National Report of 5th round of NFHS-5

 

When was the survey conducted?

The National Family Health Survey (NFHS) was conducted between 2019 and 2021.

What did the report say regarding marriage age?

• National average of underage marriages has come down.
• According to NFHS-5, 23.3% of women surveyed got married before attaining the legal age of 18 years, down from 26.8% reported in NFHS-4.
• However, in some states like Punjab, West Bengal, Manipur, Tripura, and Assam, underage marriages increased.
• West Bengal and Bihar are the states with one of the highest rates of underage marriages in the country. Underage marriages are lowest in Jammu and Kashmir, Lakshadweep, Ladakh, Himachal Pradesh, Goa, Nagaland, Kerala, Puducherry, and Tamil Nadu.
• Tripura has seen the largest jump in marriages under the legal age of 18 years for women. And biggest gains in improving legal marriage have been seen in Chhattisgarh.

What did the report say about contraceptive usage?

• The knowledge of contraceptive methods is almost universal in India. But the use of modern contraceptives for family planning is only 56.4%
• Women who are employed are more likely to use modern contraception.
• Contraceptive usage increases in communities and regions that have seen more socioeconomic progress.
• Usage of modern contraceptives also increases with income.

What is the total fertility rate?

Total Fertility Rate (TFR) is the average number of children that would be born to a woman if she were to live to the end of her child-bearing years and give birth to children in alignment with the prevailing age-specific fertility rates.

What is India’s Total fertility rate (TFR)?

Total Fertility Rates has declined from 2.2 (NHFS-4) to 2.0 (NFHS-5) at the national level. Thus, the TFR is currently below the replacement level of fertility.

What is the replacement level of fertility?

Replacement level fertility is the level of fertility at which a population exactly replaces itself from one generation to the next.

How many states in India have a fertility rate above the replacement level of fertility?

Only five states are above the replacement level of fertility of 2.1. These five states are Bihar (2.98), Meghalaya (2.91), Uttar Pradesh (2.35), and Jharkhand (2.26) Manipur (2.17).

What is the National Family Health Survey (NFHS)?

The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted on a representative sample of households throughout India.

What information is provided by the National Family Health Survey (NFHS)?

NFHS 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.

What are the goals of the National Family Health Survey (NFHS)?

NFHS has two specific goals:

1. To provide essential data on health and family welfare for policy and program purposes.
2. To provide information on important emerging health and family welfare issues.

Who is designated as the nodal agency?

The Ministry of Health and Family Welfare (MOHFW) designated the International Institute for Population Sciences(IIPS) Mumbai, as the nodal agency, to provide coordination and technical guidance for the survey.

Our gender gap in contraception needs public policy intervention

 The recently-released fifth round of our National Family and Health Survey (NFHS-5) highlights that there has been a more than 10 percentage-point increase in the use of contraception among currently married women aged 15-49 years: that is, from 53.5% in 2015-16 to 66.7% in 2019-20. A significant jump has been observed in the use of condoms, which rose from 5.6% to 9.5%. It’s noteworthy that despite the near doubling in the use of condoms, female sterilization continues to be the most popular choice, with an adoption rate of 37.9% (NFHS-5), even many years after the inception of family planning as a concept in India

This brings forth a glaring gender divide in the methods of contraception used in India. The divide could imply two things. First, it may indicate greater bodily autonomy exercised by women today; in charge of their own lives and bodies, women could be making their own contraception choices, thereby determining when and how they want to plan their children and careers. Alternatively, this divide could also indicate the deep-rooted patriarchy that exploits and subjugates women. To evaluate which of the two are at work, we need to take a diligent look at our data

According to the NFHS-4, conducted during 2015-16, only about 8% of women were found to make independent decisions on the use of contraception, while for nearly every tenth woman, it was the husband who decided contraception use. The irony is that while it is husbands who decide the method, the actual burden of it falls on women. Ipso facto, female sterilization is the most wide-spread method, with more than a third of India’s sexually-active population opting for it, despite the lower cost and safer procedure of male vasectomy. Interestingly, based on data from NFHS-3 and NFHS-4, we also observe that a higher proportion of women with college or higher levels of education tend to opt for male or female reversible methods of contraception (33.7%) over female sterilization (17.2%). All these facts give credence to the ‘subjugation’ explanation of the divide over the ‘bodily autonomy’ hypothesis outlined above.

These observations have also been highlighted in a recent study published as a working paper by O.P. Jindal Global University in 2021, titled Gender Gap in the Use of Contraception: Evidence from India. The study lends evidence to the pertinent role that women’s education plays in the choice of contraception. The Bihar model is an excellent illustration of this, with the Population Council of India’s director Niranjan Saggurti cited as saying, “The most significant [factor] in the Bihar case is the increase in education—which has translated into increased use of contraception and increased family planning."

Therefore, in addition to educating children, there is an imperative to impart knowledge about the use and benefits of different methods of contraception to the community at large. It is paramount to target such awareness campaigns at both men and women. Special emphasis should be given to convincing men about the relevance of family planning, and hence, the use of several male contraceptive methods that are safer, cheaper and procedurally simpler than female sterilization. This can be done by utilizing the country’s existing network of community health workers, like Asha workers or Anganwaadi workers or Auxiliary Nurse Midwives. However, currently, most of these frontline workers who have the mandate to disseminate information on family planning are females. Additional male workers could also be deployed to ease direct communication with men.

Additionally, India conspicuously has no law on contraception that makes access to a sound sexual health our legal right, despite it being one of the key indicator variables of the Sustainable Development Goals of the United Nations (SDG indicator 3.7.1). Inclusion of sexual well-being as our legal right under the ambit of law can ensure that there are no unnecessary restrictions on the advertisement and publicity of contraceptives, thus easing people’s access to information and knowledge on them. Further, such a law could also be used to make the availability and accessibility of contraceptives easier by enrolling the services of Primary Health Centres, particularly to improve access in small towns, peri-urban and in rural areas.

With the introduction of a bill to amend the Prohibition of Child Marriage Act, 2006, so as to increase the legal age at marriage of girls from 18 to 21 years, the government has taken a step in the right direction. There exists literature that suggests that an increase in the age of marriage for females reduces the total fertility of women (Maitra, 2004). While this would be a relatively direct result of a higher age of marriage, as it simply reduces the reproductive years of married women, a probable indirect consequence of this move could be an improvement in the bargaining power of women, as it may reduce age gaps between husbands and wives.

Further, exceptional pandemic measures like lockdowns and the exigencies of essential supplies have interrupted contraceptive supply chains. According to the World Health Organization (WHO), family planning has been severely affected during this period, with seven out of ten countries affected. According to United Nations Population Fund, of 114 low/middle-income countries, more than 47 million women were unable to access contraceptives. India alone, as per the report Resilience, Adaptation and Action: MSI’s Response to Covid-19, witnessed 650,000 unwanted pregnancies during the covid pandemic.

Therefore, it is a need of the hour that sexual and reproductive health become a priority at the policy level. Fostering better informed and healthier reproductive behaviour among the country’s masses is a long-term endeavour that should not cease on account of a health emergency.

Sonal Dua, Aditi Singhal & Divya Gupta are assistant professors, O.P. Jindal Global University

Source: Mintepaper, 16/02/22

Worrying trends in nutrition indicators in NFHS-5 data

 

Veena S Rao writes: India’s nutrition programmes must undergo a periodic review addressing gaps such as institutional delivery and adolescent anaemia

The NFHS-5 factsheets for India and all states and Union territories are now out. At first glance, it appears to be a mixed bag — much to cheer about, but concern areas remain.

The good news is that there seems to be a change in our demographic trends, particularly in the sex ratio. For the first time since the NFHS 1992-93 survey, the sex ratio is slightly higher among the adult population. It is also for the first time in 15 years that the sex ratio at birth has reached 929 (it was 919 for 1,000 males in 2015-16).

The total fertility rate has also dropped from 2.2 per cent to a replacement rate of 2 per cent, albeit with not much change in the huge fertility divide between the high and low fertility states. It appears that states which were already experiencing a decline in fertility rates have continued to do so, without much change in the trends in the higher fertility states. This fertility divide can have several socio-economic and political repercussions in any society. One assumes that adequate attention will be given to this challenge at the policymaking and social levels after the detailed report is out. But, clearly, policies and programmes for the girl child and women’s empowerment have produced positive results, and a direct correlation between higher female literacy, the improvement in the sex ratio, and the decrease in the total fertility rate can easily be drawn.

There has been an appreciable improvement in general literacy levels and in the percentage of women and men who have completed 10 years or more of schooling, which has reached 41 per cent and 50.2 per cent respectively. Of course, much remains to be done, especially because these figures imply that around half of our workforce still does not have the qualifications and skills to achieve upward mobility and escape the poverty trap.

The health sector deserves credit for achieving a significant improvement in the percentage of institutional births, antenatal care, and children’s immunisation rates. There has also been a consistent drop in neonatal, infant and child mortality rates — a decrease of around 1 per cent per year for neonatal and infant mortality and a 1.6 per cent decrease per year for under five mortality rate.

Now turning to the areas of concern — nutrition or nutrition-related indicators. To begin with, India has become a country with more anaemic people since NFHS-4 (2015-16), with anaemia rates rising significantly across age groups, ranging from children below six years, adolescent girls and boys, pregnant women, and women between 15 to 49 years. Almost half our human capital lacks iron power.

The insidious, adverse effects of anaemia affect all age groups — lower physical and cognitive growth and alertness among children and adolescents, and lesser capacity to learn and play, directly impacting their future potential as productive citizens. Lower capacity to work and quick fatigue for adolescents and adults, translates into lower work output and lesser earnings. Further, anaemia among adolescent girls (59.1 per cent) advances to maternal anaemia and is a major cause of maternal and infant mortality and general morbidity and ill health in a community.

Though there has been some improvement, an area of concern is the poor consumption of IFA tablets by pregnant women. Perhaps the detailed report will explain why a dedicated programme like Anaemia Mukt Bharat which focused on IFA consumption failed to gain impetus.

Equally worrying is the exceedingly slow pace of improvement in nutritional indicators across all age groups. Between NFHS 4 and NFHS 5, the percentage of children below five years who are moderately underweight has reduced from 35.8 per cent to 32.1 per cent, moderately stunted children have fallen from 38.4 per cent to 35.5 per cent, moderately wasted from 21 per cent to 19.3 per cent and severely wasted have increased slightly from 7.5 per cent to 7.7 per cent. Details regarding severely stunted and underweight children will be published in the detailed report.

The root cause for this is that the percentage of children below two years receiving an adequate diet is a mere 11.3 per cent, increasing marginally from 9.6 per cent in NFHS-4. This foundational nutritional deficit which ought to be considered an indicator of great concern, is generally ignored by policy makers and experts. Unless this is addressed, rapid improvement in nutritional indicators cannot happen.

India’s nutrition programmes must undergo a periodic review, just as our health programmes did right from the Reproductive and Child Health (RCH) programme in 1997 to the present National Health Mission (NHM), addressing gaps such as institutional delivery, ambulance services, adolescent anaemia, and additional health volunteers. The Integrated Child Development Services (ICDS), which is perceived as the guardian of the nation’s nutritional well-being must reassess itself and address critical intervention gaps, both conceptually and programmatically, and produce rapid outcomes. Ad hoc add-ons are just not enough, and smartphones, tweets and webinars cannot substitute hard action on the ground.

Written by Veena S Rao

Source: Indian Express, 7/01/22

What the latest NFHS data says about the New Welfarism

 

Abhishek Anand, Arvind Subramanian write: On the key child stunting metric, it suggests not a catch-up, but a great switch between some of the BIMARU states and the mid-peninsular/western states

After the release of the first phase of the fifth wave of the National Family Health Survey (NFHS-5), we wrote in these pages (‘New welfarism of India’s Right’, IE, December 22, 2020), providing evidence for: (i) The success of the Narendra Modi government’s New Welfarism — the public provision of essential, and essentially private, goods and services such as cooking gas, toilets, bank accounts, power, housing, and cash; and (ii) setbacks in health and nutrition outcomes for children such as stunting, and the prevalence of anaemia and diarrhoea.

The release of the second and final phase of NFHS-5, which covered 11 states (including Uttar Pradesh (UP), Tamil Nadu, Punjab, Rajasthan, Madhya Pradesh (MP), Jharkhand, Haryana, and Chhattisgarh) and about 49 per cent of the population calls for an update of our previous findings.

First, it is now clear that the evidence for the success of New Welfarism is as strong as we had suggested earlier. Figure one plots household access to improved sanitation, cooking gas and bank accounts used by women. The improvements are as striking as they were based on the performance of the phase 1 states. In all cases, access has increased significantly, although claims of India being 100 per cent open defecation-free still remain excessive.

Second, on child-related outcomes, our earlier findings have to be qualified, significantly in the case of stunting and diarrhoea. Earlier we had found that child stunting had stagnated between 2015 and 2019 after decades of progress. When phase 2 states are added, we find that India-wide, stunting has declined although the pace of improvement has slowed down post-2015 compared with the previous decade. For example, stunting improved by 0.7 percentage points per year between 2005 and 2015 compared to 0.3 percentage points between 2015 and 2021. On diarrhoea too, adding the new data reverses the earlier finding. However, on anaemia and acute respiratory illness, there seems to have been deterioration as we had found earlier.

The new child stunting results are significant but also surprising because of the sharply divergent outcomes between the phase 1 and phase 2 states. Figure 3 tries to unpack the new evidence. It plots child stunting rates for the most recent period on the y-axis and rates for 2015 on the x-axis along with a 45-degree line. Points to the north of the line indicate deterioration in performance between 2015 and 2020, while points below the line denote improvement. The phase 1 and 2 states are shown in black and red, respectively. The interesting pattern is that nearly all the phase 2 states show large improvements, whereas most of the phase 1 states exhibited a deterioration in performance.

The survey for the latest data was conducted in two waves, the first before the pandemic and the second during the peak of the second wave (October/November 2020 – March/April 2021). How much the circumstances of the NFHS survey might have affected the results is difficult to say; and if anything, our priors would have been that phase 2 states would have fared worse due to the impact of Covid.

Evidently, the converse has happened. For the moment, we must accept the results while investigating this and other possible anomalies: For example, the data for Tamil Nadu shows a dramatic deterioration in the sex ratio at birth from 954 females to males in 2015 to 878 in 2020, indicating a sharp increase in selective abortion, despite an improvement in the sex ratio of the overall population from 1,033 to 1,088 females per males.

But here’s the real surprise in Figure 3. If the new child stunting numbers are right, a different picture of India emerges. Apparently, Madhya Pradesh now has fewer stunted children than Gujarat; Uttar Pradesh and Jharkhand are almost at par with Gujarat; Chhattisgarh fares better than Gujarat, Karnataka, and Maharashtra; and Rajasthan and Odisha fare better than Gujarat, Karnataka, Maharashtra, West Bengal, Telangana and Himachal Pradesh! On child stunting, the old BIMARU states (excepting Bihar) are no longer the laggards; the laggards are Gujarat, Maharashtra, and Karnataka, and to a lesser extent, West Bengal, Andhra Pradesh and Telangana.

If true, on the key child stunting metric, what we are seeing is not catch-up but the great switch between some of the BIMARU states and the mid-peninsular/western states. Indeed, the decline in stunting achieved by the poorer states such as UP, MP, Chhattisgarh and Rajasthan would be all the more remarkable given the overall weakness in the economy between 2015 and 2021. When commentators speak of two Indias, it is now important to ask: Which ones and on what metrics?

Finally, insofar as health and nutrition are determined by actions of the states, stunting outcomes reflect on their performance. The improvements in Rajasthan have happened under the Congress, in MP and Haryana under the BJP, in Odisha under the BJD, and in UP under both Samajwadi Party and BJP; and the stagnation/setbacks have occurred in Gujarat (BJP), West Bengal (Trinamool), and Telangana (TRS). Neither success nor failure seems to be the monopoly of any one political party.

Written by Abhishek Anand , Arvind Subramanian 

This column first appeared in the print edition on December 3, 2021 under the title ‘New geography of welfare’. Anand is Robert S. McNamara Fellow, World Bank and Subramanian is Senior Fellow, Brown University

Source: Indian Express, 3/12/21