"Once upon a time Madhya Pradesh was included in the BIMARU states of the country, but today it is carving its identity as a developed state," the BJP's Madhya Pradesh unit quoted him as saying in Hindi.

Earlier in November, Chief Minister Shivraj Singh Chouhan, citing the state's economic growth rate of 19.76%, had reportedly said that in past times, Madhya Pradesh was considered BIMARU but since then it has progressed rapidly. While the growth rate mentioned by Chouhan is technically correct, it does not provide the true picture of economic growth in the state, FactChecker found.

Madhya Pradesh's Gross State Domestic Product (GSDP) was Rs 976,281 crore in 2020-21 and Rs 1,169,004 crore in 2021-22, per the Central Statistics Office, Ministry of Statistics and Programme Implementation. This amounts to a growth rate of 19.74%. These GSDP figures, however, are at current prices, which do not factor in the effects of inflation, according to the World Bank. Madhya Pradesh's GSDP at constant prices, which do account for inflation from the base year of 2011-12, was Rs 564,514 crore in 2020-21 and Rs 621,653 in 2021-22, amounting to a real growth rate of 10.12%.

Back to Gadkari and Chouhan's claims that Madhya Pradesh is now counted among developed states. Do they check out? Not according to Union government surveys and reports over the last two years, our context check shows. FactChecker referred to these official data sources to determine Madhya Pradesh's performance among large states with populations above 20 million, and against the national average, on key health and socio-economic indicators. The reports show that the state continues to lag behind national averages on many indicators, remains far behind more developed states, and remains in the bottom four states with the largest proportions of the multidimensionally poor.

What is the 'BIMARU' classification invoked by Gadkari and Chouhan? And is it still valid?

The acronym 'BIMARU' used by Gadkari and Chouhan is an amalgamation of the names of Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh, and is a play on the Hindi word 'bimar', meaning sick or unwell, according to a 2015 study by economist Vinita Sharma. The acronym was first coined by demographer Ashish Bose in the early 1980s to refer to this set of large states which at the time comprised 40% of the country's population and had poor records on demographic indicators related to the problem of overpopulation, including infant mortality, birth and death rates.

The acronym 'BIMARU', was more of an informal term, rather than an administrative category, which also came to synonymously denote this group of states that lagged behind in overall human development, Professor Himanshu Upadhyaya from the School of Development, Azim Premji University, told FactChecker, adding that it was considered a derogatory term.

Analysing the performance of these states on the same indicators used by Bose in the 1980s, Sharma had found in 2015 that, despite making progress over three decades, these states continued to be "bimaru as the gap between them and the national average persists in a majority of indicators."

The term 'BIMARU', however, has today lost its relevance, Dr Soham Bhaduri, chief editor of The Indian Practitioner health journal and health policy expert, pointed out. "The acronym 'BIMARU' has been around for long enough to outlive its significance, and most references to it today are rhetorical rather than technical or practical," said Bhaduri. Further, with three of the four 'BIMARU' states being bifurcated in 2000 (with Jharkhand carved from Bihar, Uttarakhand from Uttar Pradesh and Chhattisgarh from Madhya Pradesh), it cannot form a credible classification any longer, Bhaduri added.

Hence, neither Madhya Pradesh nor any other state is 'BIMARU'; yet politicians time and again invoke the term to claim that due to their political party's governance, a state that was once BIMARU no longer falls under the category. FactChecker has previously analysed one such claim in November 2021.

Madhya Pradesh still Classified Among States with Lagging Economic and Demographic Indicators

"Empowered Action Group (EAG) states is the newer, less pejorative classification used these days, which also includes those states which were formed by (the original BIMARU states) division," said Bhaduri.

The Union government in 2001 categorised Bihar, Jharkhand, Uttar Pradesh, Uttarakhand, Madhya Pradesh, Chhattisgarh, Odisha and Rajasthan as EAG states. These states altogether account for about 47% of India's population in 2022, and are more rural and socioeconomically disadvantaged, IndiaSpend reported in May 2022.

These states were also the poorest performing on multiple health indicators relating to reproductive, maternal, newborn and child health, according to a Canadian Centre for Global Public Health (CGPH) study from June 2020. The purpose of the EAG classification was primarily to have more intensive monitoring of socioeconomically disadvantaged states and districts through more frequent and additional data collection, per the CGPH study.

Besides being an EAG state, Madhya Pradesh is also among the 10 high focus states and Union territories (UTs) outside the North East under the National Rural Health Mission (NRHM), classified as such because of relatively higher fertility and mortality indicators. The challenge of strengthening poor public health systems and thereby improving key health indicators is the greatest in the NRHM high focus states, per the National Institute of Health and Family Welfare.

Madhya Pradesh Among Bottom Five States in Niti Aayog's Poverty Index

Madhya Pradesh is among India's five poorest states in terms of per capita income, Union government data show. The state is also among those with higher than average levels of deprivation, per the Multidimensional Poverty Index 2021 (MPI 2021), compiled by the Union government's policy think-tank Niti Aayog. MPI 2021 captured overlapping deprivations in health, education and living standards in each of India's states, UTs and districts. Among all states as well as among large states, Madhya Pradesh's percentage of population who were multidimensionally poor in 2021 was 36.7%, placing it in the bottom five among all states, as well as among the 18 large states which have populations above 20 million.

MPI 2021 was calculated based on 12 indicators related to health, education, and standard of living included in the National Family Health Survey-4 (NFHS-4), dating from 2015-16, per the Niti Aayog. The NFHS is a large-scale household health survey conducted under the aegis of the central Ministry of Health and Family Welfare. The Niti Aayog added that the baseline data for its poverty index would be updated once NFHS-5 was released.

NFHS-5 was subsequently released in two phases, with Madhya Pradesh included in the second phase states and UTs, for which data were gathered in April 2021. Madhya Pradesh's infant and child mortality rates remained among the highest in India per NFHS-5, IndiaSpend reported in November 2021. FactChecker analysed Madhya Pradesh's performance on six other NFHS-5 indicators, two each from the health, education and standard of living indicators listed by Niti Aayog. Here's what we found.

Madhya Pradesh Far Behind more Developed States on Key Health Indicators

For the dimension of health, we picked one indicator each related to child and maternal health. Niti Aayog considered a household to be deprived if any child under the age of 5 years was found to be undernourished. A household in which any woman who had given birth in the five years preceding the MPI survey, but had not received at least four antenatal care visits (by trained healthcare practitioners during pregnancy) for the most recent birth, was also considered deprived.

1. One in three children under the age of five (33%) in Madhya Pradesh are underweight (low weight for their age) in 2021. While this is close to the national average of 32.1 and a 10 percentage point improvement from 2015-16, the state ranked 14 out of the 18 large states. Madhya Pradesh has a long way to go to catch up with the non-EAG states of Kerala and Punjab, where fewer than 1 in 5 children are underweight.

2. The percentage of mothers who received at least 4 antenatal care visits in Madhya Pradesh in 2021 was 57.5%. Again, this is a big improvement from the state's performance of 35.7% in 2015-16, bringing Madhya Pradesh close to the national average of 58.1. The state's rank among large states, however, is 13 out of 18 and it continues to lag far behind the non-EAG states, where closer to 70% or more mothers received this level of care.

Only 2 of 5 men in Madhya Pradesh had 10 or more years of schooling

For the dimension of education, Niti Aayog considers a household to be deprived if not even one member of the household, aged above 10 years, has completed six years of schooling. As the probability of girls receiving primary education in India is about 42% lower than boys, according to the United Nations, we looked at how many adult men in Madhya Pradesh had 10 or more years of schooling, and how many females aged above 6 years had ever attended school.

1. Only 2 out of 5 men (39.9%) in Madhya Pradesh in 2021 had 10 or more years of schooling, with the state ranking a low 15 out of the 18 large states on this metric. The national average is 1 in 2 men; in Haryana it is 3 in every 5 men and in Kerala, nearly 4 in 5.

2. Two-thirds (67.5%) of females aged 6 years and above in Madhya Pradesh had ever attended school by 2021. While the state has not improved much on this metric since 2015-16 (64%), it performed better than the non-EAG states of Andhra Pradesh and Telangana, ranking 12 out of the 18 large states. However, it still lags behind the national average of 71.8% and far behind the two best performing states, Kerala (95.5%) and Tamil Nadu (80.4%).

Madhya Pradesh Ranks in Bottom 5 among Large States on Standard of Living Indicators

For standard of living, Niti Aayog considers households with no clean fuel source, i.e. who use cow dung, crop waste, shrubs, wood, charcoal or coal for cooking, to be deprived. It also counts households without an improved sanitation facility of their own, among the deprived.

1. In Madhya Pradesh, only 2 out of 5 households (40.1%) use clean fuel for cooking, compared to nearly 3 out of 5 countrywide. The state ranks in the bottom 5 out of the 18 large states on this indicator, and far behind all the non-EAG, more developed states, except West Bengal.

2. Despite doubling the share of households that use their own improved sanitation facility since 2015-16, every third household in Madhya Pradesh still lacks such a facility, with the state ranking a poor 15 out of the 18 large states.

Madhya Pradesh lags behind other EAG, high focus states Rajasthan and Chhattisgarh

Overall, despite showing improvement since NFHS-4, Madhya Pradesh remained in the lower half in the ranking of larger states for all 6 indicators that we examined. It fell behind the national average on all 6 indicators that FactChecker examined.

In contrast, the EAG states of Rajasthan and Chhattisgarh performed better than the national average on three out of these six indicators. These two states also rank higher than Madhya Pradesh on Niti Aayog's poverty index.

"At this stage, focus should shift to social indicators rather than harping on high growth rates. In this respect, while Madhya Pradesh has shown considerable improvement, there is little that proclaims its unequivocal exit from the lagging state category in terms of health," Bhaduri concluded.

FactChecker wrote to both Nitin Gadkari and Shivraj Chouhan for a better understanding of which indicators informed their assessment of Madhya Pradesh being counted among developed states. We have not received a response by the time of publishing this article. If and when we do, we shall update it here.