More hospital births but limited gains in childhood nutrition: National Family Health Survey-5

Births in institutional facilities, such as a hospital, improved by nearly eight percentage points but children who were either stunted or displayed signs of wasting only dropped by a maximum of three percentage points, shows a comparison of National Family Health Survey (NFHS)-5 and NFHS-4.

The complete results of the NFHS-5 were made public on Wednesday. The NFHS-4 was released in 2014-15 and the latest, which captured population health indicators in 2017-19, was delayed due to the pandemic.

Growth under check

India has also officially hit a total fertility rate (TFR) of 2.0 that indicates a decrease from the 2.2 in the NFHS-4. According to the United Nations Population Division, a TFR of about 2.1 children per woman is called replacement-level fertility. If replacement level fertility is sustained over a sufficiently long period, each generation will exactly replace itself. The urban TFR is 1.6 and the rural TFR is 2.1

“This is a significant feat for the country’s family-planning programme, which does not include coercive policies. These findings bust the population-explosion myth and show that India must steer away from coercive measures of population control. While the increase in the use of modern contraceptive methods is heartening, an increase in female sterilisation coupled with continued stagnation in male sterilisation uptake shows that the onus of family planning still lies with women,” the Population Foundation of India, a nongovernmental organisation, said in a statement.

An overall survey of the major differences between the NFHS-5 and NFHS-4 suggests that the use of contraceptives has improved from 53.5% to 66.7% in the latest NFHS-5 and institutional births increased from 78.9% to 88.6%.

The proportion of children (12-23 months) who were fully vaccinated improved from 62%-76% and children under 6 months who were exclusively breastfed also showed a sharp improvement from 54.9 to 63.7%.

Nutrition concerns

There were, however, mixed signals in nutrition. Though the gains in childhood nutrition were minimal, women and men (15-49) who had a below normal body mass index (BMI) each dropped roughly four percentage points. Those overweight (or had a higher BMI than ideal) increased by around 4 percentage points. Abnormal BMIs are linked to an increase in obesity and other non-communicable diseases (NCD).

India’s battle with anaemia also appears to have faltered. The proportion of anaemic children (5-59 months) increased from 58% to 67%. Women aged 15-49 who were anaemic increased from 53% to 57% and men of the same age increased from 29% to 31% between both editions of the NFHS.

An expert said that a nutritionally deficient diet likely explained the rise in obesity.

“What is gobsmacking is the increase in those overweight, the very large burden of NCD and the very challenging findings on waist-hip ratio. 56.7% women and 47.7% men have high-risk waist-to-hip ratio. What we are going to see is that many of these are diet-related diseases, especially the quality of people’s diets and what people can afford to eat,” said Purnima Menon, Senior Research Fellow, International Food Policy Research Institute.

“Slow and steady progress [is seen] on stunting, which seems to be coming from change happening in big States such as Uttar Pradesh and others. These are outcomes that depend on multiple interventions and take longer to achieve,” she said.

The findings of NFHS-5 from 22 States & UTs covered in Phase-I were released in December, 2020 and the remaining comprising Arunachal Pradesh, Chandigarh, Chhattisgarh, Haryana, Jharkhand, Madhya Pradesh, NCT of Delhi, Odisha, Puducherry, Punjab, Rajasthan, Tamil Nadu, Uttar Pradesh and Uttarakhand were made public on Wednesday.

The NFHS-5 survey work has been conducted in around 6.1 lakh sample households from 707 districts (as on March, 2017) of the country; covering 7,24,115 women and 1,01,839 men to provide disaggregated estimates up to district level.

NFHS-5 includes some new focal areas, such as death registration, pre-school education, expanded domains of child immunisation, components of micro-nutrients to children, menstrual hygiene, frequency of alcohol and tobacco use, additional components of non-communicable diseases (NCDs), expanded age ranges for measuring hypertension and diabetes among all aged 15 years and above, which will give requisite input for strengthening existing programmes and evolving new strategies for policy intervention.

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