NFHS – Ideology trumps analysis?

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December 26, 2020 5:30 AM

The newly released NFHS data reveals large improvements in welfare for Indian children, women, and households. Then why the deep angst?

To help negate this falsehood, it is important to compare India with the rest of the developing world, about 180 countries and a population of 6.5 billion. (Representative Image)

By Surjit S Bhalla
A typo here, and a typo there, and soon it can begin to add up to a “story”, a point of view. All of us have made data errors in print—the editors allow a “correction” post-publication and do so easily on the web. I have had an occasion to correct my data—and everybody should. We have been in an era of data-based policy for some time now—not just in India, but around the world. There are several “Fact-Check” websites around the world. This article should be seen primarily in that light.

But there is more, much more, to the recent data release of the preliminary results of the National Family Health Survey (NFHS) for 2019-20. These preliminary results have been released for 2019-20 along with comparable data for the 2015-16 survey. Data are presented for 21 states (12 “big” and nine small) and population coverage of approximately 700 million. Tabular data for 131 variables have been released for 2019-20, along with comparable data for 2015-16. The data shows there has been considerable improvement in many of these 131 indicators of social welfare; and that in very few (you can count such instances in the fingers of one hand) there has been stagnation rather than a decline.

But that is not the first impression one obtains from the writings of distinguished scholars like Jean Dreze (IE, Dec 19) and Arvind Subramaniam (IE, Dec 22), as well as editorials like Hunger Alarm (IE, Dec 15), as well as pronouncements on worsening teenage pregnancy (The Hindu, Dec 15). Dreze starts his essay with the conclusion that “Leaving aside two or three countries like Niger and Yemen, India has the highest proportion of underweight children in the world…”, and adds, for effect, that this proportion is much higher than in neighbouring countries like “Bangladesh (22%) and Nepal (27%). Arvind Subramaniam, “After showing a slow but steady decline, especially between 2005 and 2015, there has been a disappointing reversal thereafter”.

Hunger Alarm editorial, “There have been several indicators of the slowing down of economic growth and employment distress, which are bound to have an effect on hunger and nutrition” (emphasis added). The Hindu’s (Dec 15) verdict on worsening India was reflected in the title “Rise in teenage pregnancy, higher anaemia rate in women: NFHS-5 phase data”.

The collective interpretation one obtains from reading these, and many other articles on the subject, is, after years of progress in health, nutrition, and child welfare, things have really worsened in the last four years, 2015/16 to 2019/20. Some authors are explicit, others indulge in nudge-nudge, wink-wink—these four years were also the first-four years of the changing political order in India—the beginning of Modi as PM.

I have often stated in my articles (starting from “India, the Incomparable”, Economic Times, March 3, 1989) that Indians suffer from a special disease—we think we are unique. To help negate this falsehood, it is important to compare India with the rest of the developing world, about 180 countries and a population of 6.5 billion. Thus, the accompanying graphic tries to put interpretation, and data, into both an absolute (e.g., what happened in India) and a worldwide perspective (what happened elsewhere in comparable economies). The World Bank (WB) provides these comparable data annually and the data are easily available to all interested. Trends in hunger, nutrition, inequality, growth, etc, can be assessed in a comparative perspective.

Let us look at some of the typos, falsehoods, misinterpretation of the data. Dreze states that Bangladesh’s underweight percentage in 2015 was 22%; WB data pins it at 30.1 %—some 4.7 percentage point (ppt) lower than India’s, but not 12.8 ppt lower as implied by Dreze. Hunger Alarm: “Exceptionally rare to see stunting gains being undone” with reference to India where presumably Hunger Alarm observed the undoing. WB figures for all developing countries with data on stunting (63 countries, population 2.5 billion): In 2000, stunting average excluding India was 29.3%; in 2010 23.8%; and, in 2015, 28.7%. In other words, a lot of zig-zag, reversals, and no net improvement over 20 years. In contrast, in India, it was 46% in 2000, 10 ppt lower in 2015, and still lower in 2019.

Teenage pregnancies on the rise? Really? In 2005, teenage pregnancies in India were 19.9%; in 2015, 8.7 %, and one ppt lower in 2019. Net improvement—about 12 ppt in 15 years. Contrast this with a constant 10 ppt higher level in the developing world over the same period. The decline in teenage pregnancies in India is a genuine success story. India had the 10th lowest level in 2015, with Nepal nine positions lower (16.7%) and Bangladesh (30.8% in 2014) with the ninth highest magnitude of teen pregnancies (women 15-19 years of age).

Wasting: Not one of the authors look at the data on wasting (weight for height). A curious but revealing omission. The wasting percentage in India was 17.5% in 2000, and 3.3 ppt higher in 2015, and did not deteriorate further in 2019. Contrastingly, in the same time-period, wastage in the developing world improved by 1.6 ppt.

None of the data presented above shows Indian performance to have worsened post-2015. In other words, the pessimistic conclusion of “many” (or some) of deterioration is false. Further, according to a vast number of NFHS indicators, welfare improved “Big-Time” between 2015 and 2019. A summary version of these data is as follows (comparable data for other countries not as yet available).

All data are for change (difference in percentages), as revealed by NFHS on an aggregate population-weighted basis, rather than an elevator economics basis as presented in many analyses, e.g., for X, Y states showed improvement and Z states showed decline.

Child mortality: Data on three indicators (neonatal, infant and under-five) shows an improvement between 3 and 4 ppt. Immunisations: This is one big story of improvement; for example, hepatitis B vaccine percentage (for children 12-23 months) increased from 64.8 % in 2015 to 83.6 % in 2019. Breast-feeding and diet of children 6-23 months: Average gain of 4 ppt for four indicators.

Negative trend in 26 children indicators: Only two worsened. Children with fever taken to a health facility (71.3 % in 2019, vs 72.6 % in 2015); and children under five years severely wasted—increase to 8.6 %, from 7.6 % in 2015.
Negative trend in seven young women indicators: Zero. Modern birth control methods, age at marriage, teenage pregnancies, and sexual violence show improvement—average improvement in these seven indicators: 3.9 ppt.
Negative trend in 15 adult indicators: Zero. Average gain 4.1 ppt. Some indicators show an increase of 9 ppt and above: households with electricity (9.2 ppt), improved sanitation facilities (17.3 ppt), clean fuel for cooking (18 ppt) and women with bank account that they use (29.8 ppt increase, to 77.2% in 2019).

Why such a large divergence between perception and reality? If there is an improvement in ~100 indicators and stagnation (not worsening) in very few (less than five) then why editorials, special shows on TV, and scholarly (but motivated) conjectures about the larger “reality” that may be causing a non-existent worsening? The intelligentsia, domestic and international media got the Modi election, and his re-election, horribly wrong. As I have argued earlier (The New Wealth of Nations and Citizen Raj) one consistent explanation for this misreading is that the old elite has not come to grips with the reality that there is a change in leadership on issues relating to politics, economics, culture & society.

Executive Director IMF representing India, Sri Lanka, Bangladesh and Bhutan. The views expressed are those of the author and do not necessarily represent the views of the IMF, its Executive Board, or IMF management

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