National Family Health Survey 4: The highs and the lows


The recently released National Family Health Survey (2015-16), the fourth in the NFHS series, which comes a decade after the previous one (2005-06) has noted advancements in many areas, including women’s empowerment, child marriages, and infant mortality rate, along with a number of problem areas, such as health and nutrition, where the country is still lagging behind. The survey, which for the first time, provided district level estimates and took into consideration all the six Union Territories, apart from the 29 states, obtained information from 6 lakh households, 7 lakh women and 1.3 lakh men. The largest assessment of the state of the country’s family health and welfare, unveiled by the Ministry of Health, was designed to also provide information on sexual behaviors, life-style indicators, HIV/AIDS knowledge, with data being collected using Computer Assisted Personal Interviewing, using mini notebooks.

We take a look at the areas where the nation has progressed in the last ten years, and those where it is still lagging behind.

Infant Mortality Rate: On the positive side, the Survey noted a reduction in the Infant Mortality Rate (IMR), by 16 points over the last 10 years. The ratio declined from 54 deaths per 1000 live births in 2005-06, to 41 deaths per live births in 2015-16. The IMR has dropped by more than 20 percentage points in Tripura, West Bengal, Jharkhand, Arunachal Pradesh, Rajasthan and Odisha. The under-five mortality rate has also decreased from 74 in the last NFHS (2005-06) to 50 in the current one – revealing a 24 point reduction in deaths.

On an international level, though, the picture is not that rosy. The ratio is comparable to Madagascar, which is a much poorer African nation.  Many of our neighbours, including Bangladesh (31), Nepal (29) and the African countries of Botswana (31) and Rwanda (35), are ahead of us. Similarly. India’s under five mortality rate (50) is also much behind those of its neighbours, such as Nepal (36), Bangladesh (38) and Bhutan (33). There is also a large difference between states, showing that development has not been equal throughout. While Kerala has an IMR of 6 at par with the US, Chhatisgarh, has lagged way behind with an IMR of 54.

Sex ratio: The sex ratio at birth has only improved slightly from 914 females to 1000 males in 2005-06, to 919 in 2015-16. This was led by Kerala which has the highest sex ratio (1047). Chhattisgarh did well in the sex ratio field, with a higher than national average ratio of 977, Haryana marked the highest improvement from 762 to 836.

Contraception: While the overall contraception usage has decreased by 2 percentage points from NFHS-3 to NFHS-4 (54 per cent), pills and condom usage have shown increasing trend. There is however a vast gender disparity in sterilisation with the national average standing at 0.3 percent for males and 36 percent for females.

Institutional births: Births conducted at hospitals and health institutions increased by 40 percentage points from 38.7 percent during the last NFHS, to 78.9 percent this Survey. The Empowered Action Group (Bihar, Jharkhand, Uttar Pradesh, Uttarakhand, Rajasthan, Madhya Pradesh, Chhattisgarh and Odisha) and Assam, saw a more than 40 percentage point increase.  However, more babies have been delivered through Caesarian than through normal delivery, indicating a push, especially by private players, towards c-sections. The nationwide average on the number of Caesarians conducted has witnessed an increase from 8.5 percent of all deliveries in NHFS 3 to 17.2 percent in NFHS 4. This has prompted the Ministry of Health to ask states to curb caesarians which are not necessary.

Health and sanitation: The Immunisation drives that have been routinely conducted in the country have proven to be successful with 62 percent of children between the ages of 12 and 23 months being fully immunised for BCG, measles, polio, diphtheria and tetanus. This is an increase of 18 percentage points from 43.5 percent in 2005-06. According to the survey, full immunisation coverage increased in the states of Punjab, Bihar and Meghalaya by 29 percentage points each, and by 28 percentage points each in Rajasthan, Uttar Pradesh, Jharkhand and Chhattisgarh.

In the category of children under three who were breastfed within the first hour of their lives, there was an increase of 19 percentage points from NFHS 3. Around 41.6 percent of children are being breast fed within the first one hour, as compared to 23.4 percent a decade ago. However, that still accounts for less than half of the population. The data also showed that breastfeeding has dropped by 10 percentage points in children in the 6-8 month age, once they start receiving semi sold food.

The survey has shown that 58.4 per cent of Indian children below five years of age are anaemic and around 38 per cent of children in the same age group are stunted (low height for age), while 21 percent were wasted (low weight for height) and 36 per cent were underweight (low weight for height). India lags behind in the global nutrition scene with widespread levels of hunger, standing at a dismal 97 among 118 developing countries, according to the Global hunger Index. However, obesity among men has seen an increase of 9.3 percent, and in women, of 8.1 percent.

The percentage of houses using improved sanitation facilities has increased from 29.1 percent to 48.4, while those with access to improved drinking water has also seen an increase 87.6 percent to 89.9 percent.

Women’s empowerment: While literacy rate for women has gone up from 55.1 percent to 68.4 percent, the number of women who got married before the age of 18 has also gone down from 47.4 percent in 2005-06 to 26.8 percent in 2015-16. More number of women (84 percent) are also participating in household decisions now. However, domestoc violence has shown an increase, with 84 percent of married women facing gender-based violence in 2015-16, as opposed to 76.5 percentin the year 2005-06.