Measuring progress

NFHS data should guide policy

The Union Ministry of Health and Family Welfare has released the disaggregated microdata from the fifth round of the National Family Health Survey, or NFHS-5, which was conducted over two years starting in 2019. This is the first release of the NFHS since the fourth round, conducted in 2015-16, and provides considerable information about the direction of several indicators of broader welfare in India. The big headline number was already generally known: That India’s total fertility rate, or TFR — the number of children a woman of childbearing age is expected to have — has dipped below the “replacement rate” of 2.1, down from 2.2 in NFHS-4. This has happened sooner than had been expected till recently. While the effect on population growth will be seen only with a lag, it is clear that growing prosperity and female education have, among other factors, begun to address the population problem, which had been seen as insoluble as recently as the 1990s.

Since much attention is paid to the geographical and social dimensions of fertility, it is worth noting that all communities saw a decline in fertility. The TFR for Hindu women in NFHS-5 was at 1.94, and for Muslim women at 2.2. Some of that difference is explained by geographical, income, and educational variations. Muslim women saw the fastest decline in fertility since NFHS-4, and the percentage of Muslim women with no schooling at all has declined sharply from 32 per cent in NFHS-4 to 22 per cent in the latest round, as compared to a decline from 31.4 per cent to 28.5 per cent for Hindu women. Geographically, urban areas are now well below the replacement rate with a TFR of 1.6, and rural areas are just about at the replacement rate of 2.1.

Other aspects of the NFHS data are, however, somewhat worrying. For example, the percentage of children under five years of age who are stunted — below the acceptable height range for their age — is at 23.4 per cent in NFHS-5, as distinct from 19.7 per cent in the previous round. The percentage of children under five who are underweight has also increased from 16.1 per cent to 19.1 per cent. Anaemia in both children and women has increased. Meanwhile, a quarter of adults in India are now obese. While other indicators for sanitation and nutrition may have improved, these indicators are clearly going in the wrong direction and show that focused attention on health and nutrition, particularly for young people and women, is essential.

The NFHS has also provided essential data relevant to the quality of life, particularly for women. For example, thanks to sustained work by the government, almost 100 per cent of households have an LPG connection. But in many parts of the country, the actual utilisation of LPG is closer to 60 or 70 per cent. A shocking large number of Indians, including in states like Tamil Nadu that are generally considered progressive, believe that physical violence against women is permissible in a household. Nearly a third of women between 18 and 49 have experienced physical violence, and only 14 per cent of those experiencing sexual violence report it to the authorities. The likelihood that a woman experiences physical violence declines sharply with their educational level. This points to the continuing need for female-targeted legal and administrative protections, and for their economic and educational empowerment.