A report card for Karnataka: Rich state, poor indicators

Karnataka loses three times more babies than Kerala and 53-83% higher than Tamil Nadu

Karnataka is the largest state south of the Vindhyas, with one of the highest per capita incomes of all large states across India. At Rs 2.49 lakhs per capita, it is over 160 per cent higher than the national average of about Rs 1.51 lakhs. This allows the state to spend more per person while providing a better quality of life for its residents. Do the people of Karnataka indeed have better life outcomes? An examination of the recently released data from the Government of India reveals how Karnataka performs on key indicators of people’s well-being: health, education, and employment.

Health

One important indicator of public health is the sex ratio at birth. When untampered, the number of females and males that nature delivers is close to equal, with slightly more boys than girls; 105:100 is the natural human ratio, which translates to about 952 girls per 1000 males. It is important to note that a healthy sex ratio is an essential ingredient of social stability.

As seen, Karnataka’s sex ratio at birth is low, but what is alarming is that its urban sex ratio at birth is the lowest, not only in South India, but even far below the national average! This indicates rampant sex determination, leading to female foeticide or infanticide, unchecked by law enforcement in cities. Unlike in rural areas where education, awareness, cultural practices, etc., could contribute to lower sex ratios, urban areas have higher education and income levels, but startling numbers for unborn girl children point to poor state oversight.

DH illustration

Karnataka’s urban sex ratio at birth is the fourth worst in the country, despite the state being the third richest! Furthermore, it has fallen since 2018, while many states have improved.

Another set of key indicators of public health are the rates at which babies survive. The infant mortality rate is the number of infant deaths per thousand live births in a given year. It is a fundamental metric of public healthcare and, hence, good governance. Despite high per capita income, i.e., greater affordability, infant mortality is three times more than that of Kerala; 46 per cent more children die within a year in Karnataka than in Tamil Nadu.

Similarly, for every thousand live births, the neonatal mortality rate measures infant deaths within a month of birth, the early neonatal mortality rate measures infant deaths within a week of birth, and the under-five mortality rate measures the death of children before they reach their fifth birthday.

As with IMR, these reflect on the state of public health, including the general health of the father, the health of the mother during pregnancy, delivery, and prior, the quality of medical attention and emergency medical services available, accessible, and affordable throughout gestation and the early life of the baby, and the nutrition provided for the early sustenance of the child.

Here too, Karnataka loses three times more babies than Kerala and 53-83 per cent higher than Tamil Nadu.

Maternal Mortality Ratio (MMR) is the number of maternal deaths per 100,000 live births for a given time period. The target globally is to reduce MMR to under 70. Karnataka has just recently barely achieved the SDG goal of 70 (the actual score is 69), several years after Tamil Nadu and Kerala went way past it. This is ironic considering the state records the second highest out-of-pocket expenditure.

As per the National Family Health Survey-5 (NFHS-5), Karnataka has 97 per cent institutional deliveries with registered births, with two-thirds of these in public facilities. This implies that women, babies, infants, and toddlers are dying either due to a lack of quality healthcare or negligence by public institutions. Maternity is a fundamental public health issue, with catastrophic consequences for families and hence society, when deaths are high. Most of India’s neighbours are well below 70: China, Korea, Malaysia, Thailand, Sri Lanka, and many more.

The health of a society is the sum total of the health of its individuals; the health of individuals is determined by many public services delivered by the government, including access to food, water, sanitation, and nutrition; education and awareness; and medical and hospital infrastructure, personnel, and services.

Education

Recent data from the Ministry of Education, Government of India, sheds light on the 2021–22 gross enrolments in elementary, secondary, and high schools across states. The reason these metrics are particularly important is that they assess how effectively states keep children under 18 in schools and learning. The lesser the transition across classes, the more the drop outs and the more under-read young people are as they cross into adulthood. Without 18 years of education, which amounts to a base level of learning, it is difficult for youth to pursue gainful employment and realise their dreams, thereby impacting society’s well-being and stability.

The Gross Enrolment Ratio (GER) measures the proportion of children of a given age enrolled in a specific level of education. When numbers are higher than 100, it implies that children even beyond that age have been enrolled at that level. In Karnataka’s elementary schools, children beyond 6-14 years of age are enrolled, bringing the ratio to 107. After the eighth grade, 8 per cent drop out, leaving 95 per cent of 15-year-olds enrolled in the ninth grade.

So far, so good, but barely 60 per cent of its 15- and 16-year-olds enter the eleventh grade! In the state that is the hub of the knowledge industry in the country, over 40 per cent of children did not get even a full 12 years of basic education as of 2021–2022. Compare this with 81 per cent of Tamil Nadu’s and 85 per cent of Kerala’s teenagers transitioning to high school.

This leaves Karnataka woefully under-educated compared not only to states within the south, but its GER at higher secondary is below the all-India average of 58, making its future uncompetitive. It mostly outperforms the poorest states, including Uttar Pradesh (51), Madhya Pradesh (51), and embattled Jammu and Kashmir.

Things get even worse from there on! GER for Higher Education measures the percentage of school (twelfth standard or second PUC) graduates entering college. At 32 per cent overall, Karnataka is at the bottom among the south Indian states. At 23 per cent for SC students, it is not only at the bottom but worse than the national average.

These statistics are even more concerning when one considers that Karnataka has the third highest number of colleges in the country and the highest number of colleges per one lakh eligible population!

Employment

As far as labour force participation is considered, the male rates are comparable across South India, except for Kerala, while Karnataka imposes a gender penalty of 12–21 per cent compared to its neighbours.

In the final analysis, what is the implication of being born in Karnataka, compared to other states in the Deccan? For every 1000 children conceived in Karnataka, Kerala, and Tamil Nadu, what the data says, as can be seen in the table, is apart from Sex Ratio at Birth, drop out rates for boys and college enrolment rates are similar. This means the state is producing, at most, 19 per cent of youngsters with a college education.

With a significantly greater population to govern, a comparable per capita GSDP, and an equally poor sex ratio at birth, Tamil Nadu does a 2.3 times better job of getting minors, girls included, to sit through 12 years of schooling and a further college education.

All any government can do is enable a healthy public and a well-educated young populace so they can self-actualise. Why is the Karnataka government’s performance sub-par?

There are many factors affecting governance; a reductive approach is tempting but rarely helps with genuine reform. As per the Fifteenth Finance Commission, Karnataka receives only 33 paise for its own development, for every rupee sent to the Union kitty; so does Tamil Nadu. While both states and other southern states are penalised, Karnataka does have a health and education problem to fix.

Secondly, as per the budgets presented by the Government of Karnataka, allocations to health (5.8 per cent) and education (12.9 per cent) are lower than the Indian average across states (6 per cent and 15.2 per cent); this cannot improve human development.

In addition, since 2014, comprehensive assessments of real per capita income by the Union have been inadequate. What and how much each family spends is determined by their income. That in turn determines its health, education, and well-being. Families prioritise rice over vegetables and daals at the stress end of the economic spectrum, as does the public distribution system. This impacts the general health of the parents, babies, and mortality rates. As they get fiscally more flexible, they may spend more not only on food but also on private education, health, and consumer goods. The level of economic pressure influences college enrolment, and educational qualification leads to eligibility for the formal labour force rather than just the informal sector.

Niti Aayog’s State Hunger Index for 2021 gives Karnataka 53 points, colouring it Yellow, not Green. This compares to the national average at 47 points, well below Tamil Nadu at 66 and Kerala at 80. How does one reconcile high per capita incomes with the same hunger levels as in Rajasthan?

Using a state’s GDP divided by its population is theoretically, but not realistically, reflective of per capita income. With the richest people in a state earning tens, hundreds, or even a thousand crores per day—yes, you read that right—the simplistic formula for per capita income is unrealistic in a land of great inequities. Employment in certain sectors has salaries in very high brackets while others barely pay living wages; calculating per capita income as an average between two extremes is fraught with skew.

Instead, as in the pre-2014 era, consumption expenditure per household must be surveyed regularly and comprehensively and used to arrive at real incomes that can explain the levels of hunger, malnutrition, mortality, under-education, real affordability, and guide state priorities.

Finally, government priorities are the weightiest parameters that drive socio-economic outcomes. Government of Karnataka’s focus needs to be redirected towards Sustainable Development Goals, with budgets, staffing, and programmes aligned to deliver on them. No amount of strongman politics can save women from dying at delivery, children from anaemia, or young adults from dropping out; that takes assiduous, tedious, old-fashioned governance.

(The writer is the co-founder of Citizens for Bengaluru, a citizens’ movement for a sustainable Bengaluru.)