How protein deficiencies impact the health of communities in India

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)