For a nation obsessed with whether it’s the fastest-growing large economy or the sixth largest, it’s tragic that its elites do not even know that the country’s future is being severely compromised by the abysmal nutrition of its children.
The just-released sixth National Family Health Survey shows that India’s child malnutrition rate was at a substantial 32 percent in 2023-24—almost unchanged from 2019-21 (NFHS-5). Worse, India’s number is far higher than sub-Saharan Africa’s 20-22 percent levels. How will the children of a country where every third one is undernourished grow up prepared for the tougher new world that awaits them?
Wasting (too thin for height), which was severe for Indian children under 5 in 2019-21 at 19.3 percent, has stagnated at 19 percent. This indicates a severe lack of calories and protein. In sharp contrast, just over 7 percent of 35 African nations’ children were counted as wasted last year.
While wasting can be addressed quickly by feeding a child sufficient calories and proteins, stunting (low height for a particular age) constitutes chronic malnutrition and requires long-term interventions with high-quality food for mother and child, care in early childhood and adequate public health services to prevent repeated illnesses in early childhood. Thankfully, this count has fallen from 35 percent to 29 percent in India. But the fact that it’s still so high bears witness to India’s gross neglect of nutrition over decades.
Even more stunning is the incidence of adult malnutrition, which increased between 2019-21 and 2023-4! Women below a body mass index of 18.5 (the threshold for adult malnutrition), which was 18.7 percent of the population in 2019-21, rose to 19.7 percent in 2023-24. Men’s share rose from 16.2 percent to 19.7 percent—a 15 percent worsening in just a few years. This shows that India’s poorest saw their distress worsening, while their children are not doing any better.
The health status of mothers—and hence their children—is majorly affected by the age at which they marry. NFHS-6 reveals that 20.1 percent of women aged 20-24 were married before the legal age of 18, barely down from NFHS-5’s 23.3 percent. Women’s ability to take decisions in the household are impacted by their level of education. Now consider that only 46 percent of Indian women in 2023-24 had 10 years of schooling. Though it’s up from 41 percent, the progress is far too little. It means over half the nation’s women have little chance of securing work outside of agriculture. No wonder India still has one of the lowest female labour force participation rates in the world, comparable to Saudi Arabia and Yemen.
A critical international comparison
The striking point is that in the early 1990s, Vietnam and India were not very different on undernutrition—but the comparison has become much more distorted in less than four decades.
In Vietnam, 42 percent of the population was underweight in the early 1990s; it has brought the level down to 10-12 percent today. India, which was at 53 percent in 1992-93 (NFHS-1), was at 32 percent in 2023-24. India’s stunting came down from Vietnam’s level (52 percent in 1992) to only 29.3 percent (2024), whereas the Southeast Asian nation has taken it down to 20 percent.
How did Vietnam succeed? The answer lies in a combination of factors—rapid agricultural growth after land reforms; broad-based poverty reduction due to non-farm job creation; substantially high female literacy; strong primary healthcare coverage; extensive community nutrition programmes; near-universal immunisation and maternal-child health services; faster fertility decline than India; and finally, better targeting of disadvantaged regions, though ethnic-minority areas still lag the national averages.
The result is that, today, Vietnam has child nutrition outcomes close to those of upper-middle-income countries than to South Asia. This is one reason the country is frequently cited in development economics as an example of exceptionally rapid improvement accompanying structural transformation and poverty reduction.
Why is this relevant today? Vietnam and India are today competing to attract foreign capital—part of what is moving out of China. And the state of human capital matters for investors planning for the long term. So it’s not surprising that Vietnam has succeeded in attracting foreign investment far more convincingly than India has managed in recent years.
A critical national comparison
Bihar is one of India’s poorest states. In the early 1990s, it had the highest stunting prevalence in India (63.8 percent) and among the highest underweight prevalences (60-63 percent). NFHS-6 indicates that though the state’s child nutrition indicators have improved over NFHS-5, stunting remains around 42 percent and underweight around 40 percent—still among the highest in the country.
Bihar’s underweight prevalence is higher than the Indian average by roughly 8 percentage points, and the gap is even higher for stunting. It suggests that though India’s poorest state has made some progress, its nutrition transition has lagged the national average by roughly 15-20 years.
For almost 20 of the past 30 years, the current ruling coalition at the Centre has been in power in Bihar too. Its policies have favoured cash handouts over jobs or education and nutrition. And yet, it does not prevent the regime from claiming that it has pulled almost 25 crore Indians out of multi-dimensional poverty between 2013-14 and 2022-23. The disjunction between malnutrition or other human development figures in NFHS-6 and the poverty decline is too glaring to ignore. It asks serious questions about the quality of the multi-dimensional poverty count and its methodology.
Another area of concern is why a large number of crucial indicators, which were standard for national family health surveys, were dropped for NFHS-6. Sex ratio of the population at birth was dropped—a count that has been a global embarrassment for decades. The numbers representing two much-touted government schemes—for sanitation and clean cooking fuel—have also gone missing. Even under-5 mortality rate is missing. Most surprising is that seven indicators linked to anaemia, which have had seriously embarrassing outcomes, are also missing. India cannot claim to be a country high on human development if it is not measuring human development.
If Bharat is to become viksit, it will first need to score high on human development. Only then is it likely to become a high-income country.
(Views are personal)
Read all columns by Santosh Mehrotra
Santosh Mehrotra
Research Fellow, IZA Institute of Labour Economics, Luxembourg; Visiting Professor, HSE University, Moscow; and author most recently of India Out of Work