WHAT IS NATIONAL FAMILY HEALTH SURVEY (NFHS-5)
The National Family Health Survey (NFHS 5), which presents a bird’s eye view of the state of the nation’s health, has provided encouraging outcomes on several fronts: stabilizing population growth, improved family planning services and better delivery of health systems. However, it also highlights the need for further improvement to address gender-based violence and harmful practices against women and girls, such as child marriage and gender-biased sex selection. These have been exacerbated by discriminatory social norms and practices hindering the achievement of the Sustainable Development Goals (SDG) 2030 Agenda and India’s development goals.
WOMEN-SPECIFIC FINDINGS OF NFHS 5: THE POSITIVE SIDE
- TFR below Replacement Level: India’s population growth appears to be stabilizing. The Total Fertility Rate (TFR), which is the average number of children born per woman, has declined from 2.2 to 2.0 at the national level. A total of 31 States and Union Territories (constituting 69.7% of the country’s population) have achieved fertility rates below the replacement level of 2.1.
- Better Family Planning: The main reasons for decline in fertility is an increase in adoption of modern family planning methods (from 47.8% in 2015-16 to 56.5% in 2019-21) and a reduction in unmet need for family planning by 4% points over the same period.
- Improvements in Female Literacy: Significant improvements in female literacy have been witnessed with 41% women having received 10 or more years of schooling (compared to 36% in 2015-16). Girls who study longer have fewer children, and are also more likely to delay marriage and find employment.
- Improved Maternal Health Delivery: Maternal health services are steadily improving. Antenatal care in the first trimester has increased by 11.4% points (from 2015-16 to 2019-21) to reach 70%
- The recommended four antenatal care check-ups have increased by 7% points to reach 58.1%. Postnatal care visits have gone up by 15.6% points to reach 78%. Institutional births were accessed by 88.6% of women in 2019-21, marking an increase of 9.8% points from 2015-16. There has also been an increase in institutional deliveries in public health facilities (52.1% to 61.9%).
- Better Menstrual Health and Bodily Autonomy: Evidence indicates significant progress where women have the right to bodily autonomy and integrity and the ability to take decisions about their lives. The proportion of women (aged 15-24 years) who use menstrual hygiene products has also increased by almost 20% points between 2015-16 and 2019-21 and currently stands at 77.3%.
- Technology and Banking Related Progress: The proportion of women who have their own bank accounts has gone up by 25.6% points over the same time period to reach 78.6%. Around 54% of women have their own mobile phones and about one in three women have used the Internet.
NATIONAL FAMILY HEALTH SURVEY (NFHS-5)
Recently, the latest data from the National Family Health Survey (NFHS 2019-21) has been released. Earlier in 2020, the first-phase data of the NFHS-5 2019-20 was released by the Ministry of Health and Family Welfare, which provided data on various issues related to women in india.
HIGHLIGHTS OF THE REPORT
- Prevalence of Child Marriage: The share of women aged 20-24 who married before turning 18 has declined from 27% to 23% in the last five years. Child marriage is a key determinant of high fertility, poor maternal and child health, and lower social status of women. West Bengal and Bihar, with around 41% such women each, had the highest prevalence of girl child marriage. The maximum reduction in the proportion of underage marriages was observed in Rajasthan, Madhya Pradesh, and Haryana.
- Rampant Anemia: As many as 57% women aged 15-49 were anemic in 2019-21, compared to 53% in 2015-16, while the same for men rose from 22.7% to 25%. The most formidable increase—8.5% was observed for children aged 6-59 months (67.1%). Among larger states, West Bengal and Kerala reported the highest and lowest prevalence, respectively, of anemic women. Child anemia rates worsened the most in Assam, Mizoram, Chhattisgarh, and Odisha.
- Improving Amenities: All states, except Manipur, Meghalaya, Assam and Jharkhand, had over 90% population with access to improved drinking water sources. Bihar, Jharkhand etc states had almost doubled the access since 2015-16, but most fell below the 75% mark.
- Women who own House: The number of women who own a house or land in Delhi, either alone or jointly, has significantly dipped over the past five years. While the percentage of women who had a house or land registered in their name in 2015-16 was around 35%, it dipped to 22.7% in 2020-21.
- Women who have a Bank Account: It has gone up 8% and women who have a mobile phone that they use is up by 7%.
- Access to Internet: The percentage of women who have ever used the internet was around 64% as compared to 85% men. This data was not available in the previous survey.
- Participation in the Household: It has gone up from around 74% in 2015-16 to 92% now. The participation of married women in household decisions includes health care for self, making major household purchases, and visits to her family or relatives, etc.
- Out-of-Pocket Expenditure: It went from Rs 8,518 to Rs 2,548 in five years. Average out-of-pocket expenditure has seen a significant improvement in the per delivery in a public health facility.
- Rise in Obesity: Obesity among both men and women has risen. While 41.3% of women are now overweight or obese, this figure is 38% for men. The rise in the percentage of men who are overweight or obese, however, has been faster in men than in women.
- High Malnutrition: The share of under-five children who were stunted (too short for age), wasted (low weight for height), or underweight has declined. However, every third child still suffers from chronic undernourishment, and every fifth child is acutely malnourished.
- Stunting: Meghalaya had the prevalence, followed by Bihar while Rajasthan, Madhya Pradesh, Jharkhand recorded declines of 5-7% since 2015-16.
- Wasting: Bihar had the highest prevalence of underweight children, followed closely by Gujarat.
NATIONAL FAMILY HEALTH SURVEY (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 has designated the International Institute for Population Sciences (IIPS) Mumbai, as the nodal agency for providing coordination and technical guidance for the survey. IIPS collaborates with a number of Field Organizations (FO) for survey implementation.
The survey provides state and national information for India on:
Fertility, Infant and child mortality, the practice of family planning, Maternal and child health, Reproductive health, Nutrition, Anemia, Utilization and quality of health and family planning services Each successive round of the NFHS has had two 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. The funding for different rounds of NFHS has been provided by USAID, the Bill and Melinda Gates Foundation, UNICEF, UNFPA, and MoHFW (Government of India).
DOWNSIDE OF THE SURVEY
- Lesser Institutional Delivery in Certain States: The survey indicates a worrisome figure of 11% of pregnant women who were still either unreached by a skilled birth attendant or not accessing institutional facilities. Further analysis reveals the institutional delivery rate of under 70% in 49 districts of India over two-thirds (69%) of which are from five States (Nagaland, Bihar, Meghalaya, Jharkhand and Uttar Pradesh).
- Teenage Pregnancy: Teenage pregnancy has declined only marginally by 1% point and 7.9% of women in the age group of 15-19 years were already mothers or pregnant at the time of the survey.
- Low Access of Reproductive Health Services: A very small segment of the population is currently accessing the full range of sexual and reproductive health services such as screening tests for cervical cancer (1.9%) and breast examinations (0.9%).
- Negligible Decline in Child Marriage: The prevalence of child marriage has gone down but only marginally from 26.8% in 2015-16 to 23.3% in 2019-21. One in three women continue to face violence from their spouse.
- Low Economic Contribution: Women’s participation in the economy continues to remain low (only 25.6% women engaged in paid work, a meager increase of 0.8% point). Women still bear a disproportionate burden of unpaid domestic and care work, hindering their ability to access gainful employment.
CONCLUSION
- Encouraging Comprehensive Sexuality Education: The above issues highlight the need to invest in comprehensive sexuality education as a key component of life-skills education for both in school and out-of-school adolescents, and ensuring access to quality sexual and reproductive health services for them. While expanding the basket of reproductive health services, the services like screening tests and breast examinations should also be included.
- Addressing Discriminatory Social Norms: To empower women and ensure gender justice, it is imperative to address harmful practices, such as child marriage and gender-biased sex selection. There is a need to enhance the value of women and girls by working on transforming unequal power relations, structural inequalities and discriminatory norms, attitudes and behaviours. Also, it is important to engage with men and boys, particularly in their formative years, to promote positive masculinity and gender-equal values.
- Promoting Technology Based Services among Women: In the next few years, the combination of mobile technology, banking, education and women’s economic empowerment will be significant drivers to address informal discriminatory norms. Although the percentage of women using mobile, internet and banking facilities have increased, this is still not at par with those of men. There should be sufficient stress on promoting and teaching the use of such facilities to women as availability and utilization of such resources is also an indicator of empowerment among women.
- Integrated Efforts for Better Health Services: The NFHS findings are a reminder of the urgent need to close gaps in girls’ education and address the poor health status of women. Current times require integrated and coordinated efforts from all health institutions, academia and other partners directly or indirectly associated with the health care services to make these services accessible, affordable and acceptable, especially for those who can’t easily afford it.
