On the heels of the National Family Health Survey-5 (NFHS-5), which revealed new demographic trajectories including the replacement level of fertility, the government will, on Monday, unveil extensive economic data related to health and the broader economy. New data will relate to per capita spending on health and proportions of the GDP to health spending.
Health ministry sources said the NFHS-5 marked some areas for celebration but also some markers that should cause concern. While the Total Fertility Rate (TFR) (children per women) has reached 2 children per women compared to 2.2 in 2015-16, which means women are giving birth to fewer children than before indicating better knowledge and use of family planning services, two-thirds of the currently married women (in the ages 15 to 49) are using family planning methods to delay or limit pregnancies in NFHS-5 (2019-21 period) compared to only 53.5 per cent in NFHS-4 (2015-2016). This means overall better quality of life for families as resources are not spread as thin, but it also means India will have to begin thinking about its ageing population sooner.
NFHS-5 also reveals that birth registration of children under 5 has increased from 79.7 to 89 per cent. This ensures a birth certificate, the right to vaccinations and other essential social services. The increase in institutional deliveries from 78.9 per cent to 88.6 per cent in NFHS-5 suggests overall better health for both mother and child, by properly trained health personnel preventing maternal and newborn death. In all, 78 per cent mothers now receive postnatal care from health personnel within two days of delivery, a significant rise from 62.4 per cent in NFHS-4.
However, stunting of children, largely as a result of poor diet or recurrent infection that puts children at great risk for illness and death, has declined only marginally between the two surveys, which means both state and central governments (health is a state subject) need to act immediately. NFHS-5 showed stunting at 35.5 per cent, while the earlier round showed the proportion of stunted children at 38.4 per cent. A similar marginal reduction was seen in wasting in children (weight for height), usually a symptom of acute undernutrition. Wasting in children was 21 per cent in NFHS-4 and has gone down to 19.3 per cent in NFHS-5. The proportion of underweight children also shows only a small decline from 35.8 to 32.1 per cent.
Anaemia was a similar area of concern. The proportion of pregnant women between 15 and 49 who are anemic has actually increased between the two surveys: from 50.4 per cent to 52.2 per cent. Overall figures of anaemic women between 15 and 19 has gone up from 54.1 per cent to 59.1 per cent, suggesting the current regimen of folic acid tablets and iron supplements is not working.
Officials said the figures on health insurance in India were low but this should be seen in context. The full impact of Pradhan Mantri Jan Arogya Yojana (PMJAY) could not be captured by the survey as it was started in September 2018 when the survey was in the middle of being completed. The full extent of health insurance will be seen in the next round of the health survey due 2023, officials said.
A heartening aspect of the health survey is that the battery of efforts to prevent sex discrimination at birth seem to have worked. The gender ratio at birth for children born in the last five years is still 929, which suggests preference for male children, but the sex ratio which was 991 to 1,000 in 2015-16 in NFHS-4 has improved to 1,020 women for every 1,000 men.
The detailed NFHS-5 will be out by the end of the year.