Children line up for food at a relief camp near a fishermen’s colony after a disaster in Tamil Nadu, India. (Photographer: Amit Bhargava/Bloomberg News)

New Method Reveals India’s Malnutrition By Parliamentary Constituency

A new technique can measure malnutrition by parliamentary constituency in India, which has the world’s largest number of malnourished children, according to a new study.

The analysis shows 72 of 543 parliamentary constituencies in the top two quintiles (20 percent) of prevalence of child malnutrition indicators: stunting, low weight for age, wasting and anaemia. Of these, 12 constituencies are in Jharkhand, 19 in Madhya Pradesh, 10 in Karnataka, eight in Uttar Pradesh and six in Rajasthan.

Many Indian parliamentary constituencies experience multiple forms of malnutrition, which should be addressed “on priority”, says the study, published January 2019 in the journal Economic and Political Weekly.

Currently, since the boundaries of Lok Sabha constituencies and districts do not overlap, constituencies’ performance cannot be measured because malnutrition data are measured by district.

Malnutrition retards learning, employability and economic growth. Yet, in a country with 46.6 million stunted children--about one third of the world’s burden, which will make India lose up to $46 billion by 2030--malnutrition has almost never been an electoral issue.

“We wanted to initiate a discussion around the importance of collecting data at the political constituency level and the value of making political constituency identifiers available in routinely collected surveys and the Census,” said SV Subramanian, a co-author and professor of population health and geography, Harvard University, in an email interview. “What better way to make research outcomes more relevant to policymakers than by measuring indicators in areas where policymakers are directly responsible?”

The national means for stunted (low height for age), underweight (with low weight for age), wasted (low weight for height) and anaemic (low haemoglobin) children are 35.9 percent, 33.5 percent, 20.7 percent and 56.8 percent, respectively, meaning almost a third of children under five are stunted and underweight, a fifth are wasted and more than half are anaemic.

Across parliamentary constituencies nationwide, the proportion of stunted children under five ranged from 15 percent to 63.6 percent; of underweight children from 11.1 percent to 60.9 percent; of wasted children from 5.9 percent to 39.6 percent; and of anaemic children from 17.8 percent to 83.6 percent.

Multiple forms of malnutrition were observed especially in Jharkhand and Madhya Pradesh, India’s sixth- and fifth-poorest states by per capita income, and should be addressed with the “highest priority”, said the authors, who developed new methods to calculate malnutrition data--available only by district--by parliamentary constituency, which do not overlay on district boundaries.

How Are High-Profile Constituencies Doing?

Prime Minister Narendra Modi’s constituency of Varanasi in Uttar Pradesh fares worse on malnutrition indicators than the constituencies of eight cabinet colleagues. For children under five, Varanasi has a stunting prevalence of 43.1 percent, higher than national average of 35.9 percent and ranking 124 from the bottom.

While these indicators do not directly reflect the performance of members of parliament (MPs) elected in 2014, since they are based on the latest national family health survey--which was conducted in 2015-16, and nutrition indicators take years to change--they do reveal the nutrition status of the constituency.

Modi was elected from Varanasi for the first time in 2014, but the constituency has been with his Bharatiya Janata Party since 2009. A majority of Modi’s eight cabinet ministers from the Lok Sabha have constituencies in North India, especially in Uttar Pradesh, Madhya Pradesh and Rajasthan.

Among other parties, Karnataka’s Gulbarga constituency of the leader of the opposition in the Lok Sabha, the Congress party’s Mallikarjun Kharge, fared the worst among 18 high-profile constituencies--analysed by IndiaSpend based on the Harvard paper--with 49.7 percent prevalence--one in every two children being stunted.

INC president Rahul Gandhi’s Amethi constituency in Uttar Pradesh and his Congress party colleague Jyotiraditya Scindia’s Guna in Madhya Pradesh ranked second and third from the bottom by stunting, after Gulbarga among those we compared.

Kharge has been elected from the same seat since 2009, Gandhi since 2004 and Scindia since 2002.

Thiruvananthapuram (18.5 percent) in Kerala, the Lok Sabha constituency of the Congress party’s Shashi Tharoor, and Telangana’s Hyderabad (20.6 percent) constituency of All India Majlis-E-Ittehadul Muslimeen’s Asaduddin Owaisi, are the best performers by stunting among 18 high-profile constituencies we compared. Tharoor has been elected from Thiruvananthapuram since 2009 and Owaisi from Hyderabad since 2004.

Best And Worst Constituencies By Malnutrition

IndiaSpend used the findings of Harvard study and added data on members of parliament for each constituency, and visualised them on maps below.

Stunting: Parliamentary constituencies in central and northern India--especially Uttar Pradesh, Bihar, Madhya Pradesh and Jharkhand, together home to about 400 million or 31 percent of Indians--have the highest proportion of stunted children under five years.

Constituencies with the highest proportion of stunted children are all in Uttar Pradesh: Bahraich (63.6 percent) of Sadhvi Savitri Bai Phule who quit the BJP to join the Congress in March 2019, Shrawasti (61.3 percent) of BJP’s Daddan Mishra, and Kaisarganj (59.7 percent) of BJP’s Brijbhushan Sharan Singh.

Parliamentary constituencies in Punjab, Himachal Pradesh, Telangana, Tamil Nadu and Kerala have the lowest burden of stunting, with the lowest all in Kerala: Kollam (15 percent) of the Revolutionary Socialist Party’s NK Premachandran, and Alappuzha and Mavelikkara (15.4 percent) of the INC’s KC Venugopal and Suresh Kodikunnil, respectively.

Underweight: Prevalence of low-weight-for-age follows the same trend as stunting. Parliamentary constituencies with the highest proportion of underweight children are Singhbhum in Jharkhand (60.9 percent) of the BJP’s Laxman Giluwa, Purulia in West Bengal (54.1 percent) of the All India Trinamool Congress’ Mriganka Mahato, and Budaun in Uttar Pradesh (52.7 percent) of the Samajwadi Party’s Dharmendra Yadav.

Punjab, Himachal Pradesh, Uttarakhand, Telangana, Tamil Nadu, Kerala, Sikkim, Assam, Arunachal Pradesh, Nagaland, Manipur, Mizoram and Tripura have the lowest proportion of underweight children.

The political constituencies of Anantnag in Jammu and Kashmir (11.1 percent) of former chief minister and Peoples Democratic Party president Mehbooba Mufti, Kottayam (12.3 percent) of Kerala Congress’ Jose K Mani (who has since been nominated to the upper house), and Inner Manipur (12.5 percent) of INC’s Thokchom Meinya have the lowest proportion of underweight children.

Wasting: Prevalence of wasting is highest in central and western India, particularly in Madhya Pradesh, Gujarat, Maharashtra, Chhattisgarh and Jharkhand. Constituencies with the highest proportion of wasted children are Jamshedpur in Jharkhand (39.6 percent) of the BJP’s Bidyut Baran Mahato, Garhchiroli-Chimur (39 percent) of the BJP’s Ashok Mahadeorao Nete, and Khunti in Jharkhand (36.7 percent) of the BJP’s Khariya Munda.

Himachal Pradesh, Punjab, Andhra Pradesh, Sikkim, West Bengal, Assam, Arunachal Pradesh, Nagaland, Manipur, Mizoram and Tripura have the lowest proportion of wasted children, while Inner Manipur (5.9 percent) of INC’s Thokchom Meinya, Outer Manipur (6.8 percent) of INC’s Thangso Baite, and Mizoram (7.3 percent) of INC’s C L Raula have the lowest prevalence of wasting.

Anaemia: Madhya Pradesh, southern Rajasthan, Haryana and Gujarat have the highest proportion of anaemic children. Constituencies with the greatest proportion of anaemic children are Singhbhum in Jharkhand (82.7 percent) of the BJP’s Laxman Giluwa, Banswara in Rajasthan (80.3 percent) of the BJP’s Manshankar Ninama, and Khargone in Madhya Pradesh (80.1 percent) of the BJP’s Subhash Patel.

Tamil Nadu, Kerala, Maharashtra, Punjab, Chhattisgarh, Sikkim, West Bengal, Assam, Arunachal Pradesh, Nagaland, Manipur, Mizoram and Tripura have the lowest prevalence of anaemia. Kollam (17.8 percent) of Revolutionary Socialist Party’s NK Premachandran, Nagaland (20 percent) of National Democratic Progressive Party’s Tokheho Yepthomi, and Odisha’s Bhubaneswar (20 percent) of Biju Janata Dal’s Prasanna Kumar Patasani have the lowest prevalence.

Why Measuring Malnutrition By Constituency Matters

In 1993, the government began the member of parliament local area development scheme (MPLADS), which gives each member of parliament Rs 5 crore for development projects in their parliamentary constituency. Over 26 years to 2016, MPs have received Rs 31,833 crore in all.

Among the uses for MPLADs money for health purposes have been purchase of equipment for local hospitals, ambulances, hearses, outdoor gyms, etc. as per the Harvard paper.

Measuring malnutrition data by constituency could not only help MPs make informed choices but provide more information to voters, which would decrease the likelihood that the funds would be used for political considerations, the authors said.

“We hope that voters, advocates, and fellow policy makers will use this data to hold MPs accountable for the health of their constituents,” said Subramanian, on behalf of seven co-authors. “Our methodology provides a framework for replicating our study for infinitely many population indicators, for instance wealth, literacy, crime, life expectancy, etc.”

Malnutrition Data And Political Accountability

As the Harvard researchers did with malnutrition data, future studies could similarly analyse the relationship between parliamentary constituencies and population indicators, voting behaviour, approval ratings, duration of tenure, political dynasties and other performance indicators, the authors said.

“Political constituency-wise data has great potential for research,” said Rahul Verma, fellow at the New Delhi think-tank Centre for Policy Research. “For example it will allow us to study the relationship between electoral patterns and development indicators, whether voter turnout rates are related to the infrastructure development of the constituencies, etc.”

Whether this information could improve political accountability or increase voter awareness is unclear, said Verma, who was not associated with the Harvard study. “However, this kind of research is welcome and even though the results or methodology may not be perfect it is worthwhile to analyse this data,” he said.

Data by political constituency on development indicators can improve accountability, but it is better if these data consider the performance of development programmes than an indicator such as child growth, which takes time to change, said Purnima Menon, senior research fellow with the International Food and Policy Research Institute, a research advocacy.

“For example, how health and ICDS [Integrated Child Development Services] services, school enrolment and quality of services work in their constituency, these are more actionable in the time frames that MPs and MLAs are in power and they likely have more instruments available to change some of these,” said Menon.

With inputs from Neha Abraham.

(Yadavar is a principal correspondent and Madhavapeddi is news editor at IndiaSpend.)

This copy was published in a special arrangement with IndiaSpend.