National Family Health Survey (NFHS)
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GS 2: Government policies and interventions
- National Family Health Survey (NFHS) has recently been released by the Union Health Ministry.
- Several of India’s nutritional indicators have worsened since the fourth round of the NFHS, which was held in 2015-16. But the country has hit a major demographic milestone of replacement-level fertility.
- Total Fertility Rate (TFR), or the average number of children per woman, has declined further from 2 reported in 2015-16 to 2.0 at the all-India level.
- According to the United Nations’ population division, countries experiencing below-replacement fertility — lower than 2.1 children per woman — indicates that a generation is not producing enough children to replace itself, eventually leading to an outright reduction in population.
- The data in NFHS 2019-21, the fifth in the survey series, shows the fertility rate at 1.6% in urban areas and 2.1 in rural India.
- TFR of 2 is a “definite indicator” of stability of population in the long term in the country.
- Five states with TFR above 2: Bihar (3), Meghalaya (2.9), Uttar Pradesh (2.4), Jharkhand (2.3) and Manipur (2.2).
- Two states reported TFR at the same level as the national average: Madhya Pradesh and Rajasthan.
- Two states have a TFR of 1.6: West Bengal and Maharashtra.
- Six states have a TFR of 1.7: Maharashtra, Karnataka, Andhra Pradesh, Himachal Pradesh, Nagaland and Tripura.
- Six more states have a TFR of 1.8: Kerala, Tamil Nadu, Telangana, Arunachal Pradesh, Chhattisgarh and Odisha.
- Five states have a TFR of 1.9: Haryana, Assam, Gujarat, Uttarakhand and Mizoram.
- This is a significant feat for the country’s family-planning programme, which does not include coercive policies.
- These findings bust the population-explosion myth and show that India must steer away from coercive measures of population control.
Modern contraceptive method:
- NFHS-5 finds that there has been a significant increase in current use of any modern contraceptive method, which stands at 56.5% in 2019-21 against 47.8% in 2015-16. The share of condoms is 9.5% against 5.6% in 2015-16.
- The increased use of modern contraception also means that the total unmet need for family planning, which has been a major issue in the past, has come down to 9.4% in 2019-21 against 12.9% in 2015-16.
- It is less than 10% for all states except Jharkhand (12%), Arunachal Pradesh (13%) and Uttar Pradesh (13%).
- However, the uptake of female sterilisation has gone up to 38% against 36% in 2015-16. The uptake of injectable contraceptives, introduced in 2017, remains abysmally low at 0.6%.
- The increase in female sterilisation shows that the onus of family planning remains with women, with men not participating in the process and “shrugging responsibility.
- The Government must adopt a targeted social and behaviour-change communication strategy to ensure that men also take responsibility for family planning.
- The quality of care in family planning has shown significant improvement with 62% of current users reporting that they received information on side effects from service providers. This has increased from 46% in the last survey.
- The number of women who have a bank account they operate themselves has increased significantly from 53% in 2015-16 to 79%.
- Anaemia among children and women continues to be a cause of concern.
- More than half of the children and women (including pregnant women) are anemic in all the phase two states and UTs and all-India level compared to NFHS-4, in spite of substantial increase in the composition of iron folic acid (IFA) tablets by pregnant women for 180 days or more.
- The number of anaemic children under five years of age rose to 67.1% from 58.6% in the last survey. This means that two out of every three children-under-five in India are anaemic.
- The percentage of anaemic women rose to 57% from 53.1%, anaemic teenage girls (15-19 years of age) to 59.1% from 54.1%. The number of anaemic men also rose to 25% from 22.7%.
- Figures for Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh have shown an upward trend in anaemic cases between now and 2015-2016. A 2-6 per cent increase has been recorded in all age groups for Bihar, Uttar Pradesh and Madhya Pradesh, while Rajasthan is the worst among them with a 9-12 per cent increase.
- Assam is among the worst performing states, with a huge spike in anaemic cases. The figure for children has increased to 68.4 per cent (NFHS 5) from 35.7 per cent (NFHS-4).
- Child nutrition indicators showed a slight improvement at all-India level.
- Stunting (which is children who are short of height in proportion to their weight and age) declined from 38% to 36%.
- Wasting (which is loss of body weight in proportion to the height of the body) also declines from 21% to 19% and underweight from 36% to 32%.
- In all phase two states and UTs, the situation improved in respect of child nutrition but the change was not significant as drastic changes in respect of these indicators are unlikely in a short span.
- Exclusive breastfeeding to children under six months of age has shown an improvement in all-India level from 55% in 2015-16 to 64% in 2019-21. All the phase two states and UTs are also showing a considerable progress.
- The number of non-breastfeeding children between 6 and 23 months old receiving an adequate diet fell to 12.7% from 14.3%.
- The proportion of children (12-23 months) who were fully vaccinated improved from 62%-76%.
- Survey points to rising instances of domestic and sexual violence against women in the state.
- Married women, between the ages of 18-49, who have ever experienced spousal violence, has more than doubled from 20.6 in 2014-15 to 44.5%.
- The rise of spousal violence among pregnant married women has come down marginally from 6.5 in 2014-15 to 5.8.
- Young women (18-29), who have experienced sexual violence by age 18, has risen from 10.3 in 2014-15 to 11.0. This indicates to a higher instances of domestic and sexual violence during the Covid-19 pandemic-induced lockdowns.
- This data contradicts the recently released National Crime Records Bureau (NCRB) data that shows a decrease in crimes against women in 2020.
- Data from the NFHS also show that issues like obesity have been on the rise among adult male and females.
- The emphasis on health insurance with union government schemes like Ayushman Bharat too appears not to have the desired impact.
- Households with any usual member covered under a health insurance or financing scheme remain stagnant at 28.1 as compared to the 2014-15.
Water and sanitation:
- Survey indicates that India is far from achieving SDG 6 which aims to “ensure availability and sustainable management of water and sanitation for all” by 2030.
- Its importance extends beyond this mere objective, as it will help nations achieve other SDG goals as well, such as SGD 1 (poverty eradication), SDG 2 (improving nutrition), SDG 3 (promotion of well-being) and SDG 5 (gender equality), among others.
- India needs adequate provisions for the upkeep of toilets in future budgets to lower the chances of a slide-back.
- Finally, linking SDG 6 goal with the sanitation programmes of governments at all levels—national, state and local—will allow a unified approach towards that end.
- The findings of NFHS-5 from 22 States & UTs covered in Phase-I were released in December, 2020 and the remaining comprising Arunachal Pradesh, Chandigarh, Chhattisgarh, Haryana, Jharkhand, Madhya Pradesh, NCT of Delhi, Odisha, Puducherry, Punjab, Rajasthan, Tamil Nadu, Uttar Pradesh and Uttarakhand.
- The latest data also show significant progress on several indicators related to fertility, family planning, age at marriage and women’s empowerment — all of which have contributed to the decrease in TFR.
- The International Institute for Population Sciences, Mumbai, was the nodal agency for the survey.
- The data from NFHS-5 will help in identifying the need for new programmes with an area-specific focus, and groups that are most in need of essential services.
Global Nutrition Report
Down to earth
GS 1: Issues related to children and health
- According to 2021 Global Nutrition Report (recent released), India has made no progress on anaemia and childhood wasting.
- This survey has found that almost half of the people on Earth are either underfed or overfed, and our choice of nutrition has serious implications not only for human health, but the health of the planet.
- This survey is an independent survey conducted annually since 2013.
- It assesses the nutrition financing landscape and provides a comprehensive overview of reporting on past Nutrition for Growth commitments.
- The data show that a quarter of all deaths among adults are attributable to poor diet, and that the world is not on track to meet five out of six global nutrition targets set by the WHO.
- Food production currently generates more than a third of all GHG emissions globally, and meat-heavy diets are responsible for the lion’s share of those emissions.
- Over half of Indian women in the age group 15-49 years are anaemic.
- There has been a rise in anaemic Indian women since 2016. In 2016, 52.6% of Indian women were anaemic. But in 2020, 53% were found to be anaemic.
- India is also among 23 countries that have made no progress or are worsening on reducing ‘childhood wasting’.
- Over 17% of Indian children under 5 years of age are affected. It is much higher than the average for Asia where close to 9% children are affected.
- India is ‘off-course’ in meeting 7 of the 13 global nutrition targets. These include sodium intake, raised blood pressure (both men and women), obesity (both men and women) and diabetes (both men and women).
- Some 6.2% of adult (aged 18 years and over) women and 3.5% of adult men are living with obesity.
- In fact, no country in the world was ‘on course’ to achieve the target for obesity
- India is among 53 countries ‘on course’ to meet the target for stunting. But over 34% of children under 5 years of age are still affected.
- This figure is higher than average for Asia, where close to 22% are affected by stunting.
- The country is also among 105 countries that are ‘on course’ to meet the target for ‘childhood overweight’ and among 53 countries ‘on course’ to meet the target for ‘exclusive breast feeding’. Some 58% of infants in the age group 0-5 months are exclusively breastfed in India.
- India does not have adequate data on prevalence of ‘low birth weight’.