New Delhi: The summary findings of the fifth round of the National Family and Health Survey (NFHS-5) that was released by the Union Health Ministry on Wednesday has come as a much-needed encouragement for Government of India, which has been focusing on improving the socio-economic-health parameters of the country.
The survey has brought positive news, especially on parameters related to improvement in the lives of women. More women are now operating bank accounts, using mobile phones, internet, family planning methods, hygienic methods during menstrual period and owning houses in their names than previously.
Among the multiple findings, spread across several parameters impacting the life of a common man and woman, the NFHS has found that the sex ratio of India (females per 1,000 males) is now 1,020. This was 991 in 2015-12016 when the previous survey was done. More encouragingly, this is 1,037 in the rural areas.
The survey was conducted in two phases between 2019 and 2021. The NFHS is the most comprehensive survey on socio-economic and health indicators in the country. The phase one survey was done from 17 June 2019 to 30 January 2020, while phase two was conducted from 2 January 2020 to 30 April 2021 by 17 field agencies and gathered information from 636,699 households, 724,115 women and 101,839 men.
As per the findings, the percentage of female population constituting 6 years and above who ever attended school was 71.8%, which was 68.8% in the previous survey. The country saw a significant jump in people registering birth with civic bodies. It was found to be 89.1%, a figure which was 79.7% previously. The percentage of households with electricity, which was 88% in the last survey, rose to 96.8% this time. Similarly, people living in households with improved drinking water sources were found to be 95.9%, while 70.2% of the population was using improved sanitation facilities in their households, a figure which was 48.5% in the last survey.
The country also saw a rise of nearly 14% in the category of households with any usual member covered under a health insurance/financing scheme. This was found to be 41% in the present survey, a number which was 28.7% in the last. Households using clean fuel for cooking increased from 45% to 53.2%. For the first time, the survey also found that 33.3% of the women had used internet while the corresponding number for men was 57%.
India’s total fertility rate (average children per woman) was found to be decreasing and it was recorded at 2.0, which was 2.2 previously. This number is below the 2.1 mark, which is known as the replacement TFR, indicating that in the coming years, India’s population growth will stabilize and then decline if the current trend continues. This number of 2 would have come down even more if the TFR level in five states—Madhya Rajasthan, Jharkhand, Uttar Pradesh, Bihar, Manipur and Meghalaya—too had moved parallelly with the national trend. All these states saw a TFR of more than 2.1.
In the field of Infant Mortality Rate (IMR) or death per 1,000 births, the number was recorded at 35.2, which was 40.7 in 2015-2016. A “good” IMR is considered to be under 5.
The number of married women using family planning methods saw an impressive rise of 13.2% to register a figure of 66.7%, which was 53.5% previously. Institutional births were recorded at 88.6%, which was 78.9% previously. Institutional births in public facilities too saw an increase from 52.1% in 2015 to 61.9 % presently.
Children in the age bracket of 12-23 months, who were fully vaccinated saw a sharp rise from 62% to 76.4% this time. Worryingly, 35.5% of children under 5 years were found to be stunted (height-for-age), a number which was 38.4% previously. The percentage of obese women (BMI ≥25.0 kg/m2) increased from 20.6% to 24 %. The corresponding number for men was 22.9%, which was 18.9% previously.
A total of 27% of women were found to be having high blood sugar, the corresponding figure for men was 30%. Hypertension among women was recorded at 39%, while for men it was 45%. The percentage of married women who usually participate in three household decisions was found to be in 88.7% cases, which was 84% previously. Women owning a house and/or land (alone or jointly with others) was found to be in 43.3% cases, which was 38.4% in 2015. Women having a bank or savings account that they themselves use was found in 78.6% cases; this was 53% earlier. Women having a mobile phone that they themselves use was found to be 54%, up from 45.9%.
The number of women aged 15-24 years who use hygienic methods of protection during their menstrual period saw an impressive increase of 20% from 57.6% in 2015. Of the total surveyed women, only 1.3% said that they consume alcohol, while the percentage of men was 18.8%. In the case of tobacco use, it was 8.9% for women and 38% in men.
The previous four rounds of the NFHS were conducted in 1992-93, 1998-99, 2005-06 and 2015-16. The NFHS provides estimates on key indicators related to population, family planning, child and maternal health, nutrition, adult health, and domestic violence, among others. The fourth round of NFHS was conducted five years ago in 2015-16.
NFHS provides important indicators that are used to understand the impact of policy decisions at the macro and micro level and amend it if needed. This time the NFHS, for the first time, included new parameters like preschool education, disability, access to a toilet facility, death registration, bathing practices during menstruation, and methods and reasons for abortion.
It also includes estimates of indicators of sexual behaviour, husband’s background and woman’s work, HIV/AIDS knowledge, attitudes and behaviour and domestic violence. The survey was conducted by the International Institute for Population Sciences, Mumbai.
The survey team collected information related to socio-economic characteristics of the household, water, sanitation, and hygiene, health insurance coverage, disabilities, land ownership, number of deaths in the household in the three years preceding the survey; and the ownership and use of mosquito nets.
The Woman’s Schedule covered a wide variety of topics, including women’s characteristics, marriage, fertility, contraception, children’s immunizations and healthcare, nutrition, reproductive health, sexual behaviour, HIV/AIDS, women’s empowerment, and domestic violence. The Man’s Schedule covered men’s characteristics, marriage, his number of children, contraception, fertility preferences, nutrition, sexual behaviour, health issues, attitudes towards gender roles, and HIV/AIDS.
The Biomarker Schedule covered measurements of height, weight, and haemoglobin levels for children; measurements of height, weight, waist and hip circumference, and haemoglobin levels for women aged 15-49 years and men aged 15-54 years; and blood pressure and random blood glucose levels for women and men aged 15 years and over. In addition, women and men were requested to provide a few additional drops of blood from a finger prick for laboratory testing for HbA1c, malaria parasites, and Vitamin D3.
Significantly, during the time of the survey, Ayushman Bharat AB-PMJAY and Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) were not fully rolled out and hence, the impact of its coverage may not have been factored in the results of the percentage of households with any usual member covered under a health insurance/financing scheme and percentage of mothers who received four or more antenatal care check-ups.