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How protein deficiencies impact the health of communities in India

Parvati Singh's picture
Soybean farmers discuss best practices that can leverage improvement of food and nutrition security in Madhya Pradesh.

The state of Madhya Pradesh in India is largely vegetarian with limited consumption of eggs and meat. 

While these dietary preferences are commonplace in other Indian states, Madhya Pradesh is facing a protein deficiency epidemic which threatens the long term health of its population.

How did it get there?

In 2015 I spent five weeks in rural and tribal areas of Madhya Pradesh evaluating the World Bank’s Madhya Pradesh District Poverty Intervention Project (MPDPIP II), with the support of the South Asia Food and Nutrition Security Initiative (SAFANSI)

Across the 8 districts I visited, families shared how they had improved their agricultural productivity, started backyard kitchen gardening, and supplemented their income through dairy and poultry farming, collective procurement and small scale enterprises.

As I examined local village level health records, Anganwadi Center (AWC) registers, Auxiliary Nurse and Midwife (ANM) registers and Primary Health Center (PHC) documents, I noticed a reduction in severe malnutrition and severe anemia among pregnant women and under 5-year-old children.

However, this decrease did not extend to moderate or mild malnutrition and anemia.

This was puzzling, as I had expected rates of malnutrition and anemia, be they moderate or high, to be lower for families who were backyard gardening and therefore benefited from a more diverse and nutrient-dense diet.

Furthermore, I did not observe a correlation between higher income and reduced malnutrition. I realized that perhaps acute malnutrition can be addressed to a certain extent by rise in income, but improvement of chronic conditions cannot be brought about by income increase alone.

Based on the data I had gathered, and several discussions with PHC doctors, the missing link, I concluded, appeared to be the lack of dietary protein in daily consumption. This deficiency may be the result of multiple factors:

First, there are no incentives for small farmers in Madhya Pradesh to cultivate dried legumes known as pulses, which are very high in proteins.  Additionally, market prices of pulses and lentils are prohibitively high, which discourage consumption by poor families.

Second, the government practice of banning eggs in mid-day meals and Anganwadi health centers for children has exacerbated the current protein deficit.

Finally, and ironically, household consumption of the protein-rich soya bean is almost non-existent, despite Madhya Pradesh being one of the largest soya producers in the country.

Addressing this grave issue will require a multi-pronged approach involving improved accessibility to food items rich in protein, behavior change communication, and fortification of commonly used food products.

There is also a need for production support, through agriculture extension services, value chain interventions that make protein rich crops lucrative for farmers, input support through credit access and convergence with allied government activities.

Furthermore, households that cannot afford to produce or purchase protein-rich foods need to be provided consumption support through credit access and subsidies through public distribution systems and other means.

To learn more, read the full report (PDF)

Comments

Submitted by George Kent on

This article says, “there are no incentives for small farmers in Madhya Pradesh to cultithvate dried legumes known as pulses, which are very high in proteins.  Additionally, market prices of pulses and lentils are prohibitively high, which discourage consumption by poor families.”

Why can’t small farmers produce pulses and lentils, taking advantage of the high market prices, and helping to bring those prices down?

Submitted by Parvati on

Thank you for this insightful question. I too had raised this point during my fieldwork, and the answers I received varied from crop fragility, to weather uncertainties, low Minimum Support Price (MSP) from government-based centralized procurement, fertilizer pricing and processing costs associated with some lentils and pulses. Additionally, cultivation of pulses by small farmers owning < 1 acre land does not provide economies of scale. Growing other crops which have assured MSPs from government procurement offer greater security to small scale farmers. All these factors appear to interact together in a complex web. It is difficult to isolate one specific cause, but if I had to, I would say government procurement and higher MSP assurance would probably offer relatively better incentives towards pulse cultivation.

Thanks,
Parvati

Submitted by Parvati on

Thank you for this insightful question. I too had raised this point during my fieldwork, and the answers I received varied from crop fragility, to weather uncertainties, low Minimum Support Price (MSP) from government-based centralized procurement, fertilizer pricing and processing costs associated with some lentils and pulses. Additionally, cultivation of pulses by small farmers owning < 1 acre land does not provide economies of scale. Growing other crops which have assured MSPs from government procurement offer greater security to small scale farmers. All these factors appear to interact together in a complex web. It is difficult to isolate one specific cause, but if I had to, I would say government procurement and higher MSP assurance would probably offer relatively better incentives towards pulse cultivation.

Thanks,
Parvati

Submitted by Ekadashi Nandi on

The question of George Kent is really insightful. We forget the impacts while introducing a project. A state like MP is famous for its protein rich soybean, especially organic soybean during near past for export purpose, but unable to supplement protein in food for the people. There is need of in-depth study why the people are not taking soybean in their diets for protein supplements.

Submitted by david seddon on

Im working on pulses production and consumption in South Asia with IWMI with special reference to Nepal. I also would have asked why if price of pulses is high in the market for consumers dont farmers grow more to generate more income? simple issue of supply and demand. But answer suggests other constraints - costs of production, risk and uncertainty, govt restrictions on market prices, no economies of scale. Also maybe problems of marketing (transport, knowledge etc.)

dr david seddon

Submitted by George Kent on

Thank you for your responses to my question. They are very constructive.

One point that might be worth pursuing is this. So far Parvati focused on the economic incentives to produce pulses and lentils, and perhaps other products with good protein value. What about the home gardeners who produce mainly for their own consumption, those for whom the nutritive value is more important than the monetary value? What protein rich products would be easily produced on a small scale? Ekashi Nandi mentioned soybeans. Is there any reason why home gardeners can’t be encouraged to raise soybeans for their own consumption?

Of course the answer about what protein-rich products to favor is likely to be different in different regions, depending on the physical geography of the place and also the prevailing cultural norms and practices.

A second point: As I understand it, the subsidized foods distributed under the right to food program are mainly inferior quality grains, leading to excessive grain consumption and poor, monotonous diets. Arguments should be made to the government to diversify and improve the quality of the subsidized foods that are distributed. This might require increases in the Minimum Support Prices paid to farmers, but paying those increased costs might be necessary in order to improve the quality of the diets. Who could take the lead in formulating and presenting that argument?

This is important because simply increasing the production of protein rich foods will not ensure that it will get to those who need them most. In the normal operation of the market system, with no subsidies, higher quality products migrate to those with more money.

If you would like to continue this discussion we could switch over to email or Skype. My email address is kent@hawaii.edu My Skype ID is geokent

Aloha, George

Submitted by Parvati on

Thank you for generating such an interesting discussion! I agree with Ekadashi Nandi's point that there is a need for detailed examination of reasons why soya bean is not consumed, and I have a feeling that the answer involves going into people's kitchens and making them change the way they cook and eat. This is a huge expectation- for instance, think about how much people struggle to change their diet habits to lose weight- it is a tremendous effort, does not work for everyone, and only few people are able to convert this into a sustainable lifestyle. So, if we are expecting people from rural areas to start including soya bean in their diet, we will have to find ways to motivate them to make this change, start eating something they are not used to, and convince them of the health benefits. It does not appear that health is the first priority among households with limited financial stability. That makes this undertaking quite daunting.

To Dr. David Sedon's points, I completely agree with you- the consumption basket and choice set of food items is not simply determined by market costs and supply-demand dynamics. It is much more nuanced than meets the eye, and we need intensive behavior change communication, combined with other enablers (mentioned in your response) in order to overcome this chronic deficit.

I find George Kent's questions particularly insightful- How do we make subsistence farmers grow protein-rich crops for home-consumption, and, who should take the lead on advocating for higher MSPs for pulses? I think, for the first question, the answer lies in behavior change interventions that create awareness about benefits of protein consumption. Of course, this is easier said than done, but could be the catalyst needed to set things in motion. The second question is a little trickier- and would need multi-sectoral collaboration. Currently, we import pulses from Canada and the US. How do we change that? Who bears the cost of providing good seeds, fertilizers, agriculture extension, support, assured market price and crop insurance against pestilence, which is the most common vice of pulses? I believe the first step would be to make policy makers realize the magnitude of the problem, and how endemic, chronic protein deficiency can only be overcome through self-reliance and promotion of home-grown pulses.

Thank you once again for your invaluable inputs. Please feel free to email me with more comments/questions at p.singh@utexas.edu.

Submitted by George Kent on

Greetings all –

I appreciate the interest all of you are showing in this discussion. Let’s continue on!

To review, Parvati’s article on protein deficiencies in India mentioned that market prices of pulses and lentils are prohibitively high, discouraging consumption by poor families. I responded by asking why small farmers can’t produce these items, taking advantage of the higher market prices.

Parvati’s reply, basically, that it was not economically feasible to raise these products on a small scale.

Ekdadi Nandi then mentioned protein-rich soybeans, and said there was a need to study why people don’t include soybeans in their diets.

It is important to notice the change in perspective here. We had been talking about the economic incentives for farmers, but then we switched to talking about the nutritive value for consumers. Broadly speaking, we might say farming is for income, while most household food production is mainly for the nutritive value of the food, not its value as a commodity. David Seddon’s comment was mainly on the commercial value, not the nutritive value.

On February 24 Parvati came back to the nutritive value, asking why soybeans are not consumed. That is a good question, but I am troubled by the thought that there is a need to MAKE people change what they cook and eat. Instead, let’s talk about helping people understand why a particular change in their diet would be good for them and their children People need to make their own well-informed choices. Here I am reminded of the way some ministers in India want to ban eggs from children’s Mid Day Meals because THEY think children should not eat animal products.

I am glad to see that Parvati does come around to saying there is a need to motivate people to make the change, partly by convincing them of the health benefits. This is not easy, but it is not impossible.

Whether we focus on soybeans, lentils, or other protein-rich plants, a lot could be done with demonstration projects, showing how they could be raised in home gardens and how they could be prepared. This is an approach that I think of as “gardening with friends,” an idea I discuss in an essay available at http://www2.hawaii.edu/~kent/GardeningwithFriends.docx

India’s people could benefit from state and national systems for facilitating household food production, providing social as well as technical support.

If middle class people began to raise protein-rich foods in their gardens, and talked about it, poorer people might soon follow, especially if they had support from friends.

Aloha, George

Submitted by George Kent on

This report on pulses might be of interest: http://www.fao.org/3/a-bq757e.pdf

Aloha, George

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