By Komal Jain & Lekha Chakraborty
In the Global Hunger Index 2018, India ranks 103rd (with an alarming score of 31.1) among the 119 qualifying countries, which clarifies the persistent inequality in access to quality food. This is further accentuated by stark interstate disparities in nutritional status, coupled with poor health infrastructure in most states, particularly in Gujarat. The report Rapid Survey on Children noted that Gujarat is the only developed state with malnutrition rates worse than the national average.
An analysis of anthropometric features (based on data from fourth round of the National Family Health Survey, NFHS-4) reveals Gujarat is performing poorly on account of percentage of stunted children (31.7), as against the national average of 31. Protein-energy malnutrition (PEM) in women of childbearing age (15-44 years) and young children (up to 59 months of age) is one of the underlying reasons for malnourishment. The percentage of wasted children is seen to be increasing from 16.2 (NFHS-2) to 19.7 (NFHS-3) to 26.4 (NFHS-4) in Gujarat, as compared to a trend in the national level figures starting from 15.5 (NFHS-2) to 22.9 (NFHS-3) and finally to 21 (NFHS-4).
In fact, 8.6% children in urban regions of Gujarat are severely wasted, as against 10.2% in rural regions, much above the national average (7.5%). Although Gujarat has progressed in improving the conditions of underweight children, it needs to progress tremendously as 39.3% of the children are still underweight. Decreasing the number of anaemic pregnant mothers—which feeds onto poor physical health of children—should be a policy priority. As we dig deeper into the dismal health conditions in the region, we find that Gujarat has been successful in reducing the infant mortality rate (IMR) from 62.6 (NFHS-2) to 34 (NFHS-4) over a span of 20 years, but still demands better policy priority. For a comparative perspective, in Kerala, the IMR is 10 per 1,000 births. In Gujarat, the under-five mortality rate (U5MR) has seen almost a 50% reduction from 85.1 (NFHS-2) to 43 (NFHS-4). However, the progress is not enough.
Anthropometric indicators
Before the national elections of 2019, it is crucial to analyse the “below-state level” performance of the socio-economic indicators of each state. In Gujarat, the district-wise (based on NFHS-4) analysis of nutrition unveils an alarming picture. Despite ever-increasing literacy rates in Ahmedabad—one of India’s most famous industrial hubs—the city has not been a good performer in anthropometric indicators, namely stunted (29.4), wasted (27.1), severely wasted (11.5) and underweight (31), as compared to its semi-urban counterparts of Vadodara and Anand.
The tribal districts in Gujarat—Dohad and Panchmahal—have high numbers of stunted (44.4 in Dohad; 40.4 in Panchmahal) and underweight children (50.8 in Dohad; 42.3 in Panchmahal), due to partial immunisation coverage of 40%. Gandhinagar, the capital, has 42.6% underweight and 52.3% stunted children in the rural region. Surat, despite being the eighth largest city of India, has not been able to perform well on the social indicators, because of about 11% gap in urban and rural figures of anaemia cases. Poor implementation of schemes like Janani Suraksha Yojana has added to the problem.
Navsari, the district in south Gujarat, has performed relatively better than Surat, Valsad and Bharuch, due to success of Vatsalyadham Project, under which screening of acute malnutritioned children is taken care of. Rural districts of Patan, Mehsana and Banaskantha have on an average 40% stunted children. Another rural district, Sabarkantha, has 53% of stunted children.
On comparing health characteristics of the four largest districts of Gujarat—Vadodara, Ahmedabad, Surat and Rajkot—Ahmedabad continues to fare the worst in the number of women with low body mass index (BMI). Anaemia incidence among children, women and men is lowest in Surat and highest in Ahmedabad.
Dangs continues to be the worst performer amongst all the districts of Gujarat in all four anthropometric features. Porbandar has the least percentage of children under five who are stunted, and Rajkot has the least percentage of children under five who are severely wasted (Kachchh and Dangs are the worst), whereas Junagadh and Jamnagar outperform all other districts with minimum number of underweight children. This dismal variation is seen because of variations in the implementation of different health schemes and probably because of their geographical locations.
Mehsana, Kachchh and Sabarkantha have the highest percentage of anaemic children. Even though Surat has the least (42.3) percentage of anaemic children, the number does not seem to be low, in absolute terms. The average percentage holds as high as 63.9 for the same category amongst all the districts of Gujarat, which is alarming. Anaemia amongst women does not seem to be any lower, with an average value of 56.4% for all the districts, while for men it is 23%. While urban regions have more of obese women, rural have more women with anaemia. There is an urgent need to re-prioritise the state’s investment plans towards nutrition.
The arrangement of public expenditure benefits crucially depends upon the structure of economic growth and the stability of revenue in the state. It is alarming that industrial output in Gujarat fell by 40% over the last year and a half, as noted by the Gujarat Chamber of Commerce and Industry (GCCI) on November 17. The GCCI noted that demonetisation, inadequate implementation of GST, and the uncertainties and industrial sickness in the MSME sector are the reasons for industrial slowdown.
The Statue of Unity inaugurated on October 31, 2018, can reward India if it is a well-packaged tourist spot, but even an ever-increasing GSDP cannot translate itself into human development. There is an urgent need to conduct a public expenditure review to re-prioritise spending towards nutrition in Gujarat.
“Jain is with Gokhale Institute of Politics & Economics, Pune. Chakraborty is associate professor, NIPFP”
