The NFHS-5 factsheets for India and all states and union territories are now published. At first glance, it seems like a mixed bag – lots to cheer, but concerns remain.
The good news is that our demographics, especially the gender balance, seem to be changing. For the first time since the 1992-93 NFHS survey, the gender ratio in the adult population is slightly higher. It is also the first time in 15 years that the gender ratio at birth reached 929 (in 2015-16 it was 919 for 1,000 men).
The overall fertility rate has also fallen from 2.2 percent to a replacement rate of 2 percent, although little has changed in the huge fertility gap between high and low fertility states. It appears that states that were already seeing declines in fertility rates continue to do so, without any significant change in trends in the states with higher fertility rates. This fertility gap can have several socio-economic and political implications in any society. It can be assumed that this challenge will be given adequate attention at the political and social level after the detailed report has been published. But it appears that policies and programs to empower girls and women have had positive results, and a direct link can easily be drawn between increased literacy among women, improved gender ratios and decreased overall fertility rates.
General literacy and the proportion of women and men who have completed ten or more years of schooling has improved noticeably, reaching 41 percent and 50.2 percent, respectively. Of course, much remains to be done, especially as these figures imply that around half of our workforce still lacks the qualifications and skills to move up and escape the poverty trap.
The health sector deserves credit for improving the percentage of home births, prenatal care and child vaccination rates. Newborn, infant, and child mortality rates have also steadily decreased – a decrease of about 1 percent per year in newborn and infant mortality and 1.6 percent per year in the under-five mortality rate.
Let us now turn to the problem areas – nutrition or nutrition-related indicators. First of all, since NFHS-4 (2015-16) India has grown into a country with more anemic people aged 15 to 49. Almost half of our human capital lacks iron power.
The insidious, adverse effects of anemia affect all age groups – lower physical and cognitive growth and vigilance in children and adolescents, and lower learning and play skills, which directly impacts their future potential as productive citizens. Reduced work ability and rapid fatigue in adolescents and adults lead to lower work performance and lower income. In addition, anemia progresses to maternal anemia in adolescent girls (59.1 percent) and is a leading cause of maternal and infant mortality, as well as general morbidity and illness in a community.
While there have been some improvements, there is cause for concern that pregnant women are inadequately consuming IFA tablets. Perhaps the detailed report explains why a special program like Anemia Mukt Bharat, which focused on the use of IFAs, failed to gain momentum.
Equally worrying is the extremely slow improvement in nutrition indicators across all age groups. Between NFHS 4 and NFHS 5, the proportion of children under five who are moderately underweight has decreased from 35.8 percent to 32.1 percent, moderately stunted children have decreased from 38.4 percent to 35.5 percent, moderately wasted from 21 percent to 19.3 percent and heavy waste rose slightly from 7.5 percent to 7.7 percent. Details on severely stunted and underweight children are published in the detailed report.
The main reason for this is that the proportion of children under two years of age receiving adequate nutrition is only 11.3 percent, up slightly from 9.6 percent in NFHS-4. This fundamental nutritional deficit, which should be viewed as an indicator of great concern, is generally ignored by policy makers and experts. If this is not addressed, rapid improvement in nutritional indicators cannot occur.
India’s nutrition programs need regular review, just like our health programs from the Reproductive and Child Health (RCH) program in 1997 to the current National Health Mission (NHM) to fill gaps such as institutional care, ambulance services, adolescent anemia, and other health care volunteers. The Integrated Child Development Services (ICDS), perceived as guardians of the country’s nutritional welfare, need to reassess themselves and close critical intervention gaps both conceptually and programmatically and achieve quick results. Ad hoc add-ons are not enough, and smartphones, tweets and webinars cannot replace tough on-site actions.
The author is a retired minister from the Government of India
