05 2.95 4.78 4.98 2.23 0.76 6.42 7.36 2.98 2011–12 3.01 4.9 5.2 1.85 0.82 7.07 9.01 7.04 Change (1993–94 to 2011–12) 0.36 0.10 0.28 -0.17 0.14 0.92 3.67 4.63 1993–94 2.54 6.21 6.05 3.26 1.02 8 8.79 5.6 2004–05 2.82 5.69 6.68 3.17 1.05 8.61 10.58 5.32 2011–12 2.73 5.62 6.41 2.62 1.13 9.07 12.17 8.61 Change (1993–94 to 2011–12) 0.19 -0.59 0.36 -0.64 0.11 1.07 3.38 3.01 Urban Source NSS reports urban areas. The highest percentage point increase was observed in miscellaneous food category, mostly fast food, processed food, sugary beverages etc. (Table 3). This diversion of calorie sources towards unhealthy foods might be one of the causes of increasing overweight in India. 2.3 Protein Intake Trends Fig. 8 Per person per day intake of protein Protein intaake (Grams) The average consumption of protein declined in rural and urban areas (Fig. 8) in 62 60 58 56 54 52 50 Rural Urban 1993-94 2004-2005 2009-2010 2011-2012 Year 46 S. Mahendra Dev and V. L. Pandey b 100 80 60 1993-94 40 2004-05 20 2011-12 0 MPCE class Protein intake ( Grams) Protein intake (Grams) a 100 80 60 1993-94 40 2004-05 20 2011-12 0 MPCE class Fig. 9 a Protein intake in different MPCE class in rural areas (Grams). b Protein intake in different MPCE class in urban areas (Grams) 2011–12 compared to 1993–94. The average intake of protein is above the norms in both rural and urban areas. The recommended dietary allowance (RDA) norms for protein consumption are 48 g and 50 g per person per day in urban and rural areas, respectively (GoI, 2014). However, there is a vast gap in protein intake among the MPCE classes. Wealthier households consume higher than RDA norms. The average consumption of the poorest households is below the RDA norms in rural and urban areas (Fig. 9a, b). Though protein consumption in the lowest decile classes (first and second) has improved from 1993–94 to 2011–12, still there is a need to increase the protein intake by the poor households. Cereals are also the primary source of protein in the Indian diet (Fig. 4b), followed by pulses, milk and milk products and egg, fish, meat and other miscellaneous foods (Table 4). Though cereals are a moderate source of protein (NIN, 2017), they become the major source of protein due to their large quantity of consumption. The percentage point increase for other food products covering fast food, processed food, etc., is highest (3.34%) in rural areas. Protein-rich foods such as milk and milk products and egg, fish and meat have recorded a modest increase in the share of total protein intake. 2.4 Fat Intake Trends The per capita per day consumption of fat increased significantly by 32.5 and 25% in rural and urban areas, respectively, during 1993–94 to 2011–12 (Fig. 10). The intake is much higher, in urban areas (52.5 g), than the RDA norms of 26 g (RDA for rural areas is 28 g). There is a considerable gap in fat intake among the MPCE classes. The average consumption of the poorest households is below the RDA in rural areas (Fig. 11a, b). However, fat consumption in the urban areas is above the RDA (25 g) across all the MPCE classes. Dietary Diversity, Nutrition and Food Safety 47 Table 4 Percentage of protein intake from different food groups Cereals Pulses Milk & milk products Egg, fish & meat Other food 1993–94 69.42 9.76 8.81 3.66 8.35 2004–05 66.37 9.47 9.28 3.98 10.84 2011–12 62.45 10.57 10.56 4.73 11.69 Change (1993–94 to 2012) -6.97 0.81 1.75 1.07 3.34 1993–94 59.41 11.54 11.66 5.29 12.1 Rural Urban 2004–05 56.16 11 12.33 5.47 14.98 2011–12 53.69 12.41 13.57 6.39 13.94 Change (1993–94 to 2011–12) -5.72 0.87 1.91 1.10 1.84 Source NSS reports 60 Fat intake (Grams) Fig. 10 Per person per day consumption of fat 50 40 30 Rural 20 Urban 10 0 1993-94 2004-05 2011-12 Year 1993-94 2004-05 70-80 MPCE class 100 80 60 1993-94 40 2004-05 20 2011-12 0 90-95 50-60 30-40 0-5 2011-12 Fat intake (Grams) b 80 70 60 50 40 30 20 10 0 10-20 Fat intake (Grams) a MPCE class Fig. 11 a Intake of fat for different MPCE class in rural areas (Grams). b Intake of fat for different MPCE class in urban areas (Grams) 48 S. Mahendra Dev and V. L. Pandey 2.5 Micronutrients Intake Percentage of women An adequate amount of micronutrient intake is necessary for sound health. The problem of chronic micronutrient deficiency (hidden hunger) is relatively severe (George & McKay, 2019). Milk and milk products, dark and green leafy vegetables, fruits, pulses, fish, egg and meat, are rich sources of micronutrients but its content in each food is different; therefore, various foods are required to get sufficient vitamins and minerals. The NFHS-4 data (NFHS-4, 2017) show that only 45 and 38% of women between the age 15–49 years consumed pulses and dark and green leafy vegetables, respectively, at least once a week in 2015–16. The data showed an increase in the percentage of women in the age group 15–49 years consuming milk and curd, pulses, egg, fish and fruits at least once a week but decreases for leafy vegetables, from 1998–99 to 2015–16 (Fig. 12). There is a significant difference in the consumption of milk, curd and fruits between rich and poor households (Fig. 13). Recent Comprehensive National Nutritional Survey 2016–18 (CNNS) shows that among school-age children (5–9 years) and adolescents (10–19 years), consumption of dairy products was less frequent (61% among school-age children and 60% among 50 40 30 20 10 0 45.1 38.3 33.2 37.4 28.4 22.9 1998-99 2005-06 Milk or curd Pulses or Dark & Fruits beans green leafy vegetables Food groups Eggs Fish 2015-16 Percentage of women Fig. 12 Consumption of different food by women between 15–49 years at least once a week. Source NFHS-2 (2000), NFHS-3 (2007), NFHS-4 (2017) 100 80 60 40 20 0 Poor (Lowest Quantile Class) Rich (Highest Quantile Class) Food groups Fig. 13 Consumption of different foods at least once in a week by women aged 15–49 years in poor and rich households (2015–16). Source NFHS-4 (2017) Dietary Diversity, Nutrition and Food Safety 49 adolescents) and of fruits, eggs and fish or chicken or meat was even less regular. The report shows that mothers’ education and household wealth significantly impact the consumption of these food groups as well as of unhealthy foods such as fried food and aerated drinks (Fig. 14a, b; Fig. 15a, b). The mean level of consumption of various micronutrients among the adult women (≥ 18 years of age and involved in sedentary work) show a decline in intake of almost all the micronutrients except for thiamine and niacin, between 1996–97 and 2011– 12 in the rural areas (Table 5). The intake of calcium, vitamin A and vitamin C is much below the RDA. The gap from RDA in iron intake may be the primary cause of anaemia in women of reproductive age. According to CNNS, in 2016–18, about 28 and 22% of adolescents had anaemia and iron deficiency, respectively. Iron deficiency was much higher in adolescent women (31%) than men adolescents (12%). The CNNS also reported that children and adolescents in urban areas had a higher prevalence of iron deficiency than their rural counterparts. Prevalence of deficiency of vitamin A (16%) and vitamin zinc (32%) was also considerably high Percentage of children a 100 80 60 40 20 0 No Schooling <5 yrs completed 5–7 yrs completed 8–9 yrs completed 10–11 yrs completed >12 yrs completed Maternal Education Milk or curd Dark Green Leafy Vegetables Fruits Eggs Fish Chicken or Meat Fish or Chicken or Meat Fried Foods Aerated Drinks No Schooling 5–7 yrs completed Percentage of children b 100 50 0 <5 yrs completed 8–9 yrs completed 10–11 yrs completed >12 yrs completed Maternal Education Milk or curd Dark Green Leafy Vegetables Fruits Eggs Fish Chicken or Meat Fish or Chicken or Meat Fried Foods Aerated Drinks Fig. 14 a Consumption of food groups by children of ages 5–9 years at least once per week (Percentage). Source MoHFW 2019. b Consumption of food groups by children of ages 10–19 years at least once per week (Percentage). Source MoHFW 2019 50 S. Mahendra Dev and V. L. Pandey b 100 Percentage of children Percentage of children a 80 60 40 20 0 Poorest 90 80 70 60 50 40 30 20 10 0 Richest Poorest Richest Fig. 15 a Consumption of food groups by children of age 5–9 years at least once per week. b Consumption of food groups by children of age 10–19 years at least once per week Table 5 Mean intake of micronutrients (per day) among adult women (≥ 18 years of age) for sedentary worker Non-pregnant non-lactating women Micronutrients Calcium (mg) Iron (mg) Vitamin A (µg) Thiamine (mg) Riboflavin (mg) Niacin (mg) Vitamin C (mg) 1996–97 593 24.1 311 1.1 1 12 44 2005–06 443 13.8 254 1.1 0.6 14.2 47 2011–12 372 14.4 251 1.3 0.8 14 39 RDA 600 21 600 1.1 1.3 14 40 Pregnant women Calcium Iron Vit A Thiamin Riboflavin Niacin Vit.-C (mg) (mg) (µg) (mg) (mg) (mg) (mg) 1996–97 575 24.3 269 1.1 0.9 12 39 2005–06 456 14 261 1.1 0.6 13.7 42 2011–12 418 13.7 291 1.3 0.8 13.8 43 RDA 1200 35 800 1.2 1.4 14 60 Calcium Iron Vit A Thiamin Riboflavin Niacin Vit.-C (mg) (mg) (µg) (mg) (mg) (mg) (mg) 1996–97 553 26.7 277 1.3 1 14 40 2005–06 447 14.7 249 1.2 0.6 15.5 46 2011–12 411 15.8 304 1.4 0.8 15.5 47 RDA 1200 21 950 1.2 1.45 15.5 80 Lactating women Source NNMB 2006, NNMB 2012 Dietary Diversity, Nutrition and Food Safety 51 among adolescents (MoHFW 2019). There is a need to give more focus on the nutritional status of adolescent women. There is a structural shift in the dietary pattern and it points towards India’s nutrition transition (Drewnowski & Popkin, 1997). A dietary shift towards high-value food commodities such as vegetables and animal-sourced foods would significantly impact the agricultural production system and environment. The intake of calorie and protein has reduced, and the intake of micronutrients is still very low. The average consumption of protein is above the RDA but below it in the poorest households. The contribution of non-cereals items in calories and proteins is increasing in both rural and urban areas. At the same time, the consumption of unhealthy foods such as processed and fast foods, beverages, etc., increased (Table 3). However, these trends are based on quite old data sets, and to make meaningful policy suggestions the recent shift in dietary pattern needs to be understood. In India, rising income, demographic transition and the spread of retail chains have transformed households’ dietary habits (Pingali et al., 2019; Shetty, 2002). Food expenditure elasticities have also changed over time, contributing to nutrition transition. Kumar et al. (2016) showed that consumers spend additional income on spices and beverages, followed by animal products. Cereals are losing their importance in Indian diets, and their demand has become more income inelastic and price elastic suggesting that cereals are a substitute rather than a complement to animal products in a diet (Law et al., 2019). Both price and non-price factors were responsible for changes in consumption patterns. 3 Malnutrition Trends Malnourished children and adolescents are at increased risk of impaired growth, poor cognitive development, low immunity and mortality (Black & Dewey, 2014). In India, stunting among children under five declined from 48% in 2005–06 to 38.4% in 2015– 16 at an average rate of 1% per year (Table 6). Underweight among children under-5 also declined from 42.5% to 35.7%, a 0.7% decline per year during this period. According to CNNS, stunting and underweight among children under-5 was even lower at 35% and 33%, respectively, during 2016–18. On the other hand, wasting has slightly increased (19.8 to 21% during 2005–06 to 2015–16) as per NFHS-4 (2017) data; however, CNNS shows that wasting was 17% during 2016–18. Malnutrition and anaemia for children and women is higher in rural than that in urban areas (MoHFW, 2019). Although anaemia decreased for children and women, and BMI improved for women, the levels are still not satisfactory. Around 58% of children and 53% of women were anaemic in 2015–16 (Table 6). Malnutrition is 51% in the lowest wealth quintile in 2015–16. It is very high and nearly 2.5 times of malnutrition levels than the highest quintile (Table 7). Scheduled castes and Scheduled tribes have 10% points higher malnutrition than other castes. No education category has 20% points higher malnutrition than the category with secondary or more (Table 7). Maternal education influences nutrient intake and 52 S. Mahendra Dev and V. L. Pandey Table 6 Nutritional status of children under five years and women (15–49): all India, per cent Total (Rural + Urban) 2015–16 (NFHS-4) Children under 5 years 2005–06 (NFHS-3) 2015–16 (NFHS-4) Rural Urban Stunting (height for age) 48.0 38.4 41.2 31.0 Underweight (weight for age) 42.5 35.7 38.3 29.1 Wasting (weight for height) 19.8 21.0 21.5 20.0 Anaemia among children 69.4 58.4 59.4 55.9 Anaemia among women 55.3 53.0 54.2 50.8 BMI below normal (women) 35.5 22.9 26.7 15.5 Women (15–49 years) Sources NFHS-3 (2007) and NFHS-4 (2017) Table 7 Nutrition status of children under five years, stunting (height for age): all India, 2015–16 Wealth Quintile Stunting Social groups (per cent) Stunting Education (per cent) Stunting (per cent) Lowest 51 Scheduled Caste 43 No education 51 Second 44 Scheduled Tribe 44 Primary complete 44 Middle 36 Other Backward Class 39 Secondary or more complete 31 Fourth 29 None of them 31 Highest 22 Source NFHS-4 (2017) reduces malnutrition in children under-5 (Figs. 14a, 16, Jose et al., 2020; Pandey et al., 2016). However, the decline in malnutrition is much higher during 2005–06 to 2015– 16 compared to 1998–99 to 2005–06. Despite the non-improvement of diet quality in terms of protein and quantity of micronutrients at the aggregate level, the nutritional outcomes are getting better. The decline in malnutrition depends on several 50 0 HAZ WHZ WAZ No Schooling <5 yrs completed 5–7 yrs completed 8–9 yrs completed 10–11 yrs completed >12 yrs completed Fig. 16 Maternal education and anthropometry of children (0–4 years). Source MoHFW 2019 Dietary Diversity, Nutrition and Food Safety 53 multidimensional factors—(i) increased protein intake in the lowest 20% of the MPCE class, (ii) expansion and improvement of several programmes targeting a mix of direct and indirect causes of undernutrition, (iii) increasing efficiency in these programmes’ delivery systems and (iv) improvements in drinking water, sanitation, hygiene (WASH) and women’s literacy rate. Studies showed that hygiene and sanitation are strongly associated with nutritional status, especially for children (Jose et al., 2020; Shively, 2015). The NFHS-5 fact sheets of key indicators were released in December 2020 for 22 States and UTs. Table 8 presents comparison of NFHS-5 with NFHS-4 for six major states and shows an increase in: (i) children’s dietary adequacy, drinking water, sanitation facilities, clean cooking fuels, women’s education and women’s empowerment, (ii) stunting in children under-5 in Gujarat, Maharashtra and West Bengal (WB), (iii) proportion of severely wasted under-5 children in all the states except Karnataka, (iv) diarrhoea in children in all the five states except Gujarat, (v) underweight children under-5 in Gujarat, Maharashtra and WB, (vi) percentage of overweight children in all six states. The overweight children are 2% more than wasted children. Anaemia among the children between age 6–59 months increased in all the states, and among women aged 15–49 years it increased in all the states except Andhra Pradesh (Table 8). The worsening of nutritional status despite improvement in WASH, maternal education and programme coverage could be due to decline in household income, poor maintenance of sanitation facility, increase in environmental pollution, etc., but it has to be explored further once full data is made available. India is also suffering from increase in overweight and obesity in the population (8.1% point (12.6–20.7%) among the women during 2005–06 to 2015–16) that poses more significant risks for NCDs (MoHFS, 2019). It increased by 9.3% points (9.3–18.6%) among the men during the same period. Undernutrition in utero and early childhood can affect individuals to become overweight and develop NCD in adulthood (WHO, 2018). According to 2019 CNNS, overall, 2% of children under5 were overweight or obese during 2016–18. In the well-nourished population, it is normal. But in India, as almost 20% of under-5 children were wasted, with the mean weight-for-length/height z-score (WHZ score) for the population being -1.0, the prevalence of overweight or obese at 2% was considered significantly higher and could indicate rise of overweight and obesity in the country (MoHFW, 2019). 4 Different Interventions and Impact Policies related to social protection are important as they would directly deliver support to the needy. Research showed that risk and vulnerability justification should be added since the poor do not have formal instruments for risk mitigation and coping (Devereux, 2006). In order to alleviate poverty and achieving food security, India adopted a twofold strategy of letting the economy grow fast and attacking poverty directly through AP Characteristics Bihar Gujarat Karnataka Maharashtra 54 Table 8 Comparing status of child feeding, nutritional outcome and prevalence of diseases in children under-5 ([FHS -5 (2019–20) and NFHS-4 (2015–16)] WB NFHS-5 NFHS-4 NFHS-5 NFHS-4 NFHS-5 NFHS-4 NFHS-5 NFHS-4 NFHS-5 NFHS-4 NFHS-5 NFHS-4 Women with 10 or more years of 39.6 schooling (%) 34.3 28.8 22.8 33.8 33 50.2 45.5 50.4 42 32.9 26.5 Population with an improved drinking-water source (%) 96.7 95.6 99.2 98.4 97.2 95.9 95.3 95.3 93.5 92.5 97.5 97.2 Population that use an improved sanitation facility (%) 77.3 54.4 49.4 26.5 74 63.6 74.8 57.8 72 52.3 68 52.8 62 37.8 17.8 66.9 52.6 79.7 54.7 79.7 59.9 40.2 27.8 54.2 71 56.6 53.3 52.3 9 6.5 23.4 19.6 Households using clean cooking 83.6 fuel (%) Child feeding Children under age 6 months exclusively breastfed (%) 68 70.2 58.9 53.4 65 55.8 61 Children age 6–23 months receiving an adequate diet (%) 9.3 7.6 10.9 7.5 5.9 5.2 12.8 8.2 Nutritional status and diahorrea among children under-5 31.2 31.4 42.9 48.3 39 38.5 35.4 36.2 35.2 34.4 33.8 32.5 Wasted (%) 16.1 17.2 22.9 20.8 25.1 26.4 19.5 26.1 25.6 25.6 20.3 20.3 Severely wasted (below-3 standard deviations) 6 4.5 8.8 7 10.6 9.5 8.4 10.5 10.9 9.4 7.1 6.5 Underweight 29.6 31.9 41 43.9 39.7 39.3 32.9 35.2 36.1 36 32.2 31.6 Overweight 2.7 1.2 2.4 1.2 3.9 1.9 3.2 2.6 4.1 1.9 4.3 2.1 Prevalence of diarrhoea in the 2 weeks preceding the survey (%) 7.2 6.6 13.7 10.4 8.2 8.4 5.3 4.5 8.9 8.5 6.5 5.9 (continued) S. Mahendra Dev and V. L. Pandey Stunted (%) AP Characteristics Bihar Gujarat Karnataka Maharashtra WB NFHS-5 NFHS-4 NFHS-5 NFHS-4 NFHS-5 NFHS-4 NFHS-5 NFHS-4 NFHS-5 NFHS-4 NFHS-5 NFHS-4 Prevalence of symptoms of acute 2.4 respiratory infection in the 2 weeks preceding the survey (%) 0.5 3.5 2.5 1 1.4 1.5 1.2 3.2 2.4 2.8 3.3 Anaemia among children and adults Children age 6–59 months who are anaemic (< 11.0 g/dl) (%) 63.2 58.6 69.4 63.5 79.7 62.6 65.5 60.9 68.9 53.8 69 54.2 Non-pregnant women age 15–49 years who are anaemic (< 12.0 g/dl) (%) 59 60.2 63.6 60.4 65.1 55.1 47.8 44.8 54.5 47.9 71.7 62.8 Pregnant women age 15–49 years who are anaemic (< 11.0 g/dl)(%) 53.7 52.9 63.1 58.3 62.6 51.3 45.7 45.4 45.7 49.3 62.3 53.6 60 63.5 60.3 65 54.9 47.8 44.8 54.2 48 71.4 62.5 All women age 15–49 years who 58.8 are anaemic (%) Dietary Diversity, Nutrition and Food Safety Table 8 (continued) Source NFHS-4 (2017) and NFHS-5 (2021) 55 56 S. Mahendra Dev and V. L. Pandey poverty alleviation programmes. We first examine here the trends in poverty and the role of direct social protection programmes before going to the individual schemes. 4.1 Poverty Trends Based on NSS Consumer Expenditure data there are two conclusions on the trends in poverty. (i) Datt et al. (2016) showed that poverty declined by 1.36% points per annum in post-1991 compared to that of 0.44% points per annum prior to 1991. This study also showed that among other things, urban growth is the most important contributor to the rapid reduction in poverty even in rural areas in post-1991 period. Second conclusion is that within the post-reform period, poverty declined faster in 2000s than in 1990s. The official estimates based on the Tendulkar poverty lines showed that poverty declined much faster during 2004–05 to 2011–12 as compared to the period 1993–94 to 2004–05. In fact, the number of poor came down by 137 million during 2004–05 to 2011–12 while it increased by 3.4 million during 1993–94 to 2004–05. According to the Rangarajan Committee methodology, the decline from 2009–10 to 2011–12 is 92 million.3 Faster reduction in poverty is true even on the basis of multidimensional poverty index (MPI). According to the Report of the Global MPI, 2019 (Oxford and UNDP, 2019), India has made momentous progress in reducing multidimensional poverty. The incidence of multidimensional poverty was almost halved between 2005–06 and 2015–16, climbing down to 27.5%. Thus, from consumption based poverty or MPI point of view, poverty declined faster during the high growth period; GDP growth was 8.5% per annum during 2004–05 to 2011–12 as compared to 6.3% per annum during 1993–94 to 2004–05. During the period 2004–05 to 2011–12, several poverty alleviation programmes, like MGNREGA (Mahatma Gandhi National Rural Employment Guarantee Act) and NFSA (National Food Security Act), were introduced. These programmes were responsible for faster decline in poverty in India. Data after 2011–12 is not available. The importance of individual programmes in reducing poverty and improving nutrition has been examined here. 4.2 MGNREGA In India, the provision of employment has been extensively used as a tool of entitlement protection from many centuries. After independence in 1947, central government sponsored many schemes, beginning with the Rural Manpower programme in 1960. However, the most important programme at the state level is the Maharashtra Employment Guarantee Scheme (EGS), introduced in 1972. 3 Rangarajan Committee estimates only for the years 2009–10 and 2011–12. Dietary Diversity, Nutrition and Food Safety 57 The National Rural Employment Guarantee Act (NREGA) was notified in September 2005. It is now called Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA). Its objective is to enhance livelihood security in rural areas by providing at least 100 days of guaranteed wage employment in a financial year to every household. MGNREGA has been subject to much scrutiny, and assessment in terms of its effectiveness as a social protection intervention.4 These assessments have yielded mixed findings, in terms of the effectiveness of the programme’s design and objectives, its impact on the socially disadvantaged, especially children and women. Several pathways lead to better outcomes in nutrition, health and education of children due to social protection programme like MGNREGA. These can be grouped into three heads (i) indirect effects of reduction in risks and vulnerabilities and increase in livelihoods and incomes of households, (ii) women’s well-being and intra-household decisions and (iii) direct effects of childcare facilities and linkages with school education and ICDS. Dev (2011), while examining the impact of MGNREGA on the well-being of children and the impact of the scheme on women, reported positive impact of MGNREGA on child well-being5 as well as on household incomes, empowerment and well-being of women, in improving nutrition, health and education of children and reducing child labour.6 Related to the issue of children in agriculture, especially girls, is the gender aspect of recognizing women as producers and farmers and linking to household food security. Strengthening extension training curriculum on gender and child protection issues in agriculture can help in reducing child labour. Narayanan and Gerber (2017) and Narayanan (2020) also showed positive impact of MGNREGA on women and children. MGNREGA benefits the poor and the marginalized, who generally are more undernourished and have poor health.7 MGNREGA can have links to nutrition and health at the micro level in two ways: (i) through rise in earnings and expenditures that seem to have a positive impact on calories, proteins and micronutrient intake in Andhra Pradesh, Rajasthan and Maharashtra8 ; (ii) through the assets created under MGNREGA (Narayanan & Gerber, 2017). Narayanan et al. (2014) studied the assets created in Maharashtra under MGNREGA, and revealed that 87% of works exist and function and over 75% of these are directly or indirectly related to agriculture. MGNREGA is the most important social protection programme in India. Apart from direct benefits, it has secondary benefits such as creation of assets for agriculture and rural development; more participation of women (more than 50% of workers 4 For example, see Dreze and Khera (2009), Khera (2008), Dev (2011), Narayanan and Gerber (2017), Narayanan (2020). 5 Child well-being indicators are child labour, nutrition and education. 6 Studies showed a positive relationship between MGNREGA and child nutrition indicators. Also it is shown that access to food also increased for the households including children. 7 MGNREGA provided employment to 55 million rural households in 2019–20. Majority of them belong to poorer households as they are self-selected for doing manual unskilled work. 8 This is based on Jha et al. (2011). 58 S. Mahendra Dev and V. L. Pandey Table 9 Allocation and offtake under NFSA, 2019–20 (in million tonnes) TPDS ICDS MDMS Total Allocation 52.2 2.2 2.5 56.9 Offtake 50.1 1.2 2.1 53.4 Source Food Bulletin, Department of Food and Public Distribution System (GoI) are females); helping marginalized sections like SCs and STs; reducing distress migration; involvement of panchayats, etc.9 The programme demonstrated varying degrees of success across the country. The achievements are still short of potential, which can be harnessed to strengthen the right to employment enhancing the rights of women and children. 4.3 NFSA The Indian Public Distribution System (PDS) is one of the instruments for improving food security at the household level. The PDS ensures availability of essential commodities like rice, wheat, edible oils and kerosene to the consumers through a network of outlets or fair price shops. These are supplied at below market prices to consumers. The National Food Security Act (NFSA) 2013 aims to provide subsidized food grains to approximately two-thirds of India. It includes the Midday Meal Scheme (MDMS), Integrated Child Development Services scheme (ICDS) and Targeted Public Distribution System (TPDS). Further, the NFSA 2013 recognizes maternity entitlements. The MDMS and the ICDS are universal in nature whereas the TPDS reaches about two-thirds of the population (75% in rural areas and 50% in urban areas). Under the provisions of the Act, beneficiaries of the PDS are entitled to 5 kg per person per month of cereals at INR 3 per kg of rice, INR 2 per kg of wheat and INR 1 per kg of coarse grains (millets). Pregnant women, lactating mothers and certain categories of children are eligible for daily free cereals. In 2019–20, the offtake under TPDS was 50 million tonnes while it was 1.2 million tonnes and 2.1 million tonnes for ICDS and MDMS, respectively (Table 9). 4.3.1 The Impact of PDS on Food and Nutrition Security In general, the poor and the vulnerable groups benefited from the PDS although the impact varies across states. Narayanan and Gerber (2017) showed a range of limited to modest positive impact on calorie intake.10 The study also indicated that most of the studies are limited to assessing the intermediary outcomes than on undernutrition. 9 On benefits of employment guarantee schemes, see Dev (1995) and Dev (2011). This is based on literature survey by Narayanan and Gerber (2017). 10 Dietary Diversity, Nutrition and Food Safety 59 Krishnamurthy et al. (2014) revealed an increase in consumption of protein, calcium and iron due to the PDS (12.9%, 26.4% and 14.2% respectively). Himanshu and Sen (2013) estimated that the value of PDS transfer was 2.4% of MPCE for the total population, and 5.2% of MPCE for the bottom 40%. In other words, poor benefited more than others due to these in-kind food transfers. Their study showed that in 2009–10, total poverty ratio (Tendulkar methodology) was 30.68% with PDS transfers, while it was 33.85% without transfers in 2009–10. One issue of NFSA is its adverse impact on diversification of cropping pattern. The policies in India support rice and wheat due to minimum support prices, buffer stock and PDS. These policies provide incentives for farmers to produce more of rice and wheat which are water intensive. They act as disincentives to undertake diversified farming. Related criticism is that NFSA is not going to solve the problem of malnutrition as they give mainly calories. It is possible that savings from subsidized food items indirectly helps in consuming protein and micronutrient related foods. It is true that the poor and vulnerable spend more on cereals. It is known that health is determined by calorie, proteins, micronutrients, sanitation, safe drinking water, etc. NFSA mainly provides rice, wheat and coarse cereals. It, however, has some provision for nutritious food for women and children. 4.4 Child Nutrition Schemes 4.4.1 ICDS The Integrated Child Development Services (ICDS), launched in 1975, aims at the holistic development of children up to 6 years of age with a special focus on children up to 2 years, besides expectant and nursing mothers. This is done through a service package—health check-ups, immunization, referral services, supplementary feeding, non-formal pre-school education and advice on health and nutrition. The scheme has to focus more on 0–3 year children as malnutrition sets in in utero and is likely to intensify during the 0–3 year period, if not addressed. A child malnourished during 0–3 years will be marred physically and mentally for life. The scheme is designed to address this problem frontally. Mother’s malnutrition has knock-on effects on child malnutrition. Exclusive breastfeeding for six months is necessary to avoid unnecessary infections to the baby, develop the baby’s immunity and ensure growth. The baby must begin to receive solid, mushy food at 6 months (i.e. together with breastfeeds) for the baby to continue to grow in the way nature intended it to grow. The ICDS scheme accordingly needs to be restructured in a manner that addresses some of the weaknesses that have emerged and is suitable for universalization. The programme must effectively integrate the different elements that affect nutrition and reflect the different needs of children in different age groups (GoI, 2008). 60 S. Mahendra Dev and V. L. Pandey Apart from the above, preliminary findings of FOCUS (Focus on children under6) survey conducted in May–June 2004 in six states brought out some of the problems and regional disparities in the working of ICDS (Dreze, 2006). This study showed that Tamil Nadu scores over Northern states in infrastructure, quality of preschool education, immunization rates, mother’s perceptions and quality of anganwadi workers. Saxena (2008) informed that ICDS reached only 12.5% of children in the age group 6 months to 6 years. The aim of the 11th Five Year Plan document was to halve the incidence of malnutrition by the end of the Plan period, and reduce anaemia among pregnant women and children to under 10%. It stated that to achieve these objectives, ICDS has to be restructured with higher allocations of funds and effective implementation. The above studies were done more than a decade back. Jain (2015), using NFHS 2005–06, showed that the supplementary feeding component of ICDS had sizable positive effects on heights of 0–2 year olds in 2005–06; girls who received ICDS food daily were at least 1 cm taller than those who did not. It also indicated that the supplementary nutrition could potentially bridge the height gap between the richest and poorest girls by at least 28% and for boys by 19% at adulthood. However, the study warned that one can have all these benefits only if the programme is targeted towards 0–2-year-old children. ICDS was restructured in recent years including focus on supplementary feeding on children below 3-years of age and pregnant and lactating mothers. Apart from other factors, ICDS restructuring helped in decline in stunting in recent years. A study by Chudasama et al. (2016) evaluates ICDS programme during 2012– 2015. Some of the findings are mentioned here. (a) A majority of pregnant women (94.7%) and lactating mothers (74.4%), and adolescent girls (86.6%) were availing ICDS services. (b) Two-thirds (66.2%) children were covered by supplementary nutrition (SN). (c) Only 14.6% of the AWCs (Anganwadi Centres) reported 100% preschool education (PSE) coverage among children. (d) More than half (55.4%) of the AWCs reported an interruption in supply during the last 6 months. (e) Various issues were reported by AWWs (Anganwadi Workers) related to the ICDS. The study reported gaps in terms of infrastructure facility, different trainings, coverage, supply and provision of SN, status of PSE activities in AWCs and provision of different services to the beneficiaries. These gaps have to be addressed to improve the impact of ICDS on nutrition. One has to examine the working of ICDS more thoroughly and find out the reasons for less take off in this scheme as compared to schemes like PDS and mid-day meal scheme. 4.4.2 Mid-day Meals Scheme The MDMS in India is a programme covering primary school children to improve nutrition as well as increase educational enrolment, retention and attendance. Using Young Lives project data, Porter et al. (2010) examine the effect of the scheme on children’s nutrition and their learning. Among the children surveyed by Young Lives Dietary Diversity, Nutrition and Food Safety 61 in Andhra Pradesh, the scheme delivered significant nutritional benefits for children aged 4–5 years with respect to better height-for-age and weight-for-age than would otherwise be expected, suggesting that MDMS helps reduce malnutrition. For older children (aged 11–12 years) there is evidence of significant positive impacts on children’s learning, although it is not clear if these effects are generated by less hunger or by improved school attendance. The school meals have most impact in areas affected by drought. For younger children, there are large and significant gains in height-for-age and weight-for-age, which more than compensate for the negative effects of the drought. The success of Tamil Nadu MDMS on nutrition and education is well known. 4.5 Cash Transfers Some argue unconditional cash transfers (CTs) to reduce poverty and undernutrition. It is advocated that the system should move towards direct benefits transfer in place of present social protection programmes. There has been a lot of discussion on universal basic income (UBI) in both developed and developing countries. Rangarajan and Dev (2017) say introducing UBI is unrealistic. In fact, the concept of basic income must be turned essentially into a supplemental income. A study on Bangladesh (Ahmed et al., 2019) showed positive relationship between cash transfers and nutrition. They implemented randomized control trials in rural Bangladesh, with two treatments: (a) cash transfers, a food ration or a mixed food and cash transfer and (b) cash and nutrition behaviour change communication (BCC) or food and nutrition with BCC. The study revealed only cash plus nutrition BCC had a significant impact on nutritional status, but its effect on height-for-age was large. Improved diets—including increased intake of animal source foods – along with reductions in illness in the cash plus BCC treatment were responsible for improvement in children’s nutrition. 4.6 COVID-19 and Safety Net Programmes COVID-19 created health and economic crisis in India similar to many other countries. The complete shutdown of all economic activities except essential services created an economic crisis and misery for the poor, with massive job losses and rising food insecurity. The central and state governments and the RBI recognized the economic crisis and responded using fiscal and monetary policies. The Central government announced Atmanirbhar package with INR 21 trillion (around 10% of GDP). But most of the package relates to liquidity measures. The real fiscal stimulus seems to be around 2% of GDP. It also includes food transfers and cash transfers for the informal poor workers including migrants. Government allocated more funds for MGNREGA. 62 S. Mahendra Dev and V. L. Pandey India has nearly 56 million tonnes of excess stock of grains and cereals compared to the usual norms. In March 2020, the government declared 5 kg free rations in addition to the present entitlement of buying 5 kg at subsidized prices. In June 2020, the Prime Minister announced extension of the Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY), a programme to provide free ration for over 80 crore people, mostly poor, for five more months till November end. It was to help the informal sector workers in both rural and urban areas. However, government has to make sure that no one is excluded as there are still exclusion errors in the PDS. State governments have also announced free basic and enhanced rations. The Central government also announced ‘One Nation-One Ration Card’. The nutritional levels of informal workers and unemployed poor were low even before the crisis. It will decline further due to lack of jobs and incomes during lockdown and beyond. Therefore, there is a need to have pulses, oils, etc. in the provision to ensure a diversified diet for them. Anganwadis and schools can provide rations at home. Eggs can be added to improve nutrition for children and women. Government has to make sure that the prices of essential food items are under control. Otherwise high prices would have adverse impact on the food and nutrition security of the poor. 4.6.1 Minimum Basic Income for the Poor in Post-COVID-19 period Universal Basic Income (UBI) was discussed in detail during pandemic times. It is true that a universal scheme is easy to implement. Feasibility of such a scheme is the critical question. Targeted programme is another option but its main problem is of identification. Narrowly targeted programmes will run into complex problems of identification and give rise to exclusion and inclusion errors. Rangarajan and Dev (2020) suggested three proposals to avoid the identification problem and help in providing minimum basic income to poor and vulnerable groups in both rural and urban areas. These are: (a) (b) (c) give cash transfer to all women—above the age of 20 years—in both rural and urban areas; expand the number of days provided under MGNREGA; and launch National Employment Guarantee Scheme in urban areas. In all the three proposals, there is no problem of identification. A combination of cash transfer and an expanded MGNREGA can provide minimum basic income. a. Total cost of the three proposals The proposal of providing cash transfers to women above 20 years costs INR 1.72 lakh crore (0.84% of GDP). The total cost of the expenditure on MGNREGA for providing 150 days employment and 150 days for urban employment guarantee scheme would cost INR 3.21 lakh crore in a year (1.58% of GDP). The total cost of the three proposals would be INR 4.9 lakh crores or 2.4% of GDP. A person working in MGNREGA and urban programme can get an additional INR 30,000 if 150 days are provided. Dietary Diversity, Nutrition and Food Safety 63 It may be noted, however, that the total expenditure of the proposals could be lower due to two reasons. First, the number of days availed of by the employment guarantee programmes could be lower as it is a demand based programme. This is happening even now. Second, on cash transfers, some women particularly from richer classes may voluntarily drop out of the scheme or alternatively a declaration may be obtained from those receiving cash transfer that their total monthly income is less than INR 6000 per month. In addition it may be noted that the government is already incurring a total expenditure of INR 67,873 crore on MGNREGA. In the post-COVID-19 situation, we need to institute schemes to provide minimum income for the poor and vulnerable groups. For this purpose, it is proposed to offer cash transfers for women, increase MGNREGA from the present 100 days to 150 days of work in rural areas and introduce 150 days of work as an urban employment guarantee scheme. This will cost around 2% of GDP and will help the poor, informal workers including migrant workers and poverty and food and nutritional insecurity can be reduced significantly. 5 Food Safety Concerns Food safety refers to ways to prevent food-borne diseases (FBD) due to food contamination in the entire food system—production, processing, storage, transport, food distribution and at the household level. It also refers to the prevailing standards and controls to protect consumers from unsafe foods. The Food Safety and Standards Authority of India (FSSAI) finalizes science-based quality and safety standards for food and regulate the manufacturing, storage, distribution, sale and import to ensure safe and healthy food (Food Safety and Standards Act, 2006). However, several shortcomings in FSSAI functioning are also reported (Siruguri & Bhat, 2018). Food safety, security and nutrition (FSN) are closely linked, with unsafe food creating a vicious circle of diseases and malnutrition, affecting the more vulnerable groups (WHO, 2015). Nutritional and food safety objectives generally contradict, as the most nutritious foods are usually the riskiest ones (FAO, 2016). Economic growth, improved literacy rates, rising incomes, urbanization and liberalization have influenced Indians’ dietary pattern and have made them more aware of food safety. Food safety is determined by—how food is produced, delivered and also by how consumers procure, handle, cook, store and consume food. Access to safe water, toilets and washing hands with soap is required for proper utilization of the consumed food. Food contaminations also affect the export of fresh and processed food commodities. In January 2020, the USA rejected 112 consignments of food and beverages from India. Major Indian products rejected by USFDA include spices, shrimps and prawns, vitamins and proteins, honey, sweets, biscuits and flavoured snacks (USFDA Rejection Data). In 2009–10 European Union (EU) rejected around 1200 of total 3400 Indian containers of grape consignments, citing the presence of pesticide residue on the fruit. The EU banned the import of Indian mangoes in 2014 because they were 64 S. Mahendra Dev and V. L. Pandey infected with pests that could harm indigenous crops, which was lifted in 2015. EU has also banned eggplant, bitter gourd and snake gourd after consignments of these items were found infested with fruit flies. The Indian basmati rice was also subjected to import restrictions because London’s Pesticide Safety Directorate stated that it contained a high level of fumigants. Spain, Italy and Germany detained the import of Indian spices owing to the presence of aflatoxin and pesticide residue. Aflatoxins are produced by fungi that infect crops and are highly toxic and cancer-causing. Indian marine products were also banned by the EU because antibiotic residues were more than the prescribed level. Likewise, shrimp import by Japan was restricted on the ground of non-freshness, foreign bodies and unhygienic practices. Kohli and Garg (2015) reported that the FBD are infrequent and often not reported in India and referred to a study conducted in 2006 that showed only 13.2% of households reported FBD. The FBD outbreaks, together with acute diarrhoeal diseases and measles, constitute a majority of all reported outbreaks of diseases in India (GoI, 2020). To increase the productivity, farmers use a range of fertilizers and pesticides. These agrochemicals are often found in trace quantities in the final product and enter the food chain adversely affecting human health. Similarly, in animal farming, veterinary drugs/antibiotics are commonly used, and which, by entering the food chain, become injurious to human health. It is estimated that FBD costs stood at around 0.5% of the country’s GDP in 2011 (Kristkova et al., 2017); they projected that there would be a higher consumption of food, mainly fruits, vegetables and meat, between the period 2011 and 2030, resulting in a significant increase of FBD cases to 150–177 million in 2030 compared to 100 million in 2011. Most cases of FBD illnesses are preventable by following food protection principles. WHO promotes five keys to food safety measures viz., keep clean; separate raw and cooked; cook thoroughly; keep food at safe temperatures; use safe water and raw materials. There is a need to have food safety literacy at the household level, especially for the women, as they are generally custodians of food preparation and handling. In India, diverse food habits, cultural practices and the changes brought in by globalization and scarcity of resources, especially clean water, money, appliances, etc., at the household level, make food safety promotion a difficult task (Subbarao, 2019). According to the World Water State in 2018, around 19.33% of the population do not have access to clean water in India, which has implications for food safety. Clean water, sanitation and hygiene (WASH) are essential for reducing malnutrition and mortality rates (Headey & Palloni, 2019). The inadequate WASH leads to diarrhoea, undernutrition, helminthiases and vector-borne diseases. Interventions to address water and sanitation simultaneously have positively affected child health (Checkley et al., 2004; Duflo et al., 2015; WHO, 2008). Spears (2013) studied India’s Total Sanitation Campaign and reported a decrease in infant mortality by 4 per 1000 and an increase in children’s height by 0.2 standard deviations at the mean programme intensity. The NFHS-4 (2017) reports that handwashing places with soap and water availability are present in 78.4% of households. Around 3.31% of households have handwashing places with no water or soap arrangements in India’s urban areas, and it is even worse in rural areas. Under such circumstances, food safety issues at the Dietary Diversity, Nutrition and Food Safety 65 household level become crucial for good health, and require interventions focusing on improved practices at the point of consumption. Proper cooking is needed, as inadequate cooking or not thoroughly reheating leads to food safety risks. But in situations where cooking fuel is difficult to get or inconvenient to use, households may try to save energy, effort, or time and may not thoroughly reheat before consumption. Therefore, WASH (water, sanitation and hygiene) and access to clean and convenient cooking fuel are necessary for food safety. However, as mentioned earlier, the recent fact sheets of NFHS-5 for 22 States and UTs showed, that despite improvements in WASH and access to clean fuels for cooking, children and women’s nutritional status has worsened in most of the states. There is a need to explore further the factors behind the worsening of the nutritional status. 6 Sustainability in Consumption Presently, India is self-sufficient in addressing calorie intake requirements by producing staple crops (rice and wheat). Based on the review of 11 studies projecting the consumption of foods in India up to 2050, Alae-Carew et al. (2019) reported an increase in per capita consumption of meat, vegetables, fruits and dairy products and consumption of cereals and pulses to remain constant. Kumar et al. (2016) projecting the demand for 2030 reveals that demand for all the cereals is likely to be met with domestic production in India. However, pulses, edible oils, sugar, vegetables and fruits would be short in supply (Annexure 1). Though the production of fruits and vegetables is sufficient to meet the demand, supply reduces due to very high post-harvest losses. Therefore, the issue is to target hidden hunger by using micronutrient-rich products for food and nutrition security and sustainable food systems. India’s dietary patterns are changing, and this trend is likely to continue (AlaeCarew et al. 2019). These changes in dietary habits, together with a growing population, will have consequences on food systems. They might have potential implications for environmental sustainability through GHG emissions, ground- and surface- water depletion, soil pollution, etc. (Foley et al., 2005) and subsequently, lead to unsustainable agricultural production. Green et al. (2018) quantified GHG emissions, associated with five distinct dietary patterns, based on the life cycle assessment approach. The results showed substantial variability in the environmental impact between diets. The rice-based dietary patterns had higher associated GHG emissions and green water (precipitation) footprints (WFs), but wheat-based diets had lower GHG and higher blue (irrigation) WFs. The rice and meat patterns had the highest environmental impacts. Thus, the increased consumption of animal-sourced foods would significantly increase GHG emissions from Indian agriculture; this is a fact, which has to be kept in mind while adopting animal diet. Aleksandrowicz et al. (2019) using NSSO 2011–12 data calculated the potential changes in GHG emissions, blue and green WFs and land use (LU) that would result 66 S. Mahendra Dev and V. L. Pandey from shifting current national food consumption patterns in India to healthy diets that meet dietary guidelines (RDA) and also moving to diets currently consumed by the wealthiest quartile of the population. They modelled the changes in consumption of 34 food groups necessary to meet Indian dietary guidelines. The analysis showed that shifting to healthy guidelines at the national level will require increased dietary energy by 3%, fruit intake by 18% and vegetable intake by 72% in the year 2011– 12. Meeting healthy guidelines would slightly increase environmental footprints (3–5%). However, shifting to healthy diets among those with dietary energy intake below RDA would increase 28% in GHG emissions, 18 and 34% in blue and green WFs, respectively, and 41% in LU. Decreased environmental impacts were shown for those who currently consume above RDA energy (−6 to −16% across footprints). Thus, in India widespread adoption of healthy diets may lead to small increases in the environmental impact relative to the current status. For attaining healthy diets and the sustainability of the food production system, it is required to improve resource use efficiency in food production and reduce postharvest losses. 6.1 Reducing Postharvest Losses Postharvest losses (PHL) add to food insecurity, wastage of natural resources and wastage of labour and energy used to produce the food (UNEP 2016). A reduction in food waste will affect the total demand for food production while simultaneously reducing pressure on natural resources and the environment (FAO, 2019). In India, PHL are as high as around 40% in fruits and vegetables produced every year (NAAS, 2019). The Ministry of Food Processing Industries estimated losses of 23 million tonnes of grains, 12 million tonnes of fruits and 21 million tonnes of vegetables for a total approximate value of 4.4 billion USD in 2018–19. This is happening due to absence of rural infrastructure for food processing. According to Fan et al. (2008), rural infrastructure is one of the three most effective public-spending items for promoting agricultural growth and reducing poverty. Therefore, proper transportation and storage facilities are must for reducing PHL. Food processing and packaging can preserve the available nutrients and even enhance the shelf life and nutrient content of foods. Thus, proper processing and packaging can help make nutritious foods to reach those vulnerable groups who cannot access or afford fresh products. If unhealthy ingredients are present in the food, product reformulation can be carried out, e.g. reducing sodium and trans-fats (HLPE, 2017). There is also a need to regulate and monitor food processing by setting standards and labelling processed food products. Enforcement of standards is required to ensure food safety and reduce FBD. Thus, it is necessary to make the functioning of FSSAI more effective by removing the shortcomings (Siruguri & Bhat, 2018). Dietary Diversity, Nutrition and Food Safety 67 7 Fortification and Bio-fortification Dietary diversity can help tackle malnutrition, but implementing it may not always be feasible among poor households. The diet that meets all the recommended nutrient requirements in vulnerable populations of Uttar Pradesh was over twice more expensive than the diet that meets only the calorie requirements. A nutritious diet was unaffordable by 75% of the households in 2018 (Kachwaha et al., 2019). Agricultural research has focused on increasing the production and productivity of calorie-dense staple crops. The prices of nutrient-dense non-staple foods have increased because of high demand and relatively low supply (Bouis & Saltzman, 2017). The effectiveness of dietary diversity may also be impacted by seasonality of crops and low bioavailability of specific micronutrients. Nutrient deficiency in food can be tackled either by providing supplements or by food fortification such as iron and folate-fortified flour, iodized salts, etc. There was an increased focus on food fortification in the Union Budget 2019–20. However, these approaches may not be sustainable because they rely on a robust distribution, good infrastructure and consumer compliance (Yadava et al., 2018). Generally, fortification is done with synthetic minerals, which are lower in bio-availability than bio-fortification (Mitra-Ganguli et al., 2019). Therefore, bio-fortification may be one of the more cost-effective solutions to provide the desired levels of nutrients, e.g. rice bio-fortified with zinc, iron-rich pearl millet, etc. (Pfeiffer & McClafferty, 2007). Studies demonstrated the positive effects of bio-fortified crops on human health. Meenakshi et al. (2010) reported that the bio-fortification of staples may be more cost-effective in reducing the burden of diseases than fortification and supplementation. Stein et al. (2007) estimated that zinc bio-fortification of rice and wheat might reduce loss of Disability Adjusted Life Years (DALYs) burden by 20–51% and save 0.6–1.4 million DALYs each year. Scott et al. (2018) showed that consumption of bio-fortified pearl millet twice daily for six months by 12–16-year-olds from economically-disadvantaged classes had significantly improved their cognitive skills in Maharashtra, India. Distribution of bio-fortified cereals through PDS will ensure its reach to nutritiondeficient groups at a subsidized price. The incorporation of bio-fortified staples in welfare schemes, such as ICDS and MDMS, might reduce children’s malnutrition levels. There is a need to intensify efforts by public sector institutions for the adoption and acceptance of bio-fortified crops. To popularize the bio-fortified varieties, the seeds’ genetic purity and vigour need to be retained (Yadava et al., 2018). Farmers should be encouraged and given incentives to grow bio-fortified crops with assured markets and minimum support prices for bio-fortified crops. Effective extension services are needed to increase the awareness of the production and consumption of bio-fortified crops. For the successful adoption of bio-fortified crops by the consumer, food industry participation is also vital to bring bio-fortified crops into the food system for Indian consumers. The food industry can participate via food product development and innovations that fit into the consumers’ growing demand due to increasing concerns for 68 S. Mahendra Dev and V. L. Pandey plant-based protein, reduced food additives, lower genetically modified ingredients and more natural foods (Walton, 2019). For this purpose, the identification of sustainable routes to market is required (Mitra-Ganguly et al., 2019). A HarvestPlus workshop to discuss ways to increase the scale, reach and impact of bio-fortified foods in India highlighted a significant demand from the food industry but lack of awareness is a major barrier (MitraGanguly et al., 2019). 8 Pathways for Safe and Healthy Diets for Nutritional Security The pathways for safe and healthy diets that ensure nutritional security require meeting food demand for 18.1% of the world population whose share in total global DALYs attributable to the child and maternal malnutrition was 25.4% in 2017 (Lancet, 2020). India’s population is projected to reach 1.5 billion by 2030, peaking at 1.6 billion by 2048 (Lancet, 2020). This will require sustainable food systems that cater to nutritional requirements by increasing the production efficiency of agricultural systems that is faced with small landholdings, fragmentation of farmland, climate change impacts and degradation of natural resources. However, for making meaningful suggestions it is necessary to have recent and integrated data on food consumption patterns and agricultural production systems. The pathways for safe and healthy diets for nutritional security in India consist of: (a) improving dietary diversity, (b) reducing postharvest losses, (c) bio-fortification of staples, (d) empowerment of women, (e) enforcing standards of foods safety, packaging and labelling, (f) improving WASH, (g) food safety awareness and nutrition education, (h) implementation of food safety and nutrition programmes and (i) use of ICT. 8.1 Improving Dietary Diversity Availability and access to adequate amounts of diverse food groups are required to address undernutrition and micronutrient deficiency. The household dietary diversity can be improved by increasing crop diversity and having access to kitchen gardens, including diverse food groups in the safety net programmes such as PDS, MDMS and THR (take-home ration). The Government of India has programmes for diversifying the cropping system such as Crop Diversification Programme (CDP), National Horticulture Mission, National Food Security Mission - Pulses. There is a need to improve the coverage of these programmes and increase the production of fruits and vegetables rich in micronutrients. It is required to integrate these programmes with resource Dietary Diversity, Nutrition and Food Safety 69 conservation technologies like micro-irrigation, precision agriculture, postharvest management infrastructure and marketing infrastructure (Manjunatha et al., 2017). The studies showed that home production of diverse food increases affordability and accessibility of nutritious diet. Improving access to kitchen garden (own or community) results in a strong association with household dietary diversity and child nutrition (Dev et al., 2020). The local food and nutrition security can check the adverse effects of food supply shocks and food price volatility (Galhena et al., 2013), which can immediately impact children’s nutritional status and persist in their adult lives (Hoddinott et al., 2013). Many such non-government and government initiatives of kitchen gardens have helped people accessing nutritious foods. Few such initiatives are discussed here. An initiative ‘Gardens of Hope—Emergency Kitchen Gardens’ by Utthan, a Gujarat based NGO, helps vulnerable rural communities in four districts of Gujarat to grow their own chemical-free vegetables at home. Despite the financial crunch during the COVID-19 induced lockdown and the consequent livelihood crisis, the beneficiaries’ nutritional needs were met. There is a unique sharing mechanism under which each family growing vegetables share the produce with three other families who do not have land, water resources, or currently not growing vegetables. It has been estimated that each person will get nutritional security of around 700 g/day from these kitchen gardens (Karelia, 2020). A community-based malnutrition management programme by Vikas Samvad, a non-profit organization, in Madhya Pradesh, developed kitchen gardens in the backyards of 232 families across six districts. This initiative gave people self-sustenance and helped them during the COVID-19 lockdown when the anganwadis were closed. Under this initiative, a network was created through which around 37 quintals of vegetables grown were shared among 425 families. The beneficiaries included 217 malnourished children, 140 pregnant and lactating mothers and 68 elderly persons (Sushma, 2020). The School Nutrition (Kitchen) Garden (SNG) scheme of Government of India aims to address the malnutrition and micronutrient deficiencies and enhance the knowledge of children for nutritional traits of vegetables. It has been reported that after the introduction of SNG, consumption of fresh vegetables in the daily diet among the children increased in fourteen selected schools of Raichur and Bagalkot districts of Karnataka (Kammar et al., 2017). Many state governments have also taken the initiative to promote the kitchen gardens. Odisha Livelihood Mission, as part of the farm livelihood/promotion of Nutrition-sensitive Agriculture, is promoting kitchen gardens. The Karnataka Horticulture Department, with funds from MGNREGA is developing kitchen gardens called ‘Akshara Kaitoota’ in government schools. The vegetable gardens already exist in many schools to promote the consumption of vegetables and fruits. In Chhattisgarh, kitchen gardens are encouraged to secure livelihood for rural households by converging MGNREGA with the Panchayat and Rural development departments. To create awareness of the significance of vegetables and fruits, Tamil Nadu Horticulture Department has tied up with the School Education Department to establish roof gardens. Maharashtra, in a joint initiative of Rajmata Jijau Nutrition Mission under the Department of Women and Child Development 70 S. Mahendra Dev and V. L. Pandey and Reliance Foundation, has developed kitchen gardens at anganwadi centres to grow fruits and vegetables (Suri, 2020). Thus, households should be encouraged to have their own or community kitchen gardens with more diverse vegetables and fruits to take seasonality into account for a better dietary diversity. Perennial vegetables and fruits and wild edible vegetables and fruits depending on the agro-climatic conditions, should be encouraged. The role played by information and communication technologies (ICT) is very important in providing information regarding new crop varieties, seeds, fertilizers, weather, raising awareness about nutrition, etc. 8.2 Reducing Postharvest Losses Another important pathway for ensuring food and nutrition security is to reduce PHL. India is the second-largest producer of food next to China. However, in India, only 2.2% of the farm produce is processed against around 23% in China. A high level of PHL in India is unacceptable when a large section of the population is undernourished. These high levels of losses are mostly due to improper handling, inadequate transportation and packaging, low storage and poor postharvest management. Boss and Pradhan (2020) reported that use of postharvest technologies like storage bags and drums and the application of postharvest loss management practices have positive outcomes on farmers’ price realization. New and innovative methods are required to reduce the PHL. At Tamil Nadu Agricultural University, researchers developed a method to control losses in package houses, transportation and retail shops by spraying Enhanced Freshness Formulation (EFF) on trees before the harvest. The method slows down ripening and controls losses at the farm level (ToI, 2018). Such technologies should be encouraged after assessment of environmental and health impacts. Strong farm-firm linkages might also reduce PHL by providing assured markets. These institutional services and reducing PHL can also help smallholders raise their farm productivity and income and mitigate the risks involved in participating in the markets for high-value crops, livestock and fishery products. However, achieving these goals will require new institutions and innovations to develop supply chains and facilitate linkages between farmers, wholesalers, processors and retailers. These institutions and innovations may include various contract farming models, including those by farmer groups and private-sector resource intermediation (Gulati et al., 2008). Thus, a holistic approach engaging proper postharvest storage and management technologies, institutions for efficient marketing of the products and food processing and packaging technologies is required to reach end consumer with its original nutritional value, intact or enhanced. Dietary Diversity, Nutrition and Food Safety 71 8.3 Bio-fortification of Staples and Improving Awareness Bio-fortification may be one of the more cost-effective solutions to provide the desired levels of nutrients. Indian diets are shifting towards high-value foods, therefore, require more emphasis to bio-fortifying vegetables and fruits along with staples in India. The initiative of distributing bio-fortified staples through PDS will help in reducing hidden hunger. There is a need to develop the supply chain for bio-fortified crops. ICT initiatives of both public and private sectors can improve awareness among the farmers to adopt bio-fortified crops and among consumers for safe and natural nutrient-rich primary and processed produce. The involvement of food business firms is required along the supply chain for broader adoption by the consumers. However, food businesses require guidance for food product development and marketing of bio-fortified food products (Walton, 2019). 8.4 Empowerment of Women Empowering women positively impacts dietary diversity (Dev et al., 2017; Malapit et al., 2015; Pandey et al., 2016). As discussed in Sect. 2.5, mother’s education has a significant role in improving children’s dietary diversity and nutritional status. Hence, there is a need for targeted policies to increase women’s education and empower them for a healthy diet. According to NSSO, India’s female literacy rate was 70.3% in 2017–18, which has improved from 65.5% in 2011 (Census 2011). GoI has taken many initiatives to empower women. The Right to Education Act (RTE) came into force in 2010 for free and compulsory education for children between 6 and 14. The central government introduced the Beti Bachao Beti Padhao (BBBP) campaign (translates to ‘save the girl child, educate the girl child’) in 2015 to address the declining sex ratio and improve girls’ education level. The Samagra Shiksha scheme was launched in 2018– 19 to make good quality education accessible and affordable to all. This scheme subsumes the three Schemes of Sarva Shiksha Abhiyan, Rashtriya Madhyamik Shiksha Abhiyan and Teacher Education. To empower the adolescent ‘SABLA’ scheme was launched in 2010 to improve their nutritional and health status and promote awareness about health, hygiene and nutrition. The role of women in Indian agriculture is increasing. Nearly 77% of the total rural women workforce is employed in this sector (Labour Bureau, 2014). However, around 83% of agricultural land in India is inherited by male members of the family (Mehta, 2018). Land ownership rights to women is critical for their empowerment. Conditions under which women are engaged (for example, prolonged exposure to fertilizers, pesticides, long working hours) and the support systems to strengthen women’s capacity to care for themselves and their children are of utmost importance. Easy access to maternity entitlements (JSY, THR), optimum quality day-care 72 S. Mahendra Dev and V. L. Pandey facilities for children within the community and at the place of work are vital to strengthen caring capacity and translate to higher incomes. A greater emphasis on women’s collectives11 based on primary surveys, Agarwal (2018) examined the impact of group farming by women on productivity and profitability in Kerala and Telangana. The farms of women’s groups under Kudumbashree (also called joint liability groups) in Kerala performed much better than the predominantly male-managed individual farms in their annual value of output per hectare and annual net returns per farm. In the case of Telangana (Samatha Dharani Groups) and Kerala group farms perform much better in commercial crops than in traditional food grains (Agarwal, 2018). The study demonstrated that group farming can provide an effective alternative, subject to specified conditions and adjustment of the model to the local context. 8.5 Enforcing Standards of Foods Safety, Packaging and Labelling Food safety has become a serious issue with its public health implications. FSSAI is revising Food Safety and Standards (Packaging and Labelling) Regulations 2011, with having three different regulations dealing with packaging, labelling and advertisement and claims requirements. Food processing and packaging can preserve the available nutrients and even enhance the shelf life and nutrient content of foods. Thus, proper processing and packaging can help make nutritious foods to reach those vulnerable groups who cannot access or afford fresh products. The micronutrients can be added to less nutrient-dense foods by food fortification during food processing. However, fortifications have some limitations, as discussed in Sect. 7. Product reformulation can be carried out, e.g. reducing sodium and trans-fats, for taking care of unhealthy ingredients present in the food (HLPE, 2017). There is also a need to regulate and monitor the labelling of processed food products. The processed foods can contain high amounts of certain ingredients that are not healthy, such as “hidden” salt, which consumers may not be aware of and maybe desensitize to those amounts (HLPE, 2017). The evidence shows that food label information of quality and nutrition, production and storage process, influences informed decision-making by the consumers (Ali & Kapoor, 2009). A study in the village of South Delhi by Bhilwar et al. (2018) reported that about 64.1% of the consumers read food labels. Still, a majority of them (86%) only check for the manufacture and expiry dates. Generating awareness would be required to improve this behaviour. The factors that influence reading labels are associated with the study participants’ educational status, socioeconomic status and body mass index (Bhilwar 11 Has shown positive results. The NGO Deccan Development Society (DDS), for example, enables women from landless families to access various government programmes to establish land claims, through purchase and lease. Dietary Diversity, Nutrition and Food Safety 73 et al., 2018). Therefore, in the areas with lower education levels, regulatory policies need to be followed strongly for promoting and marketing healthy foods. FSSAI is overhauling the labelling regulations for packaged food products. The draft regulations propose colour-coded front-of-pack nutrition labelling to enable consumers to identify high fat, salt and sugar products. Accordingly, the product will have a red colour if the total amounts of calories, fats, trans fats, sugar and sodium per serving exceed the recommendations. However, there are some concerns from people and food industries related to the proposed labelling regulation, such as it is intended for individuals who are literate and nutritionally aware, the colour red is a danger sign and might deter consumers from the products, etc. (Pande et al., 2020). A food traceability system is an essential tool for managing food quality and safety risks and developing effective supply chain management. The traceability techniques used in India are radio-frequency identification (RFID) tags to track inventories, Holograms, Barcode, Nuclear techniques and other tracking media to monitor the production process. Dandage et al. (2017) have reported that the development of an effective food traceability system is adversely affected by factors like restrictive government marketing standardization and unstable actions for food safety. Inefficient infrastructure in the market area and inadequate agricultural practices with many small and medium players further make the system difficult to work. Indian food regulation lays more emphasis on food adulteration due to it being an important issue. However, there is a need to focus on other food safety issues, together with food adulteration. Sudershan et al. (2008) reported about limited knowledge of basic food microbiology of the food regulators in South India. These regulators were not equipped to check newer adulterations. Therefore, to improve the effectiveness of FSSAI in ensuring the availability of safe and nutritious food, along with enforcing its standards and regulations there is need to increase and upgrade technical manpower, strengthen food safety infrastructure and surveillance system (Parliamentary Standing Committee, 2018). 8.6 Improving WASH Access to adequate WASH and clean cooking fuel is crucial for nutritional security, as discussed in Sect. 5. GoI has taken many initiatives towards improving WASH, such as Jal Jeevan Mission (JJM) and Swachh Bharat Mission (SBM) (Clean India Mission). JJM aims to provide Functional Household Tap Connection to every rural household by 2024. Under SBM, around 10.28 crore of toilets were built, and the coverage of rural sanitation increased from 34% in 2014 to 100% in 2019. The usage of these toilets is reported to be around 95% (GoI, 2019). SBM is now moving towards Phase II of SBM-Grameen to ensure that the open defecation free behaviours are sustained, no one is left behind, and that solid and liquid waste management facilities are accessible. These programmes will help in reducing FBD. 74 S. Mahendra Dev and V. L. Pandey 8.7 Implementation of Programmes Pathways for a sustainable diet that is safe and healthy need sustainable food systems and require better implementation and synergy between different policies and programmes. To achieve SDG 2 of reducing hunger and malnutrition by 2030, effective implementation of programmes can contribute significantly in attaining the targets. The MGNREGA positively impacted child and woman well-being. It positively impacted household income, empowerment and well-being of women and improved children’s nutrition and health and education and reduced child labour. Apart from its direct benefits, it has secondary benefits such as creating assets for agriculture and rural development, more women’s participation, helping marginalized sections like SCs and STs reducing distress migration and involvement of panchayats, etc. The Public Distribution System (PDS) is a critical instrument towards improving food security at the household level in India. The impact of ICDS on child nutrition and protecting children’s rights is quite limited. There is a need to increase its coverage to ensure rapid universalization, change the design and restructure it with higher allocations of funds and effective implementation. The ICDS programme must effectively integrate the various elements that affect nutrition and reflect children’s different needs in different age groups. The midday meal has helped reduce serious malnutrition, and for older children (aged 11–12), there is evidence of significant positive impacts on children’s learning. Supplemental income can be started with old age populations by enhancing the amount of old-age pensions scheme and making it nearly universal. 8.8 Nutrition Education and Food Safety Awareness Education, especially for women, is found associated with a reduction in the mortality rate, dietary diversity and improved nutrition (Alderman & Headey, 2017; Gillespie & Haddad, 2003; Gulati et al., 2012; Spears, 2013). There is a need to make nutrition education and nutrition information part of the education system and be integrated with other community programmes for behavioural change and to improve the intake of nutritious food in a safe and hygienic manner. Banerji et al. (2016) reported that when nutrition information is provided, consumer acceptance and willingness to pay increases for healthy food. 8.9 Use of ICT ICT can play a vital role in providing useful information such as nutrition-sensitive messages, healthy meal menus, recipes, etc. and educating people about lifestyle Dietary Diversity, Nutrition and Food Safety 75 recommendations. ICT can also be used for real-time monitoring, data management and convergence of schemes. Radio broadcasting can be a medium for comprehensive coverage in a less expensive manner related to food safety measures, labelling, etc (Bilali & Allahyari, 2018). Penetration of mobile phones has rapidly increased in India. It can be used to disseminate different information related to food safety, food handling, processing, etc. The information can be sent in the local language and can also engage symbols and digital pictures, as smartphone users have increased. Thus, for achieving food and nutrition security, sustainable food systems are required through multi-pronged strategies with better targeting and coordination between different policies and programmes. However, it is necessary to have recent data on food consumption for making meaningful suggestions. In India, these strategies need to focus on improving dietary diversity, kitchen gardens, reducing postharvest losses, bio-fortification of staples with their inclusion in safety net programmes, women’s empowerment, enforcement of standards and regulations, improving WASH, nutrition education and behavioural change and effective use of digital technology in more innovative ways in food systems. The recent fact sheets of NFHF-5 indicated that besides WASH, women’s empowerment and education status, other factors like household income, personal hygiene, health information and nutrition knowledge might be critical for sustainability in improving nutritional outcomes. In the future, food and nutrition security initiatives will have to be tuned in keeping with changing demographic structure, livelihood patterns, climate change and health-specific needs. These also have to be linked with the overall development activities of the country. Acknowledgements The authors thank the reviewers for useful comments on an earlier draft. Annexure Demand–supply projections and gaps (Million tonnes). Commodities Year Supply projection Demand projection Demand-supply gap Rice 2020 108.1 111.8 − 3.7 2030 122.1 122.4 − 0.3 2010 104.2 98.3 5.9 2030 128.8 114.6 14.2 2020 50.4 42.5 7.9 2030 64.2 47.2 17.0 2020 262.6 252.6 10.0 2030 315.1 284.2 30.9 2020 20.7 21.9 − 1.3 Wheat Coarse cereals Total cereals Pulses (continued) 76 S. Mahendra Dev and V. L. Pandey (continued) Commodities Food grains Edible oils Sugar Vegetables Fruits Milk Eggs Year Supply projection Demand projection 2030 26.4 26.6 Demand-supply gap − 0.2 2020 281.2 274.4 6.8 2030 338.8 310.8 28.0 2020 12.5 17.0 − 4.5 2030 19.1 21.3 − 2.1 2020 33.4 33.1 0.3 2030 40.3 39.2 1.1 2020 186.4 155 − 13.1 (Post harvest losses (PHL) 23.99%) 2030 210 192 − 32.0 2020 97.7 81 − 2.7 (PHL 20%) 2030 116.4 103 − 9.9 2020 156.6 138 10.4 (PHL 5.03%) 2030 188.7 170 8.8 2020 4.7 4.4 0.1 (PHL 5.02%) 2030 6.2 5.8 0.1 Source Kumar et al. (2016) References Agarwal, B. (2018). Can group farms outperform individual family farms? Empirical insights from India. World Development, 108, 57–73. Ahmed, A., Hoddinott, J., & Roy, S. (2019). Food transfers, cash transfers, behavior change communication and child nutrition evidence from Bangladesh. IFPRI Discussion paper no. 01868, Washington DC. Alae-Carew, C., Bird Frances, A., Chudhury, S., Harris, F., et al. (2019). 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