While India’s economic transformation and growth have received much attention in recent years, what is less well-known is the great progress made on many social fronts, with declining fertility rates, expanded schooling, and efforts to bridge the gender gap in schooling, especially at primary and lower-secondary levels.
But there are two areas of human development in which India has not fared particularly well: child malnutrition and the population’s gender balance.
Child malnutrition rates in India are extraordinarily high — among the highest in the world — with nearly one-half of children under the age of three being either underweight or stunted. Further, the incidence of child malnutrition has remained stubbornly high even after nearly two decades of post-reform growth and prosperity.
Child malnutrition in India seems to bear little correlation with a family’s income, with research suggesting that a quarter of children whose mother possesses 10 or more years of schooling — and an equivalent proportion of children from the top income quintile — are also underweight. These children are very unlikely to face food insecurity. Even in a relatively prosperous and dynamic state like Gujarat, child malnutrition rates have remained static over the past decade.
Still more surprising is the persistence of child malnutrition rates in the face of declining infant and child mortality. This disparity is difficult to understand, as most factors associated with low rates of infant and child mortality (like safe deliveries and the utilisation of high-quality health services, high female literacy, and good environmental hygiene) typically also improve child nutrition.
This phenomenon, which is true more generally of the entire South Asian region, has been referred to as the ‘Asian enigma’. Commentators point to the fact that child malnutrition is much higher in South Asia than in sub-Saharan Africa, even though infant and child mortality is lower in South Asia. The Asian enigma throws up many interesting questions: is it culture and dietary habits (India has extensive vegetarianism) that account for high child malnutrition in South Asia? Is it the poor nutritional status of mothers and their low weight gain during pregnancy that leads to babies with low birth-weights who then become malnourished children?
The high rate of child malnutrition does not bode well for India’s future. There is compelling evidence from around the world that early-life malnutrition has significant adverse impacts on cognitive development, human capital formation and labour-market productivity in adulthood.
India’s gender balance is the second human development indicator that raises concern. Robust economic growth in recent decades has been associated with a significant deterioration in the population’s gender balance — and India is quite rare in having more males than females. The problem is particularly severe among the young population: the child sex ratio has declined from 964 females per 1000 males in 1971 to 927 per 1000 in 2001. India, like China and some other East Asian countries, has one of the lowest sex ratios at birth in the world.
While for biological reasons many countries around the world have a small imbalance in their juvenile sex ratios, India’s imbalance is acute, and is most likely the reflection of three major behavioural factors: prenatal sex-selection by parents (with parents choosing to abort female foetuses based on prenatal ultrasounds), excess female infant and child mortality due to parental neglect, and differential contraceptive use depending upon the existing sex composition of children (including the use of contraceptives only after a son has been born).
Much of the literature on Indian sex ratios has focused on a north–south dichotomy, arguing that the country’s northern and western regions not only have more rigid norms of female seclusion — particularly related to participation in economic activities outside the home — but also have marriage customs, such as large dowry payments, that make female children economic burdens. In contrast, women in the south and the east enjoy greater autonomy and higher social status within the family.
These cultural differences manifest themselves in the form of lower sex ratios at birth in the northern and western states than in the southern and eastern states. The data is broadly consistent with these predicted patterns, but the picture is more nuanced. For instance, the phenomenon of low juvenile sex ratios has become more pervasive over time, and has spread to states in the south and east. States which had more balanced sex ratios — Orissa, Gujarat, Maharashtra and even Tamil Nadu — than the northern states have recently seen large declines in their juvenile sex ratios. In fact, every major state in the country, other than Kerala, saw its juvenile sex ratio decline between 1991 and 2001.
India’s low and declining sex ratio at birth is a matter of grave policy concern, not only because it violates the human rights of unborn and infant girls but also because it deprives India of the potential economic and social contribution that these ‘missing women’ could have otherwise made. Some estimates put the number of India’s ‘missing females’ — the number of unborn or prematurely dead girls — as high as 50 million. It is almost impossible to place a value the economic output foregone by the loss of these women, but it is likely to be very large. Although women still earn less than men in labour markets, there is increasing evidence that the pecuniary returns of female schooling are in fact greater than those of male schooling.
One unusual empirical finding from India is that improved literacy and schooling among women are associated with a worsening of the sex ratio at birth, possibly because educated women tend to have fewer children than less-educated women and, in the context of a strong son-preference culture, the lower levels of fertility lead to greater pressure on couples to have boys instead of girls. Likewise, micro-level data suggest that urbanisation and a greater availability of quality health services in rural areas are also associated with India’s deteriorating sex ratio at birth. Thus many of the factors associated with economic and social progress actually seem to have perverse effects on gender balance.
How effective are laws against pre-natal sex diagnosis and selection? While the Indian government passed the Pre-Conception and Pre-Natal Diagnostics Techniques (PNDT) (Prohibition of Sex Selection) Act in 1994, the popular press does not seem to believe it has been particularly effective, as the government has not enforced the law strongly. But some research suggests the legislation was indeed successful in reducing what might have been an even greater increase in gender imbalance, arguing that in the possible absence of the PNDT Act, India’s child sex ratio would have declined by another 13–20 points.
Both the persistence of child malnutrition in India and the country’s deteriorating gender balance highlight the importance of culture in development. They reflect the fact that not all social indicators necessarily move in unison with economic indicators. Indeed, because of cultural and contextual factors, economic and social ‘progress’, like the expansion of female literacy and education, could even promote socially undesirable behaviour and outcomes.
Anil B. Deolalikar is Professor of Economics at the University of California, Riverside
This article appeared in the most recent edition of the East Asia Forum Quarterly, ‘Ideas from India’.
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