Five Bright Spots and Four Causes For Worry From The First Official Indian Health Survey In A Decade

The Ministry of Health and Family Welfare finally released the findings of the fourth National Family Health Survey (NFHS), India’s primary source of data on public health, on Tuesday. The NFHS-4, which is meant to be conducted every five years, comes after a ten year gap this time because of differences of opinion between the government and its partners.

Nevertheless, the new data is a rich source of information on public health indicators and an important measure of the success and failure of government interventions over the last decade.

First the (mostly) good news.

1. On most key public health indicators such as infant mortality, maternal mortality, child marriage, teen pregnancy, child immunisation and institutional deliveries, the NFHS reports improvements in the ten years between 2005-06 and 2015-16.

2. There have been significant improvements in child nutrition; and the share of stunted (lower than expected height for age) and underweight (lower than expected weight for age) children has decreased. However, the proportion of wasted (lower than expected weight for height) and severely wasted children has grown.

The prevalence of low BMI (Body Mass Index) among adult men and women has also fallen.

3. The NFHS has recorded a big jump in the proportion of people covered by health insurance or a health scheme, from less than 5 percent in 2005-6 to nearly 30 percent in 2015-16.

4. The share of women who participate in household decisions and have a bank account has gone up, and the share of those who said they experienced spousal violence has gone down.

5. Both alcohol and tobacco use have gone down.

Now the worrying news.

1. The use of family planning has fallen further in the last ten years, and now just half of all women of reproductive age use any kind of contraceptive method; female sterilisation remains the most common choice, with over a third of the women surveyed reporting using this method.

2. Nearly one in three urban women and one in four urban men are now obese, a significant increase over the last ten years. The NFHS defines obesity as having a Body Mass Index (weight-to-height ratio) of more than or equal to 25 kg/m2.

3. India is progressing very slowly on combating anaemia. While anaemia among children between 6 months to five years of age has fallen from nearly 70 percent in 2005-06 to around 60 percent now, the figure still remains alarmingly high. Progress has been even more modest in combating anaemia among adults; 53 percent of all women (including 50 percent of pregnant women) are anaemic, as are 23 percent of all men, and there has been little improvement over the last decade.

4. While India has made big progress in increasing institutional deliveries (deliveries in hospitals or health centres), a key measure in tackling neonatal and maternal mortality, the share of Caesarean section deliveries is rising alarmingly fast. The need for C-sections should not exceed 10-15 percent, a WHO paper argued in 2010. Yet, the NFHS-4 confirms that urban India and private hospitals in particular appear to be conducting far more C-sections than necessary. In private hospitals in urban India, the share of C-sections rises to an astonishing 45 percent of all deliveries.