A Matter of Priorities

adults and children at the state and national level; previous surveys were conduced in 1998-99 and 1992-93.

The latest survey provides very valuable information on a variety of indicators that can be used to assess the progress on various social objectives and the efficacy of government programmes. Looking at the data for the five states, it is clear that undernutrition in women and children is the most persistent problem, on which progress has been halting and uneven. Though the number of women with chronic energy deficiency (measured by body mass index) has reduced all round, their proportion in the population remains high: around one-third in Maharashtra and Gujarat and 40 per cent in Chhattisgarh and Orissa. More surprisingly, nearly all the states, with the exception of Chhattisgarh, reported a stagnation in the number of women who are anaemic, while Gujarat charted a rise. India is already notorious for its number of malnourished children, especially in the 0-3 years age bracket; but the rate of reduction of undernutrition continues at a comparatively slower pace than in countries that have successful nutrition programmes. Of the five states, Gujarat registered an increase in undernutrition in this age group, while Punjab did not show any significant decline. Infant mortality rates in the five states show an allround decline, but the troubling aspect is the drop in full immunisationcoverage evident in the states of Maharashtra, Gujarat and Punjab.

Thus, though in general the states with a higher gross state domestic product (GSDP) – Maharashtra, Gujarat and Punjab

– display superior indicators, there are significant exceptions that must be explained. These could be related specifically to local conditions, cultural practices or the outcomes of policy action (or inaction). As in previous surveys, however, the results of the present exercise underline the importance of sex, education and location (urban vs rural) in determining nutrition and welfare across the board. The other noticeable pattern is that although the GSDP per capita of Maharashtra and Gujarat approaches that of Punjab quite closely, their performance on key indicators is much worse than the latter (except in the case of infant mortality rate), creating a large gap between the two. The mixed outcomes on nutritional indicators also point to the inadequacies of government interventions such as the Integrated Child Development Services and National Anaemia Control Programme that have been ostensibly designed to fast-track progress on nutrition and health.

Perhaps the most consistent progress has been made in the area of fertility decline, with Punjab and Maharashtra as well as the urban areas of all five states, reaching replacement level fertility already, with the other states not far behind. That the reduction of fertility to replacement levels by 2010 might be one of the few policy goals to be met, even as others relating to health and education remain a chimera, might say something about national priorities.

What is striking about the survey this time is its large sample size: 2.3 lakh women and men were interviewed in the 29 states as compared to 90,000 respondents in NFHS 2. In addition, NFHS 3 also included a large component on testing for both anaemia and HIV. Certainly, the aim is to make the sample more representative and reduce the scope for error, yet the question is whether a quantitative survey of this size is really needed for some of the more sensitive issues NFHS has begun to cover. NFHS 2 broke new ground by including questions on domestic violence, quality of reproductive healthcare and status of women in the survey, which though critical, might be better addressed in a qualitative fashion. In fact, concern was expressed at the sheer length of the questionnaires in NFHS 2 (231 questions) and the relatively short time taken to administer (mostly one hour or less) them. If anything, NFHS 3 seems to have broadened its scope further and it would be interesting to see how these have been accommodated in the survey process. Further, the decline in quality of data from NFHS 1 to NFHS 2 that was identified was partly traced back to the fact that private consultants were engaged in data collection rather than the Population Research Centres used in the former. NFHS 3 does not seem to have reversed this trend.

EPW

Economic and Political Weekly September 9, 2006