17 states and five union territories were covered in the survey
The first set of findings from the fifth round of the National Family Health Survey (NFHS), conducted in 2019-20 were released by the Ministry of Health and Family Welfare, Government of India, four years after the last survey (NFHS-4, 2015-16). NFHS 5 merits urgent attention, as this is the most comprehensive, robust data at scale on health and family welfare and emerging issues in this area. The findings cover 17 states and five union territories.
While the detailed report with data for all states is awaited, Population Foundation of India has analysed the first phase of the NFHS-5 data and shared some of the key highlights from the state/UT factsheets.
According to PHFI, India’s population is indeed stabilising, as total fertility rate has decreased across majority of the states. Of the 17 states analysed in the NFHS-5 data, except for Bihar, Manipur and Meghalaya, all other states have a TFR of 2.1 or less, which implies that most states have attained replacement level fertility. All 17 states have witnessed an increase in use of modern contraceptives of family planning. The proportion of women with unmet need for family planning who want to stop or delay childbearing but are not using any method of contraception has declined in all states, except Meghalaya and Andhra Pradesh. Except for Manipur, all states have reported an increase in users getting information on side effects of current contraceptive methods.
There is greater use of hygienic methods of protection during menstrual period by women in several states. There has been some improvements in women’s empowerment related indicators. More women can participate in household decision making in nine states while 30 per cent more women now have bank accounts in Assam, Bihar, Gujarat and West Bengal.
On a negative side, NFHS data shows a decline in nutritional status of children under five years in several states. In Kerala, which is considered to be an advanced and model state for others, the percentage of children under five years with stunting has increased to 23.4 per cent as per NFHS against 19.7 per cent in NFHS.
Anaemia among women remains the big concern. In all the states, anaemia is much higher among women compared to men. Female sterilisation continues to dominate as the modern method of contraceptives in states like Andhra Pradesh (98 per cent), Telangana (93 per cent), Kerala (88 per cent), Karnataka (84 per cent), Bihar (78 per cent) and Maharashtra (77per cent).
Male engagement in family planning continues to be limited and disappointing as seen by the low uptake of condoms and male sterilisation across states. Despite the efforts being made, it is alarming to see the increase in child marriages in several states. There has been an increase in child marriages in Tripura (40.1 per cent from 33.1 per cent in 2015-16), Manipur (16.3 per cent from 13.7 per cent in 2015-16) and Assam (31.8 per cent from 30.8 per cent in 2015-16), while states like West Bengal (41.6 per cent) and Bihar (40.8 per cent) still have high prevalence of child marriages.
States like Manipur, Andhra Pradesh, Himachal Pradesh and Nagaland have also shown increase in teenage pregnancies. Along with increase in child marriage, Tripura has also shown an increase in teenage pregnancy from 18.8 per cent in 2015-16 to 21.9 per cent.
It is very concerning to see the increase in average out of pocket expenditure (OOPE) per delivery in public health facilities in some states. Compared to NFHS-4, OOPE has increased in several states – Sikkim (109 per cent), Mizoram (63 per cent), Bihar (60 per cent), Assam (42 per cent) and Manipur (40 per cent).
While spousal violence has generally declined in most of the states and UTs, it has witnessed an increase in five states, namely Sikkim, Maharashtra, Himachal Pradesh, Assam and Karnataka. Karnataka witnessed the largest increase in spousal violence, from 20.6 per cent in NFHS 4 to 44.4 per cent in NFHS. Sexual violence has increased in five states (Assam, Karnataka, Maharashtra, Meghalaya and West Bengal).
The NFHS-5 depicts a stark disparity in access to the Internet by men, in contrast to women in several states. In Karnataka and Bihar, for example, twice as many men have access to the Internet as compared to women. Sikkim is the only state where access to Internet among men (78.2 per cent) and women (76.7 per cent) is almost equal.
Population Foundation of India welcomes the progress made on several health, fertility and women’s empowerment related indicators in NFHS. However, what merits serious concern is that this data was recorded before the pandemic wreaked further havoc on our health and lives.
