A Cost of the Diet Analysis in Pindra Block, Varanasi District, India

Location: Pindra Block, India Date collected: December 2014 HEA data: November-December 2014 Lead agency: Save the Children India

Acknowledgments

The Cost of the Diet analysis was led by Archana Choudhary (Save the Children India) and Alexandra King (The Food Economy Group), with in- country support from Fazlul Krishnan (Save the Children India) and remote technical support from Amy Deptford (Save the Children UK). This report was written by Archana Choudhary and Alexandra King, based heavily on a report format developed by Amy Deptford.

The Cost of the Diet fieldwork was conducted by Nutrition Counsellors from Save the Children and SRF’s Karuna Project. The field team included Ram Prakash Yadav, Sunil Mishra, Rakesh Choubey, Sanjay Lal Srivastav, Virendra Tiwari, Vijay Kumar, Krishna Kumar Yadav and Fazlul Krishnan.

The analysis was funded by the Dalai Lama Foundation under Save the Children’s Karuna Programme.

Thanks are due to the Save the Children Food Security and Livelihoods team in Uttar Pradesh and to the SRF team in Varanasi District for their warm welcome and for making the practical arrangements for the analysis to take place. In particular, Sunil Kumar (Save the Children India) and Dr. Shreya Singh (SRF) helped to facilitate the exercise, Rajesh Rai (SRF) helped with area and market identification, Rajeev Kumar (SRF) helped with Hindi translations and typing. Rajeev Kr. Singh, Secretary of SRF, is sincerely thanked for allowing the use of project staff time for the study.

Last but by no means least, this analysis would not have been possible without the willing help of the market traders of Pindra Block and of the women who participated in the focus group discussions. Their time, hospitality and insights are greatly appreciated.

Suggested citation: Save the Children UK, (2015). A Cost of the Diet Analysis in Pindra Block, Varanasi District, India. London: Save the Children, U.K.

Table of contents

1. Summary ………………………………………………………. 4 2. Introduction ………………………………………………… 12 3. Methods ……………………………………………………….. 15 4. Results …………………………………………………………. 21 5. Key findings ………………………………………………..... 42 6. Recommendations and conclusions …………… 44 7. Annex ………………………………………………………….. 48

Summary

Purpose of the assessment

A Cost of the Diet analysis of Pindra Block, Varanasi (UP), has been conducted as part of an integrated study with a Household Economy Approach (HEA) assessment, funded by Dalai Lama Foundation under Save the Children’s Karuna Programme. The aim of this analysis was to assess the degree to which economic constraints might prevent households in Pindra Block from having access to a nutritious diet. The data collection and analysis set out to answer the following questions:

 What is the cost of a nutritionally adequate diet for typical households in Pindra Block?  What nutrients have the greatest influence on the cost of a nutritious diet?  What local foods are inexpensive sources of essential micronutrients and could be promoted through programme interventions?  How affordable is a nutritious diet for a typical household in different wealth groups?  How might nutrition, food security and social protection interventions improve access to a nutritious diet by households in the assessment area?

Introduction to the study area

Pindra Block is located in Varanasi District of Uttar Pradesh State. Pindra is divided into 14 Nyay Panchayats and 98 Gram Panchayats. As per the census of 2011, the population of Pindra Block is 276,000.

According to the Karuna Programme baseline, 50% of children (aged 6-59 months) were stunted or too short for their age, 29.1% were wasted or too thin for their height and 46.6% were underweight. The MUAC (Mid-Upper Arm Circumference) was less than 11.5 cms for 2% of children in project block.

An encouraging 78% of mothers with children in the age group of 0 to 24 months started breastfeeding within an hour of birth. 76% of mothers gave colostrum to their newborn, while only 37% exclusively breastfed their babies for the first six months.

According to mothers of children aged 0-24 months, 65.2% had begun complementary feeding of their child within the age group of 6-8 months in the project.

Methods

This Cost of the Diet analysis was done in Pindra Block, which falls in an agricultural plain livelihood zone. This block was selected because the Karuna project is active throughout the block.

144 market surveys, 32 dietary habit interviews and 4 focus group discussions were conducted in the selected zone. The market price, seasonal availability and consumption patterns of all local foods was collected, including herbs, spices and condiments. For the purpose of the assessment, retrospective price data were collected to cover a period from January – December 2014.

With these data the cost of three theoretical diets were estimated using the Cost of the Diet software for a typical household of 7 individuals: a lowest cost diet that only meets recommended average energy requirements; a lowest cost diet that meets recommended intakes for energy and nutrients (nutritious diet); and a lowest cost ‘nutritious’ diet that meets recommended intakes for energy and nutrients based upon typical dietary habits of households in Pindra Block (the food habits diet).

A nutritious diet for the typical family is defined as one which provides all of the following: the estimated average requirement (EAR) for energy1; the 95th percentile of an individual’s intake of protein2; between 30% and 60% of total energy intake from fat3 and the reference nutrient intake (RNI) of vitamins and minerals4 all specified by the World Health Organization and the Food and Agriculture Organization.

The annual cost of the foods selected by the software were expressed as a percentage of the estimated annual cash income and expenditure from the HEA undertaken in Pindra Block, to estimate the affordability of a nutritious diet for households in each wealth group. The shortfall in income when the cost of the diets and the expenditure on essential non- food items is applied is defined as the ‘affordability gap’.

1 WHO/FAO (2001). Human energy requirements. Geneva: World Health Organization 2 WHO/FAO (2007). Protein and amino acid requirements in human nutrition. Geneva: World Health Organization 3 WHO/FAO (2008). Fats and Fatty Acids in Human Nutrition. Geneva: World Health Organization 4 WHO (2004) Vitamin and mineral requirements in human nutrition. Second edition. Geneva: World Health Organization 5

Key findings

In a nutritious diet (not the food habits diet), wheat flour, buffalo milk, Bengal grams and fenugreek leaves provide the majority of essential macro and micronutrients in Pindra Block. Although the diet that the software selects is hypothetical and does not reflect local dietary habits, it does give an indication of which foods found on the local market are the least expensive and most nutritious. In this diet, wheat flour is the largest provider of energy, protein, vitamin B1, niacin and zinc (plus a significant provider of vitamin B6); buffalo milk is the largest provider of fat and vitamins B2 and B12 (plus a significant provider of energy, protein and calcium); Bengal grams are the largest provider of vitamin B6 and iron (plus a significant provider of energy, protein, folic acid, zinc and vitamin B1); fenugreek leaves are the largest provider of vitamins A and C, folic acid and calcium (plus a significant provider of vitamins B6 and B12).

In a nutritious diet, recommended intakes of calcium, fat and iron are the most difficult for the software to meet. These nutrients are available in the local markets but they are in expensive foods such as buffalo milk, fenugreek leaves and Bengal grams. These nutrients are therefore expensive for the software to meet and are likely to be deficient in the current diet. These foods and nutrients should therefore be prioritised in programmes that aim to improve the quality of the diet.

The availability of nutrient-rich foods is not a key barrier to typical poor households obtaining a nutritious diet. The data collection team found 110 foods on the market in Pindra Block. The foods selected by the software for the food habits diet were all available in more than half of the markets that were visited and were therefore considered to be available in Pindra Block. This finding suggests that economic constraints and cultural practices are exacerbating poor dietary diversity in the assessment area rather than availability of nutrient-rich foods.

A nutritious diet is not possible when typical food habits of households in Pindra Block are imposed. The food habits diet does not meet the recommended intake of calcium. The main constraints that are imposed with the food habits diet are to force rice, mustard oil and potato into the daily diet. Rice is not very rich in micronutrients compared to other cereals. Potato is considered a vegetable in this part of India – indeed it is considered the main vegetable – but it does not have the micronutrient content of other available green vegetables. Unconstrained, the software selects buffalo milk and dried coconut as sources of fat rather than mustard oil, suggesting that they contain other required nutrients in addition to fat.

A diet that takes into account typical dietary habits (the food habits diet, which is deficient in calcium) is over 6 times more expensive than a diet that only meets energy requirements. The analysis indicates that a nutritious diet was over 5 times as expensive as the energy only diet, meaning that it costs over 5 times as much money to meet recommended protein, fat and micronutrient requirements compared with only meeting energy requirements. The food habits diet was 22% more expensive than the nutritious diet, which means that the constraints applied to the software to reflect typical dietary habits have required the software to add more expensive foods to meet the recommended nutrient intakes of a typical poor household (and in this case the software does not succeed in meeting the RNI for calcium).

Based on current livelihood strategies, very poor, poor and middle households cannot afford the nutritious diet or the food habits diet as well as expenditure on non-food items. The results from the affordability analysis present a concerning picture for households in Pindra Block and estimate that only the better off wealth group can afford the nutritious diet or the food habits diet plus expenditure on non-food items such as productive inputs, healthcare, clothes, schooling and soap. The additional amount of money that very poor, poor and middle households require a year to be able to afford the nutritious diet plus non-food items is approximately 81,000 INR (1325 USD), 43,000 INR (705 USD) and 40,000 INR (655 USD) respectively. The additional amount of money that very poor, poor and middle households require a year to be able to afford the food habits diet (which is deficient in calcium) plus non-food items is approximately 111,000 INR (1820 USD), 72,000 INR (1200 USD) and 70,000 INR (1150 USD) respectively.

Suboptimal breastfeeding practices are preventing infants and young children from receiving a nutritious diet. An analysis of three common feeding practices, giving water instead of breast milk, giving cow’s milk, and giving infant formula produced concerning results. Not only do these models highlight the potential additional costs that households are incurring by not breastfeeding their children as recommended, breast milk also has additional benefits such as containing immunoglobulins that helps to build a child’s immunity to infections. It is also sterile, unlike other foods, which prevents the risk of contamination and infections which may cause diarrhoea and contribute to malnutrition due to their cyclical relationship. Providing other foods and water during the first six months of life has both economic and health implications for the household and the child.

Recommendations and conclusions

The results from the Cost of the Diet analysis show that it is possible for households to obtain their recommended intakes of energy, fat, protein and micronutrients from foods found in the local markets. However, very poor household’s access to the nutritious foods selected by the software is restricted by poverty and eating practices.

It is highly recommended that a multi-sectoral approach involving key government departments, to improve nutrition and increase nutrition outcomes be adopted. Emphasis should be laid on building greater awareness at household & community level on nutrition & positive practices leading to improved nutrition of women, children & adolescent girls.

The following five recommendations are based upon this approach and aim to address the major findings from the Cost of the Diet analysis.

Behaviour change and communication (BCC) interventions aimed at mothers, husbands, mothers-in-laws and community or religious leaders are needed to dispel the current perceptions of taboo foods and practices for pregnant and lactating women and children under the age of 5 years.

The typical beliefs around taboo foods and practices reported in focus group discussions with women present a concerning picture. Women’s reported practices during pregnancy, lactation and with regards to IYCF are potentially harmful to themselves and their child and may increase the risk of low birth weight and stunting. Cultural eating habits, in particular the dependence on rice to give a feeling of ‘fullness’ and high consumption of potato in place of vegetables, may be preventing households from consuming a nutritious diet.

The scenarios modelled in this report have shown the potential for milk from cows to reduce the daily cost of the diet. These other sources of milk can improve intakes of essential micronutrients such as protein, fat, vitamin A, B group vitamins, folic acid, calcium and zinc. Currently, poor households view their livestock as a source of income as opposed to a source of nutrition and need to be educated in the importance of providing milk to children and pregnant or lactating women to improve nutritional status.

programme should also advocate to parents the inexpensive nutritious foods identified in this report and develop recipes or review existing recipes to identify culturally acceptable preparation of these key foods that are more likely to preserve the nutrient content.

The results from this Cost of the Diet analysis have shown that very poor and poor households cannot afford a nutritious diet. It is therefore unlikely that poor households will purchase the nutritious foods identified in this report unless their income increases. Potential interventions that aim to increase income are suggested in section 5.4

Focus on optimal IYCF practices with stress on exclusive breastfeeding and complimentary feeding

Data from the project baseline regarding IYCF practices in Pindra indicate a concerning situation in which infants are being given other foods of poor nutritional quality before 6 months of age, increasing their risk of infection and malnutrition. A recent workshop organized for understanding the barriers around optimum breastfeeding revealed the myths associated around breastfeeding (e.g. after delivery it takes around 2-3 days for the breast to produce milk, breast milk is not sufficient for the baby, in summers the child should be given water, etc).

The level of knowledge that women have regarding nutritious foods to feed their children also is limited. Based on the demand from children, most of the women spend money on biscuits and chips instead of fruits, vegetables and eggs.

The cost of the diet results for the 12-23 month old child emphasise the importance of continued breastfeeding until the age of 2 years. In the analysis of the food habit diet, breast milk provided over half of fat and contributed to energy, vitamin A, vitamin B1, vitamin B2, niacin, folic acid and calcium requirements. Promoting the benefits of exclusive and continued breastfeeding is therefore highly recommended. However, breast milk is not rich in iron. Therefore making iron rich foods such as meat more accessible in terms of their price and physical presence in the market needs to be undertaken so that the consumption of these foods can be advocated for.

consequences of introducing other foods to the child before 6 months of age. It is also recommended to develop the capacity of front line workers and staff nurse of hospitals on importance of early and exclusive breastfeeding.

Further investment is needed in social protection interventions that increase income and improve nutrition outcomes

The gap in the affordability of a nutritious diet for very poor, poor and middle households is too large to be closed by the Public Distribution System (PDS). The food subsidy provided through the PDS only slightly improves diet affordability for these families; hence it is essential to have a relook at the subsidy that is provided to families below the poverty line (BPL) and also to expand the food basket to include food items that are more nutritious. This study shows that ICDS (Integrated Child Development Services) supplementary food does bring down the cost of a nutritious diet. The ground reality however is that this food is either not consumed by the households or there is sharing among all the family members. It is essential to design communication strategy to emphasize better utilization of ICDS supplementary food (panjiri).

Investment is needed in livelihood interventions that increase income and improve nutrition outcomes

Given the limitations of social protection schemes to fully address the economic barriers to a nutritious diet, the earning potential of very poor, poor and middle households needs to be increased by strengthening their livelihood opportunities so that households can access foods in the long term. The results have highlighted that current consumption patterns are unlikely to change unless income is increased. Very poor households in this zone are landless and rely on income from casual labour (mainly in agriculture, brick making and construction). Harvesting is the main type of agricultural work available locally. These forms of labour easily change with change in the season and other market demands and limit household’s ability to purchase nutritious food. Market and other livelihood assessments are therefore required to identify livelihoods that are viable in the target area.

The results from the HEA showed that most very poor and poor households have access to a small plot of domestic land. There is a potential to maximise the use of this land to grow vegetables for household consumption.

The results from the HEA also revealed that women do not engage with economic activities. Varanasi is a major producer of silk, silk garments and carpets. It may be possible to train these women in garment making and to link them with the silk/carpet industries. Also Varanasi is a major religious destination and has a heavy requirement for garlands; these women could also be engaged in garland making or crafts from their homes which could then be sold by linking them to supply chains or to businesses. However more information would need to be collected regarding the reasons as to why women are currently not working and the potential social or cultural stigma.

Seasonal market survey data collection should be undertaken to better understand how the cost of a nutritious diet changes over the year.

Very poor households are very vulnerable to rising food prices because they don’t own land of their own to grow crops or rear animals and therefore rely on local market to obtain their food. To build upon the seasonal analysis of the cost of a nutritious diet that has been presented in this report it is recommended that the data collection team in Pindra continue to undertake a market survey during each season. It is recommended that the food list is reduced to approximately 50 foods, especially cutting down on the spices. Another function of this seasonal data collection would be to monitor food prices and provide early warning regarding food price increases so that action could be taken to mitigate the potential devastating effects of this, thus in turn building resilience.

1. Introduction

1.1 Introduction to Pindra Block

Uttar Pradesh is one of the 29 states of India, and is divided into seventy districts. The Indian States that border Uttar Pradesh are Bihar, Jharkhand, Chhattisgarh, Madhya Pradesh, Rajasthan, Haryana, Uttarakhand and Delhi. The Himalayas lie to the north of the state and the Deccan Plateau to the south.

Varanasi is located in the middle Ganges valley, in the Eastern part of the state of Uttar Pradesh. It is 320 km southeast of the state capital Lucknow. Varanasi District shares a border with Chandauli District to the east, Jaunpur District to the north, and Mirzapur District to the West. The district occupies an area of 1,535 km² and has a population of 3,682,194 (2011 Census). Varanasi, or Benaras, (also known as Kashi), is the district capital and one of the oldest living cities in the world. Being located in the Indo-Gangetic Plains of North India, the land is very fertile because low level floods in the Ganges continually replenish the soil.

The sex ratio5 of Varanasi is 909 females per 1000 males whereas the child sex ratio6 is 896 males per 1000 females. The literacy rate7 is 77.05%. 38% of girls get married before the age of 188. The infant mortality rate9 is 72. MMR10 is 281. Institutional Delivery11 is 55%. 74% of children aged 6-59 months were

5 Census 2011 6 Census 2011 7 Census 2011 8 District Level Health Survey 3 9 Annual Health Survey 2012-13 10 AHS 2012-13 11 DLHS 3 12

anaemic, while 52% of pregnant and 58% of lactating women were anaemic12. 5.7% of children received at least one Vitamin A13 dose in the last 6 months. 25% of children (aged 6 to 35 months) received iron tablets/syrup14 in last three months. As per NFHS 3, 46% of children under 5 are stunted, 14% are wasted and 47% are underweight.

Varanasi is divided into eight administrative units called blocks and Pindra is one of them. Pindra is divided into 14 Nyay Panchayats and 98 Gram Panchayats. As per the census of 2011, the population of Pindra Block is 2.76 lakhs.

In Pindra Block, Save the Children India, together with local NGO SRF, is running a nutrition programme called Karuna: To Improve Nutrition Security in Pindra Block of Varanasi.

Some of the key findings of the project baseline:

Socio-economic Profile: Pindra is a rural block with the majority of people being Hindu. 16.5% of people belong to general category, 24.6% belong to scheduled castes (SC), 2% belong to scheduled tribes (ST) and 54% belong to other backward caste (OBC) categories. The literacy level is 66.3%.

Food Security: The availability of food supply round the calendar is one of the biggest and important elements in ensuring good health. 13.4% of households reported being worried about food supplies in the last 30 days.

Water, Sanitation and Hygiene: Almost all the HHs (95.3%) in the area has access to improved sources of drinking water. Only 27.9% of households have improved sanitation facilities (latrines). In Pindra, 75.2% of people wash their hands after defecation, 41.3% after cleaning a young child's faeces, 55.2% before eating, 54.4% before preparing food, and 30.6% before feeding children.

Pregnancy and Antenatal care: Services under antenatal care is the main programme of NRHM (National Rural Health Mission) to strengthen RCH (reproductive and child health) care and safe motherhood. 78.5% of pregnant women got their pregnancies registered. 63.3% of pregnant women received ANC (antenatal care) services, whereas among the mothers with children less than six months of age category, 76.1% reported receiving ANC services.

12 National Family Health Survey 3 13 AHS 2012-13 14 AHS 2012-13 13

Childcare and Infant and Young Child Feeding practices: An encouraging 78.3% of mothers with children in the age group of 0 to 24 months started breastfeeding within an hour of birth. 76.3% of mothers gave colostrum to their newborn, while only 37.2% exclusively breastfed their babies for the first six months.

According to mothers of children aged 0-24 months, 65.2% had begun complementary feeding of their child within the age group of 6-8 months in the project.

Under the ICDS (Integrated Child Development Services), mothers receive cooked / uncooked / ready to eat food from the AWC (Angan Wadi Centres) as ration to take home, which was reported to be received by meagre 14.7% of mothers in the block.

Child Health and Vaccination: According to 60.5% of mothers, their children had fallen ill (from any illness) in the last three months. Among the children fallen ill, the highest cases reported were normal fever (82.2%) followed by diarrhoea (25.8%). Among these, 54% of mothers had either stopped or reduced breastfeeding during illness.

22.1% of children aged 12-23 months received full immunization comprising of BCG, three doses of DPT, three doses of Polio (excluding Polio 0) and measles. 4.1% of children did not receive any kind of immunization in Pindra Block.

Malnutrition Status: 50% of children (aged 6-59 months) were stunted or too short for their age, 29.1% were wasted or too thin for their height and 46.6% were underweight. The MUAC (Mid-Upper Arm Circumference) was less than 11.5 cms for 2% of children in project block.

1.2 Aim of the analysis

2. Methods

For a detailed description of the Cost of the Diet tool, the diets it can analyse, its uses and limitations, please refer to Annex 1.

2.1 Location

A livelihood zone is defined as a geographical area within which people share broadly the same patterns of access to food. Cost of the Diet assessments are often conducted in a livelihood zone because the foods that are available and that people consume are homogenous. This Cost of the Diet assessment took place in Pindra Block, which falls entirely in the agricultural plain livelihood zone. This block was selected because the Karuna project is active throughout the block.

2.2 Data collection, sources and entry

This section describes the data collected to undertake an analysis of the cost of the diet.

2.2.1 Market survey to collect price data

Market data surveys were conducted in the following markets: Pindra, Mangari, Gathama, Sindhora, Hiraunpur, Phoolpur. These markets were selected to be representative of where poor households in Pindra Block purchase their food.

A list of all food items available in the markets of Pindra Block was developed using key informants and the knowledge of the data collectors who are Nutrition Counsellors in the Karuna Project. This was followed by a

field trial in a local market in Baragaon (data not included) where participants practiced data collection methods whilst adding items to the food list. The resulting comprehensive food list was then used to collect data on price and weight in the Pindra Block markets.

For the purpose of the assessment, both real time and retrospective data were collected so that a baseline analysis of the last year could be produced. The reference year selected for data collection was from January – December 2014. Six seasons were identified, as follows:

Season 1: November-December 2014: fall winter (hemanta) Season 2: September-October 2014: autumn (sharada) Season 3: July-August 2014: monsoon (varsha) Season 4: May-June 2014: summer (grishma) Season 5: March-April 2014: spring (vasant) Season 6: January-February 2014: winter (shishir)

To collect the information needed to estimate the cost of the diet, market traders were asked the price of the smallest unit of each food item that they sold during each season, assuming that the poor were likely to be able to afford this amount. The poor typically buy foods in small amounts as they cannot afford bulk purchases. Three samples of each food were weighed using electronic scales that had a precision of 1g. Where possible in each market, weight and price data was collected from four traders giving a possible total of four prices and 12 weights for each food item found in every market. Market traders were then asked questions about annual trends in prices, seasonality and changes in the demand and supply of commodities. This qualitative data provided important contextual information which was used to inform the results. The quantitative data was entered into the Cost of the Diet software every evening after collection, which averaged the price and weight of each food across every market.

The final averaged weight and price for each food was then divided to calculate the cost per 100g of each food item by season.

Each food item identified in the market survey was selected from the food composition database in the Cost of the Diet software, choosing the variety consumed in the region nearest to India if there was more than one type available to select.

2.2.2 Interviews and focus group discussions to collect data on typical food consumption habits

To estimate a diet that is nutritious but takes into account typical food habits of households in Pindra Block, the software needs to be told how many times a week it can or cannot include a food. These are called the minimum and maximum food frequency constraints, which need to be determined for each food found in the market. For example if the minimum constraint for Irish potato is set at 5 and the maximum is set at 14 this means that the software must include potato in the diet no less than 5 times a week but no more than 14 times a week (or twice a day). It is important to note that the constraints applied are intended to reflect typical dietary patterns rather than reflect economic constraints, because the Cost of the Diet is a tool to illustrate a diet that could be achieved if economic limits were removed.

To create these constraints, a one hour interview based upon a questionnaire and focus group discussions were carried out to understand local dietary patterns. The questionnaire was based upon the food list generated by the market survey and aimed to determine how often the foods were consumed. The questions asked during the focus group discussion were based on early observations from the market data, comments from traders, and responses to the questionnaire. In particular, information was collected on the foods that infants and young children, pregnant and lactating women were or were not consuming, cultural taboos, ‘normal’ consumption patterns, and key staples.

The discussions were held in 4 of villages. Each group consisted of 8 women, 2 from each wealth group identified by the HEA, all of whom were responsible for preparing food for the household.

During the interview the women were asked to state the frequency with which they ate each item of food on the list. The frequency options given were never, rarely, often (1-4 times a week) or usually (more than five times a week). The responses were given a numerical score: ‘never’ and ‘rarely’ were awarded 0 points, ‘often’ 1 point and ‘usually’ 2 points, then the total for each food item from all 8 respondents was calculated. This meant that each item could receive a minimum total score of 0 and maximum of 16. The software translates a total score of 0-1 points into a minimum and maximum constraint of 0 and 0, a total score of 1-8 points into a minimum and maximum constraint of 0 and 7 (a food eaten once a day), a total score of 9-15 points into a minimum and maximum constraint of 0 and 14 (a food eaten two times a day), and a total score of 16 into a minimum and maximum constraint of 7 and 14 (a food eaten at least once but no more than twice a day).

During the focus group discussions the women in each village stated that the household consumed 2-3 meals a day. They stated that wheat flour and rice were the staple foods and that mustard oil and tea were consumed on a daily basis. The minimum and maximum constraints for wheat flour, rice, mustard oil and tea were therefore entered as 7 and 14 to mimic this (consumed at least once per day). This is what is presented below as the food habits diet.

With the market and food consumption data the cost of three theoretical diets were estimated using the Cost of the Diet software: a lowest cost diet that only meets recommended average energy requirements (energy only diet); a lowest cost diet that meets recommended intakes for energy and nutrients (nutritious diet); and a lowest cost ‘nutritious’ diet that meets recommended intakes for energy and nutrients based upon typical dietary habits of households in Pindra Block (food habits diet).

The average cost of each diet is given in Indian rupees. Where costs have been converted to US dollars an exchange rate of 61 rupees per US dollar15 has been used.

2.2.3 Specification of a typical family

A typical household was specified during the HEA focus group discussions and was judged to contain 7 individuals. As the estimates of household income for these typical families are based on an energy requirement of 2,100 kcals per person per day, or 14,700 kcal per household per day in total, the Cost of the Diet method identifies a family of the same individuals that require as close to these energy requirements as possible. The typical HEA/Cost of the Diet family for a 7 person household consists of:

. An adult man, aged 30-59 years, weighing 50 kg and moderately active (2,750 kcal/day) . An adult woman, aged 30-59 years, 45 kg, moderately active (2,300 kcal/d) and lactating (567 kcal/d) . An adult women , aged >60 years, 45 kg, moderately active (2050 kcal/d) . A baby (either sex) aged 12-23 months (906 kcal/d) . Child (either sex) aged 8-9 years (1764 kcal/d) . Child (either sex) aged 10-11 years (2078 kcal/d) . Child (either sex) aged 12-13 years (2412 kcal/d)

The total energy requirement of this family is 14,827 kcal/d.

15 Historical interbank exchange rate for last 12 months from www.oanda.com. 18

The specification of the HEA/CoD families of between four and ten members are shown in Annex 2 and are recommended as standard families for all Cost of the Diet analyses, where HEA data has been used. This ensures that the analysis can be aligned with any HEA.

2.2.4 Recommended intakes for energy and micronutrients

The needs of individuals for energy are taken from a database embedded in the Cost of the Diet software that specifies the estimated average requirement (EAR) recommended by the WHO and FAO1 for individuals by age, sex and activity level. As this intake is based on the estimated average requirement, the probability that any given individual’s requirement is met is 0.5 or 50%.

The needs of individuals for protein are taken from a database embedded in the software which specifies the 95th percentile recommended by the WHO and FAO2 for individuals by age and sex. The needs of individuals for fat are specified as between 30%and 60% of total energy intake3.

The needs of individuals for vitamins and minerals (collectively called micronutrients) are taken from a database embedded in the software which specifies the recommended nutrient intake (RNI) proposed by the WHO and FAO4 for individuals by age and sex. This intake is defined as the 97.5th percentile of the distribution of individual requirements, so the probability that any given individual’s requirement is met is 0.975 or 97.5%.

A diet selected by the Cost of Diet software which meets all of the requirements described above is called a ‘nutritious’ diet.

2.3 Estimating the affordability of diets

2.3.1 Estimating affordability according to annual income

The cost of a nutritious diet becomes a more meaningful figure when compared with the income and purchasing power of the poorest members of the community. A diet may be inexpensive in comparison to other contexts, but if it is beyond the means of the poor, then the risk of malnutrition remains.

Estimates of cash income were made during an HEA that was carried out at the same time as the Cost of Diet survey. For the purpose of the present analysis, in addition to the estimated cash income, the cash value of all food that is consumed but not purchased was estimated based on the market cost of the same foods. In the case of Pindra Block, this includes crop and livestock production, the school feeding programme (called midday meal) and the ICDS programme (cooked and take-home food). The full value of subsidised food provided through the Public Distribution System (PDS) was also estimated based on the market cost of the same foods.

Table 1 below shows income estimates for four wealth groups, defined by the HEA.

Table 1. Total estimated annual household income in Indian rupees unless otherwise stated, for four wealth groups rounded to the nearest thousand.

Very poor Poor Middle Better off Annual Cash 55,000 76,000 88,000 225,000 Income (906 USD) (1,254 USD) (1,443 USD) (3,695 USD) Annual Own Produce/Social 13,000 53,000 69,000 85,000 Scheme Foods (216 USD) (863 USD) (1,131 USD) (1,397 USD) Total Annual 68,000 129,000 157,000 310,000 Income (1,122 USD) (2,117 USD) (2,574 USD) (5,092 USD)

2.4.2 Estimating affordability after accounting for non-food expenditure

The income figures in Table 1 represent the total and potential income for households in different wealth groups. However, households have many needs in addition to food, some of which are critical for their survival. The ‘non-food expenditure’ (NFE), is defined as the annual cost of non-food items purchased by each specified wealth group. These figures are estimated by subtracting the staple food and non-staple food expenditure figures, generated by the HEA, from the total annual expenditure figures for each wealth group, again, generated by the HEA. By subtracting the non-food expenditure from the total annual income figures presented above, a more realistic indication of what amount households may have available to spend on food can be estimated.

Table 2 below shows the total income of each wealth group after subtracting household’s needs for essential non-food items.

Table 2. Total income and non-food expenditure, by wealth group. Very Poor Poor Middle Better off 68,000 129,000 157,000 310,000 Total Annual Income (1,115 USD) (2,115 USD) (2,574 USD) (5,082 USD) Non-food expenditure 15,000 38,000 63,000 145,000 (NFE) (245 USD) (623 USD) (1,033 USD) (2,377 USD) 53,000 91,000 94,000 165,000 Total annual income - NFE (870 USD) (1492 USD) (1,541 USD) (2,705 USD)

The difference between the total estimated annual income minus the non- food expenditure and the annual cost of a nutritious diet was defined as the ‘affordability’ of the diet.

3. Results

The list of all foods found in the markets and used in the Cost of Diet analysis, their price per 100g, and their food habits diet minimum and maximum constraints can be found in Annex 3.

3.1 The availability of foods in the local markets

The data collection team found 110 foods on the markets of the assessment area: 8 cereals, 4 roots/tubers, 12 pulses/seeds, 24 vegetables, 21 fruit, 2 types of meat, 4 varieties of fresh fish, 6 dairy products, 17 herbs/spices, 4 sugars/confectionary, 1 beverage, 2 supplementary foods, and 5 fats/oils.

In terms of availability, the largest variation between markets was in the availability of fish and meat, which were less available in smaller markets. Fish is not available throughout the day in most markets and there are only a small number of traders in each market. Goat meat also has limited availability. Many of the fruits and vegetables on the list are seasonal. Other items on the list of foods with quite limited availability included millet, taro, kidney beans, and butter.

3.2 Typical food consumption habits and food taboos

The results from the interviews and focus group discussions found that both rice and wheat are considered staple food in the assessment area and one or other staple is eaten at least twice a day. Women prefer eating rice because of the ease of preparation and also because they prefer its taste.

Pulses, onions, potatoes and tomatoes are used in curries and are also eaten daily. Within the category of pulses, pigeon peas are mostly consumed. Although pigeon peas are expensive compared to other pulses, it was reported that they are preferred because people grew up eating them. Poor families generally mix pigeon peas with other pulses to manage the high cost.

Potatoes are consumed as a vegetable throughout the year, with consumption increasing during the winter months. Other vegetables are consumed based on seasonal availability. The vegetables most commonly consumed are cauliflower, cabbage, bottle gourd, peas, pumpkin and green leafy vegetables. Vegetables such as pointed gourd and lady finger are eaten rarely and are considered more expensive. During the focus group discussions the women said that they either fry or boil vegetables within a curry. The cooking time ranges from 20 – 40 minutes.

Other than bananas, which are consumed often (1-4 times a week), most of the fruits are rarely eaten because of the high costs. Dairy products and meat are also rarely consumed due to their cost. Cow’s milk is the preferred type of milk and is mainly consumed in tea. Eggs are occasionally eaten.

The results from the interviews and focus group discussion reveal that households eat two to three meals a day, prepared by the women. Husbands get the food from market and wives prepare whatever is brought home, while trying to prepare foods that children like. The women categorically mentioned that children do not like eating green vegetables and the emphasis is more on potato (as a vegetable).

The women were also asked about specific foods that are eaten during different stages of the life cycle. Children under the age of 2 are often given soft, watery foods such as kichdi (rice and pulse cooked together), powdered rice with water or milk, banana and boiled vegetables. There are no specific taboos for this age group but they are not given spicy foods, hard foods, or cold water because the women said that these foods make children sick with flu and diarrhoea. By the age of 5 years, children are

eating the same foods as the rest of the household. In general, adolescent girls pre and post marriage consume the same foods as the other members of the family. However, during their period they do not eat spicy foods like pickle.

When asked about food consumption habits during pregnancy, various taboos were mentioned. Previously, the practice was to give less food to pregnant women, because the belief was that if the foetus grows too large, the woman would have to undergo a caesarean. Giving birth to a small baby was perceived as being good because there would not be birthing complications. Pregnant women are not allowed to eat rice, the belief being that it causes a thick layer around the baby. This is no longer a prevalent practice.

Specific foods are avoided during pregnancy. Papaya is associated with causing abortion and hence is avoided by pregnant women. Pregnant women also avoided tea and spices as they are associated with causing heartburn. In some families, the intake of ghee (clarified butter), although expensive, is increased when a woman was pregnant. Ghee is liberally added to her share of the food. The belief is that ghee not only makes the baby healthy, it eases the delivery process and ensures a safe birth.

There were both positive and negative practices mentioned when women were asked about typical food habits during lactation. Previously no food was given to the woman who had just given birth. The belief was that the muscles of the stomach had loosened up during childbirth and were not able to handle cereals. Nowadays, the woman is given 'hot natured' foods so that the new born gets nutritious milk. The view is that such foods help in releasing the placenta from the body. In most villages, specific foods are eaten to increase the amount of milk that women produce such as rice, spinach, potatoes, lentils and cumin seeds in warm water. Eggplant, black gram, jackfruit, pumpkin and meat are taboo for lactating women as they are associated with causing diarrhoea in children.

When asked who influences or enforces these practices the women in every focus group discussion said that these beliefs had been imposed for generations. They also said that their mothers and mother in laws are currently enforcing these beliefs.

3.3 The cost of the diets

3.3.1 Energy only diet

Table 3 below shows the analysis of the cost of the diet by season. The minimum cost of a diet that meets only a household’s energy need has been estimated at between 70 – 71 rupees per day, depending on the season, and features only 3 of the110 foods included in the software, plus breast milk. The annual cost of the diet for the typical family is estimated to be 25,634 rupees.

Table 3. The lowest cost diet for the HEA/CoD family in Pindra Block, Varanasi District, India, that meets only their energy requirements. Daily Daily Daily Daily Daily Daily Cost Cost Cost Cost Cost Cost Season 1 Season 2 Season 3 Season 4 Season 5 Season 6 Annual Individuals Nov/Dec Sep/Oct Jul/Aug May/Jun Mar/Apr Jan/Feb Cost 12-23 month old 2.70 2.71 2.71 2.70 2.70 2.66 984 Total 70.35 69.85 70.69 69.70 70.38 70.42 25,635

It should be noted that the cost of the diet of the child aged 12-23 months only includes the cost of the solid complementary foods the child is given, it does not include the cost of breast milk which is costed within the average extra energy and nutrients required by the mother each day.

The key foods in the energy only diet are rice, wheat flour and dried coconut.

Annex 4 shows the absolute weight and cost of the foods selected for the family for the whole year for the energy only diet with the percentage contributed by each food in terms of weight, cost, energy, protein and fat, the percentage contribution of each food for eight vitamins and four minerals and the percentage of the total requirements met for each nutrient.

Although the energy only diet meets the recommended requirements for energy by design, it lacks several essential macro and micronutrients. Figure 1 below shows that RNIs for only protein, niacin, pantothenic acid, magnesium and zinc are met.

Figure 1. The percentage of energy and the recommended nutrient intakes for micronutrients met by an energy only diet for the HEA/CoD family in Pindra Block. 180

160 Nov/Dec 140 Sep/Oct Jul/Aug 120 May/Jun Mar/Apr 100 Jan/Feb 80

0 Percentage of energy and nutrient targets(%) met energynutrient of and Percentage Fat Iron Zinc Niacin Energy Protein Calcium Vitamin C Vitamin A Vitamin B1 Vitamin B2 Vitamin B6 Folic Acid Vitamin B12 Magnesium

Pantothenic Acid

3.3.2 Nutritious diet

The minimum cost of a nutritionally adequate diet that meets the average energy requirements and the RNIs for micronutrients of a family of 7 people is estimated to cost between 332 and 395 rupees per day, depending on the season. Table 4 shows the cost by season. The annual cost of the nutritious diet for the typical family is estimated at 133,934 rupees, which is more than 5 times more expensive than the energy only diet. This diet includes 21 of the 110 foods known to be eaten by people in Pindra, some of which have to be eaten at three meals a day, every day, which is unlikely.

Table 4. The lowest cost diet for the HEA/CoD family in Pindra Block, India that meets needs for energy and micronutrient but does not take into account the typical diet. Daily Daily Daily Daily Daily Daily Cost Cost Cost Cost Cost Cost Season 1 Season 2 Season 3 Season 4 Season 5 Season 6 Annual Individuals Nov/Dec Sep/Oct Jul/Aug May/Jun Mar/Apr Jan/Feb Cost 12-23 month old 23.29 26.41 27.21 27.54 26.46 24.58 9,463 Total 332.29 362.18 393.51 394.74 377.99 339.62 133,934

The key components of the diet selected by the Cost of the Diet software in terms of quantity are buffalo milk, fenugreek leaves, wheat flour, Bengal grams, spring onions, rohu fish, snake gourd, cabbage and spinach.

Annex 5 shows the absolute weight and cost of the foods selected for the family for the whole year for the nutritious diet with the percentage

contributed by each food in terms of weight, cost, energy, protein and fat, the percentage contribution of each food for eight vitamins and four minerals and the percentage of the total requirements met for each nutrient.

Figure 2 below shows the percentage of the recommended requirements met for the essential macro and micronutrients by the nutritious diet, for the HEA/CoD family. Figure 2 shows that the RNI is exactly 100% for calcium. Although the software has been able to meet the recommended intakes of calcium using local foods, this analysis identifies that the software has found this micronutrient the most difficult to obtain from the local markets in a nutritious diet that is not constrained by typical dietary patterns. Calcium is therefore driving up the cost of the nutritious diet, because the software has to include large quantities of expensive foods such as buffalo milk and fenugreek leaves to meet these requirements.

Figure 2. The average percentage of energy and the recommended nutrient intakes for micronutrients met in a year by a nutritious diet for the HEA/CoD family in Pindra Block 650 600 550 Nov/Dec Sep/Oct 500 Jul/Aug 450 May/Jun 400 Mar/Apr 350 Jan/Feb 300 250 200 150 100 50

Pantothenic Acid

3.3.3. Food habits nutritious diet

The nutritious diet specified in section 3.3.2 above was not chosen to be typical of the foods eaten by people in Pindra Block; that diet reflects the least expensive way for the typical family to meet the specified amounts of energy and micronutrients using all foods available in the market, but in unconstrained amounts.

Table 5 below shows the breakdown of costs by family member and by season for a food habits diet. The estimated minimum amount of cash that a family of 7, including a child aged 12-23 months, would need to be able to purchase

this diet from the market is between 372 – 504 rupees per day and includes 27 of the 110 foods known to be eaten by people in Pindra Block. The annual cost of the food habits diet for the typical family is estimated at 163,600 rupees, which 22% more expensive than the nutritious diet.

Table 5. The lowest cost diet for the HEA/CoD family in Pindra Block, India that meets needs for energy and micronutrients and is adjusted to account for usual dietary habits. Daily Daily Daily Daily Daily Daily Cost Cost Cost Cost Cost Cost Season 1 Season 2 Season 3 Season 4 Season 5 Season 6 Annual Individuals Nov/Dec Sep/Oct Jul/Aug May/Jun Mar/Apr Jan/Feb Cost 12-23 month old 21.24 27.31 30.34 29.91 27.58 23.35 9,727 Total 372.12 456.69 504.34 498.99 461.96 392.45 163,600

Table 6 below shows the absolute weight and cost of the foods for the whole year with the percentage contributed by each food in terms of weight, cost, energy, protein and fat, and the percentage contribution of each food for eight vitamins and four minerals for the HEA/CoD family.

The key foods selected by the software for the food habits diet in terms of quantity are Indian spinach, radish, buffalo milk, potato, rice, wheat flour, spring onions, fenugreek leaves, cauliflower, snake gourd, rohu fish, mustard oil, pumpkin and paneer cheese.

The food habits diet for the 12-23 month old child, detailed in Table 7, emphasises the important contribution that breast milk makes to nutrient requirements in Pindra Block as it provides the greatest total percentage of energy and fat. Breast milk contains little iron however, so it is important that iron-rich complementary foods are given to the child. Table 7 shows that spinach, wheat flour and rohu fish have been selected by the software as important sources of iron.

Table 6. The percentage of the average requirements for energy, protein and fat met each day by the food habits diet and the percentage of the recommended daily intake of vitamins and minerals provided by the diet for the HEA/CoD family.

Quantity % Cost % % % % % % % % % % folic % % % % Food List (Kg) quantity (INR) cost energy protein fat vit A vit C vit B1 vit B2 niacin vit B6 acid vit B12 calcium iron zinc Aalu (Potato, diamond, raw) 391 7.9 9 493 5.8 4.8 2.2 0.4 0.2 5.9 5.4 4.3 3.8 13.2 2.4 0.0 0.1 2.4 8.8 Aata (Wheat, flour, local or hyv) 362 7.3 6 517 4.0 22.9 23.9 4.6 0.0 0.0 22.3 8.2 40.6 13.7 3.8 0.0 1.3 17.5 29.9 Bandhagobi (Cabbage, raw) 4 0.1 55 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.1 0.1 0.0 0.0 0.0 0.1 Bhains ka dudh (Milk, buffalo, whole 415 8.4 16 344 10.0 7.8 7.6 20.9 3.6 0.5 3.3 10.8 0.5 1.2 0.9 43.0 12.2 1.9 2.6 fat) Breast milk 194 3.9 0 0.0 2.3 1.0 5.1 1.8 0.6 0.7 0.8 1.0 0.2 0.6 2.1 0.8 0.0 0.7 Chai pata (Tea, powder) 6 0.1 2 021 1.2 0.3 0.6 0.0 0.0 0.0 0.0 0.7 0.8 0.3 0.2 0.0 0.0 0.2 0.3 Chana dal (Bengal gram, dehulled, split, 21 0.4 926 0.6 1.5 2.0 0.9 0.0 0.0 1.7 0.7 0.6 1.4 1.1 0.0 0.1 2.3 2.0 dried, raw)

Chauli, Hara saag (Leaf, amaranth, 39 0.8 903 0.6 0.2 0.4 0.1 5.4 1.2 0.2 0.8 0.8 0.9 1.1 0.0 0.2 4.1 1.1 green, raw) Chawal (Rice, grain or flour) 368 7.4 6 447 3.9 25.0 11.9 1.5 0.0 0.0 3.8 2.6 10.7 6.3 0.8 0.0 0.3 2.7 11.5 Chirchira (Gourd, snake, raw) 183 3.7 3 099 1.9 0.8 0.4 0.4 0.0 2.7 1.3 1.3 1.8 0.9 1.0 0.0 1.2 0.9 1.7 Chola, safed (Bengal gram, whole, 21 0.4 858 0.5 1.4 2.1 0.9 0.0 0.0 1.1 0.7 1.3 1.4 1.3 0.0 0.5 2.3 1.6 dried, raw) Haldi (Turmeric, dried) 2 0.0 458 0.3 0.1 0.1 0.1 0.0 0.0 0.0 0.0 0.1 0.5 0.0 0.0 0.1 0.9 0.2 Jira (Cumin, seeds) 6 0.1 1 031 0.6 0.4 0.5 0.7 0.1 0.0 0.6 0.2 0.3 0.3 0.0 0.0 0.8 3.2 0.6 Karela (Gourd, bitter, raw) 2 0.0 52 0.0 0.0 0.0 0.0 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Kohara (Pumpkin, raw) 43 0.9 1 065 0.7 0.1 0.3 0.1 2.9 0.7 0.5 0.3 0.4 0.3 0.2 0.0 0.5 0.4 0.1 Methi Saag (Leaf, fenugreek, raw) 327 6.6 14 636 8.9 3.0 6.9 2.0 46.1 13.5 6.7 12.1 6.8 10.7 11.7 0.0 27.8 7.7 3.2 Muli (Radish, raw) 547 11.0 9 930 6.1 1.8 2.4 0.4 0.0 7.5 40.3 0.0 3.0 4.7 4.7 0.0 2.8 2.7 5.9 Nariyal (Coconut, dried) 10 0.2 381 0.2 1.4 0.3 4.7 0.0 0.0 0.2 0.0 0.3 0.1 0.2 0.0 0.1 0.6 0.7 (Onion, spring or scallion, raw) 334 6.7 7 599 4.6 2.0 2.9 0.4 3.1 5.0 3.1 3.2 2.1 2.5 7.3 0.0 5.2 6.1 3.7 Palak (Indian spinach, raw) 1116 22.5 26 842 16.4 5.2 12.7 2.4 35.1 46.0 3.8 47.9 6.8 32.6 53.5 0.0 26.7 30.3 11.1 Paneer (Cheese, cottage) 42 0.8 7 548 4.6 2.7 5.0 7.1 1.6 0.0 0.1 2.3 3.3 0.0 0.6 4.4 4.8 0.4 4.3 Phoolgobhi (Cauliflower, raw) 272 5.5 14 929 9.1 1.4 3.4 0.5 0.0 15.7 1.4 1.0 3.5 6.1 5.3 0.0 2.0 2.7 3.2

Rohu (Fish, rohu, river, raw) 129 2.6 24 942 15.2 2.2 10.3 2.3 0.0 0.0 1.1 1.1 9.3 1.8 0.0 50.4 12.1 8.0 4.2

% Quantity % Cost % % % % % % % % % % folic % % % % Food List (Kg) quantity (INR) cost energy protein fat vit A vit C vit B1 vit B2 niacin vit B6 acid vit B12 calcium iron zinc Sarson (Mustard, seeds) 2 0.0 99 0.1 0.2 0.2 0.5 0.0 0.0 0.3 0.1 0.2 0.1 0.1 0.0 0.1 0.3 0.4 Sarson tel (Oil, mustard) 65 1.3 6 101 3.7 10.9 0.0 43.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 Sem (Broad beans, raw) 15 0.3 324 0.2 0.1 0.3 0.1 0.0 0.1 0.2 0.2 0.4 0.1 0.5 0.0 0.2 0.3 0.2 Sukha Matar (Pea, dry) 21 0.4 757 0.5 1.3 2.3 0.2 0.0 0.1 1.5 0.4 1.6 0.8 2.5 0.0 0.2 2.0 1.7 Tori (Gourd, ridge, raw) 14 0.3 244 0.1 0.1 0.1 0.0 0.0 0.0 0.3 0.0 0.1 0.1 0.0 0.0 0.1 0.2 0.2

Total 4 954 100 163 600 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 % target met 100 242 109 356 1 129 213 298 233 256 314 159 86 113 216

The percentage of target met is an average of the % nutrient requirements met over the year.

Table 7. The percentage of the average requirements for energy, protein and fat met each day by the food habits diet and the percentage of the recommended daily intake of vitamins and minerals provided by the diet for the 12-23 month old child.

% % %

Total 475 100 9 727 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 % target met 100 244 128 244 858 240 288 240 269 364 177 78 107 140

The percentage of target met is an average of the % nutrient requirements met over the year.

Figures 3 and 4 below illustrate that the food habits diet is not nutritious because 100% of the RNI for calcium is not being met, in all seasons of the year. For the HEA/CoD family as a whole, 86% of the annual calcium requirement is met, but this masks large differences for different individuals in the household: 78% for the 12-23 month old infant, 67% for the 10-11 year old child, 74% for the 12-13 year old child and 91% for the woman over 60 years. This analysis identifies calcium as the most difficult to obtain from the food habits diet using foods found in the local market of Pindra Block.

Figure 3. The percentage of energy and the recommended nutrient intakes for micronutrients met by a food habits diet for the HEA/CoD family in Pindra Block 1 200 1 100 Nov/Dec 1 000 Sep/Oct 900 Jul/Aug 800 May/Jun 700 Mar/Apr Jan/Feb 600 500 400 300 200 100

Pantothenic Acid

Figure 4. The percentage of energy and the recommended nutrient intakes for micronutrients met by a food habits diet for the 12-23 month old child in Pindra Block 1 000 900 Nov/Dec 800 Sep/Oct Jul/Aug 700 May/Jun 600 Mar/Apr Jan/Feb 500 400 300 200 100

Pantothenic Acid

The food habits diet does not meet the recommended intake of calcium. The main constraints that are imposed with the food habits diet are to force rice, mustard oil and potato into the daily diet. Rice is not very rich in micronutrients compared to other cereals. Potato is considered a vegetable in this part of India – indeed it is considered the main vegetable – but it does not have the micronutrient content of other available green vegetables. Unconstrained, the software selects buffalo milk and dried coconut as sources of fat rather than mustard oil, suggesting that they contain other required nutrients in addition to fat.

Loosening the constraints on rice, mustard oil and potatoes from 7-14 (minimum 7, maximum 14) to 0-14 (minimum 0, maximum 14) greatly increases the percentage of RNI covered for calcium (to 98% for the whole household). However, it also greatly increases the cost of the food habits diet to 199,330 rupees, an increase of 22% over the food habits diet and of 49% over the nutritious diet presented above. The cost is greater because the diet is more nutritious.

3.4 Seasonal fluctuations in the food habits diet

Figure 5 below shows the cost of the food habits nutritious diet by season of the year. The results show that the cost of the diet was lowest during the late autumn and winter months of November – February and the highest during the summer and monsoon months of May to August.

The HEA found that various crops are harvested from October through April, whereas there are few crops harvested in May to September. The main lean season is in August – September, before the rice harvest. The HEA found that very poor households in Pindra Block used the market to purchase the majority of their energy requirements. The seasonal fluctuation of food prices may therefore greatly impact very poor household’s access to food in this area, even if the price increase of individual food items is small. Also, these results only capture changes in food prices by season; they do not capture changes in affordability. The HEA found that access to labour and therefore household incomes, changes throughout the year. Expenditure is also not static, with some household expenses such as healthcare and education, increasing at different times of the year. These factors must be taken into consideration when considering seasonal affordability of a nutritious diet.

Figure 5. The cost of the food habits diet by season of the year for the HEA/CoD family in Pindra Block.

Jan/Feb Mar/Apr May/Jun Jul/Aug Sep/Oct Nov/Dec 600 550 500 450 400

350 300 250

200 150

Daily cost of the food habits diet (INR) diet habits cost food Daily the of 100 50

0 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

3.5 The contribution of food groups to the cost of the food habits diet

Figure 6 below shows for the food habits diet that vegetables are the most costly element of the diet for the HEA/CoD family in Pindra Block across all seasons. This is because spinach, radishes, fenugreek leaves, spring onions, snake gourds and pumpkins are included in the diet in large quantities. Fish and milk are other costly items.

Figure 6. The weekly cost of foods each week selected by the Cost of the Diet software for the food habits diet which meets needs for macro and micronutrients in a culturally acceptable diet for the HEA/CoD family in Pindra Block. 2 000

1 800 Nov/Dec Sep/Oct 1 600 Jul/Aug 1 400 May/Jun Mar/Apr 1 200 Jan/Feb

1 000

800

600

Weekly cost of the diet in INR in costWeekly diet the of 400

200

0 Grains and Roots and Legumes, Fish, Milk and Vegetables Fruit and Oils and Herbs, Beverages tubers nuts and seafood, milk and fruit fats spices and grain-based products seeds amphibians and products vegetable products products condiments invertebrates

3.6 Affordability of the diets

In order to calculate affordability, the cost of the three diets plus non-food expenditure is compared with total income (cash income plus the value of own produced foods, as defined in the HEA baseline done concurrently with this Cost of Diet assessment), all of which are estimates based on multiple

assumptions and variable parameters. Table 8 below shows the cost of the diets per year and of the non-food expenditures specific to each wealth group compared to annual incomes.

Table 8 and Figure 7 below indicate that very poor, poor and middle households in Pindra Block cannot afford the nutritious diet or the food habits diet plus non-food expenditure. Households in the better off wealth group can only just afford a food habits diet and their non-food expenditure. The additional amount of money that very poor, poor and middle households require a year to be able to afford the food habits diet plus non-food items is approximately 111,000 INR (1820 USD), 72,000 INR (1200 USD) and 70,000 INR (1150 USD) respectively.

Table 8. The estimated incomes by wealth group, non-food expenditure (NFE), and the costs of three diets estimated by the Cost of the Diet software for the HEA/CoD family in Pindra Block. Annual Annual % extra Annual cost % extra cost Annual non % NFE cost of % income cost of cost of of food of food food for Wealth Annual energy of energy nutritious nutritious habits habits expenditur wealth Group income only diet only diet diet diet nutritious nutritious e group Very Poor 68 000 25 627 37.7 133 934 159.3 163diet 600 43.6diet 15 000 22.1 Poor 129 000 25 627 19.9 133 934 84.0 163 600 23.0 38 000 29.5 Middle 157 000 25 627 16.3 133 934 69.0 163 600 18.9 63 000 40.1 Better-off 310 000 25 627 8.3 133 934 34.9 163 600 9.6 145 000 46.8

Figure 7 below visually presents the affordability analysis for four wealth groups in Pindra Block based upon the numbers presented in Table 8 (above). Anything above 100% is unaffordable.

Figure 7. The affordability of an energy only diet, nutritious diet and food habits diet for the HEA/CoD family in Pindra Block 280 260 % income of energy only diet 240 % extra cost of nutritious diet 220 % extra cost of food habits nutritious diet % NFE for w ealth group 200 180 160 140 120 100

Percentage of income (%) income of Percentage 80 60 40 20 0 Very Poor Poor Middle Better-off

As noted in section 3.3.3 above, the food habits diet does not meet the recommended intake of calcium. The main constraints that are causing this problem are related to rice, mustard oil and potato. Loosening the constraints on these three food items from 7-14 (minimum 7, maximum 14) to 0-14 (minimum 0, maximum 14) greatly increases the percentage of RNI covered for calcium (to 98% for the whole household). However, it also greatly increases the annual cost of the food habits diet to 199,330 rupees per year, an increase of 22% over the food habits diet and of 49% over the nutritious diet presented above. Combined with non-food expenditure, this would be 315% of annual income for very poor households.

3.7 Modelling scenarios and nutritional interventions

The Cost of the Diet software can be used to examine the effect of changing variables and assumptions on the cost and affordability of each diet, but usually the food habits diet. For example the effect of activities to generate income, the effect of changing the cost of foods and the effect of providing foods that have a higher nutrient content could all be examined in terms of their effect on the cost, quality and composition of the diet. Such models can illustrate the potential for activities to improve the diet either through nutritional interventions or by poverty alleviation. The models presented can help to generate ideas and test assumptions about the impact of activities on household nutrition, and to set targets and indicators. All the models described here are theoretical and, in reality, the situation will be influenced by numerous external factors that cannot be included in the model, so the actual effect on the cost of the diet may be different.

A total of 5 interventions or ‘what if’ scenarios were modelled to examine the effects on the cost, composition, quality and affordability of the diet:

 Adding free ICDS panjiri to the diet  Reducing breast milk by 50%  Livestock distribution project  Vegetarian scenario for castes that do not eat meat, fish, eggs  Impact of social protection programmes (PDS)  Impact of a kitchen garden project

3.7.1 Modelling the potential impact of adding panjiri (ICDS free food) on the cost, quality and composition of a nutritious diet of a 12-23 month old child and lactating women

Integrated Child Development Services (ICDS) is a major national programme that addresses the health and nutrition needs of children under the age of six. It seeks to provide young children with an integrated package of services, including supplementary nutrition (panjiri), health care and pre-school education. Since the needs of a young child cannot be addressed in isolation from those of his or her mother, the programme also extends to adolescent girls, pregnant women and nursing mothers.

It is important to understand what potential impact this free food is having on the quality of the diet for an infant. Therefore, to understand the potential impact of panjiri on the cost, quality and composition of a nutritious diet of a child aged 12-23 months, 143g of panjiri was introduced in the diet with minimum and maximum constraints set at 7. Figure 8 below shows that adding panjiri to the diet led to a 38-48% reduction in the daily cost of a food habits diet for a 12-23 month old child depending on the season. In terms of cash, this decrease in cost was 16 INR per day. Diet which was earlier deficient in calcium (89.6) showed an improvement with Panjiri as the calcium requirement was met at 100. Annex 6 shows the absolute weight and cost of the foods selected for the 12-23 month old for the whole year for the food habit diet with panjiri. The nutrient composition of panjiri is included in Annex 7.

Figure 8. Daily cost of food habits diet for the 12-23 month old child in Pindra Block with and without free panjiri ICDS distribution

The impact of the model was also tested on the cost and quality of the diet of lactating women. Figure 9 below shows that the cost of the food habits diet of lactating women went down significantly when compared with that without panjiri. Adding panjiri to the diet led to a 24-28% reduction in the daily cost of a food habits diet for a lactating mother, depending on the season. In terms of cash, this decrease in cost was 16 INR a day. The requirement for calcium and iron remain at 100 in both the scenarios, fat requirement is met by 120 in the Panjiri diet and was 100 in the diet without Panjiri. Annex 8 shows the absolute weight and cost of the foods selected for the lactating mother for the whole year for the food habits diet with panjiri.

Figure 9. Daily cost of food habits diet for lactating women in Pindra Block with and without free panjiri ICDS distribution

3.7.2 Modelling the potential impact of current infant feeding practices on the cost, quality and composition of a nutritious diet of a 12-23 month old child

The National Family Health Survey 3, reported that 51.3% of children were exclusively breastfed in UP whilst, 37.2% were exclusively breastfed in Pindra (project baseline, 2013). Data regarding common practices centred on what children were being fed instead of breast milk and the study reported that children were given honey and water, bottle feed and infant

formula. It is important to understand what potential impact these feeding practices are having on the quality of the diet for an infant.

The results in previous sections also highlight the importance of breast milk in a nutritious diet for a 12-23 month old child. Therefore, to understand the potential impact of common infant feeding practices on the cost, quality and composition of a nutritious diet of a child aged 12-23 months, three scenarios were modelled:

1. Reducing breast milk intake by 50% (from 532g a day to 266g a day) 2. Replacing 50% of breast milk intake with fresh cow’s milk 3. Replacing a proportion of breast milk intake with 15g of milk powder

To model the potential impact of replacing half of breast milk with water on the cost, quality and composition of a nutritious diet in the Cost of the Diet software, the daily amount of breast milk included in the 12- 23 month old child’s diet was reduced from 532g a day to 266g a day. Water has very little nutritional value and so, nothing else was added to the diet to mimic its inclusion.

To model the potential impact of replacing half of breast milk with fresh cow’s milk, the daily amount of breast milk included in the 12- 23 month old child’s diet was reduced from 532g a day to 266g a day. The portion size entered for cow’s milk was 265g, which provided the same kilocalories as 266g of breast milk to replicate a diet of half breast milk and half fresh cow’s milk. The cost per 100g used was determined by the market survey.

According to the packet of a milk powder found in Pindra, a typical daily serving size for children aged 12-23 months is 15g a day. To model the potential impact of replacing a proportion of breast milk with 15g of milk powder, the daily amount of breast milk included in the 12- 23 month old child’s diet was reduced from 532g a day to 426g a day. This reduction in portion size represented a 70 kcal reduction in the total kilocalories that breast milk should provide this child a day, which was instead provided by the 15g of milk powder. The nutrient composition of a milk powder is shown in Annex 9. Milk powder was entered into the software at an average of 36.64 INR per 100g for the six seasons. This cost was based upon the market price and weight of this product in the assessment area.

Figure 10 below shows the potential cost implications of the three feeding practices compared with the food habits diet which included 532g of breast milk. It shows that reducing the amount of breast milk by half led to a 55-87% increase in the daily cost of a food habits diet for a 12-23 month

old child depending on the season. In terms of cash, this increase in cost was an average of 22 INR per day. Figure 10 shows that the cost of replacing half of breast milk with cow’s milk varied across seasons, in one season it reduced by 5% whereas in another it increased by 16%. This cost analysis shows that dairy products are not very expensive in the markets in Pindra Block. Replacing a proportion of breast milk with 15g of milk powder led to an 24-28% increase in the daily cost of a food habits diet for a 12-23 month old child depending on the season. In terms of cash, this increase in cost was an average of 9 INR per day.

Figure 10. A bar chart comparing the daily cost of the nutritious food habits diet for a 12-23 month old child compared with the three infant feeding models

Annex 10 to 12 shows the absolute weight and cost of the foods selected for the 12-23 month old for the whole year for the food habits diet with 50% breast milk, 50% breast milk and 50% cow’s milk, and breast milk and 15g milk powder, with the percentage contributed by each food in terms of weight, cost, energy, protein and fat, the percentage contribution of each food for eight vitamins and four minerals and the percentage of the total requirements met for each nutrient, averaged over the six seasons.

The table in Annex 10 shows that reducing the amount of breast milk in the diet of the young child by half has resulted in the software needing to include seven additional foods to meet the shortfall in nutrients provided by 266g of breast milk: almond, eggplant, plantain, sweet lime, bottle gourd, cumin and cabbage. The tables in Annex 11 shows that reducing the

amount of breast milk in the diet of the young child by half and replacing this with cow’s milk has reduced the price in some season and marginally increased in other seasons. This shows that cow’s milk is very nutritious and hence the software did not have to select other expensive source of nutrients.

For the first model the nutrient requirements for fat were not met and calcium is just met by 100% all year except Jan/Feb where it is 99.7%. For the cow’s milk model the nutrient requirements for fat and iron are just met by 100%. For the milk powder model the nutrient requirements for fat and calcium are not met, which were 88.8 and 88 respectively.

These scenarios potentially highlight the increased economic presure that households are putting themselves under by not feeding their children as recommended by the WHO as well as the implications associated with the nutritional quality of the diet. It is important to note that these models do not take into account the health implications of not exclusively breast feeding a child such as an increased risk of infection and diarrohea due to the consumption of contaminated water or food, which could exacerbate malnutrition due to their cyclical relationship.

3.7.3 Modelling the potential impact of a livestock distribution project on the cost, quality and composition of a nutritious diet

Most very poor households do not own a cow or buffalo and this section models the impact of owning one cow per very poor household. The quantity of milk produced per cow per year was taken from the HEA assessment (calculated from the birth interval, lactation period and daily milk production at about 900 litres per year) and it was assumed that this milk is consumed by the household. Another assumption made is that the cost of maintaining the cow (fodder, livestock drugs) was provided by the project that provided the cow, at least for the initial year.

Under this scenario, the cost of a food habits diet decreases from 163,600 rupees per year to 132,000 rupees per year, which is a decrease of 19%. Figure 11 below shows the impact of the cow’s milk on the affordability of the original energy-only, nutritious and food habits diets in another way (note that the food habits diet costs almost the same amount as the nutritious diet in the ‘with cow’ scenario so there is no separate black bar). There is a small improvement in the affordability of the food habits diet, which goes from requiring over 260% of very poor household annual income to requiring less

than 220%. However, this diet is similarly deficient in calcium, with only 84% of the household’s RNI met.

Figure 11. The affordability of energy only, nutritious and food habits nutritious diets for very poor households in Pindra Block with and without one cow

3.7.4 Modelling the potential impact of a vegetarian diet on the cost, quality and composition of a nutritious diet

A minority of households are vegetarian in Pindra Block and a scenario has been created to look at the impact of vegetarianism on the cost of diet.

Table 9 below shows the breakdown of costs by family members and by season for a vegetarian food habits diet. The estimated minimum amount of cash that a family of 7, including a child aged 12-23 months, would need to be able to purchase this diet from the market is between 341 – 497 rupees per day and includes 28 of the 110 foods known to be eaten by people in Pindra Block.

Table 9. The lowest cost vegetarian diet for the HEA/CoD family in Pindra Block, India that meets needs for energy and micronutrients and is adjusted to account for usual dietary habits. Daily Daily Daily Daily Daily Daily Cost Cost Cost Cost Cost Cost Season 1 Season 2 Season 3 Season 4 Season 5 Season 6 Annual Individuals Nov/Dec Sep/Oct Jul/Aug May/Jun Mar/Apr Jan/Feb Cost 12-23 month old 18.16 26.79 31.11 30.59 26.88 19.39 9,321 Total 341.04 443.63 497.41 494.73 446.58 352.67 156,932

Table 10 below shows the absolute weight and cost of the vegetarian foods for the whole year with the percentage contributed by each food in terms of weight, cost, energy, protein and fat, and the percentage contribution of each food for eight vitamins and four minerals for the HEA/CoD family.

Compared to the original food habits diet, the software has removed two types of fish and added more buffalo and cow milk, cabbage, cauliflower, broad beans and ridge gourd.

Table 10. The percentage of the average requirements for energy, protein and fat met each day by the vegetarian food habits diet and the percentage of the recommended daily intake of vitamins and minerals provided by the diet for the HEA/CoD family in Pindra Block.

% Quantity % Cost % % % % % % % % % % folic % % % % Food List (Kg) quantity (INR) cost energy protein fat vit A vit C vit B1 vit B2 niacin vit B6 acid vit B12 calcium iron zinc Aalu (Potato, diamond, raw) 391 7.3 9 493 6.0 4.8 2.4 0.4 0.2 5.3 5.2 4.2 4.0 12.9 2.3 0.0 0.1 2.6 8.9 Aata (Wheat, flour, local or hyv) 356 6.7 6 413 4.1 22.5 25.1 4.5 0.0 0.0 21.1 7.8 42.5 13.2 3.6 0.0 1.4 18.0 29.7 Bandhagobi (Cabbage, raw) 78 1.5 1 379 0.9 0.3 0.6 0.2 0.1 0.9 0.8 0.5 0.6 1.5 1.1 0.0 0.5 0.5 0.9 Bhains ka dudh (Milk, buffalo, whole 545 10.2 21 476 13.7 10.2 10.7 26.8 4.7 0.6 4.1 13.7 0.6 1.5 1.1 88.5 17.4 2.7 3.4 fat) Breast milk 194 3.6 0 0.0 2.3 1.0 5.0 1.8 0.5 0.7 0.8 1.1 0.2 0.5 3.4 0.8 0.0 0.7 Chai pata (Tea, powder) 6 0.1 2 021 1.3 0.3 0.6 0.0 0.0 0.0 0.0 0.7 0.9 0.3 0.2 0.0 0.0 0.2 0.3 Chana dal (Bengal gram, dehulled, split, < 1 0.0 13 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 dried, raw)

Chauli, Hara saag (Leaf, amaranth, 52 1.0 1 171 0.7 0.2 0.5 0.1 7.2 1.4 0.3 1.1 1.1 1.2 1.4 0.0 0.2 5.7 1.5 green, raw) Chawal (Rice, grain or flour) 368 6.9 6 447 4.1 25.0 12.7 1.5 0.0 0.0 3.6 2.6 11.4 6.1 0.7 0.0 0.3 2.9 11.7 Chirchira (Gourd, snake, raw) 190 3.6 3 171 2.0 0.8 0.5 0.4 0.0 2.5 1.2 1.3 2.0 0.9 1.0 0.0 1.4 0.9 1.8 Chola, safed (Bengal gram, whole, 21 0.4 858 0.5 1.4 2.2 0.8 0.0 0.0 1.0 0.6 1.3 1.3 1.3 0.0 0.5 2.4 1.6 dried, raw) Gaye ka dudh (Milk, cow, whole) 11 0.2 338 0.2 0.1 0.2 0.3 0.1 0.0 0.1 0.2 0.0 0.1 0.0 1.2 0.2 0.0 0.1 Haldi (Turmeric, dried) 2 0.0 458 0.3 0.1 0.1 0.1 0.0 0.0 0.0 0.0 0.1 0.5 0.0 0.0 0.1 0.9 0.2 Jira (Cumin, seeds) 6 0.1 1 031 0.7 0.4 0.5 0.7 0.1 0.0 0.6 0.2 0.3 0.3 0.0 0.0 0.9 3.4 0.6 Karela (Gourd, bitter, raw) 34 0.6 885 0.6 0.2 0.4 0.1 0.2 2.2 0.3 0.1 0.3 0.0 0.5 0.0 0.1 0.8 0.3 Kohara (Pumpkin, raw) 40 0.8 995 0.6 0.1 0.3 0.1 2.8 0.6 0.5 0.3 0.4 0.3 0.2 0.0 0.5 0.4 0.1 Methi Saag (Leaf, fenugreek, raw) 305 5.7 13 672 8.7 2.8 6.9 1.8 42.9 11.2 6.0 10.9 6.7 9.7 10.3 0.0 28.0 7.5 3.0 Muli (Radish, raw) 586 11.0 10 395 6.6 2.0 2.7 0.4 0.0 7.1 41.4 0.0 3.4 5.0 4.8 0.0 3.3 3.0 6.4 Nariyal (Coconut, dried) 6 0.1 221 0.1 0.8 0.2 2.7 0.0 0.0 0.1 0.0 0.2 0.1 0.1 0.0 0.0 0.4 0.4 (Onion, spring or scallion, raw) 342 6.4 7 815 5.0 2.0 3.2 0.4 3.2 4.5 3.1 3.2 2.3 2.5 7.1 0.0 5.7 6.6 3.8 Palak (Indian spinach, raw) 1116 20.9 26 842 17.1 5.2 13.6 2.3 35.1 40.9 3.7 46.4 7.2 31.9 50.8 0.0 28.8 31.8 11.2 Paneer (Cheese, cottage) 42 0.8 7 548 4.8 2.7 5.3 7.0 1.6 0.0 0.1 2.3 3.5 0.0 0.5 6.8 5.1 0.4 4.3

Parwal (Gourd, pointed, raw) 18 0.3 703 0.4 0.1 0.2 0.0 0.0 0.2 0.5 0.1 0.2 0.1 0.1 0.0 0.1 0.4 0.2

% Quantity % Cost % % % % % % % % % % folic % % % % Food List (Kg) quantity (INR) cost energy protein fat vit A vit C vit B1 vit B2 niacin vit B6 acid vit B12 calcium iron zinc Phoolgobhi (Cauliflower, raw) 413 7.7 23 664 15.1 2.1 5.5 0.7 0.1 21.2 2.0 1.4 5.6 9.1 7.7 0.0 3.2 4.3 4.8 Sarson (Mustard, seeds) 2 0.0 91 0.1 0.2 0.2 0.5 0.0 0.0 0.2 0.1 0.2 0.1 0.1 0.0 0.1 0.2 0.4 Sarson tel (Oil, mustard) 65 1.2 6 101 3.9 10.9 0.0 42.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 Sem (Broad beans, raw) 68 1.3 1 817 1.2 0.6 1.6 0.3 0.1 0.4 0.9 0.9 2.1 0.3 2.1 0.0 0.8 1.2 1.1 Sukha Matar (Pea, dry) 19 0.4 698 0.4 1.2 2.3 0.2 0.0 0.0 1.3 0.4 1.5 0.7 2.2 0.0 0.2 1.9 1.6 Tori (Gourd, ridge, raw) 57 1.1 1 218 0.8 0.3 0.4 0.1 0.0 0.2 1.0 0.2 0.4 0.3 0.1 0.0 0.3 0.9 0.8

Total 5 335 100 156 932 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 % target met 100 227 112 356 1 271 222 308 219 261 330 102 80 108 214

The percentage of target met is an average of the % nutrient requirements met over the year.

Figure 12 below illustrates that the vegetarian food habits diet is not nutritious because 100% of the RNI for calcium is not met, in all seasons of the year. This is the same as in the non-vegetarian food habits diet, but the level of calcium met is lower in this case. For the HEA/CoD family as a whole, 80% of the annual calcium requirement is met, but this masks large differences for different individuals in the household: 69% for the 12-23 month old infant, 87% for the 8-9 year old, 60% for the 10-11 year old child, 65% for the 12-13 year old child and 84% for the woman over 60 years.

The RNI for Vitamin B12 is only just being met. This analysis identifies calcium and Vitamin B12 as the most difficult nutrients to obtain from the vegetarian food habits diet using foods found in the local market of Pindra Block. Although the cost of the diet is reduced compared to the original non-vegetarian food habits nutritious diet, the quality of the vegetarian diet is also reduced.

Figure 12. The percentage of energy and the recommended nutrient intakes for micronutrients met by a vegetarian food habits diet for the HEA/CoD family in Pindra Block 1 300 1 200 1 100 Nov/Dec Sep/Oct 1 000 Jul/Aug 900 May/Jun 800 Mar/Apr 700 Jan/Feb 600 500 400 300 200 100

Pantothenic Acid

Figure 13 below shows the cost of the vegetarian food habits nutritious diet by season of the year. The difference in cost between seasons is larger than that of the non-vegetarian food habits nutritious diet.

Figure 13. The cost of the vegetarian food habits diet by season of the year for the HEA/CoD family in Pindra Block.

Jan/Feb Mar/Apr May/Jun Jul/Aug Sep/Oct Nov/Dec 550

500

450

400

350

300

250

200

150

100 Daily cost of the food habits diet (INR) diet habits cost food Daily the of 50

0 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

3.7.5 Modelling the impact of government subsidised foods on the cost, quality and composition of a nutritious diet

The government’s Public Distribution System supplies subsidised food and non-food items to the poor. The items provided are wheat, rice, sugar and kerosene. Depending on their poverty status, households are entitled to purchase up to 15 kg of wheat, 20 kg of rice, 2 kg of sugar and 2.5 litres of kerosene per month at low prices. The value of this subsidy has already been included in the income level of very poor households in the affordability analysis in sections 2.3.1 and 3.6.

To model the impact of this programme, the value of the subsidy for a household receiving the full PDS ration was removed from the income of very poor households.

Figure 14 below shows the impact of the PDS subsidy on the affordability of the energy-only, nutritious and food habits diets. There is a small improvement in the affordability of the food habits diet when PDS is included, which goes from requiring around 290% of very poor household annual income to requiring just over 260%. In both cases, however, the cost of the food habits diet plus non-food expenditure is beyond the reach of very poor households.

Figure 14. The affordability of energy only, nutritious and food habits nutritious diets for very poor households in Pindra Block with and without PDS subsidy

3.7.6 Modelling the impact of a kitchen garden intervention on the cost, quality and composition of a nutritious diet

Figure 6 above illustrated for the food habits diet that vegetables are the most costly element of the diet for the HEA/CoD family in Pindra Block across all seasons. A kitchen garden intervention may be an important intervention which could improve household access to nutritious vegetables.

The software identified the following vegetables as sources of essential micronutrients: bandhgobhi (cabbage), chirchira (snake gourd), chauli (amaranth), kachha papita (raw papyaya), lauki (bottle gourd), kohara (pumpkin), tori (ridge gourd), phool gobhi (cauliflower). Based on the eating habits of the people of Pindra, some vegetables were modelled in the kitchen garden intervention to see the impact on quality, composition and affordability of a nutritious diet. It was assumed that programme would provide inputs for the first year and provide education around planting and crop diversification.

To model the impact of this intervention on the affordability, cost and quality of a nutritious diet, data from the Department of Agriculture, UP College Lucknow was used to estimate the expected annual yield that each household would generate from their kitchen garden. The land for the kitchen garden was assumed to be 1 decimal (453 sq ft) to estimate the production. It was then assumed that households would consume 85% of the estimated yield and sell 15% on the market. The table of this data is

shown in Annex 12. The quantities of the vegetables consumed were then entered into the Cost of the Diet software.

Figure 15 below shows that a kitchen garden intervention led to a 10-20% reduction in daily cost of a nutritious diet for the household depending on the season. In terms of cash, this decrease in cost in seasons one to six was 45 – 106 INR per day.

Figure 15 A bar chart showing cost of the most nutritious, food habit diet compared with a food habit diet with a kitchen garden intervention over the six seasons of the year.

This intervention also had a positive impact on the quality of the diet and improved intakes of protein, fat, vitamin A, vitaminB1, vitamin B12, niacin, pantothenic acid, iron and magnesium for the household. The recommended requirement for calcium was still not met.

4. Key findings

4.1 In a nutritious diet (not the food habits diet), wheat flour, buffalo milk, Bengal grams and fenugreek leaves provide the majority of essential macro and micronutrients in Pindra Block. Although the diet that the software selects is hypothetical and does not reflect the actual diet , it does give an indication of which foods found on the local market are the least expensive and most nutritious. In a nutritious diet, wheat flour is the largest provider of energy, protein, vitamin B1, niacin and zinc (plus a significant provider of vitamin B6); buffalo milk is the largest provider of fat and vitamins B2 and B12 (plus a significant provider of energy, protein and calcium); Bengal grams are the largest provider of vitamin B6 and iron (plus a significant provider of energy, protein, folic acid, zinc and vitamin B1); fenugreek leaves are the largest provider of vitamins A and C, folic acid and calcium (plus a significant provider of vitamins B6 and B12).

4.2 In a nutritious diet, recommended intakes of calcium, fat and iron are the most difficult for the software to meet. These nutrients are available in the local markets but they are in expensive foods such as buffalo milk, fenugreek leaves and Bengal grams. These nutrients are therefore expensive for the software to meet and are likely to be deficient in the current diet. These foods and nutrients should therefore be prioritised in programmes that aim to improve the quality of the diet.

4.3 The availability of nutrient-rich foods is not a key barrier to typical poor households obtaining a nutritious diet. The data collection team found 110 foods on the market in Pindra Block. The foods selected by the software for the food habits diet were all available in more than half of the markets that were visited and were therefore considered to be available in Pindra Block. This finding suggests that economic constraints and cultural practices are exacerbating poor dietary diversity in the assessment area rather than availability of nutrient-rich foods.

4.4 A nutritious diet is not possible when typical food habits of households in Pindra Block are imposed. The food habits diet does not meet the recommended intake of calcium. The main constraints that are imposed with the food habits diet are to force rice, mustard oil and potato into the daily diet. Rice is not very rich in micronutrients compared to other cereals. Potato is considered a vegetable in this part of India – indeed it is considered the main vegetable – but it does not have the micronutrient content of other available green vegetables. Unconstrained, the software selects buffalo milk and dried coconut as sources of fat rather than mustard oil, suggesting that they contain other required nutrients in addition to fat.

4.5 A diet that takes into account typical dietary habits (the food habits diet, which is deficient in calcium) is over 6 times more expensive than a diet that only meets energy requirements. The analysis indicates that a nutritious diet was over 5 times as expensive as the energy only diet, meaning that it costs over 5 times as much money to meet recommended protein, fat and micronutrient requirements compared with only meeting energy requirements. The food habits diet was 22% more expensive than the nutritious diet, which means that the constraints applied to the software to reflect typical dietary habits have required the software to add more expensive foods to meet the recommended nutrient intakes of a typical poor household (and in this case the software does not succeed in meeting the RNI for calcium).

4.6 Based on current livelihood strategies, very poor, poor and middle households cannot afford the nutritious diet or the food habits diet as well as expenditure on non-food items. The results from the affordability analysis present a concerning picture for households in Pindra Block and estimate that only the better off wealth group can afford a nutritious diet or a food habits diet plus expenditure on non-food items such as productive inputs, healthcare, clothes, schooling and soap. The additional amount of money that very poor, poor and middle households require a year to be able to afford the nutritious diet plus non-food items is approximately 81,000 INR (1325 USD), 43,000 INR (705 USD) and 40,000 INR (655 USD) respectively. The additional amount of money that very poor, poor and middle households require a year to be able to afford the food habits diet (which is deficient in calcium) plus non-food items is approximately 111,000 INR (1820 USD), 72,000 INR (1200 USD) and 70,000 INR (1150 USD) respectively.

4.7 Suboptimal breastfeeding practices are preventing infants and young children from receiving a nutritious diet. An analysis of three common feeding practices, giving water instead of breast milk, giving cow’s milk, and giving infant formula produced concerning results. Not only do these models highlight the potential additional costs that households are incurring by not breastfeeding their children as recommended, breast milk also has additional benefits such as containing immunoglobulins that helps to build a child’s immunity to infections. It is also sterile, unlike other foods, which prevents the risk of contamination and infections which may cause diarrhoea and contribute to malnutrition due to their cyclical relationship. Providing other foods and water during the first six months of life has both economic and health implications for the household and the child.

5. Recommendations and conclusions

In India, states with high level of stunting are evenly spread among low, medium and high wasting quadrants (Study Rajib Dasgupta, SAC Jul 14). Stunting is the dominant epidemiological entity and there is no state with high wasting but low stunting. Uttar Pradesh has low wasting and high stunting. In chronic poverty situation there is variation in availability, consumption and composition of food across households depending on their resource base. There is a constant struggle to produce, earn and procure food. Seasonal variation in food availability and dietary intake within households results in growth faltering, illness and mortality among children. Stunting is an outcome of latent poverty and poor feeding practices.

The following five recommendations are based upon this approach and aim to address the major findings from the Cost of the Diet analysis.

5.1 Behaviour change and communication (BCC) interventions aimed at mothers, husbands, mothers-in-laws and community or religious leaders are needed to dispel the current perceptions of taboo foods and practices for pregnant and lactating women and children under the age of 5 years

A behaviour change and communication programme is needed for women, husbands, mother-in-laws and community and/or religious leaders in Pindra to dispel these beliefs and inform women about best IYCF practices. The BCC programme should also advocate to parents the inexpensive nutritious foods identified in this report and develop recipes or review existing recipes to identify culturally acceptable preparation of these key foods that are more likely to preserve the nutrient content.

5.2 Focus on optimal IYCF practices with stress on exclusive breastfeeding and complimentary feeding

and calcium requirements. Promoting the benefits of exclusive and continued breastfeeding is therefore highly recommended. However, breast milk is not rich in iron. Therefore making iron rich foods such as meat more accessible in terms of their price and physical presence in the market needs to be undertaken so that the consumption of these foods can be advocated for.

It is important to develop appropriate communication materials to dispel the myths associated with IYCF practices. Individuals influencing the feeding practices of children, such as husbands and mother-in-laws are educated, along with mothers, in the health and economic consequences of introducing other foods to the child before 6 months of age. It is also recommended to develop the capacity of front line workers and staff nurse of hospitals on importance of early and exclusive breastfeeding.

5.3 Further investment is needed in social protection interventions that increase income and improve nutrition outcomes

The gap in the affordability of a nutritious diet for very poor, poor and middle households is too large to be closed by PDS. The subsidy provided through the PDS only slightly improves diet affordability for these families; hence it is essential to have a relook at the subsidy that is provided to families below the poverty line (BPL) and also to expand the food basket to include food items that are more nutritious. This study shows that ICDS supplementary food does bring down the cost of nutritious food. The ground reality however is that this food is either not consumed by the households or there is sharing among all the family members. It is essential to design communication strategy to emphasize better utilization of ICDS supplementary food (panjiri).

5.4 Investment is needed in livelihood interventions that increase income and improve nutrition outcomes

food. Market and other livelihood assessments are therefore required to identify livelihoods that are viable in the target area.

The results from the HEA also revealed that women do not engage with economic activities. Varanasi is a major producer of silk, silk garments and carpets. It may be possible to train these women in garment making and to link them with these silk/carpet industries. Also Varanasi is a major religious destination and has a heavy requirement of garlands; these women could also be engaged in garland making or crafts from their homes which could then be sold by linking them to supply chains or to businesses. However more information would need to be collected regarding the reasons as to why women are currently not working and the potential social or cultural stigma.

5.5 Seasonal market survey data collection should be undertaken to better understand how the cost of a nutritious diet changes over the year.

Very poor households are very vulnerable to rising food prices because they don’t own land of their own to grow crops or rear animals and therefore rely on local market to obtain their food. To build upon the seasonal analysis of the cost of a nutritious diet that has been presented in this report it is recommended that the data collection team in Pindra continue to undertake a market survey during each season. It is recommended that the food list is reduced to approximately 50 foods, especially cutting down on the spices. Another function of this seasonal data collection would be to monitor foods prices and provide early warning regarding food price increases so that action could be taken to mitigate the potential devastating effects of this, thus in turn building resilience.

Annex 1 : A detailed description of the Cost of the Diet tool

The Cost of the Diet method and software

The Cost of the Diet is a method developed by SC UK to calculate the minimum amount of money a typical household would need to purchase their recommended intakes of energy, protein, fat and micronutrients, using locally available foods. The cost of food grown and consumed at home is included in the calculation by applying market prices. Menu driven software developed that applies linear optimisation routines in Microsoft Excel 2010 is used to select locally available foods to meet these nutrient requirements at the lowest possible cost.

The Cost of the Diet software selects a mixture of foods that will enable a family to meet their energy and nutrient requirements as recommended by the WHO and the FAO (2004) at the lowest possible cost. As mentioned, this is defined as a ‘nutritious’ diet. As the software can select amounts of foods that are not realistic in terms of the frequency with which foods are eaten, for example by specifying that a particular food is eaten three times a day every day, the frequency with which each food is consumed can be adjusted to reflect typical dietary patterns.

Energy only diet

When estimating an energy only diet, the software calculates a lowest cost diet that meets only the average energy requirements of the family. The analysis is not used to promote an energy only diet because it is very unlikely to meet all micronutrient requirements, but it is useful to illustrate:

 The potential for micronutrient deficiencies in a diet that provides energy  The additional cost of meeting all nutrient requirements, including micronutrients, in addition to energy

Micronutrient RNI diet

When estimating a micronutrient RNI diet, the software calculates the lowest cost combination of foods which meets the average energy requirements and the recommended micronutrient intake of the typical family. This diet does not reflect people’s typical dietary patterns but it is useful to illustrate:

 The differences in diet composition and its cost when compared with a diet that takes into account typical dietary patterns.  The extra cost of micronutrients when compared with the energy only diet  The relatively small number of foods that can provide a nutritious diet but often in unrealistic quantities

Food habits diet

When creating a food habits diet, the software calculates the lowest cost combination of foods which meet the average energy requirements and the recommended micronutrient requirements, whilst adhering to the minimum and maximum constraints which set the number of times a week specific food items can be included in the diet. This diet therefore does reflect people’s typical dietary patterns and is useful to illustrate:

The extra cost of meeting average energy and recommended nutrient intakes when typical dietary habits such as the main staple, foods commonly consumed and food taboos are taken into account

Table 1 below summarises the characteristics of each diet.

Table 1. A summary of the diets analysed using the Cost of the Diet software.

Energy Fat at Protein Micro- Reflects a needs 30% of needs nutrient typical Diet name Definition met energy met needs met diet Energy only diet A lowest cost diet that only meets the average energy X requirements of the members of the household Macronutrient A lowest cost diet that only diet meets the average energy and the recommended protein and X X X fat requirements of the members of the household Nutritious (macro – A lowest cost nutritious diet that and micronutrients) does not take into account X X X X diet typical dietary habits

Food habits diet A lowest cost nutritious diet that reflects cultural consumption X X X X X patterns

The Cost of the Diet software can also be used:

 To estimate the minimum cost of a diet for specified households of multiple individuals;  To take into account seasonal variations in food prices when costing the diet;  To identify seasonal shortfalls in nutrient intake;  To develop models of the impact of potential interventions that might enable households to meet their nutrient requirements.

A Cost of the Diet assessment is most useful when chronic malnutrition and micronutrient deficiencies have been identified as a nutritional problem and the availability or affordability of nutritious foods are likely to be among the underlying causes.

The limitations of the Cost of the Diet software and method

It is useful to understand the limitations of the cost of the diet method before applying any analysis.

The software can identify a ‘diet’ that provides the recommended amounts of energy and micronutrients from a relatively small number of foods, but they would need to be eaten every day at every meal, which is unrealistic.

Because the actual requirements for micronutrients of any given individual cannot be known, the RNIs are set at two standard deviations above the average, to minimise the risk of deficiency. This means that when the mixture of foods selected by the Cost of the Diet software meets the RNIs of a family by 100%, the nutritional needs of 97% of all individuals will be exceeded. The result is that greater quantities of food are selected and at a higher cost than is necessary to meet the actual nutritional requirements of most individuals.

The needs for a number of nutrients are not taken into account by the software including iodine, vitamin D, essential amino acids and essential fatty acids. Iodine is not included because the amount in foods depends on the soil on which plants are grown or animals are reared, so no data are provided in food tables. Vitamin D is not included because requirements can be met by making vitamin D in skin exposed to ultra-violet light. And most food tables do not provide data on essential amino acids or fatty acids.

The cost of the diet method calculates amounts of food for a family based on the sum of recommended nutrient intakes, but food may not be distributed within a household based on nutrient needs.

The method does not take into account the additional energy, protein and nutrients needed by someone who is sick or convalescing as there are insufficient data for the calculations.

Annex 2 Family members chosen from the WHO database of average energy requirement used to create households with low and high average energy requirements plus a household with an energy requirement closest to the number of people x 2,100 kcal (HEA/CoD family). Number of family members 5 Individuals 6 Individuals 7 Individuals 8 Individuals 9 Individuals 10 Individuals Kcal/ HEA & HEA & HEA & HEA & HEA & HEA & Household member day Low CoD High Low CoD High Low CoD High Low CoD High Low CoD High Low CoD High Woman is lactating 418 X X X X X X X X X X X X X X X X X X Baby (either sex) 12-23 months 894 X X X X X X X X X X X X X X X X X X Child (either sex) 2-3 years 1,088 X X X X X X Child (either sex) 3-4 years 1,200 X X X X X Child (either sex) 4-5 years 1,300 X X X X Child (either sex) 5-6 years 1,400 X X X X Child (either sex) 6-7 years 1,500 X X X Child (either sex) 7-8 years 1,625 X X X Child (either sex) 8-9 years 1,763 X X Child (either sex) 9-10 years 1,913 X X X Child (either sex) 10-11 years 2,075 X X X Child (either sex) 11-12 years 2,250 X X X X Child (either sex) 12-13 years 2,413 X X X X Child (either sex) 13-14 years 2,575 X X X X X Child (either sex) 14-15 years 2,725 X X X X X Child (either sex) 15-16 years 2,838 X X X X X X Child (either sex) 16-17 years 2,913 X X X X X X Child (either sex) 17-18 years 2,950 Man, 18-29y, 50 kg, light activity 2,300 X X X X X X Man, 30-59y, 50 kg, moderately active 2,750 X X X X X X Man, 30-59y, 60 kg, vigorously active 3,450 X X X X X X Woman, 18-29y, 45 kg, light activity 1,850 X X X X X X Woman, 30-59y, 45 kg, moderately active 2,300 X X X X X X Woman, 30-59y, 55 kg, vigorously active 2,850 X X X X X X Woman, >60y, 45 kg, light activity 1,700 X X X X X X Woman, >60y, 45 kg, moderately active 2,050 X X X X X X 52

Woman, >60y, 55 kg, vigorously active 2,550 X X X X X X

Total average energy requirement 8,249 10,487 13,074 9,449 12,574 16,024 10,749 14,662 19,037 12,149 16,774 21,587 13,649 18,887 24,162 15,337 21,037 26,274

Annex 3 All the foods found in the markets of Pindra Block, their costs per 100g by season as reported by market traders, and their minimum and maximum constraints

Cost per 100g Frequency constraints Food items Nov/Dec Sep/Oct Jul/Aug May/Jun Mar/Apr Jan/Feb Minimum Maximum Grains and grain-based products Aata (Wheat, flour, local or hyv) 1.85 1.84 1.78 1.7 1.78 1.86 7 21 Bread (Bread, white) 4.9 4.9 4.9 4.9 4.9 4.9 0 7 Chawal (Rice, grain or flour) 1.75 1.76 1.76 1.75 1.75 1.73 Multiple 14 Chuda (Rice, flaked) 2.93 2.94 2.84 2.66 2.88 2.99 0 7 Maida (Wheat, flour, maida) 2.04 2.04 2.05 2.02 2.01 2.02 0 7 Murhi (Rice, puffed, salted) 3.86 3.83 3.85 3.85 3.79 3.95 0 7 Sevayian (Vermicelli) 4.15 4.17 4.1 4.16 4.08 4.15 0 7 Sooji (Semolina, wheat, raw) 2.37 2.37 2.32 2.33 2.37 2.35 0 7 Roots and tubers Aalu (Potato, diamond, raw) 1.7 2.57 2.31 2.06 1.94 1.64 7 14 Arbi (Colocasia or taro, raw) 0 3.3 2 2 1.8 0 0 Multiple Chukundar (Beet root, red, raw) 2.67 3.31 4.18 2.97 2.38 2.47 0 7 oal (Yam, raw) 2.11 2.28 2.43 2.47 2.31 2.22 0 7 Legumes, nuts and seeds Arhar (Pigeon pea) 6.97 7.03 6.98 6.91 6.9 7 0 14 Badam (Nut, almond like) 103.39 103 103 101.81 101.97 101.56 0 7 Chana dal (Bengal gram, dehulled, split, dried, raw) 4.42 4.44 4.45 4.32 4.41 4.39 0 7 Chola, safed (Bengal gram, whole, dried, raw) 4.08 4.08 4.09 3.92 4.15 4.16 0 7 Kabuli Chana (Chickpea, green) 6.88 6.85 6.91 6.91 6.83 6.83 0 7 Kaju (Cashew nut, raw) 57.04 57.21 57.04 56.71 56.62 57.04 0 7 Masur (Lentil) 7.19 7.17 7.17 6.91 7.16 7.11 0 7 Moongphali (Peanut) 7.38 7.34 7.38 7.3 7.26 7.34 0 7 Mung dal, vanga (Green gram, split, dried, raw) 8.84 8.84 8.94 9.06 9.12 9.01 0 7 Rajma (Bean, kidney) 8.61 8.61 8.71 8.71 8.61 8.61 0 0 Sukha Matar (Pea, dry) 3.64 3.67 3.57 3.51 3.58 3.64 0 7

Urad dal (chilke wali) (Black gram, split, dried, raw) 6.76 6.73 6.82 6.75 6.63 6.66 0 7 Cost per 100g Frequency constraints Food items Nov/Dec Sep/Oct Jul/Aug May/Jun Mar/Apr Jan/Feb Minimum Maximum Meat Bakre ka meat (Goat) 31.63 31.63 31.63 31.63 31.63 31.63 0 7 Murgi ka (Poultry) 12.71 12.71 12.71 12.79 12.83 12.71 0 7 Fish, seafood Choti Machli (Fish, small, fresh, fresh water) 5.2 5.2 5.2 4.95 4.85 5.2 0 7 Jhinga (Prawn, indian white, raw) 9.67 9.67 9.67 9.67 9.67 9.67 0 0 Rohu (Fish, rohu, river, raw) 15.75 15.75 15.83 14.92 14.5 15.83 0 7 Singhi (Fish, catfish, long whiskered, boneless, raw) 43.33 43.33 41.67 43.33 42.5 43.33 0 0 Eggs Anda (Egg, chicken, farmed, raw) 10.04 10.04 10.04 9.85 8.53 10.04 0 7 Milk and milk products Bhains ka dudh (Milk, buffalo, whole fat) 3.88 3.88 4.06 4.1 3.98 3.75 0 7 Dahi (Milk, curds) 6.16 6.37 8.21 8 6.08 4.75 0 7 Dibbe ka doodh (Milk, powder, fortified) 36.76 36.76 36.64 36.68 36.47 36.64 0 0 Gaye ka dudh (Milk, cow, whole) 3.04 3.04 3.31 3.31 3.09 3.02 0 7 Paneer (Cheese, cottage) 17.74 17.33 20.32 20.37 16.53 15.2 0 7 Vegetables and vegetable products (Onion, spring or scallion, raw) 1.61 2.33 1.88 2.34 2.34 1.84 0 7 Baigan (Eggplant) 1.59 2.6 2.58 2.47 2.33 1.86 0 7 Baigun, kala, lamba (Brinjal, purple, long, raw) 1.53 2.08 2.05 2.46 2.55 1.84 0 7 Bandhagobi (Cabbage, raw) 1.19 2.24 2.55 3.78 1.85 1.09 0 7 Bhindi (Okra, raw) 3.98 3.9 2.76 2.29 2.49 3.3 0 7 Chauli, Hara saag (Leaf, amaranth, green, raw) 1.1 1 1.8 2.27 2.67 2 0 7 Chirchira (Gourd, snake, raw) 1.07 1.62 1.85 1.83 2 0 0 Multiple Gajar (Carrot, raw) 2.49 3.69 2.95 3.52 3.6 2.12 0 7 Kancha pepe (Papaya, unripe, raw) 0.98 0.98 1.18 1.13 1.13 0.94 0 7 Karela (Gourd, bitter, raw) 6.7 4.79 2.16 2.52 2.65 6.14 0 7 Kheera (Cucumber) 4.71 4.65 2.59 2.15 2.56 3.53 0 7

Kohara (Pumpkin, raw) 2.05 1.72 1.97 2.1 1.98 1.93 0 7 Cost per 100g Frequency constraints Food items Nov/Dec Sep/Oct Jul/Aug May/Jun Mar/Apr Jan/Feb Minimum Maximum Lal saag (Leaf, amaranth, red, raw) 0 0 1.6 2.13 2.4 1.67 0 Multiple Lauki (Gourd, bottle, raw) 1.38 1.49 1.53 1.78 1.79 1.64 0 7 Matar (Peas, raw) 4.07 7.44 7.96 10.15 5.81 2.37 0 7 Methi Saag (Leaf, fenugreek, raw) 1.83 2.31 3.41 3.41 2.93 1.88 0 7 Muli (Radish, raw) 1.13 1.61 2.24 2.14 2.24 1.4 0 14 Palak (Indian spinach, raw) 1.18 1.78 2 2.06 1.82 1.4 0 14 Parwal (Gourd, pointed, raw) 3.47 3.79 3.67 4.03 4.04 4.67 0 7 Phoolgobhi (Cauliflower, raw) 1.39 2.94 3.73 3.48 2.56 1.35 0 14 Pyaj (Onion, raw) 2.44 2.67 3.01 4.45 3.84 2.45 0 14 Saihajan (Drumstick, pods, raw) 0 0 1.83 2.09 3.27 2.73 0 Multiple Sem (Broad beans, raw) 2.34 2.96 2.76 2.08 1.85 2.04 0 7 Tori (Gourd, ridge, raw) 0 1.8 2.13 2.1 1.33 1.4 0 Multiple Fruit and fruit products Aam (Mango, ripe) 0 4.75 3.73 4.23 5.44 0 0 Multiple Aam ka juice (Mango, juice) 5 5 5 5 5 5 0 7 Amrood (Guava, green) 2.6 1.81 1.92 2.01 2.09 2.23 0 7 Ananas (Pineapple, ripe) 4.86 4.53 5.07 4.92 4.61 5.17 0 7 Ananas ka juice (Pineapple, juice) 15.42 14.73 14.48 14.98 13.86 14.11 0 0 Anar (Pomegranate, ripe, with seed) 10.46 9.63 9.93 11.34 11.38 10.46 0 7 Angoor (Grapes, pale green) 15.06 9.55 5.62 6.68 9.19 13.93 0 7 Jamun (Blackberry) 0 0 5.7 6.78 0 0 0 Multiple Kathal, paka (Jackfruit, ripe) 0 4 4.13 5.01 4.92 0 0 Multiple Kela (Banana, ripe) 2.94 3.37 3.71 4.13 4 3.2 0 7 Kharbooj (Melon, musk, other fruits) 0 0 2.72 2.79 3.58 0 0 Multiple Kismish (Raisin) 28.03 28.94 27.86 25.78 26.15 26.58 0 Multiple Lichi (Lychee) 0 0 6.2 6.54 7.25 0 0 Multiple Nariyal (Coconut, dried) 3.71 3.51 3.87 4.05 3.82 4.04 0 7 Nashpati (Pear, asian) 14.63 7.28 9.14 8.39 10.22 15.53 0 Multiple

Papita (Papaya, ripe) 0 2.67 2.66 2.85 2.96 4 0 Multiple Cost per 100g Frequency constraints Food items Nov/Dec Sep/Oct Jul/Aug May/Jun Mar/Apr Jan/Feb Minimum Maximum Santra (Orange) 5.53 4.72 5.05 5.09 5.57 5.07 0 Multiple Santre ka juice (Orange, juice) 13.07 13.07 13.92 14.92 14.67 13.22 0 0 Seb (Apple) 7.76 8.38 10.13 10.67 10.21 8.01 0 Multiple Tabooj (Watermelon) 0 0 1.63 1.96 1.5 0 0 Multiple Tamatar (Tomato, ripe) 2.08 2.48 3.01 2.54 2.2 1.97 0 14 Oils and fats Dalda/Bonoshpati (Ghee, vegetable) 7.12 7.14 7.12 7.1 7.12 7.14 0 7 Ghee (Ghee) 45.08 45.08 45.14 45.08 45.06 45.08 0 7 Makhan (Butter) 37 37 37 37 37 37 0 0 Sarson tel (Oil, mustard) 9.4 9.4 9.4 9.29 9.33 9.36 7 14 Soyabean ka tel (Oil, soybean) 9.18 9.18 9.15 9.17 9.18 9.18 0 7 Sugars and confectionary Biscuit (Biscuit, sweet) 8.28 8.28 8.28 8.28 8.28 8.28 0 14 Chini (Sugar, white) 3.67 3.67 3.66 3.72 3.69 3.65 0 14 Gur (Jaggery, sugarcane, solid) 4.67 4.67 4.84 4.81 4.82 4.93 0 14 Sahad (Honey) 68.06 68.06 68.06 68.06 63.89 68.06 0 0 Herbs, spices and condiments (Coriander leaf, raw) 3.15 8.28 9.22 8.26 9.04 4.21 0 0 Adarak (Ginger root, raw) 7 9.24 9.49 10.44 10.46 7.7 0 0 Dhania (Coriander, seeds) 13.28 13.23 14.11 14.19 13.95 13.28 0 0 Elachi (Cardamom, seeds) 139.51 139.51 139.51 139.88 131.18 139.51 0 0 Haldi (Turmeric, dried) 20.29 20.29 20.29 20.17 20.29 28.62 0 14 Hari morich (Chilli, green, with seeds, raw) 3.43 4.73 5.24 5.95 5.06 4.95 0 0 Jira (Cumin, seeds) 17.68 17.68 17.68 18.35 17.41 17.68 0 7 Kali Mirch (Pepper, black) 96.09 94.01 90.72 93.17 89.84 89.55 0 0 Laehsun (Garlic, raw) 7.46 7.46 7.16 6.84 6.45 6.86 0 0 Laong (Cloves, dried) 105.8 105.8 103.72 102.16 105.8 105.8 0 0 Mushambee (Lime, sweet) 3.61 3.61 3.68 3.86 3.84 3.6 0 0

Namak (Salt) 1.03 1.03 1.03 1.03 1.03 1.03 0 14 Cost per 100g Frequency constraints Food items Nov/Dec Sep/Oct Jul/Aug May/Jun Mar/Apr Jan/Feb Minimum Maximum Nimbu (Lemon, kagoji) 6.46 6.41 7.36 6.57 6.59 5.43 0 0 Posta dana (Poppy, seeds) 61.05 61.05 61.05 59.17 60.97 61.05 0 0 Sarson (Mustard, seeds) 4.71 4.3 4.3 3.98 3.75 4.71 0 7 Shukhi lal morich (Chilli, red, dry) 17.7 17.7 18.32 18.01 17.47 17.7 0 14 Tejpata (Bay leaf, dried) 14.54 14.54 14.54 14.54 14.13 14.54 0 0 Beverages Chai pata (Tea, powder) 33.15 33.15 33.15 33.15 33.15 33.15 Multiple 14 Supplements and infant foods Cerelac (Infant cereal, Cerelac or Ceresoy) 53.39 53.39 53.39 53.39 53.39 53.39 0 7 Panjiri (ICDS take home) 0 0 0 0 0 0 0 21

Annex 4 The percentage of the average requirements for energy, protein and fat met each day by the energy only diet and the percentage of the recommended daily intake of vitamins and minerals provided by the diet for the HEA/CoD family in Pindra Block.

% % %

Quantity quantit Cost % % % % % % % % % % folic % calciu % % Food List (Kg) y (INR) cost energy protein fat vit A vit C vit B1 vit B2 niacin vit B6 acid vit B12 m iron zinc Aata (Wheat, flour, local or hyv) 205 12.8 3 649 14.2 12.9 25.4 7.6 0.0 0.0 47.9 33.3 38.9 27.4 36.3 0.0 26.6 46.3 29.8 Breast milk 194 12.1 0 0.0 2.3 1.8 14.7 100.0 72.4 2.6 5.8 1.7 0.8 9.4 100.0 27.6 0.0 1.2 Chawal (Rice, grain or flour) 1155 72.0 20 205 78.8 78.2 69.8 13.5 0.0 0.0 45.0 59.2 57.0 69.7 39.6 0.0 35.2 40.1 63.6 Nariyal (Coconut, dried) 49 3.1 1 780 6.9 6.5 2.9 64.2 0.0 27.6 4.5 1.7 2.3 2.1 14.7 0.0 10.5 13.7 5.4

Total 1 603 100 25 635 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 % target met 100 129 38 6 10 56 42 137 72 19 3 2 24 123

The percentage of target met is an average of the % nutrient requirements met over the year.

Annex 5 The percentage of the average requirements for energy, protein and fat met each day by the nutritious (macro – micronutrient) diet and the percentage of the recommended intake of vitamins and minerals provided by the diet for the HEA/CoD family in Pindra Block.

% % % Quantity quantit Cost % % % % % % % % % % folic % calciu % % Food List (Kg) y (INR) cost energy protein fat vit A vit C vit B1 vit B2 niacin vit B6 acid vit B12 m iron zinc Aata (Wheat, flour, local or hyv) 486 13.6 8 734 6.5 30.7 26.6 5.2 0.0 0.0 37.2 12.8 51.5 24.2 8.1 0.0 1.5 19.7 40.2 Bandhagobi (Cabbage, raw) 78 2.2 963 0.7 0.3 0.5 0.1 0.1 2.8 1.0 0.5 0.5 1.9 1.8 0.0 0.4 0.4 0.9 Bhains ka dudh (Milk, buffalo, whole 1255 35.1 49 497 37.0 23.6 19.2 53.0 10.7 4.6 12.3 37.9 1.3 4.6 4.0 74.2 31.9 4.9 7.9 fat) Breast milk 194 5.4 0 0.0 2.3 0.8 4.3 1.8 1.7 0.9 0.9 1.0 0.3 0.9 1.2 0.7 0.0 0.7 Chauli, Hara saag (Leaf, amaranth, 21 0.6 483 0.4 0.1 0.2 0.0 2.8 1.7 0.1 0.5 0.4 0.6 1.0 0.0 0.1 1.8 0.6 green, raw) Chawal (Rice, grain or flour) 42 1.2 733 0.5 2.8 1.1 0.1 0.0 0.0 0.5 0.3 1.2 0.9 0.1 0.0 0.0 0.3 1.3 Chirchira (Gourd, snake, raw) 80 2.2 878 0.7 0.4 0.2 0.1 0.0 3.4 0.7 0.7 0.7 0.5 0.7 0.0 0.5 0.3 0.7 Chola, safed (Bengal gram, whole, 313 8.7 12 749 9.5 20.4 25.4 10.7 0.2 0.0 19.9 11.5 17.6 26.8 31.3 0.0 5.9 28.7 23.9 dried, raw) Choti Machli (Fish, small, fresh, fresh 28 0.8 1 449 1.1 0.4 1.7 0.4 0.1 0.1 1.1 0.2 1.5 0.4 0.1 4.3 0.0 0.4 0.4 water) (Coriander leaf, raw) 11 0.3 901 0.7 0.6 0.5 0.8 0.1 0.3 0.6 0.4 0.6 2.1 1.6 0.0 0.6 3.3 1.3 Dhania (Coriander, seeds) 10 0.3 1 306 1.0 0.6 0.5 0.9 0.0 0.0 0.5 0.5 0.2 0.0 0.0 0.0 0.7 1.8 1.3 Jira (Cumin, seeds) 16 0.4 2 798 2.1 1.2 1.1 1.6 0.2 0.3 1.9 0.8 0.6 1.1 0.1 0.0 2.0 7.3 1.7 Methi Saag (Leaf, fenugreek, raw) 567 15.8 25 471 19.0 5.3 9.9 2.9 79.0 65.7 14.5 24.4 11.0 24.3 31.8 0.0 41.5 11.2 5.6 Muli (Radish, raw) 9 0.2 100 0.1 0.0 0.0 0.0 0.0 0.3 0.8 0.0 0.0 0.1 0.1 0.0 0.0 0.0 0.1 Nariyal (Coconut, dried) 37 1.0 1 401 1.0 4.9 1.0 14.1 0.0 0.5 1.1 0.2 1.0 0.6 1.0 0.0 0.2 1.9 2.3 (Onion, spring or scallion, raw) 240 6.7 4 734 3.5 1.4 1.8 0.3 2.2 10.1 2.8 2.7 1.4 2.3 8.3 0.0 3.2 3.7 2.7 Palak (Indian spinach, raw) 62 1.7 1 028 0.8 0.3 0.6 0.1 1.9 7.1 0.3 3.1 0.4 2.4 4.7 0.0 1.3 1.4 0.6 Paneer (Cheese, cottage) 3 0.1 556 0.4 0.2 0.3 0.5 0.1 0.0 0.0 0.2 0.2 0.0 0.1 0.2 0.3 0.0 0.3 Rohu (Fish, rohu, river, raw) 91 2.5 17 279 12.9 1.5 6.0 1.4 0.0 0.0 1.0 0.9 6.1 1.6 0.0 20.1 7.3 4.7 2.9 Sarson (Mustard, seeds) 14 0.4 611 0.5 1.3 1.3 2.9 0.0 0.0 2.0 0.5 1.3 0.9 1.2 0.0 0.5 1.3 2.4 Sukha Matar (Pea, dry) 10 0.3 361 0.3 0.6 0.9 0.1 0.0 0.1 0.9 0.2 0.7 0.5 1.9 0.0 0.1 0.8 0.8 Tejpata (Bay leaf, dried) 13 0.4 1 903 1.4 0.9 0.4 0.6 0.7 1.4 0.0 0.8 0.6 3.7 1.3 0.0 1.4 5.9 1.4 Total 3 579 100 133 934 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 % target met 100 292 130 359 403 172 257 246 194 200 279 100 135 215

Annex 6 The percentage of the average requirements for energy, protein and fat met each day by the food habits nutritious diet and the percentage of the recommended intake of vitamins and minerals provided by the diet for the 12-23 month old child in Pindra Block with PANJIRI.

% % % Quantity quantit Cost % % % % % % % % % % folic % calciu % % Food List (Kg) y (INR) cost energy protein fat vit A vit C vit B1 vit B2 niacin vit B6 acid vit B12 m iron zinc Bandhagobi (Cabbage, raw) 4 2.1 54 0.8 0.3 0.5 0.1 0.1 1.2 0.9 0.5 0.5 1.9 1.2 0.0 0.3 0.2 0.4 Chirchira (Gourd, snake, raw) 16 7.5 252 3.7 1.1 0.6 0.4 0.0 5.0 2.3 2.3 2.4 1.7 1.6 0.0 1.3 0.6 1.1 Chola, safed (Bengal gram, whole, 3 1.3 111 1.6 2.9 4.1 1.5 0.0 0.0 3.0 1.7 2.6 4.0 3.2 0.0 0.7 2.6 1.5 dried, raw) Jira (Cumin, seeds) < 1 0.2 71 1.0 0.5 0.5 0.6 0.1 0.1 0.8 0.3 0.3 0.5 0.0 0.0 0.7 1.9 0.3 Methi Saag (Leaf, fenugreek, raw) 36 16.9 1 606 23.6 5.4 11.5 2.9 75.8 31.5 15.6 26.5 11.6 26.1 23.3 0.0 37.0 7.3 2.6 Muli (Radish, raw) 4 2.0 69 1.0 0.2 0.3 0.0 0.0 1.2 6.6 0.0 0.4 0.8 0.7 0.0 0.3 0.2 0.3 Nariyal (Coconut, dried) 6 2.7 216 3.2 12.0 2.7 34.2 0.0 0.6 2.9 0.5 2.5 1.5 1.8 0.0 0.4 2.9 2.6 (Onion, spring or scallion, raw) 27 12.8 616 9.0 2.6 3.6 0.5 3.8 8.6 5.4 5.2 2.7 4.5 10.8 0.0 5.1 4.3 2.2 Palak (Indian spinach, raw) 37 17.3 830 12.2 2.8 6.4 1.0 17.4 32.2 2.7 31.6 3.5 24.0 32.1 0.0 10.7 8.7 2.7 Paneer (Cheese, cottage) 4 2.0 740 10.9 4.3 7.5 9.4 2.4 0.0 0.3 4.6 5.1 0.0 1.0 5.8 5.7 0.3 3.1 Panjiri (ICDS take home) 52 24.7 0 0.0 62.6 45.3 44.9 0.2 17.7 53.2 21.5 50.8 30.3 16.5 40.5 24.4 63.1 79.0 Rohu (Fish, rohu, river, raw) 10 4.8 1 950 28.7 2.8 12.4 2.5 0.0 0.0 1.8 1.7 11.5 3.1 0.0 53.7 11.5 5.5 2.4 Sarson (Mustard, seeds) < 1 0.2 17 0.3 0.6 0.6 1.3 0.0 0.0 0.9 0.3 0.6 0.4 0.4 0.0 0.2 0.4 0.5 Sem (Broad beans, raw) 12 5.7 273 4.0 1.8 4.0 0.7 0.3 1.9 3.5 3.2 5.6 1.3 7.3 0.0 1.6 1.8 1.5

Total 211 100 6 804 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 % target met 100 275 100 244 537 151 228 238 201 291 196 100 218 320

The percentage of target met is an average of the % nutrient requirements met over the year.

Annex 7 The nutrient composition of PANJIRI.

Essential Nutritional Information: Energy (kcal) 397.06 Protein (g) 11.8 Total Fat (g) 9.49 Retinol Activity Equivalent (µg 1.37 Vitamin C (mg) 20 Vitamin B1 (mg) 0.28 retinol) Vitamin B2 (mg) 0.17 Niacin Equivalent (mg) 5.08 Vitamin B6 (mg) 0.21 Folate (µg) 50.51 Vitamin B12 (µg) 0.5 Pantothenic Acid (mg) 0.63 Calcium (mg) 284.12 Iron (mg) 11.15 Magnesium (mg) 95.35 Zinc (mg) 7.26

Non-essential Nutritional Information: Carbohydrate (g) 67.27 Saturated Fat (g) 0.88 Mono Saturated Fat (g) 1.31 Poly Unsaturated Fat (g) 3.28 Fibre (g) 6.28 Phytate (mg) 369.66 Copper (mg) 0.4 Phosphorus (mg) 266.82 Potassium (mg) 438.42 Manganese (µg) 0.34 Sodium (mg) 5.6

Annex 8 The percentage of the average requirements for energy, protein and fat met each day by the food habits nutritious diet and the percentage of the recommended intake of vitamins and minerals provided by the diet for the lactating woman in Pindra Block with PANJIRI.

Chauli, Hara saag (Leaf, amaranth, 20 3.6 404 2.5 0.5 1.0 0.2 13.5 5.7 0.7 2.8 1.8 2.8 4.3 0.0 0.5 7.7 2.0 green, raw) Chola, safed (Bengal gram, whole, 18 3.2 725 4.6 6.2 9.1 4.0 0.1 0.0 5.9 3.7 4.8 7.0 8.4 0.0 2.4 7.3 4.8 dried, raw) Choti Machli (Fish, small, fresh, fresh 4 0.8 228 1.4 0.4 1.6 0.4 0.0 0.0 0.9 0.2 1.1 0.3 0.1 10.0 0.0 0.3 0.2 water) (Coriander leaf, raw) 2 0.3 171 1.1 0.6 0.6 0.9 0.1 0.1 0.5 0.4 0.5 1.6 1.3 0.0 0.7 2.4 0.7 Jira (Cumin, seeds) 2 0.3 313 2.0 0.7 0.8 1.2 0.1 0.1 1.1 0.5 0.4 0.6 0.0 0.0 1.6 3.7 0.7 Maida (Wheat, flour, maida) 6 1.1 122 0.8 2.1 1.9 0.3 0.0 0.0 1.7 0.6 2.3 0.9 0.4 0.0 0.1 0.8 1.2 Methi Saag (Leaf, fenugreek, raw) 100 17.9 4 458 28.1 5.0 11.1 3.3 69.2 40.1 13.2 24.6 9.4 19.6 26.4 0.0 51.9 8.8 3.5 Nariyal (Coconut, dried) 16 2.9 597 3.8 11.1 2.6 39.6 0.0 0.7 2.4 0.5 2.0 1.2 2.1 0.0 0.6 3.5 3.6 Palak (Indian spinach, raw) 85 15.2 1 902 12.0 2.1 5.0 1.0 13.1 34.0 1.9 24.3 2.4 14.9 30.1 0.0 12.4 8.7 3.0 Panjiri (ICDS take home) 52 9.4 0 0.0 20.6 15.5 18.5 0.1 8.1 16.1 7.1 14.7 8.1 6.7 25.5 12.2 27.1 38.6 Sarson (Mustard, seeds) 1 0.2 45 0.3 0.5 0.6 1.4 0.0 0.0 0.8 0.2 0.5 0.3 0.4 0.0 0.2 0.4 0.6 Sukha Matar (Pea, dry) 7 1.3 249 1.6 2.3 4.1 0.3 0.0 0.2 3.3 0.9 2.4 1.6 6.1 0.0 0.3 2.5 2.1 Tejpata (Bay leaf, dried) 2 0.4 306 1.9 0.7 0.4 0.7 0.6 0.8 0.0 0.7 0.5 2.7 1.0 0.0 1.5 4.2 0.8

Total 556 100 15 862 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 % target met 100 197 120 352 506 166 215 290 187 216 100 100 100 374

The percentage of target met is an average of the % nutrient requirements met over the year.

Annex 9 The nutrient composition of milk powder in the Cost of Diet software.

Nutrients Amount per 100 g powder Energy (Kcal) 490 Protein (g) 26.3 Fat (g) 2.6

Vit A (RAE) 35

Vit B1 (mg) 0.3

Vit B2 (mg) 1

Vit C (mg) 10

Niacin (mg) 0.6

Annex 10 The percentage of the average requirements for energy, protein and fat met each day by the food habits nutritious diet and the percentage of the recommended intake of vitamins and minerals provided by the diet for the 12-23 month old child for the whole year with 50% breast milk.

% % %

Quantity quantit Cost % % % % % % % % % % folic % calciu % % Food List (Kg) y (INR) cost energy protein fat vit A vit C vit B1 vit B2 niacin vit B6 acid vit B12 m iron zinc Aalu (Potato, diamond, raw) 25 4.1 604 3.0 5.0 1.8 0.4 0.2 3.3 3.6 3.6 2.8 10.0 1.6 0.0 0.1 1.9 6.3 Aata (Wheat, flour, local or hyv) 21 3.4 373 1.8 21.2 17.2 4.2 0.0 0.0 13.4 6.1 27.0 9.3 2.3 0.0 0.9 12.3 19.2 Badam (Nut, almond like) 2 0.3 2 066 10.1 3.6 2.4 11.3 0.0 0.0 0.8 2.4 2.7 0.3 0.4 0.0 0.7 1.1 1.9 Baigun, kala, lamba (Brinjal, purple, 27 4.4 598 2.9 2.0 3.1 0.2 0.3 0.2 1.4 2.9 3.6 3.1 3.3 0.0 1.5 1.5 4.9 long, raw) Bandhagobi (Cabbage, raw) 27 4.4 650 3.2 2.0 2.5 0.9 0.4 3.1 2.9 2.1 2.1 6.1 4.1 0.0 2.1 1.9 3.4 Breast milk 97 16.0 0 0.0 19.1 6.2 40.7 13.6 2.7 3.7 5.2 5.9 1.3 3.0 17.0 4.8 0.0 3.7 Chirchira (Gourd, snake, raw) 23 3.7 386 1.9 1.6 0.7 0.7 0.0 3.0 1.6 2.1 2.6 1.3 1.3 0.0 1.9 1.3 2.3 (Coriander leaf, raw) < 1 0.1 81 0.4 0.8 0.6 1.2 0.1 0.1 0.4 0.3 0.6 1.4 0.8 0.0 0.7 3.6 1.1 Dahi (Milk, curds) 19 3.1 1 233 6.0 3.4 3.5 8.0 1.6 0.1 1.0 4.0 1.1 0.8 0.5 12.4 4.0 0.7 3.6 Jira (Cumin, seeds) < 1 0.1 71 0.3 0.5 0.4 0.8 0.1 0.0 0.4 0.2 0.2 0.3 0.0 0.0 0.7 2.7 0.5 Kancha pepe (Papaya, unripe, raw) 2 0.4 34 0.2 0.2 0.1 0.0 0.0 0.3 0.1 0.1 0.1 0.0 0.0 0.0 0.1 0.2 0.2 Kheera (Cucumber) 8 1.3 326 1.6 0.3 0.3 0.1 0.2 0.3 0.3 0.2 0.3 0.4 0.4 0.0 0.3 0.4 0.5 Lauki (Gourd, bottle, raw) 27 4.4 496 2.4 2.8 1.8 0.3 0.1 1.6 0.5 0.8 1.5 1.6 0.6 0.0 1.8 3.0 5.0 Methi Saag (Leaf, fenugreek, raw) 18 3.0 814 4.0 2.7 4.9 1.8 38.7 6.6 3.9 8.7 4.4 7.1 6.8 0.0 18.9 5.3 2.0 Muli (Radish, raw) 54 8.9 978 4.8 2.9 2.9 0.6 0.0 6.5 41.6 0.0 3.5 5.5 4.8 0.0 3.4 3.3 6.5 Mushambee (Lime, sweet) < 1 0.1 21 0.1 0.1 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Nimbu (Lemon, kagoji) < 1 0.1 34 0.2 0.1 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 (Onion, spring or scallion, raw) 27 4.4 616 3.0 2.6 3.0 0.6 3.8 3.6 2.7 3.3 2.0 2.4 6.2 0.0 5.1 6.1 3.4 Palak (Indian spinach, raw) 79 13.0 1 894 9.3 5.9 11.3 2.7 37.4 28.6 2.8 43.7 5.6 27.4 39.4 0.0 23.0 26.4 8.8 Paneer (Cheese, cottage) 4 0.7 740 3.6 4.3 6.2 11.1 2.4 0.0 0.2 3.0 3.8 0.0 0.6 6.8 5.7 0.5 4.7 Parwal (Gourd, pointed, raw) 9 1.5 378 1.9 0.6 1.1 0.3 0.1 1.2 2.6 0.4 1.0 0.5 0.5 0.0 0.4 2.3 1.1 Phoolgobhi (Cauliflower, raw) 54 8.9 3 095 15.1 4.4 8.5 1.4 0.1 27.5 2.9 2.5 8.0 14.4 11.0 0.0 4.7 6.6 7.0 Rohu (Fish, rohu, river, raw) 10 1.7 1 999 9.8 2.8 10.5 3.0 0.0 0.0 0.9 1.1 8.7 1.7 0.0 63.8 11.8 7.9 3.8 Santra (Orange) 23 3.8 1 707 8.3 3.2 1.2 0.2 0.3 8.5 3.7 1.4 1.4 2.0 2.4 0.0 2.4 0.3 0.7 Sarson (Mustard, seeds) < 1 0.1 17 0.1 0.6 0.5 1.5 0.0 0.0 0.5 0.2 0.5 0.2 0.2 0.0 0.2 0.5 0.8 Sem (Broad beans, raw) 27 4.4 717 3.5 4.1 7.4 1.7 0.6 1.7 3.9 4.6 9.3 1.5 9.3 0.0 3.5 5.8 5.0 Soyabean ka tel (Oil, soybean) < 1 0.1 45 0.2 1.3 0.0 5.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Tori (Gourd, ridge, raw) 22 3.7 475 2.3 1.9 1.7 0.8 0.1 0.7 4.4 1.0 1.6 1.4 0.6 0.0 1.2 4.3 3.6

% % % Quantity quantit Cost % % % % % % % % % % folic % calciu % % Food List (Kg) y (INR) cost energy protein fat vit A vit C vit B1 vit B2 niacin vit B6 acid vit B12 m iron zinc Total 606 100 20 447 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 % target met 100 333 84 244 1 301 305 355 323 378 511 169 100 155 209

The percentage of target met is an average of the % nutrient requirements met over the year.

Annex 11 The percentage of the average requirements for energy, protein and fat met each day by the food habits nutritious diet and the percentage of the recommended intake of vitamins and minerals provided by the diet for the 12-23 month old child for the whole year with 50% breast milk and 50% cow’s milk.

% % % Quantity quantit Cost % % % % % % % % % % folic % calciu % % Food List (Kg) y (INR) cost energy protein fat vit A vit C vit B1 vit B2 niacin vit B6 acid vit B12 m iron zinc Aalu (Potato, diamond, raw) 25 5.1 604 4.8 5.0 1.8 0.4 0.2 6.0 4.7 3.2 3.5 12.6 2.0 0.0 0.1 2.3 7.4 Aata (Wheat, flour, local or hyv) 21 4.2 373 3.0 21.2 17.2 3.6 0.0 0.0 17.5 5.4 33.5 11.7 2.8 0.0 0.9 14.9 22.6 Bandhagobi (Cabbage, raw) 13 2.7 209 1.7 1.0 1.2 0.4 0.2 2.7 1.9 0.9 1.3 3.8 2.5 0.0 1.1 1.2 2.0 Breast milk 97 19.8 0 0.0 19.1 6.2 34.3 13.6 4.9 4.8 4.7 7.4 1.6 3.6 8.7 4.8 0.0 4.4 Chirchira (Gourd, snake, raw) 23 4.6 386 3.1 1.6 0.7 0.6 0.0 5.3 2.1 1.9 3.2 1.7 1.6 0.0 1.9 1.6 2.7 Chola, safed (Bengal gram, whole, 5 1.0 196 1.6 5.1 5.9 2.6 0.0 0.0 3.4 1.8 4.1 4.7 3.9 0.0 1.3 7.8 4.8 dried, raw) Dahi (Milk, curds) 5 1.1 342 2.7 1.0 1.0 1.9 0.4 0.1 0.4 1.0 0.4 0.3 0.2 1.8 1.1 0.2 1.2 Gaye ka dudh (Milk, cow, whole) 97 19.7 3 033 24.0 19.0 20.0 32.4 9.0 1.8 8.6 24.1 1.5 8.8 4.2 53.5 20.4 2.1 14.2 Jira (Cumin, seeds) < 1 0.1 71 0.6 0.5 0.4 0.6 0.1 0.0 0.5 0.2 0.3 0.3 0.0 0.0 0.7 3.3 0.6 Lauki (Gourd, bottle, raw) 5 1.0 90 0.7 0.5 0.3 0.0 0.0 0.6 0.1 0.1 0.4 0.4 0.1 0.0 0.3 0.7 1.1 Methi Saag (Leaf, fenugreek, raw) 15 3.1 679 5.4 2.3 4.1 1.2 32.3 9.9 4.3 6.5 4.5 7.4 6.9 0.0 15.8 5.3 2.0 Muli (Radish, raw) 37 7.4 630 5.0 2.0 2.0 0.3 0.0 7.9 37.0 0.0 2.9 4.7 4.0 0.0 2.3 2.7 5.2 Nariyal (Coconut, dried) < 1 0.1 26 0.2 1.5 0.3 4.2 0.0 0.1 0.2 0.0 0.3 0.1 0.2 0.0 0.1 0.6 0.6 (Onion, spring or scallion, raw) 27 5.5 616 4.9 2.6 3.0 0.5 3.8 6.4 3.5 3.0 2.5 3.0 7.5 0.0 5.1 7.4 4.0 Palak (Indian spinach, raw) 79 16.0 1 894 15.0 5.9 11.3 2.2 37.4 51.3 3.7 39.2 6.9 34.5 48.2 0.0 23.0 32.0 10.4 Paneer (Cheese, cottage) 4 0.8 740 5.9 4.3 6.2 9.4 2.4 0.0 0.2 2.7 4.7 0.0 0.7 3.5 5.7 0.5 5.5 Rohu (Fish, rohu, river, raw) 10 2.1 1 999 15.8 2.8 10.5 2.5 0.0 0.0 1.2 1.0 10.7 2.1 0.0 32.6 11.8 9.6 4.4 Sarson (Mustard, seeds) < 1 0.1 17 0.1 0.6 0.5 1.3 0.0 0.0 0.6 0.1 0.6 0.3 0.3 0.0 0.2 0.7 0.9 Sem (Broad beans, raw) 27 5.5 717 5.7 4.1 7.4 1.5 0.6 3.0 5.1 4.1 11.5 1.9 11.3 0.0 3.5 7.0 5.9

Total 491 100 12 622 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 % target met 100 333 100 244 726 233 396 261 300 418 330 100 128 177

Annex 12 The percentage of the average requirements for energy, protein and fat met each day by the food habits nutritious diet and the percentage of the recommended intake of vitamins and minerals provided by the diet for the 12-23 month old child for the whole year with breast milk and 15g milk powder.

% % % Quantity quantit Cost % % % % % % % % % % folic % calciu % % Food List (Kg) y (INR) cost energy protein fat vit A vit C vit B1 vit B2 niacin vit B6 acid vit B12 m iron zinc Aalu (Potato, diamond, raw) 25 4.7 604 3.8 5.0 1.9 0.4 0.2 3.8 4.1 3.6 3.3 11.2 1.8 0.0 0.1 2.3 7.8 Aata (Wheat, flour, local or hyv) 21 3.9 373 2.4 21.2 18.1 4.1 0.0 0.0 15.2 6.2 31.7 10.4 2.6 0.0 1.0 14.6 23.8 Bandhagobi (Cabbage, raw) 27 5.1 650 4.1 2.0 2.6 0.9 0.4 3.5 3.3 2.1 2.5 6.8 4.8 0.0 2.4 2.3 4.3 Breast milk 153 29.0 0 0.0 30.1 10.3 61.6 21.5 5.0 6.5 8.5 11.0 2.3 5.4 24.4 8.4 0.0 7.3 Chirchira (Gourd, snake, raw) 23 4.3 386 2.4 1.6 0.7 0.7 0.0 3.4 1.8 2.1 3.0 1.5 1.5 0.0 2.1 1.5 2.9 (Coriander leaf, raw) < 1 0.2 81 0.5 0.8 0.7 1.1 0.1 0.1 0.4 0.4 0.7 1.6 0.9 0.0 0.8 4.3 1.3 Dahi (Milk, curds) 19 3.5 1 233 7.8 3.4 3.7 7.7 1.6 0.2 1.1 4.1 1.3 0.9 0.5 11.3 4.4 0.8 4.4 Dibbe ka doodh (Milk, powder, 5 1.0 1 980 12.6 8.0 9.1 1.4 0.5 0.4 3.3 8.5 0.5 0.0 0.0 0.0 0.0 0.0 0.0 fortified) Jira (Cumin, seeds) < 1 0.2 143 0.9 1.0 0.9 1.5 0.1 0.1 0.9 0.4 0.5 0.6 0.0 0.0 1.6 6.4 1.2 Methi Saag (Leaf, fenugreek, raw) 15 2.8 666 4.2 2.3 4.2 1.4 31.7 6.3 3.6 7.3 4.2 6.5 6.4 0.0 17.3 5.1 2.0 Muli (Radish, raw) 54 10.2 978 6.2 2.9 3.1 0.6 0.0 7.5 47.1 0.0 4.1 6.2 5.6 0.0 3.8 3.9 8.1 Nimbu (Lemon, kagoji) < 1 0.1 34 0.2 0.1 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 (Onion, spring or scallion, raw) 27 5.1 616 3.9 2.6 3.2 0.5 3.8 4.1 3.0 3.4 2.3 2.7 7.1 0.0 5.7 7.2 4.2 Palak (Indian spinach, raw) 79 14.9 1 894 12.0 5.9 11.9 2.5 37.4 33.0 3.2 44.7 6.5 30.7 45.5 0.0 25.8 31.2 10.9 Paneer (Cheese, cottage) 4 0.8 740 4.7 4.3 6.5 10.7 2.4 0.0 0.2 3.0 4.4 0.0 0.7 6.2 6.4 0.5 5.8 Phoolgobhi (Cauliflower, raw) 54 10.2 3 095 19.6 4.4 9.0 1.4 0.1 31.7 3.3 2.5 9.4 16.1 12.7 0.0 5.3 7.8 8.7 Rohu (Fish, rohu, river, raw) 10 2.0 1 999 12.7 2.8 11.0 2.9 0.0 0.0 1.1 1.1 10.2 1.9 0.0 58.1 13.2 9.3 4.7 Sem (Broad beans, raw) 11 2.1 284 1.8 1.7 3.1 0.7 0.3 0.8 1.8 1.9 4.4 0.7 4.3 0.0 1.6 2.8 2.5

Total 528 100 15 754 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 % target met 100 316 88 244 1 128 269 347 275 337 442 185 89 131 168

The percentage of target met is an average of the % nutrient requirements met over the year.

Annex 12 Kitchen garden vegetable production

Production in 1 Average cost per Average cost per Amount of Total yield per 85% consumption Months in which Vegetable Name Decimal (1/3 15% sold (Kg) 100g (currently on 1Kg (currently on income generated Biswa (KG) (Kg) food will be avalaible Biswa) for 1 HH market) market using CotD by year (INR) Okra 250 83 71 12.5 3.1 31 387.5 Apr-Jul Cucumber 300 100 85 15 3.4 34 510 Mar-Aug Peas 100 33 28 5 6.3 63 315 Dec-Jan Cabbage 450 150 128 22.5 2.1 21 472.5 Dec-Jan Carrot 150 50 43 7.5 2.12 21.2 159 Nov-Feb Tomato 300 100 85 15 2.4 24 360 Jan-Mar Potato 300 100 85 15 2 20 300 Nov-Feb Onion 200 67 57 10 3.1 31 310 Mar-May Cauliflower 450 150 128 22.5 2.6 26 585 Dec-Feb