India continues to be successful in preventing child deaths, but the health and nutrition of the
surviving, living child has deteriorated, somewhat worryingly.
The NFHS has 42 indicators related to child’s health and nutrition (there is one indicator on
school enrolment which falls outside the scope of this analysis).
The recently released fifth round of the National Family Health Survey (NFHS-5) provides
new and reliable evidence to assess some dimensions of micro-development performance
before COVID struck. The survey covers health, nutrition (of mother and child) and the overall
quality of lives.
In a recent piece on these pages (‘New welfarism of India’s Right’, IE, December 22) we had
argued that the data illustrated significant gains achieved by the government in respect to its
distinctive approach to redistribution and inclusion that we called New Welfarism. This
involved the subsidised public provision of essential goods and services, normally provided by
the private sector. Access to banks accounts (especially for women), clean fuel for cooking,
toilets and power had increased and at a significantly faster pace since 2015 than before.
Here, we provide preliminary evidence on the health and nutrition of the child in India. Since
the latest round only has data for 17 states and five Union territories, our findings cover only
54 per cent of India’s population. Madhya Pradesh, Uttar Pradesh, Punjab, Rajasthan and Tamil
Nadu are notable exclusions. Another point to emphasise is this: The New Welfarism was
consciously driven by the Centre and it could, therefore, reasonably claim credit for its success.
In contrast, many of the child-related outcomes are also determined by state-level
implementation, therefore neither success nor failure can be attributed to one source. With
those caveats, we explain the data and then present our results.
The NFHS has 42 indicators related to child’s health and nutrition (there is one indicator on
school enrolment which falls outside the scope of this analysis). Indicators fall into nine
categories and each of these can be divided into outcomes and inputs as the table shows. For
example, neonatal, infant and under-5 mortality rates can be thought of as outcomes. Similarly,
all the nutrition indicators —stunting, wastage, excess wastage, underweight and overweight
—as well as the prevalence of diarrhoea, acute respiratory illness (ARI) and anaemia can also
be classified as outcomes. In contrast, the post-natal care indicators relating to visits made by
health workers, the provision of vaccinations and Vitamin A, and the extent and nature of
feeding for the child can be classified as inputs (details of the NFHS questions are available
online).
The input indicators are not easy to aggregate in easy or obvious ways, so we leave that as
material for future research. Instead, we present some findings on the 11 child outcomes below.
First, though, some nuances. We score wasting (weight for height of children) as an
improvement because even though the gains were marginal, they reversed a negative trend
between 2005 and 2015. However, the wasting outcome must be treated with caution because
trends on wasting move contrary to those of “severe wasting” even from 2005. There is also
one indicator we have ignored, since it is difficult to classify: Underweight, where there were
marginal gains, but a slowdown relative to the past.
Now, for the results, which can be summarised as: India continues to be successful in
preventing child deaths, but the health and nutrition of the surviving, living child has
deteriorated, somewhat worryingly.
Of the 10 outcomes, there have been improvements in four (Figure 1). It is readily apparent
that India continued to make progress in preventing child-related deaths (neonatal, infants and
under-5). That said, the pace of improvement in child mortality slowed down relative to the
previous 10 years. For example, between 2005 and 2015, the infant mortality rate came down
by nearly 2 percentage points per year while between 2015 and 2019 that pace halved to 1
percentage point per year (post-2015, the mortality lines are flatter than before in Figure 1).
Whether some slowing should be expected because India is now close enough to the desirable
benchmark is an open question.
Figure 2 shows the six indicators where outcomes have deteriorated. These all relate to what
happens after survival: The health (anaemia, diarrhoea, and acute respiratory illness (ARI)) and
nutrition (stunting, and overweight) of the child deteriorated between 2015 and 2019. In none
of these cases is the aggregate deterioration driven by outliers, that is, by one or two states.
Moreover, the absolute deterioration in health and nutrition indicators must be seen against the
fact that they reversed the historic trends of steady improvements. That is particularly true of
the prevalence of diarrhoea and anaemia and to a lesser extent of stunting and acute respiratory
illness (post-2015, the lines slope downwards whereas they sloped upwards from 2005-2015).
Several factors probably play a role in explaining these outcomes. As already noted,
implementation capacity of individual states probably played an important role. Sector-specific
factors such as changing diets are also implicated. But the fact of a broader deterioration in
outcomes hints at the likelihood of a common factor, namely the macro-economic growth
environment, which determines employment, incomes and opportunities. At the least, it is safe
to conjecture that some of these outcomes are inconsistent with the narrative of a rapidly
growing economy.
We mentioned earlier that the NFHS provides data on child-related inputs. These need to be
examined too. Suppose it turns out that the Centre and the states have done a good job in
improving the quality and quantity of inputs that go into the child, then there would be a real
puzzle: Why do outcomes and inputs diverge? Indeed, as we showed in our earlier piece, the
government has made great strides in providing a number of basic needs to households such as
toilets, clean cooking fuel, power and bank accounts. Those developments would also serve to
aggravate the puzzle of why the health and nutrition of the child in India has deteriorated.
As discussed in Chapter 5 of the Economic Survey of 2015-16, perhaps the next big welfare
initiative of the government, building on the considerable success of its NewWelfarism, should
be a mission-mode focus on the well-being of the early child (and of course the mother), from
the womb to the first five years, which research shows is critical for realising its long run
potential as an individual.
https://indianexpress.com/article/opinion/columns/national-family-health-survey-childnutrition-
development-services-malnutrition-mortality-rate-7134409/
No comments:
Post a Comment