Arshad Shaikh looks at the recently released NFHS data that provides the latest information on our population, health and nutrition.  India is aspiring to become a $5 trillion economy and seeking to transform itself into a ‘developed nation’ from its current tag of an ‘emerging economy’. However, as the United Nations Human Development Index shows (our current rank is 131/189); it is not the GDP alone that determines the position of a nation, rather it is indicators such as long and healthy life, level of knowledge and a decent standard of living that demonstrates its journey on the path of development. The NFHS data gives us an indirect glimpse of the inequalities, poverty, and the level of empowerment in society. Unfortunately, the numbers cut a sorry figure, posing numerous challenges for society, policymakers and the government.

The National Family Health Survey 2019-21 (NFHS-5) can be publicly accessed through the link – http://rchiips.org/NFHS/NFHS-5Reports/NFHS-5_INDIA_REPORT.pdf. The survey gives us information on the population, health, and nutrition for India and its various states and union territories. It is the fifth survey in the NFHS series. The indices of NFHS-5 are similar to NFHS-4 to allow comparisons of tabulated data over time.

As can be seen in the report, the “NFHS-5 contains new indicators such as preschool education, disability, access to a toilet facility, death registration, menstrual hygiene, expanded domains of child immunisation, components of micro-nutrients to children, frequency of alcohol and tobacco use, measuring hypertension and diabetes among all aged 15 years and above and methods and reasons for abortion.

“The NFHS-5 sample was chosen in such a manner as to provide national, state/union territory (UT), and district level estimates of various indicators covered in the survey. However, estimates of indicators of sexual behaviour; husband’s background and woman’s work; HIV/AIDS knowledge, attitudes and behaviour; and domestic violence are available only at the state/union territory (UT) and national level and not at district level.

“As in the earlier rounds of surveys, the Ministry of Health and Family Welfare, Government of India, designated the International Institute for Population Sciences, Mumbai, as the nodal agency to conduct NFHS-5. The main objective of each successive round of the NFHS has been to provide high-quality data on health and family welfare and emerging issues in this area.”

Let us look at some of the key findings of the survey and check what it tells us about the health of our nation.

KEY FINDINGS OF NFHS-5

The NFHS-5 data is also a useful aid in tracking our progress on the United Nations Sustainable Development Goals (SDGs). Let us look at some of the key findings in the survey.

Underage Marriages: on an overall basis, the national average for underage marriages has reduced. The NFHS-5 shows that 23.3% women in the survey were married before reaching the legal age of 18 years. This is down from 3.5% less than what was reported in NFHS-4. In men, the incidence of underage marriage is less i.e. 17.7% for NFHS-5 and 20.3% for NFHS-4. Teenage pregnancies have come down from 7.9% to 6.8% between NFHS- 5 and NFHS-4. The use of contraception to avoid pregnancy is 66.3% among working women compared with 53.4% who are homemakers.

Domestic violence against women continues to remain high around 30% although it has reduced slightly from 31.2% in the earlier survey. Incidentally, only 14% of women who experience physical or sexual violence raise the issue in public. Institutional births or deliveries in hospitals increased significantly from 79% to 89% at the national level.

The number of stunting in children less than five years continues to be as high as 38%. The gap between urban and rural stunting is about 7%. About 67% children between 6 to 59 months have anaemia. In NFHS-4, the number was 58.6%.

Another dismal statistic recorded was that 89% children between the ages of 6 to 23 months do not get an adequate diet. In contrast, obesity has gone up from 21% to 24% in women and from 19% to 23% among men between NFHS-4 and NFHS-5. The number of households not availing of a government health facility was 55.1% while it was 49.9%, in the previous survey.

The preference for having a boy over a girl continues to plague Indian society. NFHS-5 shows that about 65% of married women between 15 to 49 years with no sons and two daughters do not want any more children compared to 91% with two sons and no daughters.

Total Fertility Rate (TFR) or births per woman: this reduced from 2.2 to 2.0, between the NFHS-4 and NFHS-5 at the national level. One should note that the replacement level of fertility i.e. the level of fertility at which a population exactly replaces itself from one generation to the next without migration stands at 2.1. Only Bihar, Meghalaya, Uttar Pradesh, Jharkhand and Manipur have this replacement level of fertility of 2.1. In rural India, the TFR declined from 3.7 in 1992-93 to 2.1 in 2019-21. A corresponding decline of TFR in urban areas has been from 2.7 in 1992-93 to 1.6 in 2019-21. A significant finding of the NFHS-5 is that the TFR among the Muslim community has seen the sharpest decline compared to other religious communities over the past two decades.

CHALLENGES FOR POLICYMAKERS AND POLITICIANS

The latest health survey should act as a revelation for our politicians and policymakers. The survey throws light on a myriad of issues that deserve immediate priority. Unfortunately, our lawmakers and those who control the reins of governance at the highest level seem to be obsessed with resurrecting a mythological era of glory that can only be achieved by suppressing the rights of a large section of society. The zealotry and fanaticism seen in society for humiliating minorities and for asserting the religion and culture of the majority community seem to be significantly lacking when it comes to improving the indices on which we are significantly falling behind in terms of SDGs and our HDI. 

Our scores on issues like domestic violence, children suffering from anaemia, stunting, and an inadequate diet should give sleepless nights to the harbingers of our “Amrit-kaal”. However, because they only point to their failure of governance, other emotional issues of ‘kabristan’ and ‘mandir-masjid’ are turned into issues of national importance that deserve utmost primacy.

Our society is fast losing its moral compass and acquiring traits, which saw the decline and eventual disappearance of many a great civilization. The decline in TFR to a level at which a population cannot replace itself should have set the alarm bells ringing for our policymakers. The case of Japan and now even China and South Korea is before us. The preference for boys over girls is also symptomatic of a misogynistic, ruthless, and discriminatory society. The oft-repeated adage that ‘when wealth is lost, nothing is lost; when health is lost, something is lost; when character is lost, everything is lost; points towards the moral depravity that has engulfed us. We have already lost something. Let us not lose everything.

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