SRINAGAR: Jammu and Kashmir's public health network is turning less than a third of its resources into better health for mothers and young children, a new peer-reviewed study has found. That leaves roughly 70% of achievable outcomes on the table.
The finding lands awkwardly against a year of official messaging that casts the Union Territory as a maternal-and-child-health "success story".
The study ‘Empirical evidences in healthcare efficiency in Jammu and Kashmir using two stage DEA’, by economists Khursheed Hussain Dar and Muteeba Showkat of the Central University of Kashmir, gives J&K's reproductive and child health (RCH) system an average efficiency score of 0.30 out of 1. Half of the UT's 20 districts score below that. Three of them - Budgam, Jammu and Samba - score under 0.10.
Budgam, a district bordering the capital Srinagar, is the worst performer in the UT. It scores just 0.03, meaning it gets about 3% of the output its best-performing peers achieve with similar health infrastructure. Srinagar itself, home to the region's flagship hospitals, ranks 17th of 20.
The study also highlights the gap between J&K's two divisions. Kashmir averages an efficiency score of 0.34; Jammu trails at 0.25, meaning it turns a quarter of its potential into results. Seven of the ten best-performing districts are in the Valley. At the bottom, the winter capital Jammu (0.06) and neighbouring Samba (0.07) rank 19th and 18th. That is despite Jammu district having the UT's highest female literacy, at 91.5%.
But Kashmir's edge comes with a price, and with hungrier children. Valley families pay about Rs 1,700 more per delivery in public facilities than families in Jammu. Kashmir also has higher rates of child wasting and underweight, and its C-section rate in public hospitals is half again as high as Jammu's. Jammu, meanwhile, lags on antenatal care. Neither division is doing well: both fall short of the national average on female literacy, and both are well below the efficiency frontier.
The study ties much of the gap to how districts were set up. Newer districts carved out around 2007 — Kulgam, Bandipora and Shopian in Kashmir, and Kishtwar and Reasi in Jammu — got fresh primary health centres under the National Rural Health Mission and score well.
Districts around the big hospitals in Srinagar and Jammu score poorly, because patients skip local clinics and head straight for tertiary care. The study itself describes Kashmir's lead as slight, and the confidence ranges for the two scores (0.27–0.40 and 0.20–0.30) overlap a little.
Behind the efficiency scores sits a hunger problem the headline mortality numbers don't show. Across J&K's districts, an average of 19.2% of children under five are wasted. They are too thin for their height, the form of malnutrition most closely tied to child deaths. Nearly 10% are severely wasted, and 21% are underweight.
Shopian is worst on every child measure: one in three children (32.8%) is wasted and 17.4% severely so. In Doda, the best district, the wasting rate is 9.5%.
The study draws these figures from the government's own National Family Health Survey (NFHS-5, 2019–21). That survey showed child nutrition in J&K getting worse, not better, with stunting stuck at 27%. An analysis found four J&K districts among those where wasting rose by more than 11 percentage points in five years.
The same was the case with anaemia. The Health Ministry's own NHSRC Health Dossier records anaemia among J&K women aged 15–49 rising from 48.9% to 65.9% between the two survey rounds. About three in four children aged 6–59 months (73%) are now anaemic.
Under the national Janani Shishu Suraksha Karyakram (JSSK), delivery in a government facility is supposed to cost a family nothing — drugs, tests, food, transport and C-sections included.
In J&K, families still pay an average of Rs 4,990 out of pocket per delivery in a public facility, the study finds. In Budgam the figure is Rs 9,853, nearly double the UT average. Families in the Kashmir division pay more (Rs 5,843) than those in Jammu (Rs 4,137).
Out-of-pocket cost is one of three factors the authors found significantly linked to how efficient a district's system is. The other two are female literacy and access to clean cooking fuel.
Other gaps in the numbers are lack of Iron and folic acid, antenatal care and C-sections. Only 14.3% of mothers took the supplements during pregnancy, despite a government mandate. In Rajouri it was 3.8%. As for antenatal care, 79.6% of mothers had the recommended four check-ups, but in Kathua only 31.6% did. 40.7% of births in public facilities were by caesarean, rising to 59.7% in Pulwama, far above the 10–15% range the WHO has long treated as the population-level norm.
Ground reporting backs up the cost finding. An India Development Review report from Ganderbal found rural families still paying for ambulances, medicines, food and lodging. One mother said an ambulance alone can cost Rs 1,500–2,000.
The study's picture is far more alarming than the one the administration has been putting out. In January 2026, officials of the National Health Mission (NHM) in J&K said the UT was scripting a quiet healthcare success story. They said it ranked among the better-performing states and UTs in the country.
According to official statements based on Sample Registration System (SRS) 2023 data, infant mortality is 14 per 1,000 live births and under-five mortality 15, against national averages of 25 and 29. Officials put full immunisation at 96.5% and maternal mortality at 47 per 100,000, against 88 nationally. A government statement described a "historic" transformation of the health sector.
But the two pictures measure different things. Low death rates show how many mothers and babies survive. They say little about how many children are going hungry, or how much more the system could deliver for the money and facilities it already has.
Several of the gains officials cite are also averages that hide wide district gaps. The study's central argument is that UT-level figures obscure where the system is failing.
The authors call for district-by-district fixes rather than UT-wide schemes. Their priorities are clean cooking fuel (63% of households use it, from 98% in Srinagar to 35% in Reasi), female literacy, and stronger financial protection so that "free" deliveries are actually free. They also argue Srinagar should shift resources from tertiary hospitals back to primary care.
Some caveats apply. The study relies on NFHS-5, collected in 2019–21. Officials' 2026 figures may reflect improvement since; NFHS-6 district data will be the real test. Infant and maternal mortality are not published at district level, so the authors built their index from malnutrition, women's BMI and blood-pressure indicators instead. Efficiency is measured against population served per health centre, not spending, staff or beds, which were not available consistently.
A contradiction is that Shopian is ranked the most efficient district despite having the worst child malnutrition.
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