Child malnutrition in India is shockingly high and is falling unusually slowly in a period of large gains in aggregate prosperity. Yet technical solutions to malnutrition are known. This article suggests the disjunction is a consequence of institutional features of India, in which rent-creation and rent-sharing in an unequal society are central. Economic reforms partially altered relations between the state and business, helping spur growth, but growth is much weaker in rural areas and poorer states. And service delivery remains enmeshed in patronage and populism. This is acutely misaligned with required action on malnutrition that involves provision of complementary public goods, by different agencies, with a key role for front-line workers. Systemic institutional change is going to be a long haul
in the meantime, public action needs to be designed around existing political and organisational realities. Otherwise increased nutrition-related spending will be like pushing on a string.