CONTEXT

• The national health and demographic report card is finally completely out.
• The results from the first phase (conducted between June 2019 and January 2020) of the fifth round of the National Family Health Survey (NFHS-5) were released in 2020.
• Recently the key results from the second phase (conducted between January 2020 and April 2021) are out.

NATIONAL FAMILY HEALTH SURVEY

• NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
• All NFHSs have been conducted under the supervision of the Ministry of Health and Family Welfare, Government of India, with the International Institute for Population Sciences (IIPS) Mumbai, serving as the nodal agency.
• Every National Family Health Survey (NFHS) has two specific goals to fulfill. These goals are:
  • To provide essential data needed by the Ministry of Health and Family Welfare and other agencies for informed decision making and policy and programme intervention purposes.
  • To provide insight regarding important emerging health and family welfare issues.

GOOD PERFORMANCE

India’s performance is a mixed verdict, containing both cheer and alarm in abundant measure.

Population has stabilised

• • A comparison of NFHS-5 with NFHS-4 (2015-16) reveals improvement in several dimensions such as educational attainment, institutional deliveries, vaccinations, infant mortality and much more.
  • The biggest news from NFHS-5 is that the total fertility rate (TFR), which is the average number of children born to a woman during her lifetime, has been falling over time and is now just below the replacement rate of 2.1.

• This is true across all States of India.

• • Thus indicating that the total population has stabilised.
• This will allow politicians to devote their energies to urgent health matters, instead of raising the bogey of population explosion to justify coercive population policies.
• There is absolutely no evidence to justify tying welfare support measures or holding elected office to the number of children.

Data on sex ratio

• This survey reveals that nationally, there are 1,020 adult women per 1,000 men for the first time.

Malnutrition

• • Usually, malnutrition is associated with poverty, poor maternal health and nutrition, frequent illness and/or inappropriate feeding and care in early life.
  • It prevents children from reaching their physical and cognitive potential.
  • There are three indicators of malnutrition:
    • stunting (low height-for-age),
    • wasting (low weight-for-height)
    • underweight (low weight-for-age)

• All these three indicators have shown an overall improvement.

CONCERNS ATTACHED

Unclear reason behind improved Sex Ratio

• • Improved sex ratio of the country raises the question — if this signal the beginning of the end of another deep-rooted problem of son preference which leads to illegal but pervasive sex-selective abortions as parents repeatedly try for at least one son?
    • To gauge this, the key metric to examine would be the sex ratio at birth (SRB).
    • If there are pervasive sex selective abortions, leading to a masculine SRB, a part of this imbalance would carry forward into adulthood.
    • But adult sex ratio is shaped by many factors other than sex selective abortions, as it can be affected by sampling errors, arising, for instance, from undercounting migrant males.
  • Although nationally, the SRB has improved from 919 in 2015-16 to 929 in 2019-21, but it is still short of the natural SRB.

• The natural SRB translates to 952 girls per 1,000 boys.

• Major States with low SRBs are spread all over the country: Uttar Pradesh, Haryana, Punjab, Rajasthan, Bihar, Delhi, Jharkhand, Andhra Pradesh, Tamil Nadu, Odisha, Maharashtra.
• Therefore, there is a need to recognise that the move to a small family size combined with persistent son preference is likely to impede the improvements in SRB.

Increase in case of Anaemia

• A key health indicator that has worsened is the incidence of anaemia in under-5 children (from 58.6 to 67%), women (53.1 to 57%) and men (22.7 to 25%) in all States of India.
• Anaemia has weakening effects on overall health, which is why the World Health Organization characterises it as a serious public health concern.
• Indian States show variation: from 39.4% in Kerala to 79.7% in Gujarat: but barring Kerala, all States are in the “severe” category.
  • Further this situation may worsen as the COVID-19 effect.

Anomaly in Malnutrition estimates

• The overall reduction in national estimates of these three measures masks an anomaly.

• • In Phase 1, several States revealed a worsening in one or more of these, whereas in Phase 2, none of the States showed a worsening.
• Hence, there is a need to understand if the novel coronavirus pandemic affected the survey in Phase 2, leading to undercounting of incidence, or whether by pure chance, all States in Phase 2 happen to be better performers on the malnutrition count.
• Also, along with an improvement in these three indicators, there is an increase in the proportion of overweight children, women and men.
  • Being overweight also reflects malnutrition, with serious health consequences in the form of non-communicable diseases.

 Data on Micronutrients

• Despite micronutrient deficiencies significant role in measuring lack of adequate nutrition, NFHS does not have data on it.
  • Micronutrient deficiencies include lack of vitamins and minerals that are essential for body functions such as producing enzymes, hormones and other substances needed for growth and development.

Policing of Diet

• Indian diets display a rich diversity. Many traditional diets reflect both local climatic conditions as well as a multiplicity of sources of essential nutrients, such as proteins.
• But policing of diets, by imposing an unnatural uniformity, and preventing access to animal protein for large sections of Indians that are not traditionally vegetarian is likely to reduce micronutrient diversity and contribute to poor health outcomes.

Unethical actions of private health practitioners

• The survey shines a spotlight on women’s reproductive health, and reveals, for instance, that cesarean births have increased dramatically.
  • In private health facilities, 47.5% births are by C-section and 14.3% in public health facilities.
  • These findings are exceedingly unusual and bring into question the unethical actions of private health practitioners that put financial gain before women’s health.

ISSUES WITH THE NFHS-5

• Some analyses have suggested that the rate of progress has slowed down, based on comparisons between NFHS-4 and NFHS-5 to the improvements between the two previous rounds.
• Some have argued that COVID-19 is to blame for the bad health consequences.
• The data for the second phase of NFHS-5 have been, to a large extent, collected during the highly unusual conditions of the COVID-19 pandemic.

CONCLUSION

• The overall evidence from the NFHS-5 is compelling and clear that health ought to be a matter of concern for all political parties and all governments, both at national and State level.
• The survey highlights deep inequalities in health outcomes.
  • Hence, an action plan to improve India’s health needs to be inclusive, firm in its commitment, and backed by solid resources.

Reference:

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