Illustration by Jayachandran/Mint
Illustration by Jayachandran/Mint

The fuzzy numbers on child malnutrition

Lack of data makes it hard to draw firm conclusions from the hunger index

Child malnutrition is a national shame. The loud debates about this issue have often drowned out the nuances. Millions of Indian children are malnourished because of a combination of factors ranging from poverty to poor sanitation to inadequate use of micronutrients to lack of gender rights.

The latest global hunger index released by the International Food Policy Research Institute (IFPRI), a global think tank on food security, has led to premature celebration in India. And it is not just because child malnutrition in India is now identified in the accompanying report as a serious problem while it was earlier described as an alarming one.

Has India really won important battles in the long battle against child malnutrition?

The success story reported this week banks heavily on a 12.8 percentage point fall in the proportion of underweight children below the age of five. The third round of the National Family Health Survey (NFHS-3) said that 43.7% of Indian children below five were underweight. IFPRI has used the results of a Unicef study that was finished this year by the ministry of women and child development; it estimates that 30.7% of children under five are underweight.

At first glance, the Unicef data fits well with the broad trend in India since 2004. The District Level Health Survey (DLHS) in 2004 showed that the worst affected 100 districts had 53% children underweight. The Hungama report by Naandi Foundation in 2011 showed that this number had come down to 42%. That’s a fall of 11 percentage points over seven years. In that sense, the fall of roughly 13% over nine years across the country (rather than the worst districts) doesn’t sound dramatic. Not unless one compares the NFHS results from the early 1990s to 2005-06, which showed barely any progress in child malnutrition despite faster economic growth and falling poverty levels.

Also, comparing the all India aggregate figure of 43.7% in the 2005-06 NFHS-3 with the Hungama 2011 number of 42% would be faulty since the latter was essentially a survey of 100 worst affected districts, apart from 12 other better performing ones.

However, the biggest concern with the Unicef numbers is that neither are they in the public domain nor have they been accepted by the government internally. This casts a huge doubt about the validity of these numbers. Can they be compared with the NFHS-3 data in terms of coverage or methodology? While IFPRI is sufficiently convinced about the comparability of Unicef data—enough at least to use it for calculating its hunger index—the fact remains that even IFPRI does not have the disaggregated data. They have merely used the results.

There is another reason to look at the actual disaggregated data. The fourth round of DLHS, which came out earlier this year, actually showed that the proportion of underweight children in 2012-13 was more or less the same as it was in 2005-06. The DLHS-4 was actually a much smaller survey than DLHS-3. It did not cover the nine key states which had the bulk of malnourished children but concentrated on the better performing states. It is here that DLHS-4 findings throw a spanner in the works, as it were, since the Hungama report for 2011 showed that a third of children below five in the best performing districts were underweight. As such, the 2014 DLHS-4 data, which is publically available, runs counter to the 2011 Hungama number as well as the 2014 Unicef number.

Much is made of evidence-based policy these days. The tangle of malnutrition data means that it is too early to draw any firm policy conclusions from the latest hunger index. Many scholars still depend on the NHFS-3 survey conducted nearly a decade ago.

There was one way to clear the air—the results of the NFHS-4 should be released as soon as possible. But it too stands stalled due to a Gujarat high court ruling. Till then, the government must release the granular details of the Unicef study it has commissioned if it wants the reported hunger improvements to be taken seriously.

Otherwise, it would be difficult to gauge what is more undernourished—India’s children or the government’s data about them.

Should there be more transparency in nutrition data? Tell us at views@livemint.com

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