The term hunger is the most used in social science and policy discussions to describe the condition of people who suffer from a chronic lack of sufficient food and constantly or frequently experience the sensation of hunger. Literally, it means the physiological desire to consume food. But the subjective definition does not lead automatically to an understanding of food deprivation.

People, who are deprived of food, over time report not feeling hungry after not eating many days: the psychological distress of hunger is mitigated by reducing physiological longing for food, although the body continues to desperately need food for activity, even survival.

The ‘base-line’ of not being hungry may itself be so low for dispossessed communities that they cannot be compared with hunger reported by less habitually food-deprived people. Around 350 million Indians go to bed hungry every night. Across the world, up to 811 million people do not have enough food. Many economists and policymakers prefer to measure more objectively observable physiological consequences of hunger on those who live with it over prolonged periods.

A person deprived of adequate food suffers over time in many ways – lowered energy to pursue daily activities; psychological distress and inability to think clearly; low immunity; failure of body and mind to grow and develop to their full inherited potential; disability including blindness, weak limbs and slow minds, and premature deaths. Hunger has many manifestations, visible and invisible, chronic and transient, which in turn determine the capabilities and achievements of individuals and influence the socio-economic output of nations.

Families facing chronic food insecurity are caught in a hunger trap. However, the most immediate form of hunger is something obvious and tangible. Ensuring that everyone has enough food to eat ought to be our first priority. But we also need to simultaneously address a form of hunger that remains unnoticed called hidden hunger which, unlike the gnawing hunger of lack of food, often remains silent. In the words of Kul C. Gautam, former Deputy executive director of UNICEF: “The ‘hidden hunger’ due to micronutrients deficiency does not produce hunger as we know it. You might not feel it in the belly, but it strikes at the core of your health and vitality.”

Indeed, it is a form of undernutrition that occurs when intake or absorption of vitamins and minerals is too low to sustain good health and development in children and normal physical and mental function in adults. Causes include poor diets, disease, or increased micronutrient needs not met during pregnancy and lactation. The amounts of nutrients needed are so small that they are called ‘micro’ nutrients. The hidden hunger is also known as micronutrient deficiencies.

The effects of hidden hunger can be devastating, leading to mental impairment, poor health, low productivity, and even death. Its adverse effects on child health and survival are particularly acute, specially within the first 1,000 days of a child’s life, from conception to the age of two years, resulting in serious physical and cognitive consequences. Even mild to moderate deficiencies can affect a person’s wellbeing and development. Clinical signs of such deficiencies are night blindness due to vitamin A deficiency, goiter from inadequate iodine intake and anemia from iron deficiency. These become visible once deficiencies turn severe.

Worldwide, the poor have less diverse and monotonous cereal-based diets that are deficient in essential minerals and vitamins. The inability to access food through sources such as own-production, purchase, social protection or private charity causes food insecurity. Rising food prices compel the poor to cut back on non-staples or reduce food expenditure. Inadequate diets are associated with the ‘dislocation of food supply’ and disruptions in food systems, as people lose access to farms, forests and commons.

In their book Poor Economics, Abhijit V. Banerjee and Esther Duflo, Nobel Laureates, mentioned that “The poor, even those whom the Food and Agriculture Organization would classify as hungry on the basis of what they eat, do not seem to want to eat much more even when they can. Indeed, they seem to be eating less.” Gender inequality is linked to the prevalence of undernutrition. In terms of access to food and nutrition, deep-seated intra-household inequalities and disparities divide the women from men. In India and other parts of South Asia, women will traditionally eat after the men and children have been fed.

It is culturally accepted that men of the household, the customary breadwinners, are entitled to the lion’s share of the available food, both in terms of quality and quantity. This tradition perpetuates in most rural areas, despite the fact that women not only labour in fields alongside men, but are additionally burdened with the collection of fuel, fodder, water, and preparing food, caring for the sick, and the family in general. These deep-seated gender biases, traditions and cultural practices lead to the ‘feminization of hunger’.

The greater part of the burden of hunger is invariably borne by women. Undernourished mothers usually give birth to low birthweight babies, who may frequently suffer from ailments such as cold and cough. Lack of proper nutrition is also believed to be problematic and sometimes life-threatening for the women giving birth, causing weakness, anemia, and death. In the regions of the world where women receive less ~ sometimes far less ~ care than men, a male-female divide takes place at adolescence, with an undernourished female adolescent being burdened with the potential of transmitting malnutrition to the next generation.

Malnourished women or adolescent girls give birth to stunted and thin babies. Indeed, the most vulnerable stages of the cycle relate to pregnancy and nursing, since fetal and maternal undernutrition can have very grave consequences.

According to M S Swaminathan “the first step towards Hunger Free India is to banish the problems of maternal and fetal under-nutrition.’ It is estimated that more than two million people suffer from hidden hunger globally, with nearly half in India.

According to a report entitled ‘Adolescent, Diets and Nutrition: Growing Well in a Changing World’, one in two adolescents in India suffer from at least two of the six micronutrient deficiencies. Moreover, while the pandemic has had far-reaching effects on various facets of our lives, it may also result in an increase in the number of children suffering from Severe Acute Malnutrition (SAM).

The need of the hour is to build capacity within the public sector and to improve CentreState coordination to implement better procurement and distribution models for fortified foods. Providing fortified foods in anganwadi centres (ICDS), and using the Public Distribution System (PDS) can be some of the major channels that can be leveraged to address the issue of hidden hunger. Many of the traditional beliefs around diets of pregnant or nursing women were various forms of restriction. Restrictions extended to nutritional supplements provided by the ICDS, such as iron tablets. These irrational beliefs and restrictions seem to have a bearing on the health of women and children.

In rural areas, platforms such as Self-Help Groups can be used to create awareness and to cook meals using fortified staples. Fortification of milk with Vitamin A and Vitamin D in Kerala, and fish supplies and mushroom cultivation in Bihar are apt examples of innovation by states in the use of flexi funds under the POSHAN Abhiyan. Learnings from the Mo Chhatua programme on Odisha, under which a mobile application is used to digitize the operations and manage the supply of Take-Home Rations to the beneficiaries, can be used to introduce additional modules in POSHAN Tracker.

Some of the successful micronutrient deficiency control programs are salt iodization, Vitamin A supplementation, iron fortification and distribution of fortified atta through PDS. The technology of increasing specific nutrient content of crops through standard plant breeding or genetic engineering is termed as biological fortification or biofortification. Biofortification has emerged as a cure to micronutrient deficiencies or hidden hunger of the population of the developing world.

Initially, three nutrients, vitamin A, iron and zinc were at the forefront of the nutrient concerns. From then, about 300 biofortified crops have been developed and released. These crops that have been introduced in Asian, African and South American countries are now grown by 30 million farmers and consumed by 30 million people. The golden rice or genetically modified rice is high in provitamin High iron beans, super banana, orange maize and biofortified pearl millet are some notable examples of biofortified crops. Many other crops are on their way to the market. Examples include genetically modified cassava high in iron and zinc, genetically modified sorghum high in provitamin A, and zinc rice and pearl millet high in zinc and iron.

Globally research is currently on to develop a range of crops biofortified with various nutrients. The figure may soon skyrocket, engulfing 90 per cent of crops and embracing a majority of farming communities of the developing world. In the last few years, India has made tremendous progress in reducing the prevalence of malnutrition. But the battle is not yet won. The 2020 Global Nutrition Report mentions India amongst the 88 countries that are likely to miss their global nutrition targets by 2025.

Moreover, India is reportedly one of the countries with the highest rates of domestic inequalities in malnutrition. What is needed is the adoption of a lifecycle approach which is supported by convergence of schemes, community ownership and digital systems. Mahatma Gandhi in one of his speeches delivered during the last 100 days of his life said: “Forget the past. Remember every day dawns for us from the moment we wake up. Let us all, everyone, wake up now.”

(The writer is a retired IAS officer)