National Family Health Survey- 5

GS-Paper-3 Application-based topic and PT

The National Family Health Survey is a survey carried out on a massive scale across the country to collect information on many parameters which would ultimately help the Ministry of Health and Family Welfare (MOHFW) to frame policies and programs to help in the upliftment of the vulnerable groups in India. The first round of the National Family Health Survey was conducted in 1992-92. Subsequently, four other rounds have taken place, the latest being NFHS 5 which started in 2018-19, however, is stalled currently amid the COVID-19-associated lockdown at various states.

National Family Health Survey?

• The NFHS is a large-scale, multi-round survey conducted on a representative sample of households throughout India.
• Three rounds of the survey have been conducted since the first survey in 1992-93.
• The survey provides state and national information for India on fertility, infant and child mortality, the practice of family planning, maternal and child health, reproductive health, nutrition, etc.
• The Ministry of Health has designated the International Institute for Population Sciences (IIPS) Mumbai, as the nodal agency, responsible for providing coordination and technical guidance for the survey.

National Family Health Survey 5 is the recent round of the survey carried on by MoH&FW to bring out reliable data on emerging health and family welfare issues. The coordinating and implementing agencies that are helping the ministry to bring out this NFHS round are:

• International Institute for Population Sciences, Mumbai
• A group of survey organizations and Population Research Centres

ICF International is providing technical assistance for the NFHS 5 while the United States Agency for International Development is providing financial assistance.

Seven lakh households are being covered to collect the data. 67 indicators are being used to cover the NFHS 5 data. The list of important indicators is mentioned below:

• Population and household profile (PT POINTER)
• Marriage and fertility
• Family planning
• Contraception
• Maternal and child health
• Delivery care
• Vaccinations
• Treatment of childhood diseases
• Nutrition and feeding practices
• Anaemia
• Diabetes
• Hypertension and
• Cancer Examination

Note: The data for NFHS was expected to be released by July 2020 but due to the current pandemic situation, it has been delayed.

Key Facts

Total Fertility Rate (TFR): The TFR across most Indian states declined in the past half a decade, more so among urban women. This implies that India’s population is stabilizing. Sikkim recorded the lowest TFR, with one woman bearing 1.1 children on average; Bihar recorded the highest TFR of three children per woman.

In 19 of the 22 surveyed states, TFRs were found to be ‘below-replacement level (2.1)’.
TFR indicates the average number of children expected to be born to a woman during her reproductive span of 15-49 years.

The replacement level is the number of children needed to replace the parents, after accounting for fatalities, skewed sex ratio, infant mortality, etc. Population starts falling below this level.

Anaemia among Women: More than half of the children and women are anaemic in 13 of the 22 States/UTs.

It has also been observed that anaemia among pregnant women has increased in half of the States/UTs compared to NFHS-4. In all the states, anaemia is much higher among women compared to men.

Contraception: Female sterilization continues to dominate as the modern method of contraception in states like Andhra Pradesh (98%), Telangana (93%), Kerala (88%), Karnataka (84%), Bihar (78%) and Maharashtra (77%).

Overall Contraceptive Prevalence Rate (CPR) has increased substantially in most States/UTs and it is the highest in HP and WB (74%).

Child Marriages: There has been an increase in child marriages in Tripura (40.1% from 33.1% in 2015-16), Manipur (16.3% from 13.7% in 2015-16) and Assam (31.8% from 30.8 % in 2015-16),

States like West Bengal (41.6%) and Bihar (40.8%) still have high prevalence of child marriages. States such as Tripura, Manipur, Andhra Pradesh, Himachal Pradesh and Nagaland have also shown an increase in teenage pregnancies.

Domestic/Spousal Violence: It has generally declined in most of the states and UTs. However, it has witnessed an increase in five states, namely Sikkim, Maharashtra, Himachal Pradesh, Assam and Karnataka. Karnataka witnessed the largest increase in spousal violence, from 20.6% in NFHS 4 to 44.4% in NFHS-5. Sexual violence has increased in five states (Assam, Karnataka, Maharashtra, Meghalaya and West Bengal).

Institutional Births: Have increased substantially with over four-fifth of the women delivering in institutions in 19 States and UTs. Institutional delivery is over 90% in 14 out of the total 22 States and UTs.

Caesarean (C-section) Deliveries: There has been an increase in the number of Caesarean section (C-section) deliveries in a majority of states.

The international healthcare community has considered the ideal rate for caesarean sections to be between 10% and 15%. States such as Telangana, West Bengal, Himachal Pradesh, and some in the northeast, have shown a jump in C-section deliveries, especially at private healthcare facilities, in the last five years. In some states like Telangana and West Bengal, the C-section deliveries, at private healthcare facilities rose up to 81% and 82%.

Sex Ratio at Birth: SRB has remained unchanged or increased in most States/UTs. Majority of the states are in normal sex ratio of 952 or above. SRB is below 900 in Telangana, Himachal Pradesh, Goa, DNH & DD.

Child Nutrition: Child nutrition indicators show a mixed pattern across states. While the situation improved in many States/UTs, there has been minor deterioration in others. Drastic changes in respect of stunting and wasting are unlikely in a short period.

Financial Inclusion: Considerable progress has been recorded between NFHS-4 and NFHS-5 in regard to women operating bank accounts.

Sanitation and Clean Air: The percentage of households with improved sanitation facilities and clean fuel for cooking has increased in almost all the 22 States/UTs over the last four years (from 2015-16 to 2019-20). The Government of India has made concerted efforts to provide toilet facilities to maximum households through Swachh Bharat Mission, and improved household environment through Pradhan Mantri Ujjwala Yojana in the country.

Quick FACTS

Who Published NFHS?

MOHFW has appointed International Institute for Population Sciences (IIPS), Mumbai as the Nodal agency. IIPS has collaborated with the following international agencies for the successful conduct of the survey.

1. ORC, Macro, Maryland, USA
2. East-West Centre, Honolulu, Hawaii, USA

Note: in NFHS 4 and NFHS 5, along with USAID and ICF; DFID, the Bill and Melinda Gates Foundation, UNICEF, UNFPA, and the MacArthur Foundation, as well as the Indian Government also supported the surveys in a major way.

Which Agencies Provided the Funding for NFHS?

Many international agencies and the Central Government Ministry have provided the necessary funds to carry out the survey.

1. United States Agency for International Development (USAID)
2. United Nations Children’s Fund (UNICEF)
3. Bill and Melinda Gates Foundation
4. United Nations Population Fund (UNFPA)
5. MOHFW, Government of India

Also, the data that is published by the Ministry is also used by the WHO, World Bank & UNICEF.

What is NFHS-4?

It is the Fourth Round of National Family Health Survey conducted under the aegis of the Ministry of Health and Family Welfare (MOHFW). The following are some of the major highlights of the program.

1. District level estimates on many indicators were provided for the first time.
2. 14 Field agencies were involved in the collection of data
3. Gathered information from approximately 6 lakh households.
4. Survey took information from approximately 7 lakh women and 1 lakh men.

Conclusion

Health is the most important social infrastructure if we want to develop our demography. Current times require integrated and coordinated efforts from all health institutions, academia and other partners directly or indirectly associated with the health care services to make these services accessible, affordable and acceptable to all. The data in NFHS-5 gives requisite input for strengthening existing programmes and evolving new strategies for policy intervention, therefore government and authorities should take steps to further improve the condition of women in India.