Aashi Mendpara
With nearly 104 million Indigenous People and 705 ethnic groups recognized as Scheduled Tribes (STs) in India, tribal malnutrition has been coined ‘India’s hidden epidemic.’ According to a study conducted with India's third National Family Health Survey (NFHS) in 2016, results show trends of stunted growth, wasting, and underweight among tribal children under three years of age was 41%, 30%, and 43% respectively. When attempting to understand these rates, it’s important to recognize the history and continued prevalence of scheduled tribes, castes, and the caste system in India.
While the Indian caste system was outlawed in the 20th century following colonization, the social, cultural, and economic effects continue to pervade and impact thousands of Indian citizens every day. The term “Scheduled Castes” (SCs) was adopted in 1935 during British colonization and was used in statutory provisions, government programs, and politics. Although caste privilege wasn’t invented by the British and anti-Dalit sentiment has been present for hundreds of years, the exploitation of the caste system at the hands of the British empires has lasting consequences on South Asian communities today. This caste system—fractured along caste, religious, ethnic, and gender lines—continues to affect severely marginalized communities in India, specifically Dalits and Adivasis: Scheduled Castes and Scheduled Tribes.
5 out of 6 multidimensionally impoverished people in India come from STs and SCs. Multidimensional poverty, according to the Oxford Poverty and Human Development Initiative (OPHI), not only looks at financial income but considers health, education, disempowerment, and violence, among others.
When beginning to understand the scope of the problem at hand, one may wonder how hundreds of years of history and discriminatory policy impact STs and SCs, specifically in the realm of malnutrition. While the Indian government has initiated policies, such as the public distribution system and the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), the declining rate of malnutrition remains low.
Although data shows that India’s national nutrition-specific programs reach various social groups and differences between delivery for all groups are minimal, many NFHSs (NFHS-2, NFHS-3, NFHS-4, primarily) show that STs and SCs remain undernourished.
Again, the question remains: why are SCs and STs facing such alarming rates of malnutrition?
Many people have explored this trend in communities where there is a high percentage of SC and ST communities and groups, such as Odisha. Not only is there a lack of accessible state-run nutrition services (National Rural Health Mission (NRHM) Anganwadi centers), but some centers were as far as 5 miles from community homes. On Village Health Nutrition Days, pregnant and lactating ST women rarely receive maternal healthcare because of the distances that workers have to travel, and many SC families and communities have discussed the stories of discrimination when accessing proper and quality nutrition. According to NFHS-3, caste-based discrimination among children in SCs and STs leads to health and mortality indicators, mainly due to the lack of public health services and programs relating to food security.
As mentioned previously, while national nutrition-specific programs reach various social groups and differences in uptake are small, higher levels of malnutrition continue to persist among SCs and STs, which indicates failures in addressing fundamental issues and nutritional determinants such as access to medical care, drinking water, and healthy and nutritionally dense food.
In India, and many South Asian countries, caste is a dominant aspect of social identity. It plays a role in politics, segregation, and reservations. For SC and ST communities, the continuation and historical legacy of the social hierarchy continue to plague their lives daily. We have failed our indigenous communities in the past, we have discredited our indigenous communities in the past, and we have failed to validate our indigenous communities in the past.
Until we begin to hold our communities accountable for the stigma and discriminatory practices of Dalit and Adivasi communities in India, the health outcomes for these indigenous Indian communities will continue to suffer at the hands of the state. We have the opportunity to use our privilege, power, and understanding for social good, and we must do our due diligence in providing for the communities we have continuously failed.
Sources
Mariam Ashraf
At dinner time, a scene that has become an emblem across many South Asian households unfolds: the women of the family gather around the stove, enduring the heat and working tirelessly to prepare a feast, often with little expectation of receiving a full plate themselves after serving everyone else. Meanwhile, the men of the family wait eagerly, ready to devour plate after plate. This norm is just one part of a deeply ingrained cultural idea which has long prioritized the needs of men over women. Under these roofs, it is an unspoken rule that seemingly everyone seems to know: Women eat last.
Over time, generations of practices rooted in patriarchal norms have deepened the nutritional divide between South Asian men and women. Data from the National Family Health Survey raises urgent concerns, revealing that a quarter of Indian women of reproductive age (13 and older) are chronically undernourished. In 10 states, a staggering 65 percent of women are classified as underweight according to the BMI index. These women also face a range of health issues tied to undernutrition, including anemia, amenorrhea, and low bone density. Such conditions not only jeopardize the health of pregnant women but can also have lasting effects on the development and well-being of their children, with repercussions extending into adulthood.
In 2022, UNICEF South Asia launched its flagship regional framework, Nourishing South Asia @ 2030, aimed at accelerating nutrition outcomes across the region. The framework focuses on three key priorities: (1) improving nutrition for girls and women while preventing low birth weight; (2) ensuring early detection and care for the most vulnerable children; and (3) enhancing children's access to nutritious foods.
In addition, the Nourishing South Asia report series has created goals tailored to addressing nutrition challenges specific to South Asian women. These include promoting women's groups and movements focused on improving nutritional outcomes, providing nutrition counseling to enhance maternal, adolescent, infant, and young child nutrition, and prioritizing anemia management before, during, and after pregnancy. While these initiatives have shown progress in tackling the region's nutrition challenges, for these initiatives to reach optimal results, they must be complemented by a shift in community attitudes, particularly within the home. Behavioral changes need to take root at the family level, where traditional norms and practices often reinforce the cycle of undernutrition. Without this shift, the cycle of undernourished women giving birth to malnourished children will continue, passing onto future generations the same grim situations.
A number of socioeconomic factors are hindering progress in reversing women’s malnutrition in India and other South Asian nations. The subcontinent is regularly subjected to some of nature’s harshest faces—frequent droughts and floods that can destroy crops and wipe out entire harvests. These environmental shocks drive up the cost of essential food items like rice and vegetables, leaving impoverished communities struggling to make do with dwindling resources. While global health programs have long aimed to address these issues by providing food aid, another significant challenge remains: how that food is distributed. The conversation must also tackle the gender biases within the domestic space, where the decision of who gets to eat—and what women are allowed to eat—is often dictated by traditional roles.
Food taboos controlling what women and girls can eat persist throughout the subcontinent. A research study conducted in Uttar Pradesh by the United Nations Food Programme found that several physicians in the area advised women to eat less during pregnancy so that the fetus would grow smaller and be easier to deliver. Many women reported that fruits, leafy greens, and other nutritious carbohydrates were restricted during pregnancy. One woman from Fatehpour explained how she was told not to eat papaya during her pregnancy, as it was said to have “too much sugar” and would cause her to gain weight. This belief, held by many local practitioners, is that increasing calorie intake during pregnancy can lead to complications. However, it is well-established that undereating during pregnancy can severely harm both mother and child, and in extreme cases, lead to fatal outcomes.
The misinformation surrounding prenatal nutrition remains a hidden crisis within the broader malnutrition epidemic. Shifting long-held beliefs about women’s diets will take time, as many of these taboos are deeply entwined with gender-based power dynamics and societal expectations of women. In South Asian culture, it’s common for men to eat first, justified by the belief that they have higher caloric needs than women, which leads to prioritizing men in food distribution. Satya Nutrition recognizes the critical gap in understanding and is working to raise awareness about the importance of nutrition for women and girls in the region. The organization has been steadily distributing Ready-to-Use Therapeutic Food (RUTF) supplements to families across South Asia, regardless of gender. By fostering awareness through changing dietary practices, we can help the daughters of South Asia recover from the lasting effects of gender-biased malnutrition.
Photos taken by founder Amith Umesh in the field in West Bengal, India.
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