After the release of the first phase of the fifth wave of the National Family Health Survey (NFHS-5), we wrote in these pages (‘New welfarism of India’s Right’, IE, December 22, 2020), providing evidence for: (i) The success of the Narendra Modi government’s New Welfarism — the public provision of essential, and essentially private, goods and services such as cooking gas, toilets, bank accounts, power, housing, and cash; and (ii) setbacks in health and nutrition outcomes for children such as stunting, and the prevalence of anaemia and diarrhoea.
The release of the second and final phase of NFHS-5, which covered 11 states (including Uttar Pradesh (UP), Tamil Nadu, Punjab, Rajasthan, Madhya Pradesh (MP), Jharkhand, Haryana, and Chhattisgarh) and about 49 per cent of the population calls for an update of our previous findings.
First, it is now clear that the evidence for the success of New Welfarism is as strong as we had suggested earlier. Figure one plots household access to improved sanitation, cooking gas and bank accounts used by women. The improvements are as striking as they were based on the performance of the phase 1 states. In all cases, access has increased significantly, although claims of India being 100 per cent open defecation-free still remain excessive.
Second, on child-related outcomes, our earlier findings have to be qualified, significantly in the case of stunting and diarrhoea. Earlier we had found that child stunting had stagnated between 2015 and 2019 after decades of progress. When phase 2 states are added, we find that India-wide, stunting has declined although the pace of improvement has slowed down post-2015 compared with the previous decade. For example, stunting improved by 0.7 percentage points per year between 2005 and 2015 compared to 0.3 percentage points between 2015 and 2021. On diarrhoea too, adding the new data reverses the earlier finding. However, on anaemia and acute respiratory illness, there seems to have been deterioration as we had found earlier.
The new child stunting results are significant but also surprising because of the sharply divergent outcomes between the phase 1 and phase 2 states. Figure 3 tries to unpack the new evidence. It plots child stunting rates for the most recent period on the y-axis and rates for 2015 on the x-axis along with a 45-degree line. Points to the north of the line indicate deterioration in performance between 2015 and 2020, while points below the line denote improvement. The phase 1 and 2 states are shown in black and red, respectively. The interesting pattern is that nearly all the phase 2 states show large improvements, whereas most of the phase 1 states exhibited a deterioration in performance.
The survey for the latest data was conducted in two waves, the first before the pandemic and the second during the peak of the second wave (October/November 2020 – March/April 2021). How much the circumstances of the NFHS survey might have affected the results is difficult to say; and if anything, our priors would have been that phase 2 states would have fared worse due to the impact of Covid.
Evidently, the converse has happened. For the moment, we must accept the results while investigating this and other possible anomalies: For example, the data for Tamil Nadu shows a dramatic deterioration in the sex ratio at birth from 954 females to males in 2015 to 878 in 2020, indicating a sharp increase in selective abortion, despite an improvement in the sex ratio of the overall population from 1,033 to 1,088 females per males.
But here’s the real surprise in Figure 3. If the new child stunting numbers are right, a different picture of India emerges. Apparently, Madhya Pradesh now has fewer stunted children than Gujarat; Uttar Pradesh and Jharkhand are almost at par with Gujarat; Chhattisgarh fares better than Gujarat, Karnataka, and Maharashtra; and Rajasthan and Odisha fare better than Gujarat, Karnataka, Maharashtra, West Bengal, Telangana and Himachal Pradesh! On child stunting, the old BIMARU states (excepting Bihar) are no longer the laggards; the laggards are Gujarat, Maharashtra, and Karnataka, and to a lesser extent, West Bengal, Andhra Pradesh and Telangana.
If true, on the key child stunting metric, what we are seeing is not catch-up but the great switch between some of the BIMARU states and the mid-peninsular/western states. Indeed, the decline in stunting achieved by the poorer states such as UP, MP, Chhattisgarh and Rajasthan would be all the more remarkable given the overall weakness in the economy between 2015 and 2021. When commentators speak of two Indias, it is now important to ask: Which ones and on what metrics?
Finally, insofar as health and nutrition are determined by actions of the states, stunting outcomes reflect on their performance. The improvements in Rajasthan have happened under the Congress, in MP and Haryana under the BJP, in Odisha under the BJD, and in UP under both Samajwadi Party and BJP; and the stagnation/setbacks have occurred in Gujarat (BJP), West Bengal (Trinamool), and Telangana (TRS). Neither success nor failure seems to be the monopoly of any one political party.
This column first appeared in the print edition on December 3, 2021 under the title ‘New geography of welfare’. Anand is Robert S. McNamara Fellow, World Bank and Subramanian is Senior Fellow, Brown University