‘Anaemia mukt’ to ‘data mukt’, how health survey NFHS-6 hides the truth

That glitzy campaign has now all but faded into silence.

Eight years on, India may be far from free of the disease that affects a patient’s red blood cells and haemoglobin concentration. What the country achieved on May 29, however, is nothing short of extraordinary; just not for the right reasons. For the first time in over three decades, the National Family Health Survey (NFHS) fact sheet, released on Friday, omitted the entire section on anaemia prevalence in the country.

As such, while Bharat hasn’t become Anaemia Mukt, the nationwide statistics that the Centre and nearly every government, quasi-government and private organisation relies upon to analyse India’s public health scenario and offer policy prescriptions have been made Anaemia Data Mukt.

The severely ‘anaemic’ NFHS-6 fact sheet for the year 2023-2024 comes nearly five years after the NFHS-5 fact sheet for 2019-2021 left the Modi regime deeply embarrassed by exposing the vast schism between the Prime Minister’s lofty promises and actual delivery on what the Centre, in 2018, had described as “India’s fight against anaemia”.

Also read: NFHS-6 reveals contraceptives concern despite women's broad progress in other fields

The total number of indicators in NFHS-6 has been pruned down to 101 as against the more exhaustive list of 131 indicators measured under NFHS-5. Besides indicators for anaemia prevalence, the latest NFHS fact sheet has eliminated the entire section mentioned in the 2019-2021 report on infant and child mortality rates, cancer screening and HIV awareness.

The NFHS-6 fact sheet also carefully omits another indicator, which had left the Centre red-faced last time around.

The NFHS-5 fact sheet had exposed the falsehood in Modi’s claims about the roaring success of his government’s Ujjwala scheme for providing clean cooking fuel to all households. The data from 2019 to 2021 had showed that only 58.6 per cent households used clean fuel for cooking, which albeit was significantly higher from the 43.8 per cent households as mentioned in NFHS-4 (2015-2016) but was also far lower than the ruling BJP’s rhetoric about providing “every household” with LPG gas supply.

The bigger setback for the government on this score was the NFHS-6 revelation that meagre 43.2 per cent rural households had access to clean cooking fuel; a figure the BJP had everyone believing until then to be much higher given the Centre’s claims about the success of the Ujjwala Yojana.

Likewise, the revelation in NFHS-5 that about only 70.2 per cent households had “improved sanitation facilities” had exposed chinks in the Centre’s claims about the country taking great strides towards becoming “open defecation free” since the launch of Modi’s Swachh Bharat Mission.

This indicator too has conveniently gone missing from the NFHS-6 fact sheet.

The release of the NFHS-5 report had triggered a wave of criticism for the Centre from the Opposition as well as various economists, public health experts and policy analysts. In July 2023, when the Centre suddenly placed KS James, director of the International Institute for Population Sciences (IIPS), which conducts the survey, under suspension, there were speculations that the action was essentially a punishment not just for allowing unflattering data to be published but also for subsequently refusing to ‘revise’ it.

James resigned as IIPS chief the following month.

The NFHS-5 data, particularly on anaemia prevalence, which clearly was touching proportions of a pandemic (see Charts 1 and 2), continues to haunt the Centre today as much as it did back in 2021.

When the 2019-2021 figures were revealed, Congress leader Renuka Chowdhury, a former Union minister for Women and Child Development who has often spoken in Parliament on the need for treating anaemia as a “national emergency” had told this reporter, “the government’s lies on tackling anaemia have been thoroughly exposed by its own data; the Prime Minister’s own state of Gujarat, where he ruled for 12 years, is among the worst affected states... the data shows the filthy reality of his Gujarat Model that he now wants to replicate pan-India.”

The gulf between Modi’s promise of sharply reducing in anaemia prevalence through his 6X6X6 strategy and the reality of the blood disorder’s steeply rising rates was exposed once again a year ago.

The World Health Assembly, the highest decision-making body of the World Health Organisation, had decided on a 2025 target for reducing anaemia prevalence in women aged 15 to 49 years (the disease is more prevalent in children and women than in men) across the globe by 50 per cent compared to the 2012 baseline year figures.

This deadline has now been extended to 2030 with the WHO commenting that India’s “high anaemia prevalence is a major concern” and calling on New Delhi to initiate “bold and urgent action”.

Over five years later, during the last budget session of Parliament, sundry MPs, including several from the ruling BJP, raised queries during Question Hour in both Houses of Parliament on at least a dozen occasions about the AMB’s progress and whether the annual three per cent reduction target would be met.

Despite multiple MPs asking how the Prime Minister’s target of annually reducing anaemia prevalence by three per cent would be met given the figures revealed in NFHS-5, Union minister of state for health, Anupriya Patel, who parried most of these questions, offered no explanations in Parliament. Yet, despite all the obfuscation, Patel couldn’t help hide the spiralling prevalence of sickle cell disease, a congenital variant of anaemia highly prevalent among tribal populations, which, in the absence of early diagnosis and proper treatment can prove fatal especially for children aged below five years.

On February 13, Patel informed the Lok Sabha that as on February 3, of the 6.83 crore people screened across tribal dominated areas in 17 states for sickle cell anaemia, over 2.37 lakh had been “identified as diseased” while over 19.32 lakh were identified as “carriers”.

The Federal’s repeated attempts to get an explanation from Patel and Dr Dewaram A Nagdeve, the current director of IIPS, for purging the NFHS-6 fact sheet of indicators linked to anaemia, infant and child mortality rates, cancer screening and HIV awareness received no response.

The response of the government, arguably, could be found in an op-ed column that economist Shamika Ravi, member of the Prime Minister’s Economic Advisory Council, had written for The Indian Express back in 2023, when the Centre was still trying to cover up the embarrassment caused by the NFHS-5 data. In a response high on all the hallmarks the Modi regime adopts when faced with uncomfortable home truths, Ravi had dissed the data put out by various bodies, including the final NFHS-5 report by the IIPS.

Calling for a “major sampling overhaul” of data quality to “reflect the true status of India’s real economy”, Ravi had claimed that not just the NFHS but also the Periodic Labour Force Survey (PLFS) and the National Sample Survey (NSS) use “outdated sampling frames” and are “not representative”. She then went on to assert, “these surveys grossly and systematically underestimate India’s progress and development and the misleading estimates from these surveys impede policy-making”.

Whether the NFHS-6 fact sheet represents data collected through a methodology that follows Ravi’s prescription for a “major sampling overhaul” is hard to say considering that the Centre has offered no explanation yet for purging various crucial indicators from the latest data compared to the NFHS-5 report. The complete omission of entire categories of data, such as anaemia prevalence and cancer screening, however, only raises suspicions about the government having something to hide.

“For the last 12 years, the Opposition has been flagging how this government covers up its failures either by fudging data or simply suppressing it when things are so bad that mere fudging won’t help. This is why we say this NDA government is a ‘No Data Available’ government... The NFHS-5 data, was an exception, and everyone knows what happened to the IIPS Director (KS James) under whose supervision that report was prepared. By not disclosing important indicators which have always been part of NFHS reports, the government is doing grave injustice to the country because these statistics are important not just for the government’s own policy-making but for the society and public-spirited organisations too,” says Congress spokesperson and former Lok Sabha MP Dr. Ajoy Kumar.

Veteran journalist Mahendra Pandey, who has reported on India’s public health apparatus for over three decades, also has an intriguing theory to explain why the Modi government may have “suppressed” certain indicators in the latest NFHS report.

“If you look at NFHS-5 and compare it with the previous two surveys – NFHS-4 for 2015-2016 and NFHS-3 for 2005-2006 – you will see on many parameters the country slipped during the Modi years after somewhat stabilising during the UPA government. The NFHS-3 was for the 2005-2006 period, which was when the UPA government was just two years old. So, indicators then were largely what it would have received as legacy from Atal Behari Vajpayee’s NDA government and if you go through those figures, India was in a bad shape on most indicators," Pandey said.

Similarly, the NFHS-4 came in the second year of the Modi regime and it showed a huge improvement on many markers but those improvements were possible because the UPA was in power for the preceding decade. Even at a state level, if you see data from 2015-2016 and then 2019-2021, you will realise the bulk of worst performing states on anaemia and several other indicators are all those where BJP has been in power for prolonged periods, or at least since 2014-2015; be it Gujarat, Bihar, MP, Chhattisgarh or Assam,” added Pandey.

“After just five years of Modi’s government, the NFHS-5 fact sheet showed India going backwards on several public health indicators, anaemia being the most prominent one. A major cause of anaemia is poor nutrition. If 67 percent of India’s children aged below five years and 57 percent of women aged below 50 years are anaemic despite Modi distributing free rations to 80 crore people, it doesn’t just expose very deep flaws in the system but reveals how much this government is lying. Maybe, what they found in NFHS-6 was a picture worse than even NFHS-5 and decided to completely omit those indicators, which presented an unflattering image,” Pandey concluded.