Abstract
India’s Pradhan Mantri Ujjwala Yojana (PMUY), launched in 2016, provides below-poverty-line (BPL) households with free liquefied petroleum gas (LPG) connections. During the same period, national and state governments implemented multiple additional programs targeting BPL households, yet the health implications of these policies remain understudied. We used data from India’s National Family Health Surveys (NFHS-4, 2015-2016; NFHS-5, 2019-2021) to examine area-level associations between changes in non-clean fuel use (solid fuels and kerosene), reflecting shifts associated with clean energy policies, and child health outcomes nationwide. We applied a precision-weighted approach that incorporates survey design and sampling variability to estimate district-level prevalence of child health outcomes and socioeconomic indicators across survey periods. In parallel, we implemented a difference-in-differences (DiD) design with a non-equivalent comparison group to compare outcomes among BPL households that reported LPG as their primary cooking fuel with those that did not. A 10-percentage-point higher prevalence of non-clean fuel use was associated with a 0.70 percentage-point higher prevalence of stunting (95% CI: 0.22, 1.18), while estimates for other outcomes were generally small and imprecise. DiD estimates were similarly centered near the null across all child health outcomes. Because NFHS-5 was conducted during the COVID-19 pandemic, a period marked by disruptions to health services, household economic conditions, and energy use patterns, these factors may have attenuated observed associations. This analytic framework can be applied to future NFHS rounds to assess whether longer-term or post-pandemic trends reveal clearer relationships between clean energy transitions and child health.