Measuring the progress

(Mains GS 2 : Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources, poverty and hunger.)

Context:

• The government recently released the factsheets of key indicators on population, reproductive and child health, family welfare, nutrition and others for India as well as 14 states and UTs, clubbed under phase two of the 2019-21 NFHS-5.

Importance of exercise:

• A periodic assessment of health and social development indicators is crucial for any country that is still clawing its way towards achieving ideal standards in the Human Development Index.
• This massive exercise that covered, this year, over six lakh households across the country, aims at providing data that will help shape the policies in a manner that will correct deficiencies, and ensure equitable access to services, particularly those with impact on social determinants that improve the quality of life.

Brief about NFHS:

• The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
• The Ministry of Health and Family Welfare (MOHFW), Government of India, designated International Institute for Population Sciences (IIPS) as the nodal agency, responsible for providing coordination and technical guidance for the NFHS.
• The 2019-20 National Family Health Survey (NFHS-5), the fifth in the NFHS series, provides information on population, health, and nutrition for India and each state and union territory. 

Survey on population:

•  Policies as in the case of the family planning sector, seem to have borne fruit, years after they were implemented. 
• The gender ratio, for the first time, recorded more women per 1,000 men.There are 1,020 women per 1,000 men in India according to the recently released Fifth Edition of the National Family Health Survey (NFHS-5)
• However,  the gender ratio at birth in the last five years still underlines the persistence of a deep-rooted son preference, one that has to be countered, through policy and law. 
• The Total Fertility Rate (TFR), the average number of children per woman, has further declined from 2.2 to 2.0 at the national level and in all 14 states and UTs. 
• All phase two states have achieved replacement level of fertility (2.1), except Madhya Pradesh, Rajasthan, Jharkhand and Uttar Pradesh.

Reproductive health:

• Institutional births have increased substantially from 79 per cent to 89 per cent at all-India level. 
• Institutional delivery is 100 per cent in Puducherry and Tamil Nadu and more than 90 per cent in seven states and UTs out of 12 phase two states and UTs.
• Along with an increase in institutional births, there has also been a substantial increase in C-section deliveries in many states and UTs, especially in private health facilities. 
• Overall Contraceptive Prevalence Rate (CPR) has increased substantially from 54 per cent to 67 per cent at all-India level and in almost all phase two states and UTs, with the exception of Punjab. 

Increased anaemia:

• NFHS5 shows that the incidence of anaemia in young children has increased alarmingly; more than one in three children up to five years of age suffer from anaemia. 
• Under-five anaemia was prevalent among 58.6 percent of children in 2015-16, 67.1 percent are now anaemic. 
• Also, the proportion of women (15-49 years of age) who are anaemic has grown — from 53.1 percent to 57 percent — during this five-year period. 
• The percentage of pregnant women (15-49 years) who are anaemic has increased to 52.2 percent from 50.4 percent.

Data related to Health

• Exclusive breastfeeding to children under six months of age has shown an improvement in all-India level from 55 per cent in 2015-16 to 64 per cent in 2019-21.
• There is an increase from 51 per cent to 58 per cent of women receiving the recommended four or more ANC visits by health providers at all-India level.
• Full immunisation drive among children aged 12-23 months has recorded substantial improvement from 62 per cent to 76 per cent at all-India level.
• Also, 11 out of 14 states and UTs have more than three-fourth of children aged 12-23 months with full immunisation and it is the highest for Odisha at 90 per cent.
• Exclusive breastfeeding to children under six months of age has shown an improvement in all-India level from 55 per cent in 2015-16 to 64 per cent in 2019-2.

Women empowerment:

• Women's empowerment indicators portray considerable improvement at all-India level and across all 14 states and UTs.
• Significant progress has been recorded between NFHS-4 and NFHS-5 with respect to women operating bank accounts from 53 per cent to 79 per cent at all-India level.
• More than 70 per cent of women in every state and UT in the second phase have operational bank accounts.

Impact of the pandemic:

• The global COVID-19 pandemic and consequent losses to the economy were widely expected to exacerbate hunger in 2019-21.
• The target under the government’s Poshan Abhiyan was to reduce stunting by two percentage points per annum.
• But NFHS5 shows that the pace of reduction seen in NFHS5 has slowed compared to NFHS 3 and NFHS4.
• Thus, the impact of the pandemic and the disruption it caused to services such as balanced nutrition for children must be acknowledged for building resilient and fortified systems capable of delivering in the most trying circumstances.

Lifestyle diseases:

• NFHS-5 measured blood sugar and hypertension in the population for the first time, highlighting the looming threat from lifestyle diseases.
• Yet another worrying trend seen in NFHS5 is the rising proportion of women, men and children who are overweight.
• At an all-India level, nearly every fourth women was found to be overweight or obese against every fifth earlier; nearly 23 percent men were also overweight or obese versus just about 19 percent earlier. 
• Children under five who were overweight accounted for 3.4 percent against 2.1 percent earlier.

Conclusion:

• The main objective of successive rounds of the NFHS is to provide reliable and comparable data relating to health and family welfare and other emerging issues.
• Thus stakeholders must not treat it as a mere stocktaking exercise, but harness the opportunities the NFHS provides for launching reform or re-assessing certain policies.