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Burden of Child Malnutrition in India
In India, monitoring and surveillance of health and well-being indicators have been focused primarily on the state and district levels. Analysing population data at the level of parliamentary constituencies has the potential to bring political accountability to the data-driven policy discourse that is currently based on district-level estimates. Using data from the fourth National Family Health Survey 2016, two geographic information systems methodologies have been developed and applied to provide estimates of four child malnutrition indicators (stunting, underweight, wasting, and anemia) for the 543 parliamentary constituencies in India. The results indicate that several constituencies experience a multiple burden of child malnutrition that must be addressed concurrently and as a priority.
The appendix published on the website was erroneous and has been replaced by the correct one. The corresponding citations in the main text to the tables and fi gures in the appendix have been corrected. This is the corrected version of the article.
(Appendix Figures A1–A5 and Tables A1–A4 accompanying this article are available on the EPW website.)
Alok Kumar and R Venkataramanan would like to state that interpretations made in this article do not refl ect the views of their respective affi liated institutions.
This research was supported by the Harvard Center for Population and Development Studies, and the Tata Trusts.
In India, monitoring and surveillance of health and well-being indicators have largely focused on states, and increasingly on districts. For instance, the National Institution for Transforming India (NITI) Aayog, the premier think tank of the Government of India (GoI), continues to release financial, labour, education, health, infrastructure, and poverty statistics only at the state and district levels. Since many of the most prominent sources of population data now report district-level outcomes, districts have become the unit of interest and intervention in policy discourse. For instance, the fourth National Family Health Survey 2016 (NFHS-4), conducted across India, released district-level data on a variety of health, nutrition and population indicators. The NITI Aayog Aspirational Districts Programme, which aims to prioritise 115 districts across India for intervention—identified due to their lagging development indicators—is one example of an increased focus on districts in development policy (NITI Aayog 2018). An increased policy focus on districts creates a virtuous cycle, which in turn necessitates even more data collection at the district level, resulting in discourse that is evidence-based.
Another decentralised geographical unit of substantial political influence in India is the parliamentary constituencies (PCs): the 543 geographical regions represented by the members of Parliament (MPs) of the Lok Sabha. The MPs of the Lok Sabha are elected by first-past-the-post universal adult suffrage and serve five-year terms in the lower house of the Parliament (Parliament of India 2017). Unlike districts that do not have any direct governmental accountability, a focus on PCs can bring a greater degree of accountability to policy vision and implementation since the MPs are directly responsible for the well-being of their constituents. Whereas health and development indicators and other population data are widely available at the district level, there is a notable scarcity of PC-level data. This lack of PC-level data steers policy discourse away from PCs, which in turn discourages data collection at the PC level.
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