The National Family Health Survey (NFHS) is a multi-round, large-scale survey that is conducted in a representative sample of households across India. These findings represent a complete, comprehensive, multi-dimensional report card on India’s demographic and health trend.

Analysis

• Improvements have been seen in a variety of areas, including educational attainment, institutional deliveries, immunizations, infant mortality, and so on.
• Difference in Sex Ratio at Birth and Adulthood: For the first time in India, there were 1,020 adult women for every 1,000 men between 2019 and 21. The findings, however, should not be used to dismiss the fact that India still has a sex ratio at birth (SRB) that is more biassed towards boys than the natural SRB (which is 952 girls per 1000 boys). The major states with low SRB include Uttar Pradesh, Haryana, Punjab, Rajasthan, Bihar, Delhi, Jharkhand, Andhra Pradesh, Tamil Nadu, Odisha, and Maharashtra.
• Malnutrition Indicators’ Performance: The three malnutrition indicators, stunting (low height-for-age), wasting (low weight-for-height), and underweight (low weight-for-age), all show an improvement. However, this overall improvement creates an anomaly because, in Phase 1 of the NFHS-5, multiple states exhibited a worsening in one or more of these indicators, whereas no states indicated a worsening in Phase 2. It is probable that the covid-19 influenced the Phase 2 survey, resulting in an undercounting of instances.
• TFR Decline is a Major Positive: The Total Fertility Rate (TFR) has been declining over time and is now slightly below the replacement rate of 2.1 (at 2.0). This is true throughout all Indian states, indicating that the total population has stabilised.
• Poor Anaemia Management: The incidence of anaemia in children under the age of five (from 58.6 to 67 percent), women (53.1 to 57 percent), and men (22.7 to 25 percent) has increased in all Indian states (20 percent -40 percent incidence is considered moderate). Except for Kerala (39.4 percent), all states are classified as “severe.”
• Furthermore, the number of overweight children, women, and men is increasing, indicating malnutrition, which can lead to major health repercussions in the form of noncommunicable diseases (NCDs).

Regardless of the pace, the improvement must be applauded, especially considering the appalling state of India’s health system, which has been painfully exposed since the COVID-19 outbreak.

Where the issue lies

• Unethical Delivery Practices Affecting Women’s Health: The survey focuses on measures of women’s empowerment, autonomy, and mobility, as well as women’s reproductive health. However, according to data, caesarean deliveries have increased considerably; 47.5 percent of births in private health facilities are via C-section (14.3 percent in public health facilities). These results are exceedingly unusual and call into question the unethical actions of private health practitioners that place monetary gain ahead of women’s health.
• Pandemic Blame Game: It has been stated that the poor health outcomes reflect the effect of Covid-19 because the data for the Phase-2 of NFHS-5 were largely obtained during the highly exceptional conditions of the COVID-19 pandemic. However, the decline in public health indicators cannot be wholly attributable to the pandemic.
• A ‘One-Size-Fits-All’ Approach to Dietary Intake Monitoring: Indian meals are extremely diverse. Many traditional diets reflect both local climate conditions and a variety of necessary nutrient sources, such as proteins, fats, and so on. Diet policing, which involves enforcing an unnatural uniformity on meals and denying access to animal protein to substantial sections of Indians who are not historically vegetarian, is likely to limit micronutrient diversity and contribute to poor health outcomes.
• Non-Inclusion of Micronutrients: In addition to anthropometric measures, micronutrient deficiencies, i.e. a lack of vitamins and minerals that are essential for body functions such as the production of enzymes, hormones, and other substances required for growth and development, are used to assess malnutrition. Micronutrient data are not available from the NFHS.
• Female sterilisation continues to predominate as the modern technique of contraception in states such as Andhra Pradesh (98 percent), Telangana (93 percent), Kerala (88 percent), Karnataka (84 percent), Bihar (78 percent), and Maharashtra (77 percent ). Male participation in family planning remains restricted, as seen by the poor uptake of condoms and male sterilisation across the states.

Way forward

• Collaboration in the Health Sector: To make basic and advanced health services accessible, affordable, and acceptable to all, current times necessitate integrated and coordinated efforts from all health institutions, academia, and other partners directly or indirectly associated with health care services.
• Policy Interventions to Address Health Issues: The survey reveals significant disparities in health outcomes. The overall evidence suggests that health should be a top priority for national and state governments. To enhance India’s health needs, an action plan that is inclusive, firm in its commitment, and backed by substantial resources is essential.
• Behaviour-Change Communication Strategy: To ensure that males take responsibility for family planning, the government must implement a targeted social and behavior-change communication strategy.
• Taking cue from NFHS: The findings of the NFHS serve as a reminder of the critical need to close disparities in girls’ education and address the deplorable nutritional status of women and children. The pandemic’s impact, as well as the disruption it brought to services such as appropriate nourishment for children, must be acknowledged. Such instances highlight the importance of constructing resilient and fortified systems capable of delivering in the most challenging of circumstances.

The NFHS is secondary only to the extensive data provided by the decennial population census. It should be seen as a watershed moment in Indian policymaking. The larger objective is for states and the centre to recognise it as a matrix to work on and improve development indicators further.

How to structure:

1. Give a brief introduction about NFHS
2. Discuss the major findings of the survey
3. Suggest way forward for areas that requires attention
4. Conclude

Reference:

1. https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece