The data from the National Family Health Survey or NFHS-4 (although only for 13 states and 2 UTs) confirms the finding from the Rapid Survey on Children (RSoC) of 2015 that there has been a significant decline in child malnutrition in the country during the last decade. In spite of a number of initiatives having been launched to combat malnutrition during this period, nothing definitive on their impact could be said because of the data drought that one saw since the NFHS-3, which was conducted in 2005-06. The NFHS-4 data, when fully available, will for the first time provide comprehensive nutrition-related data at the district level for the entire country.
While there has been a decline in childhood stunting (considered one of the most important indicators as it represents chronic malnutrition) in almost all states, there still exists a wide gap between states. Therefore, while 28 per cent of children in Telangana and 27 per cent in Tamil Nadu have a low height for age, the corresponding figures for Bihar and Madhya Pradesh are 48 per cent and 42 per cent. The Global Nutrition Report 2015 finds that Bihar, Jharkhand, and Uttar Pradesh have high initial rates of stunting and yet the subsequent declines in stunting in these states are lower than most other states. Even though these states did see a considerable decline in stunting since the last survey, at this rate it will take a long time for them to catch up.
From earlier studies we do know that a number of factors contribute to malnutrition, including food availability and quality, women’s status within the household and in the society, access to health services and prevalence of open defecation. It would be wrong to focus only on economic growth as an explanatory factor for the improvement in malnutrition in this period. The period between NFHS-2 (1998-99) and NFHS-3 (2005-06) witnessed high economic growth but unimpressive improvements in malnutrition. In the current period (2005-06 to 2015-16) as well, the question to be asked is whether the rate of improvement in malnutrition that is being seen can be attributed only to the growth experience.
The India Health Report compares the levels of stunting in India to other countries with similar levels of per capita income or even lower and finds that the level of stunting in India is higher than what would be expected based on its per capita income levels. A number of countries such as Bangladesh, Nepal, Tanzania, Kenya etc have a lower per capita income than India but also lower levels of stunting.
Within India too, while the correlation between per capita income of the state and stunting prevalence is high (correlation co-efficient minus 0.67), there is no one to one correspondence indicating that it is possible to address malnutrition through multiple factors. For instance, while Tripura’s per capita state domestic product is less than half that of Haryana, stunting in Haryana (34 per cent) is considerably higher than in Tripura (24 per cent).
Other indicators such as those related to women’s status also show a very strong correlation with malnutrition levels. Calculating simple correlation coefficients between stunting levels and different indicators it is seen that stunting is most highly correlated with the percentage of women in the state having a bank account in their name (minus 0.83) and percentage of female literacy (minus 0.68). Similarly, stunting is also highly correlated with the percentage of households in a state using improved sanitation facilities (minus 0.62).
Taking the percentage of institutional deliveries and the percentage of women who received full antenatal care as proxies for the availability of health services, these factors are also highly correlated with levels of stunting in the state (minus 0.74 and minus 0.71 respectively).
Although anything conclusive can only be said after a careful multivariate analysis, which is not possible currently with the available data, what this initial analysis indicates is that there are all these other factors that have to be addressed to make a dent on malnutrition.
To keep up the momentum gained in reducing malnutrition, there is a need to put more resources into the public programmes that contribute to improvements in all of the factors discussed above.