The fifth National Family Health Survey 2019-21 (NFHS-5) conducted by the Ministry of Health and Family Welfare, Government of India, provides extensive insights on population, health and nutrition at the country and state/union territory level and even the estimates at the district level. The survey touches on over 130 parameters across 21 sub-categories, with some specific to women and children and others aimed at a broader population. It also provides a comparison of the performance of the urban and rural population.
For the first time, the sex ratio of the total population (females per 1,000 males) crossed the four-figure mark. It stood at 1,020 females per 1,000 males vis-à-vis 991 in NFHS-4 conducted in 2015-16. This is a significant achievement and success of the government measures against the practice of female infanticide. A major contribution towards this achievement is the enactment of Pre-Natal Diagnostic Technique (PNDT) Act, 1994, which prohibits sex selection and the misuse of PNDTs.
Further, India has traditionally experienced a high Maternal Mortality Rate (MMR); however, concerted efforts and targeted measures are showing results. The MMR declined to 102.7 per 100,000 live births, and the country is poised to surpass its Sustainable Development Goal (SDG) target well before 2030. Among the major causes of MMR are anaemia, non-institutional deliveries, diabetes, and high blood pressure, among other medical and delivery-related complications. As per NFHS-5, mothers who consumed iron folic acid for over 100 and 180 days when they were pregnant increased by 50 per cent and 90 per cent, respectively, vis-à-vis the previous survey. Iron folic acid helps curb anaemia. Yet, the incidence of anaemia recorded a rise both in pregnant and non-pregnant women across all age groups. This fact needs a deeper study to understand the underlying factors. Similarly, mothers with antenatal check-ups and post-natal care recorded a rise, which helps to address delivery-related complications. Another factor contributing to a reduction in MMR is the rise in institutional deliveries and those attended by skilled health professionals and a reduction in home births in both the urban and rural districts.
However, the rising lifestyle diseases pose a challenge to the progress made on MMR. The incidence of diabetes and hypertension among Indians is on the rise and affects both genders. For the first time, NFHS-5 captures the prevalence of diabetes and hypertension in India. Among adult women (aged 15-49), the incidence of high blood sugar levels or those taking medication to control it was reported at 13.5 per cent of the population (16.3 per cent urban and 12.3 per cent rural). Similarly, adult women with high blood pressure levels or those taking medications to control it were recorded at 21.3 per cent of the population (23. 6 per cent urban and 20.2 per cent rural).
On the aspect of nutritional status of adults, women with Body Mass Index (BMI) below normal (18.5 kg/m2) declined to 18.7 per cent from 22.9 per cent, indicating improving nutrition. However, women with a BMI of 25.0 kg/m2 (obese or overweight) recorded a 15 per cent rise and stood at 24 per cent vs 20.6 per cent in the previous cycle, with a substantially higher share among urban women. A first for the survey was capturing the hip-to-waist ratio. More than half of adult women (56.7 per cent) recorded a ratio of more than 0.85, which is considered the threshold. And there was not much difference between urban and rural women.
When it comes to the consumption of tobacco and alcohol, adult rural women trump their urban counterparts. At 10.5 per cent of the population, tobacco consumption in rural women is twice that of their urban counterparts (5.4 per cent), and rural alcohol consumption (1.6 per cent) is almost three times the urban share (0.6 per cent).
In conclusion, the NFHS-5 survey highlights significant progress in various health indicators of women, particularly in improving the sex ratio, reducing maternal mortality, and enhancing institutional deliveries. The survey underscores the positive outcomes of targeted government interventions such as the PNDT Act and the promotion of antenatal and post-natal care. However, the findings also draw attention to emerging health challenges, notably the rise in lifestyle-related diseases like diabetes, hypertension, and obesity, which pose a new threat to women's health. The increase in anaemia rates despite improved iron folic acid consumption further necessitates comprehensive research into its underlying causes. Additionally, the disparity in tobacco and alcohol consumption between rural and urban women signals the need for tailored awareness and intervention programs. While the NFHS-5 reflects commendable strides in health and nutrition, addressing the evolving health challenges will be crucial in sustaining and accelerating India's progress towards its health and development goals.
Very informative, and encouraging.
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