Health survey: Healthier India, but many miles to go

A key health indicator that has worsened is the incidence of anaemia in under-5 children (from 58.6 to 67%), women (53.1 to 57%) and men (22.7 to 25%).

M. A. Siraj

The National Family Health Surveys (NFHS) being conducted since 1992 summarises the health status of people in India. So far five such surveys have been conducted. The NFHS-1 was conducted during 1992-93. It was followed by the NFHS-2 during 1998-99. The third report came in 2004-04 and the fourth came in 2015-16.

The results of the NFHS-5 (2020-21) were released by the International Institute for Population Sciences on November 22. These findings are based on a representative sample of population and therefore cannot be compared to the census which takes into reckoning the entire population. The NHFS-5 covered 6.1 lakh sample households (HHs) from 707 districts. These HHs included 724,115 women and 101,839 men and provided disaggregated estimates up to district levels.

Fertility Decline

Stabilisation of population growth should be read as the most significant finding of the NFHS-5. According to the figures, Total Fertility Rate (TFR) i.e., the average number of children born to a woman in the 15-49 age group, has declined to 2.0 at the national level. The population stabilises at 2.1, which is termed replacement level. This suggests that the TFR has already dipped below the replacement level and the population is headed for a decline in years ahead. The only states where TFR is more than 2.1 are Bihar, Uttar Pradesh, Rajasthan, Meghalaya, Manipur, Jharkhand. Bihar’s case is exceptional as the state’s TFR stands at 3.

Yet another figure that must bring cheer is the demographic shift in terms of gender ratio. The survey points out that the surveyed HHs had 1,020 women for each 1,000 men. NHFS-4 had counted 991 women for every 1,000 men. However, this being only a representative survey, one still has to wait for the Census 2021 figures which carry the official stamp of authenticity.

Institutional Births

Institutional birth is another area where steady progress can be seen, from 78.9% in the NHFS-4 to 88.6% now. Tamil Nadu and Puducherry have recorded 100% institutional deliveries. Furthermore, institutional births in public facilities have grown from 52.1% to nearly 62%. However, growth in births by caesarean section points to growing commercialisation of health services, especially in private hospitals. Births by caesarean section overall went up from 17.2% to 21.5%. But figures were more appalling with relation to private health facilities where it rose from 40.9% to 47.4% between the two surveys.

Women Empowerment

The percentage of women with 10 or more years of schooling rose from 35.7% to 41%. The figures pertaining to men in this context went up to 50.2% from 47% in the last survey. Women who used the internet were 33.3% while the usage among men was 57%. Similarly, women operating bank accounts grew from 53% to 79% across the nation between the five-year duration.

Overall Contraceptive Prevalence Rate (CPR) has increased substantially from 54% to 67% at an all-India level and in almost all phase-2 states and UTs, with the exception of Punjab. Use of modern methods of contraceptives has also increased in almost all states and union territories (UTs), according to the statement.

Child nutrition indicators have made a slow climb upwards at the national level as stunting declined from 38% to 36%, wasting from 21% to 19% and underweight from 36% to 32%.

As far as family planning methods are concerned, sterilisation is mainly female centric denoting almost nil engagement of males. Figures pertaining to female sterilisation registered a growth from 36% to 37.9% while for the men they stagnated at 0.3%. Use of condoms however grew from 5.6% to 9.5%.

Severely Anaemic

Prevalence of anaemia among women and children is an area of concern. More than 50% of them were found to be anaemic in 14 states and UTs that were covered during the Phase-2 of the survey. Barring Kerala, most states fall under the ‘severe’ category in this context. Substantial improvement can be seen in full immunisation drive among children in the 12-23 month age group from 62% to 76%. Odisha reports 90% coverage of children.

The Survey portrays improvement in education level and living conditions of the people. People living in households with an improved drinking water source increased from 94.4% to 95-9%; HHs using clean fuel for cooking rose from 43.8% to 58.6%; HHs using an improved sanitation facility grew from 48.5% to 70.2%.

The survey puts the percentage of women who are literate at 71.5% and those among men at 84.4%. NHFS-4 did not collect the data pertaining to these markers. Women with 10 or more years o