Notes on the Differing ‘States’ of Child Undernutrition in Rural India
Summary (2 min read)
1 Introduction
- In spite of the indications that some progress has been made in India in recent years in the reduction of poverty (see Himanshu 2007), as other articles in this issue of the IDS Bulletin also note, little if any progress has been made with regard to malnutrition among children.
- There are, however, striking differences in the incidence of child undernutrition in rural areas across the major Indian states -although the available evidence suggests that there was little variation between them in the early 1970s, when the proportion of children who were underweight was as high as 70 per cent in rural areas in most states.
- Some states have done very much better than others over the past quarter century or so, in reducing this most serious constraint on the expansion of human capabilities in India (Table 1 ).
- The purpose of this article is to suggest explanations for these inter-state differences that may be investigated further and tested once more data become available.
- The authors particular concern is to examine underlying political and institutional variables that strongly influence the proximate and immediate drivers of nutrition status.
2 The politics of malnutrition
- The hypothesis that the authors wish to explore is that differences between states in terms of the reduction of malnutrition among children, are underlain by differences between their political regimes.
- As Harriss showed in earlier work (2003) , the authors may first differentiate between Indian states in terms of the political representation of different castes/classes (this formulation reflecting the view that while caste and class are certainly not equivalents, there is considerable overlap between the categories), and second, the nature of political competition in them.
- There are also differences of degree between states when they are assessed along a scale between 'clientelist politics' on the one hand and 'programmatic politics' on the other.
- The records of the states considered in this article, with regard to the reduction of undernutrition among children, quite strikingly bear out this analysis.
- In varying degrees the CPI(M) in Kerala and West Bengal, the Dravidian parties in Tamil Nadu and possibly the Telugu Desam party in Andhra Pradesh display these characteristics.
3 Trends in undernutrition and their determinants
- The authors note, first, broad consistency between the trends in undernutrition across states shown in Table 1 and a variety of factors that are among the more important proximate determinants of nutrition status, having to do with childcare (influenced by female literacy), local public goods (water supply and sanitation), and the local health system (immunisation and institutional deliveries).
- The authors also note correspondence with an index of institutional performance across Indian states derived by Mayer ( 2001) from a factor analysis model, and a measure of the elasticity of rural poverty (as defined by the conventional income measure) with respect to growth (using data for the period 1958-97) calculated by Besley et al. (2005) .
- If the authors take the NFHS data on the incidence of institutional deliveries as another single snapshot indicator of the quality of health services then, again, there is a clear correspondence with states' varying performances in reducing child undernutrition (with West Bengal, here, an apparent outlier).
- Of course correlation (in this case between PDS performance and trends in the reduction of malnutrition) does not constitute causality.
- An analysis by Tyagi (1990) for the single year 1988-9, comparing 'desired distribution' (taking account of poverty, agricultural production and income levels) and 'actual distribution' through the PDS showed that in Kerala, followed by West Bengal, Tamil Nadu and Andhra Pradesh, actual distribution was higher than 'desired', and that in Karnataka the two were at parity.
4 Conclusion
- The authors offer only presumptive evidence in this article, but although only descriptive, the data do show strong connections between the varying character of the political regime across states and government performance in regard to services that influence the nutrition status of children, and these with the trends of reduction of undernutrition.
- The authors note that there are two major sources of data on undernutrition in India: the results of the work of the National Nutrition Monitoring Board (NNMB) of the National Institute of Nutrition, which extend back to the 1970s, and those of the National Family Health Survey, referred to earlier, and of which the first round was conducted in 1992-3.
- There are gaps for some states for some years in the NNMB, and in the WHO series that the authors use in this analysis -which is supplemented by reference directly to the NNMB for 2000-01.
- These parties are the Communist Party of India-Marxist (CPI-M) in West Bengal and Kerala -where it has, however, regularly alternated in office with Congress-led formations -and the Dravidian parties in Tamil Nadu that have pursued policies that can fairly be described as 'populist'.
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References
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Frequently Asked Questions (7)
Q2. What is the overarching factor among the proximate determinants of nutrition status?
The overarching factor among the proximate determinants of nutrition status is that of income (an indicator of ‘household economic resources’), which is likely strongly to influence food security and dietary intake, access to health care and the quality of the health environment, and to have an influence upon the quality of childcare.
Q3. What are the parties that have been in office for some years?
These parties are the Communist Party of India-Marxist (CPI-M) in West Bengal and Kerala – where it has, however, regularly alternated in office with Congress-led formations – and the Dravidian parties in Tamil Nadu that have pursued policies that can fairly be described as ‘populist’.
Q4. What is the significance of the PDS?
The Tamil Nadu story is less well known, although the quality of provision of public services in the state, and the performance of its bureaucracy, have long been recognised, and latterly it has been marked by a strong commitment to social welfare (reflected, for instance, in the maintenance of the universal PDS).
Q5. What is the correspondence between the elasticity of poverty and growth?
In the context of an overall correspondence between this measure of the elasticity of poverty with respect to growth and performance in regard to reduction of undernutrition Tamil Nadu stands out as having done relatively well in regard to nutrition, in comparison with its performance in poverty reduction, while both Gujarat and Orissa have evidently done less well in improving child nutrition than they have done in reducing poverty.
Q6. What is the main point of the analysis?
The analysis also confirms the importance of the public distribution system, and lends support to Madhura Swaminathan’s criticisms (2008) of the introduction of targeting.
Q7. What is the effect of targeting large numbers of people under the PDS?
Following the introduction of targeting large numbers of those unquestionably in need are being excluded from the PDS – especially so in Kerala, followed by Orissa and Maharashtra.