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The rising cost of healthcare can have a range of possible effects on the poor. These include
cutbacks on other consumption like food, which directly impacts on nutrition and health status;
growing untreated illness; and growing gender biases in health seeking behaviour 4 .
Collating available evidence from national sample surveys, D B Gupta notes, ‘Despite nationwide
programmes (for e.g., the ICDS and RCH) for nutritional supplementation for pregnant women
and children, available indicators present a depressing picture. NFHS-2 (1998-99) data shows
36.8 per cent of women with BMI (34) of 1805 kg/m2 or less, indicative of chronic energy
deficiency (CED). Anaemia in women varies from 41.9 per cent in high-income groups to 60.2
per cent in low-income families. 47 percent of under-3 children are underweight and 18 per cent
are severely underweight. There has only been a marginal improvement since NFHS-1 (1992-93)
(from 52% in NFHS-1 to 47% in NFHS-2)’. The situation of women and children in the last
poverty quartile of the population is alarming – leading to an inter-generational spiral of poor
nutrition and poor health.
Table 3: Proportion of underweight mothers by social group & location, NFHS-2
SC ST OBC General Missing Total
Per cent underweight mothers
45.44 42.09
Rural
35.47 30.39 46.45
Urban
35.68
40.54 22.21
Lowest quintile 47.23 38.72
Highest quintile 28.37 8.57
Source: L Bhandari: Empirical Analysis of Integrated Child Development, 2003
Table 4: Sex ratios, 1991 and 2001
State All ages 1991 All ages 2001 Age (0-6) 1991 Age (0-6) 2001
All India 927 933 945 927
Andhra Pradesh 972 978 975 964
Karnataka 960 964 960 949
Uttar Pradesh 876 898 927 916
Source: Census of India 2001; Paper 1 of 2001 – Provisional Population Totals
by the poor and women; (iii) separation of users into two categories of those who pay and those who don’t
leads to significant quality differentials, and also reduces the political support for free or subsidised
services.
4 Until the mid-1980s, public hospitals were still the dominant providers of in-patient care especially for the
poor, even though patients were increasingly resorting to the private sector for outpatient services.
Although this varied considerably across states, public hospitals provided an important alternative to the
private sector and at significantly lower cost. By the mid-1990s, there is clear evidence that the private
sector had become dominant in terms of both outpatient and in-patient services (Gita Sen et al, 2002).
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