Department of Nutrition and Dietetics Sagar Chandramma Hospitals, Bengaluru India

^*Corresponding author: Aparna Nagendra, Department of Nutrition and Dietetics Sagar Chandramma Hospitals, Bengaluru. India Email Id: appu31@gmail.com

Article Information: Submission: 02/06/2023; Accepted: 10/07/2023; Published: 15/07/2023

Copyright: © 2023 Nagendra A. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

An adequate food intake is a key to a healthy life where quantity and quality of food plays a major role. Malnutrition is the most serious repercussion of food insecurity and has a multitude of health and economic implications. India having the largest urban population in the world and especially living in slums, have largely been the deprived areas. Food security can be examined at various levels, global, national, regional, household, and individual. Various studies have been conducted to assess food insecurity at the global level; however, the literature is limited as far as India is concerned. Therefore, achieving food security is one of the vital sustainable development goals along with adequate nutrition, which is a necessity since an undernourished or hungry population hampers economic productivity. Also, the association between education and food security indicate that empowering women through education is the key ingredient to achieve women empowerment, intra-household food and nutrition security.

Keywords: Food Security; Malnutrition; Women’s Health

Ensuring food security is of great importance for a country like India. Food security as per Food and agricultural organization (FAO, 2008) is defined as a condition when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life. [1] Nearly a billion people across the world experience the effects of food insecurity. Low and middle-income countries are facing more severe challenges of food insecurity. [2] Especially the Covid-19 pandemic has led to increase in global food insecurity, affecting vulnerable households in almost every country and has exacerbated hunger and poverty worldwide, especially in India.

The basic pillar of food security is proper access to food, which is the basic human right.[3] Household food in security, is a critical problem in the rural areas of developing countries. Four food security dimensions must be achieved as per the definition: food availability, economic and physical access to food, food utilization, and stability over time. But, degradation of natural resources, unequal distribution of food, poverty and scarcity of resources required for agriculture (water and land) etc. are some of the main causes of food insecurity [4,1].

The recent report on the State of Food Security and Nutrition, 2019 states that, the world portrays a picture of some progress, but also shows up an alarming development in certain areas. Hunger is now increasing after a period of decline, and over 2 billion people do not have regular access to safe, nutritious, and sufficient food. [5] In the 2020 Global Hunger Index, India ranks 94th out of the 107 countries. With a score of 27.2. This shows that, India has a serious level of hunger. [6] Adding to this 70-161 million people might have experienced hunger, as a result of the pandemic [7].

Malnutrition is a well-known cause of morbidity and mortality in children around the world. Malnutrition is understood as “not having the right balance of nutrition,” and it includes both over and under nutrition. It can critically affect child growth and development, along with child survival. [8] Globally, 720 -811 million people (i.e., 1 in 9) are undernourished and do not have enough food to live a healthy, active life.7The World Health Organization (WHO) estimated in a recent report that there are 178 million undernourished children in the world. [9] The UNICEF, WHO and the World Bank Joint child malnutrition estimates that, in 2020, 149 million children under 5 were estimated to be stunted (too short for age), 45 million were estimated to be wasted (too thin for height), and 38.9 million were overweight or obese. Around 45% of deaths among children under 5 years of age are linked to under nutrition. 1.9 billion Adults are overweight or obese, while 462 million are underweight. [10,11] Almost one third of women of reproductive age, globally suffer from anemia, in part due to nutritional deficiencies 7. It is known that good nutrition is a key driver in achieving healthy growth and development during childhood. Food security or nutritional security should be seen as one of the important conditions that must be achieved for an individual to be nutritionally secure and to maintain good health.

Countries are struggling with malnutrition on one hand, but on another hand double burden malnutrition (DBM), is clustering, characterized by the coexistence of both under nutrition and overweight or obesity. Since obesity was considered a concern in a developed country for long, recently developing countries like India are also observing the high prevalence of obesity among children and mothers due to globalization like - food habits and changes in their lifestyle. [8] Also when food resources become inadequate, people tend to eat low-cost, unhealthy, and highly energy-dense foods, such choices lead to people becoming overweight and undernourished at the same time [12].

Women are the pioneers of nation. Indian culture gives great importance to women, who comprise half of the world’s population. A regular and disciplined household is essential for a normal family life. Woman within the family takes care of this function. Poor health has consequences not only for women but also their families. Thus, women work twice as much as men equally at home as well as the workplace [13].

To use women’s abilities and skills, it is necessary to have a good understanding of their activities. Women perform activities such as ensuring food for the entire family, cooking, feeding, and rearing up children, selection and care of clothing, laundering, furnishing and maintenance of the house, feeding poultry birds and cattle, fetching water, collecting firewood, processing agricultural products and gardening in the homestead premises. As an administrator, she organizes various social gatherings and recreational activities to satisfy the needs of the family members. Thus, the contribution of women to their families is very significant and is not necessarily less than that of the male member of the family [14].

Besides managing household works, women are also involving themselves in the service sector like hospitals, airlines, banks, schools, and other work fields. Many women have set up their own business and they are showing excellent outcomes in their respective areas. But their contribution in terms of work or labor and their roles in agriculture do not get social recognition.

Around the world especially in the developing countries, rural women contribute significantly to rural economic growth and work as a representative of food security. Like food production - agriculture and livestock sector, in resource management, revenue generation, and the maintenance of household food and nutrition security. They play a central role in childcare and food processing even when their economic roles require extensive time and physical energy.

They are responsible to decide on what food to purchase and the use of different methods to prepare it. Food preparation requires a considerable amount of time to be spent preparing the ingredients and processing them. They spend their time, resources and income on household food needs when compared to men. Various studies have shown that women participate in production, processing, and consumption of food in many different forms, and they are increasingly engaging in production. Thus, providing equal access to men and women’s physical and natural resources could boost agricultural productivity [15,17].

Women’s empowerment is a multidimensional concept which has been widely recognized as an important objective in global development. But rural women have limited access and control over resources such as education, health, land, credit, employment, skills, lack of decision-making power, less freedom of mobility and lack of training services. This may negatively affect their contributions. [2] Evidence shows that increase in women’s education accounted for 43% of the total reduction in child malnutrition, by far the largest contribution. [18] Olumakaiye and Ajayi (2006) argued that educational level attained by women had a fairly high degree of relationship with food and nutrition for household members food security [16].

Thus, empowering women is a key to achieving food security. Women education, occupation, household income, decision making, household assets, household expenditure, and their knowledge about nutritious food had positive effect on provision of household food security (Madiha Naz, et.al2020). Women with formal education are more likely to adopt new technologies and increase productivity in their chosen career and invariably improve the food security of their households. Thus, improving women’s education is one of the most important policies to increase agricultural productivity and reduce poverty [19].

Poor education may also lead to inadequate knowledge about nutritious food, healthier methods of preparation and cooking techniques. Women’s access to education and income is also a determining factor in different levels of nutrition and child health. [20] For instance, women resource empowerment has been found to be positively correlated with household food security and poverty reduction [21].

Another study by Rashid S et.al. (2017), also pointed out women’s active role in food production which played an important role in household calorie intake, food consumption, and dietary diversity. [22] The World food summit also made commitment to ensure the active role of women in provision of food security. [23] This shows that women’s role directly influences household food availability, accessibility, and utilization thus, helps achieving nutritional security.

Every household must have physical and financial access to sufficient food for them to be food secure. Each family must always be able to meet all of the nutritional needs of its members, which involves maintaining a balanced diet that contains all of the required energy, protein, and micronutrients. Food insecurity not only has a deleterious effect on households and individuals but also efforts at achieving food security may pose a heavy economic burden where the households must shell out most of their income on procuring food.

Malnutrition is the most serious and a common cause of food insecurity. The growth, development of acute and chronic diseases, survival, and economic production are all affected by under nutrition. Adult malnutrition leads to lower productivity on farms and in the labor market. Among women, it also results in fetal malnutrition and low birth weights of babies. Poor school attendance, poor school enrollment, absenteeism, early dropout, and poor classroom performance are all partly linked to childhood nutritional deficits, with consequent losses in productivity during adulthood [24,25].

a. Accessibility and Availability
Accessibility to shops, local stores or supermarkets is another important factor influencing food security, which is dependent on resources such as transport and geographical location. There may not be easy access to a variety of foods so the food choices that are made are entirely based on what is currently available. It can sometimes be challenging to eat meals that are nutritionally balanced due to restricted availability. When purchased from stores located inside towns and cities as opposed to supermarkets on the outskirts, healthy food is prone to costing more. The purchase of additional fruit and vegetables or other nutrient-dense foods, which are still thought to be prohibitively expensive, does not increase with improved availability alone.

Individuals who are well-informed on ‘healthy eating’ are more likely to make healthy food decisions. This, however, is dependent on the individual’s ability to apply his or her knowledge. A lack of knowledge and cooking abilities might inhibit purchasing and making meals from basic components difficult. Also, knowledge about health does not lead to direct action when individuals are unsure how to apply their knowledge. Thus, educating the public is important to convey precise and consistent communication messages through various media, on food packages and of course via health professionals. Education on how to improve food consumption in an affordable way, with no additional cost in terms of money or effort, may be useful in influencing eating choices.

Work life can influence food security in several different ways. Long hours, inflexible schedules, shift work, and multiple jobs have an impact on the time and energy available for food procurement and preparation has an impact on food choice. Those with higher paid jobs may go for brand items, while those on a lower wage may opt for their own brand choices.

Individuals will be unable to make healthy choices due to time constraints. For households who don’t use professionally produced meals, buying and cooking a nutritious diet can take a lot of time. Particularly the young and those who live alone prefer convenience foods. Planning, going from the house to the grocery store or other food source, shopping, preparing, and cleaning up are just a few of the tasks, abilities, and resources needed to provide healthy meals. Thus, time involving food preparation may particularly affect choice of food thereby food security. More ready-to-cook meals and prepackaged fruits and vegetables have been introduced to meet the demand (instead of loose).

How much money we make is certainly one of the factors that influence food security and choices. Also, there are a various reason that contribute here. Relatively, one with a good income has greater purchasing power. This power can translate into the ability to buy more foods. Again, it takes more than a few rupees in the pocket to decide to buy nutritious foods. But there is nothing like such foods are more accessible through money. Nevertheless, it’s important to learn to purchase food that is as healthy as possible with the money we have.

There is no doubt that the cost of food is a determining factor when it comes to food security. The prohibition cost basically depends on the person’s income and socioeconomic status. Low-income groups are more likely to consume unbalanced diets and specially to consume less fruit and vegetables. However, access to more money does not mean better food, but the range of foods to choose from should be widened. Unfortunately, in many parts of the world where food is scarce, there can’t be any choice when it comes to food. And also, on the other hand it is true that healthier foods tend to cost more than heavily processed nutrient-drained foods. Hence, with guidance from health professionals and a little self-research, learning to buy and eat healthier foods even on a tight budget is possible.

Access to food varies considerably between households due to many factors that affect food prices. These factors include some environmental aspects, such as the geographical area of the country; urban or rural; types of stores available (e.g. supermarkets, convenience stores, supermarkets, warehouses); and available foods, such as healthier versus less healthy and highly processed.

Although biologically food is simply a source of nutrition, for humans it is much more than that. It provides one of the major sources of pleasure. Acquired food preferences are the evaluative attitudes that people adopt and express toward foods, and also how much they like or dislike them. Diversity in human attitudes and responses to food involves several developmental factors: biological factors; early experience; acquisition of cuisine; acquired preferences and aversions; changes in preferences or attitudes in adults; and the relationship of food to health. These determinants will have a major impact on an individual to acquire specific food preference over a period of time.

Individual attitudes, both implicit and explicit, have been identified as one of the multiple drivers of consumer behaviors concerning food. Sometimes it takes a while before changes become new habits. And people may face roadblocks along the way. Over the last decade, our society is witnessing a continuous increase in life expectancy and greater attention to quality. People are increasingly concerned about their health and pay more attention to their lifestyle and the healthiness of their diet. Youngsters especially are learning from the previous generation and are ready to change their habits towards healthier nutrition. Positive food-related attitudes have been linked to better diets, as indexed by higher values of healthy eating and also consumption of vegetables and fruit. The market for food with a health benefit is thus evolving.

For instance, healthy food is increasingly attracting interest from both consumers and manufacturers-super foods or foods with health related claims, including organic and functional foods, are the latest trend in the food industry.

Taste is widely cited as an important factor influencing eating habits. In reality, ‘taste’ refers to the sum of all sensory stimulation elicited by the consumption of food. This involves not just the flavor of the meal, but also its fragrance, sight, and texture of the food. These sensory factors are thought to influence spontaneous meal choices in particular.

Taste and familiarity impact food habit from an early age. A preference for sweetness and an aversion to bitterness are thought to be intrinsic human characteristics that are present from birth. Taste preferences and food aversions are shaped by our attitudes, beliefs, and expectations, as well as our experiences[26,27].

Malnutrition poses a variety of threats to women. As per the recent report of National Family Health Survey (NFHS) – 4 conducted by Ministry of Health and Family Welfare in 2015-16, 22.9% women (15-49 years of age) are underweight (BMI less than 18.5 kg/m2). [28] Many nutritional deficits experienced in infancy and childhood have irreversible consequences. It reduces a woman’s ability to survive childbirth, makes her more susceptible to infections, and depletes her reserves for recovery from illness. Malnourished HIV-infected mothers may be more likely to pass the virus on to their babies. [29] Anemia affects about 43% of women of reproductive age in underdeveloped countries and in severe anemia risk of death is higher during delivery and following childbirth [30].

Inadequate nutrition has a negative impact on women’s health as well as the health of their children. It compromises women’s productivity, capacity to generate income and ability to care for their families. Malnutrition among women may lead to low pregnancy weight gain, inadequate fetal nutrition, and low birth weight baby. Ultimately inadequate feeding, food, health, and care lead to frequent infections. The Child may end up with stunting or reduced mental capacity. [31] Therefore, adequate nutrition is important for women not only because it helps them to be productive members of society and also because of the direct effect it has on maternal nutrition and development of the next generation.

Therefore, addressing women’s nutritional health has a major positive effect, because healthy women can fulfill their multiple roles. Inequalities are often greatest among the lower section of society, especially in terms of household investment in health and education. Addressing gender disparities and sharing knowledge to improve local diets, production and household behavior through nutrition and health education, increase women’s access to basic health and nutrition services, improved access to water, sanitation, education, and equipment, also hygiene education including menstrual hygiene is essential. This can help ensure that women can get the nutrition they need, improve their own health and their family’s health, ultimately, contribute to the development of the society.

Beyond household food security, it is important to promote nutrition governance everywhere by creating sustainable and resilient food systems for healthy diets, providing coverage of nutrition interventions globally, providing social protection and nutrition education for all, and creating a safe and supportive environment for nutrition at all ages.