Infrastructure

Decoding India’s stunting and wasting numbers- The New Indian Express

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Amidst the Covid pandemic, two recently published reports did not receive the attention they normally do. The first is UNDP’s Human Development Report (HDR), published annually at this time of the year. In something like the HDR, reportage invariably focuses on India’s rank as determined by HDI (index based on life expectancy at birth, school indicators and purchasing power parity-based per capita income). Data is available with a lag for variables included in HDI computations as well as other human development or deprivation indicators.

Therefore, for the most part, data in the HDR is for 2019, not just for India, but for other countries too. Hence, it doesn’t capture the impact of Covid. Rankings are relative and are functions of how other countries perform. In rankings, India is now 131st out of 189 countries, having slipped a couple of ranks compared to a year ago. (This year, as an innovation, there is a planetary pressure adjusted HDI too and India performed relatively better on that.) India’s HDI value is now 0.645 (highest is 1 and lowest is zero), the medium human development category.

This has consistently improved since HDRs started in 1990. While progress should be faster, there is nothing in HDR data to suggest human development outcomes have worsened, including those that are health-related. However, there are a few statements in the HDR that should be mentioned. “Disasters continued to trigger most new displacements in 2020. Cyclone Amphan hit Bangladesh and India, driving the largest single displacement event in the first half of the year, triggering 3.3 million pre-emptive evacu­ations.”

“The same happens in Asia, where indige­nous children in Cambodia, India and Thailand show more malnutrition-related issues such as stunting and wasting.” “Meanwhile, the heaviest monsoon in 25 years produced cata­strophic floods and the loss of at least 1,600 lives across 13 Indian states; in Kerala more than 1,00,000 people had to be evacuated. There is a high prevalence of recent catastrophic events such as floods, cyclones and locust attacks in India and Pakistan. In 2018, India was the fifth most affected by extreme weather, with 2,100 deaths and $38 billion in losses in purchasing power terms.” Stunting concerns height and wasting concerns weight.

Without getting into technical definitions of these terms, stunting means height is significantly below the norm and wasting means weight is significantly lower than normal. The HDR also states, “In India, different responses in parent behaviour as well as some disinvestment in girls’ health and education have led to higher malnutrition among girls than among boys as a consequence of shocks likely linked to climate change.” In principle, stunting and wasting can be used for anyone, irrespective of age. But obviously, since future development is adversely affected, it is a more serious issue for children.

The HDR makes three statements: (a) Malnutrition, leading to stunting and wasting, is more concentrated in some population groups. (b) Some parts of India have suffered from floods, cyclones and locust attacks. (c) Exogenous shocks can adversely influence private investments in girls’ health and education. It has a gender angle. When we are in a position to gauge the impact of Covid, an issue like (c) will indeed be important. 

Let me now bring in the second report, the 5th National Family Health Survey (NFHS). This is for Phase I and includes 22 states and Union territories, not all. The period for the survey is 2019-20, pre-Covid. There are a host of indicators that show improvements, compared to the 4th NFHS in 2015-16. But I wish to focus on under-5 children who are stunted and wasted. Between 2015-16 and 2019-20, these percentages should decline, as they have in many states. But we then come to a state like Assam, where the percentage of under-5 children who are stunted declined from 36.4% to 35.3%, but the percentage of wasted children increased from 17.0% to 21.7%.

Bihar and J&K have the same pattern. The stunting number improved, but the wasting one did not. There is a reverse trend for Gujarat, where the stunting number deteriorated, but the wasting number improved. Both deteriorated for Himachal, Telangana and Kerala. The wasting number remained the same for Maharashtra, but the stunting number worsened. That’s also the pattern in West Bengal. There should be concern about the health of under-5 children and efficiency of public health expenditure, typically a state government function.

Improvements should have been more and one should be specifically worried about stunting and wasting. But since the numbers cited also apply to states that have not been through climate-related exogenous shocks, I don’t think this offers an adequate explanation. Given the quoted variations across states, I don’t think one can make any all-India generalisations either. Perhaps someone should probe district-level data, from which state-level data is aggregated.

Generally, stunting and wasting are correlated. Therefore, the reverse movements in these two variables are a bit of an anomaly. Surveys are based on samples. Therefore, I also wonder if the samples of the 4th and 5th NFHS are comparable. Differences in cohorts of children might very well explain these apparent anomalies. For instance, infant mortality rates are declining, a desirable outcome. This means children who would otherwise have died are not dying now.

In all probability, their heights and weights will be significantly below standard norms. Stated differently, neo-survivors pull down average heights and weights. This is a speculative assertion. But the point I am making is that there is a lot we don’t know about the numbers.

Bibek Debroy (Tweets @bibekdebroy)
Chairman, Economic Advisory Council to the PM

 

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