Meenakshi, 25, sits on a porch, breastfeeding her youngest child. She tested positive for anaemia after her third child was born two years ago. Doctors recommended hospital admission, but the family could not afford it.
Seven years ago, Meenakshi was married into the Kumar family. Today, she is responsible for the food and nutritional needs of a family of eight - husband, in-laws, three children and a brother-in-law. The family eats what they grow. But the produce is often insufficient for the whole household. "Aur kuch na ho to roti mirch kha leve (And when there is nothing, we eat roti bread with some chillies)," says Bijendra Kumar, Meenakshi's father-in-law.
Despite having buffaloes at home, the children and adults do not consume milk. "If everyone in the family starts drinking milk, what will we sell and earn?" asks Meenakshi.
"Instead, we drink chaas (buttermilk). I add some water to the curd, increasing its quantity; blend and serve it to everyone as chaas. I cannot do the same to milk," tells Meenakshi.
Staples like pulses and cottage cheese (paneer), generally packed with protein, vitamins and minerals, are absent from their diet.
"Ghana time ho gaya (It has been long since we last had pulses)," she adds in a hushed tone, drawing a veil over her lean body.
"Paneer to byah shaadi me banta hai tabhi khaate hai (Cottage cheese is prepared on special occasions like weddings and that is when we get to taste it)," adds Mr Kumar from behind. "I like to eat chicken, but where do we get it from?"
Meenakshi's nutritional status is likely to affect the health and well-being of her children. During pregnancy, anaemia has been associated with poor maternal and birth outcomes, including premature birth, low birth weight and maternal mortality.
India has stubbornly high malnutrition figures with one in five children under five reported to be "wasted" or too thin for their height. Nearly one-third of the children are stunted (too short for their age) and underweight. At the same time, obesity among children has seen a jump from 2.1 per cent to 3.4 per cent.
Anaemia, a form of malnutrition, is also prevalent among children and women in India. Nearly seven in 10 children under five are anaemic. This has increased from six in 10 in 2015-16, per the National Family Health Survey-5 (NFHS-5) for 2019-21. Over half the women aged 15-49 are reported to have anaemia.
And the food we eat is not the only reason behind our nutritional status. Agricultural practices play a crucial role too.
In the last part of our three-part series, we explore the impact of cultivating water-guzzling crops on nutrition. Read part one here and part two here.
You Reap What You Sow
Unhealthy soil produces unhealthy crops, which, in turn, leave us unhealthy.
This is how Dr Rajiv Tandon, Consultant Paediatrician and Executive Director, The Health Continuum, explains the domino effect of soil health on food.
He said, "Soil health manifests directly with micronutrient deficiencies within the food items and eventually leads to the same low levels of minerals and vitamins in the people consuming that particular food item."
Eating food grown in nutritionally deficient soils can lead to malnutrition which could manifest as long-term stunting, wasting, underweight, anaemia, among other health issues, Dr Tandon explains. "And that is reflected in both cognitive and productive outcomes of human beings."
The World Health Organisation (WHO) defines malnutrition as deficiencies, excesses, or imbalances in a person's energy and/or nutrient intake. Undernutrition (wasting, stunting and underweight), micronutrient deficiencies or excesses, overweight, obesity, and diet-related non-communicable diseases are all forms of malnutrition.
While soil health is critical for nutrient-rich plants, several other factors impact nutritional outcomes, such as poverty levels and access to basics like clean water and healthcare. An analysis of the nutritional status of children and women in states growing water-intensive and non-water-intensive crops provides a much more nuanced portrait.
Child malnutrition figures are slightly higher in states growing non-water-intensive crops, like Jharkhand, Odisha, and Tripura, than in the top three states growing water-intensive crops - Tamil Nadu, Gujarat and Rajasthan - per the NFHS-5.
Explaining one reason why water-intensive crop-growing states may have comparatively better health outcomes despite equally bad soil health, Ashok Kumar, an agronomist at FAO, said, "Jharkhand, Odisha, and Tripura have significantly higher populations of scheduled tribes. Tribes follow their traditional agriculture practices which provide lower production and low income. They have limited access to sanitation and healthcare, which leads to poor health negatively affecting nutritional status resulting in stunted, wasted and underweight children."
Notably, Tamil Nadu, Gujarat and Rajasthan have higher per capita income than states that primarily grow non-water-intensive crops. More income gives people the financial freedom to purchase better food, which may or may not be grown locally.
On average, more women were reported to have lower body mass index (BMI) - an indicator of malnourishment - in the top three states growing non-water-intensive crops. The top three states primarily growing water-intensive food crops have a higher percentage of obese or overweight women, again a parameter of malnourishment.
On average, one in five women in the top states growing water-intensive non-staple food crops - Goa, Gujarat and Rajasthan - have low BMI, a slightly higher rate than women in states growing water-intensive staple food crops.
On the other hand, nearly one in three women are obese or overweight - also a sign of malnourishment in the top states growing water-intensive staple food crops - Tamil Nadu, Madhya Pradesh and Punjab. This is slightly (8.8 percentage points) higher than the level of obese women in top states growing water-intensive non-staple food crops.
NFHS-5 reported a higher prevalence of child anaemia in the top three states growing water-intensive crops, while anaemia among women was more prevalent in the top three states cultivating non-water-intensive crops.
On average, two out of three children under the age of five had anemia in both the top three staple food growing states and non-staple food growing states. This is at par with the national average.
Anaemia in mothers can be passed to their children, which means Meenakshi's children are prone to becoming victims of an intergenerational cycle of anaemia.
Among children, anaemia can also lead to poor cognitive and motor development, states WHO.
Dietary choices impact nutritional outcomes as well
A recent study found widespread inadequate protein consumption despite access to protein-rich foods such as legumes, dairy, meat and eggs. The results show that "often most households did not intentionally choose protein-rich foods, resulting in cereals becoming the primary source of protein and contributing 63-73 per cent of total protein intake across the various districts."
An income analysis revealed that protein deficiency was rampant across seven in 10 households, regardless of their economic condition. Protein consumption is influenced by education, particularly of women's, and social, economic and cultural factors.
"Without targeted efforts to promote diverse diets and educate communities on the importance of protein, malnutrition will persist," noted Dr Shalander Kumar, the study's lead researcher and Deputy Global Research Program Director of the Enabling Systems Transformation Program at ICRISAT, in an official release.
Agroecology is the way forward
Devinder Sharma, a food policy expert, believes transitioning to agroecology will conserve water and prevent soil degradation and nutrition depletion. Agroecology is an ecological approach to agriculture that involves the sustainable use of natural resources. It seeks to optimise the interaction between plants, animals, humans, and the environment while ensuring an equitable food system. This includes diversification-agroforestry, intercropping, crop rotation - and sustainable land use.
For instance, if Meenakshi's family starts using farmyard manure (a mix of plant and animal waste), they can increase soil fertility and produce quality.
"Crop rotation means growing rice or wheat in one season and pulses and legumes in another. This can help balance nitrogen availability in the soil. Coupled with no-tilling, it can improve soil microbes," explained Mr Kumar from FAO.
Mr Kumar suggested developing drought-resistant and soil-friendly crop varieties to improve resilience to changing environmental conditions. Implementing precision agriculture techniques can optimise resource use and reduce environmental impact."
The food policy expert also recommended examining the economics of agriculture and suggests incentivising farmers to grow crops that require less material, protect soil, and retain nutrition. "A farmer will diversify or switch to any other crop only when they get a similar price."
Changing age-old practices and beliefs also remains a major challenge.
For example, farmers like Bijendra Kumar believe that water sprinkling is not sufficient as the water does not reach the plants' roots. Already knee deep in debt, he does not have more money to invest in another technique.
Other experts, however, think that soon, farmers may not have a choice but to shift to other crops.
Mr Yadav believes that groundwater depletion will eventually push farmers to non-water-intensive crops or water-saving methods, as they will be left with no other option.
As far as Meenakshi is concerned, she has accepted malnutrition as her fate and does not think or worry about the future. "What will you think when there is nothing?" she asked.
Methodology:
This data story looks at the impact of growing water-intensive crops on groundwater, soil health and human health.
To begin with, the author looked at the "Mekonnen, M.M. and Hoekstra, A.Y. (2010) The green, blue and grey water footprint of crops and derived crop products" report to identify water-intensive crops in states across India. The author considered only blue water footprint data to know how much groundwater is being used to irrigate a crop, in a state. If a state uses more blue water than the national average to grow a certain crop, then the author considered the crop "water-intensive" in that state.
The author also looked at the "Area, Production & Yield - Reports" from 2013-2023 to calculate the proportion of area under cultivation of water-intensive or non-water-intensive crops in each state. The area, production and yield reports were taken from the official website of the Directorate of Economics and Statistics, Department of Agriculture and Farmers Welfare, Ministry of Agriculture & Farmers Welfare.
Following this methodology, the author identified three states with the highest proportion of area under cultivation for water-intensive crops and three states with the highest proportion of area under cultivation for non-water-intensive crops. They then looked at Soil Health Card data (2023-24) by the Ministry of Agriculture and Farmers Welfare. They focused on the status of macronutrients (N, P, K) and micronutrients (S, Fe, Zn) in the soil to see if the soil in states growing water-intensive crops is more deficient in essential nutrients.
The author also looked at the National Family Health Survey (NFHS-5) data specifically for the six states and analysed data for key health indicators - malnutrition and anaemia among children under five and women.
All supporting data and analysis can be accessed here.
The author travelled to Alwar district in Rajasthan and met farmers in different villages to understand their challenges.
(Reporting for this story was supported by the Environmental Data Journalism Academy- a program of Internews' Earth Journalism Network and Thibi.)
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