Each successive round of the NFHS has had 2 specific goals:
To provide essential data on health and family welfare needed by the Ministry of Health and Family Welfare and other agencies for policy and programme purposes,
To provide information on important emerging health and family welfare issues.
REPORT : There are remarkable improvements, in view of very little expenditure on health and education as a share of India’s GDP.
KEY RESULTS FROM NFHS Phase 2 (conducted between January 2020 and April 2021) :-
The report has been a mixed verdict.
Thereport card on the state of India’s demographic and health trajectory, reveals improvement in several dimensions such as :-
[On comparing NFHS-5 with NFHS-4 (2015-16) ]
Population has stabilised
The positives of the report should be admired, under the following circumstances :-
Given the abysmal state of India’s health infrastructure, which has been tragically apparent since the COVID-19 pandemic hit.
Given how little India spends on health and education as a share of GDP.
The biggest positive headline news from NHFS-5 is-
The total fertility rate i.e. the average number of children born to a woman during her lifetime-
TFR – falling over time and is now just below the replacement rate of 2.1. (true across all States of India).
There is absolutely no evidence to justify tying welfare support measures or holding elected office to the number of children.
Data on sex ratio-
Nationally, there are 1,020 adult women per 1,000 men for the first time.
The sex ratio at birth (SRB)-
The natural SRB is 105 boys to 100 girls, which typically stabilises to a 50-50 adult sex ratio.
The natural SRB translates to 952 girls per 1,000 boys.
The SRB has improved from 919 (2015-16) to 929(2019-21), but it is still short of the natural SRB.
Major States with low SRBs:
States with a worsening SRBs:-
Anaemia and malnutrition
A key health indicator that has worsened–
The incidence of anaemiain all the States of India. :
Under-5 children → from 58.6 to 67%
Women→ 53.1 to 57%
Men→ 22.7 to 25%
NOTE: 20%-40% incidence of Anaemia→ moderate.
Incidence of Anaemia varies in Indian States from-
39.4% → Kerala
79.7% → Gujarat
Except Kerala, all States are in the severe category.
However, comparing the changes in anaemia (pre-COVID Surveys) to the later phase, the increase in the former is on average higher than the increase in Phase 2 States.
Phase I states- Andhra Pradesh, Assam, Bihar, Gujarat, Kerala, Maharashtra, West Bengal
Phase II States- Delhi, Uttar Pradesh, Chhattisgarh, Jharkhand, Rajasthan, Haryana, Tamil Nadu, Madhya Pradesh, Odisha, Punjab, among others.
There are other instances of clear differences between Phase 1 and Phase 2 results.
There has been an overall improvement in the three indicators of malnutrition:
stunting (low height-for-age)
wasting (low weight-for-height)
underweight (low weight-for-age)
These factors generally prevent children from reaching their physical and cognitive potential.
There has been an anomaly in the overall reduction (in the National estimates)-
Phase 1, several States revealed a worsening in one or more of these factors
Phase 2, none of the States showed a worsening.
NOTE–. Phase 2 survey could heav been affected due to COVID-19
An increase in the proportion of overweight children, women and men has also been found.
Lack of adequate nutrition is also measured by micronutrient deficiencies, i.e. lack of vitamins and minerals.
Notes of caution-
Based on comparisons between NHFS-4 and NHFS-5 to the improvements between the two previous rounds- the rate of progress has slowed down.
→ Though, the data for 2nd Phase of NFHS-5 have been collected during the COVID-19 pandemic, but as the evidence on anaemia shows, the deterioration in public health indicators cannot be attributed fully to this pandemic.
The NHFS-5 survey also focuses on :-
Autonomy and mobility indicators
The survey shines a spotlight on women’s reproductive health, and reveals that caesarian births have increased dramatically.
In private health facilities, 47.5% births are by C-section (14.3% in public health facilities).
All Governments, National and State should prioritise health as a matter of concern. The survey highlights deep inequalities in health outcomes. An action plan to improve India’s health needs to be inclusive, firm in its commitment, and backed by solid resources.