In reply to Louis's query about the LBO list's debate on Indian infant mortality, a comrade writes from India:
In the first place one should question the connection made between reduction in IMRs and a "dynamic capitalist economy". According to official data, Kerala has the lowest IMRs in India (10 per 1,000 live births) but has a stagnant economy with little industry and high unemployment. By contrast, Gujarat, considered one of the most "dynamic" states in India, attracting large investments over the last decade, has an IMR of 60. The reason appears to be Kerala's relatively high social expenditures on public health, education, and most of all universally available subsidised rations.
Indeed, India's infant mortality rate began to decline from the 1920s, under the British, despite per capita agricultural output actually falling. It is argued by some scholars that the overall improvement in India's health indices in this period was the result of measures by the British to control (politically embarrassing) famine deaths, even as endemic hunger remained or worsened. Post-transfer of power India has continued this policy. IMRs have continued to fall; but endemic hunger has persisted. A number of economists (Utsa Patnaik, M.H. Suryanarayana, Jaya Mehta, and others) have pointed out that nearly three-fourths of the rural population and half of the urban population are unable to obtain minimum calorie needs. Patnaik points out that half the rural population in India, or 350 million people, are below the average energy intake of sub-Saharan Africa. Nutritional outcomes bear this out: the National Family Health Survey and the National Nutrition Monitoring Board have concluded that roughly half of all children in India are malnourished, more than half of all women are anemic, and two-fifths of all adults suffer from chronic energy deficiency. An official committee on long-term grain policy documented the worsening consumption of the poor during the 1990s (the present round of economic `reform' was initiated in 1991). Improvement in IMRs, then, does not necessarily tell us of the quality of life of those who survive.
India's improvement in health indicators, of course, lags far behind that of China (most of the latter's improvement took place in the pre-1980 period, after which there has been a marked slowdown). But according to UNDP data, India also lags behind some of its other neighbours, barring Pakistan:
Infant mortality rate (per 1,000 live births):
1990 2002
China 38 31 India 80 67 Nepal 100 66 Pakistan 96 83 Sri Lanka 19 17 Bangladesh 96 51
-- UN Human Development Report 2004
Let us leave aside Sri Lanka, whose excellent indicators are the legacy of an earlier universal public distribution system. What of Bangladesh and Nepal: their IMRs have improved faster than, and are now lower than, India's. Are Bangladesh and Nepal thriving, dynamic economies?
Finally, there may be a problem with the Indian data. Infant mortality data is based on official registration of such deaths. A recent study by Dr Abhay Bang concludes that nearly 70 per cent of infant deaths in the state of Maharashtra go unrecorded. He has also recently headed an official committee to check the deaths of tribal children from malnutrition; the committee's tabulation of such deaths is more than double the official figure.
It is also puzzling that Bihar, one of the two poorest states in the country, and ranked at the bottom of all human development indicators, reports IMRs below the national average. ________________________________________________
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