Indian Express Editorial Analysis
03 December 2021

1) New geography of welfare

GS2: Malnutrition related


  • The authors talk about the 2nd phase of NFHS data vis-a-vis welfarism.


Editorial Insights:

  • Recently the 2nd phase of National Family Health Survey-5 data has been released.

    • It covered 11 states & 49% of the population.


About NFHS-5:

  • The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted in a representative sample of households throughout India.

  • All National Family Health Surveys have been conducted under the stewardship of the Ministry of Health and Family Welfare, Government of India, with the International Institute for Population Sciences, Mumbai, serving as the nodal agency.


The Findings of NFHS-5 Phase 2:

  • Women outnumber men: For the first time in India, between 2019-21, there were 1,020 adult women per 1,000 men.

  • However, the data shall not undermine the fact that India still has a sex ratio at birth (SRB) more skewed towards boys than the natural SRB (which is 952 girls per 1000 boys).

    • Uttar Pradesh, Haryana, Punjab, Rajasthan, Bihar, Delhi, Jharkhand, Andhra Pradesh, Tamil Nadu, Odisha, Maharashtra are the major states with low SRB.

  • Fertility has decreased: The Total Fertility Rate (TFR) has also come down below the threshold at which the population is expected to reproduce next generation.

    • TFR was 2 in 2019-2021, just below the replacement fertility rate of 2.1.

  • Worsening Anaemic situations: The incidence of anaemia in under-5 children (from 58.6 to 67%), women (53.1 to 57%) and men (22.7 to 25%) has worsened in all States of India (20%-40% incidence is considered moderate). Except for Kerala, all other states are in severe anaemic conditions.

  • Children’s nutrition improved but at a slower pace: The share of stunted (low height for age), wasted (low weight for height), and underweight (low weight for age) children have all come down since the last NFHS conducted in 2015-16.

    • However, the share of severely wasted children has not, nor has the share of overweight (high weight for height) or anaemic children.


NFHS-5 & Welfarism:

  • It is clear that the evidence from the below findings that New Welfarism is a success:

    • The improvements in household access to improved sanitation, cooking gas & bank accounts used by women are as striking as they were based on the performance of the phase 1 states.

      • In all cases, access has increased significantly, although claims of India being 100% open-defecation-free remain excessive.

    • Regarding child-related outcomes, In the 1st phase data, it had found that child stunting had stagnated between 2015 & 2019 after decades of progress.

      • After the inclusion of phase 2 data, it can be found that on all India-wide, the stunting declined although the pace of improvement has slowed down post-2015 compared with the previous decade.

      • On the diarrhoea front, While the prevalence of diarrhoea in the two weeks preceding the survey dipped slightly in NFHS-5, the fraction of children receiving ORS and zinc for diarrhoea has gone up substantially.

        • Children’s access to healthcare services – when suffering from diarrhoea and symptoms of acute respiratory infection (ARI) – has remained almost the same since the previous survey.

        • At the same anaemia, the situation has been deteriorating since phase 1.

      • Further, the new child stunting results are significant but also surprising because of the sharply divergent outcomes between the phase 1 & phase 2 states.

        • The interesting pattern is that nearly all the phase 2 states show large improvements whereas mos of the phase1 states exhibited a deterioration in performance.

  • Additionally, there are some surprising findings:

    • The Tamil Nadu case of a dramatic deterioration of sex ratio at birth from 954 females to males in 2015 to 878 in 2020, indicates a sharp increase in selective abortion, despite an improvement in the sex ratio of the overall population from 1033 to 1088 females per males.

    • The new child stunting numbers shows Indian states in a different picture.

      • The old BIMARU states (except Bihar) are no longer the laggards, the laggards are Gujarat Maharashtra & Karnataka.


Finally, the health & nutrition status is determined by the actions of the states, therefore stunting & other outcomes reflect on their performance. The need of the hour for all the govts is to work towards making a healthy & wealthy India.

Q) Critically examine the NFHS-5 data in light of the Success of Indian welfarism. (150 words)