Low wage rates, poorly functioning public schemes and patchy access to water and sanitation are the real explanation for Gujarat’s persistent malnutrition
Gujarat Chief Minister Narendra Modi’s remark in an interview to Wall Street Journal that high malnutrition persists in his State because Gujaratis are mostly vegetarian (implying vegetarianism causes malnourishment) and are middle class, and more conscious about their looks and putting on weight than their health, created a furore. What explains Gujarat’s paradox of hunger amid the seeming plenty?
Economic growth and malnutrition do not have a one-to-one relationship. However, if malnutrition persists even after high growth, there can be two sets of reasons: one, people are not aware about the importance of nutrition and/or there are cultural practices that do not allow people to consume nutritious food. For instance, they eat expensive but unhealthy food (Incidentally, there is no evidence to show that vegetarian food causes malnourishment). Two, economic growth does not create large-scale productive employment with decent work conditions i.e. with reasonable wage rate, good working conditions and social protection.
The first reason may have played a marginal role, but empirical evidence suggests that the second reason is important in Gujarat. To start with, in spite of a slightly higher workforce participation rate compared to other States, the quality of employment is extremely poor in Gujarat; with the result that a large part of the workforce does not have enough purchasing power to buy enough food for the household. About 89 per cent of men workers and 98 per cent of women workers in the State are informal workers (the all India figures are 90 and 96 per cent respectively), who usually earn low wages, have poor working conditions and low social protection.
The wage rates of casual and regular workers of both men and women workers in rural and urban areas are very low compared to other States. As per the latest National Sample Survey Office statistics, the daily wage rates of casual men and women workers in rural areas are lower than the corresponding rates in India, with the State ranking 14th (Rs.69) and ninth (Rs.56) in men’s and women’s wage rates respectively among the major 20 States. In the case of urban casual workers’ daily wages, the State ranked seventh (Rs.109) and 14th (Rs.56) for male and female wage rates. In the case of regular rural workers also the State ranked 17th (Rs.152) and ninth (Rs.108) in the male and female wage rates respectively. The corresponding ranks for urban areas are 18th (Rs.205) and 13th (Rs.182) respectively among the major 20 States in India.
In short, in spite of the high growth rate, wages in the State are repressed with the result that most workers do not have the purchasing power to buy adequate nutritious food.
There are problems with the functioning of major special schemes for nutrition. As regards the Public Distribution System (PDS), till recently the State was providing much less than the stipulated 35kg food grains to Below Poverty Line (BPL) households on the ground that the number of BPL households in the State was much larger than what the Centre had estimated and was providing for. The State was not willing to use its own funds to meet the deficit. Several studies including our own study have shown that PDS, Mid-Day Meal and Integrated Child Development Services (particularly for pregnant women and mothers) are not working well in the State. A common observation of these studies is that these schemes work well when there are local organisations putting pressure on local administration. The instructions from the top are not implemented well at the ground level, largely because there is no strong monitoring. And as only a fraction of the State is covered by such organisations, the schemes work well only in limited areas. In other words, the possibility of improved nutrition through these special schemes also is not good.
Water and sanitation
Finally, the recent data of the 2011 Census of Population has shown that Gujarat lags behind many States in providing potable water and safe sanitation, which are critical in transforming food intake into nutrition. The Census shows that about 43 per cent of rural households get water supply at their premises and only 16.7 per cent households, treated tap water. About one fifth of the rural households, mainly women, walk long distances to collect water — impacting adversely on their health. In the case of urban areas, the situation is slightly better: 84 per cent households get water at their premises and 69 per cent, treated water.
As regards sanitation, Gujarat has a long way to go. According the 2011 Census, 67 per cent of rural households do not have an access to toilets and more than 65 per cent households defecate in the open, polluting the environment. The State ranks 10th in the use of latrines. Our recent study adds that 70 per cent villages in the State have yet to organise waste collection and disposal, and 78 per cent have yet to put up drainage for managing liquid waste. In the case of urban areas, the State ranks ninth in terms of the use of latrines. As studies have shown, in spite of the efforts made, waste management is a serious problem in most urban centres.
As a result, the incidence of diseases is fairly high: our recent study shows that 44 per cent villages have reported frequent occurrence of jaundice; 30 per cent, malaria, 40 per cent, diarrhoea, and 25 per cent, kidney stones, skin diseases, joint pain, dental problems, etc. In the case of urban areas also there are frequent reports of outbreak of diseases.
In short, the growth process in the State has paid limited attention to the well-being of the masses. It is not surprising therefore that National Family Health Survey 3 has shown that Gujarat not only ranks low in nutrition of women and children but has also performed very poorly in the recent decade. There is a need for the State to take a fresh look at its growth process.
(Dr. Indira Hirway is Director and Professor of Economics at the Center for Development Alternatives, Ahmedabad, and co-author of the State Human Development Report 2004.)