Introduction

In India, the persistence of a high prevalence of undernutrition in the context of high growth is a puzzle that has engaged the keen interest of scholars both at the national and international levels (Deaton and Drèze 2009; Ghani 2011; Headey 2015; Ray 2018; World Bank 2009). Even more surprising is that the level of undernutrition is higher than that found in several sub-Saharan African countries that are much poorer. Termed in 1996 as an ‘Asian Enigma’ (Ramalingaswami et al. 1996), the situation has remained largely unchanged since then. For instance, in 2009, of the 33 sub-Saharan African countries only six (Burundi, Malawi, Ethiopia, Niger, Madagascar and Rwanda) had higher proportions of children with stunting than India (Panagariya 2013). Though by 2018, the levels of stunting had reduced from 47.9 per cent to 38.4 per cent, India was still worse off than Nepal and Bangladesh, its poorer neighbours, and several sub-Saharan countries (World Health Organization 2018a). As far as wasting was concerned, the situation was worse, with a prevalence rate of 21 per cent, Djibouti and South Sudan being the only two countries with higher rates (World Health Organization 2018b).

To explain the apparent contradiction between nutritional status and income levels, termed the Indian ‘development paradox’ (Government of India 2006, 6), several theories have been put forward. Of these, the one that has endured among the economists is the ‘small but healthy’ (SBH) hypothesis. It was first proposed in the 1980s by Seckler, an American economist, and was later aggressively promoted by Sukhatme, an Indian statistician. A current variation of this is that international standards of anthropometric measurements are inappropriate and too high for Indians (Deaton and Drèze 2009; Panagariya 2013). The SBH theory seeks to normalize the high levels of undernutrition in India and continues to find supporters even today, particularly, in the context of assessing minimum needs and poverty levels. Since the time it was proposed, the SBH has not gone unchallenged and has been critiqued by economists and anthropologists. However, not much attention has been paid from the point of view of nutrition and public health.