The Hindu Business Line : National Family Health Survey paints mixed picture

CHENNAI: The final report of the National Family Health Survey (NFHS-3), 2005-06 released today by the Ministry of Health and Family Welfare offers a comprehensive picture of the health, nutrition and population in the country.

The data set on key indicators provides a trend that includes information on several new topics, such as HIV/AIDS-related attitudes and behaviour, male involvement in family welfare and attitudes about family life education for children in school.

Among the key findings are that family planning use is up and fertility is down, half of women lack proper care during pregnancy and delivery, infant mortality is down, but full immunisation coverage is showing little progress, domestic violence is wides pread, malnutrition persists and anaemia is widespread and that most adults support family life education.

Releasing the Report, the Mission Director of the National Rural Health Mission, Mr G.C. Chaturvedi, said that findings from NFHS-3 have added substantially to the knowledge base about the health and family welfare situation of the country and will be a valuable source of information for making further improvements in health and family welfare policies and programmes.

The survey paints a mixed picture of India’s overall reproductive health status. On one hand, women are having fewer children and infant mortality has dropped in the seven-year period since the last NFHS survey in 1998-99. On the other hand, anaemia and malnutrition are still widespread among children and adults.

And, in an unusual juxtaposition, more adults, especially urban women, are overweight or obese than they were seven years ago.

Smaller families are slowly becoming the norm in the country. Fertility has continued to decline since NFHS-2, dropping to an average of 2.7 children from 2.9 children.

Ten States, mostly in Southern India, have reached replacement level or below replacement level fertility.

While preference for sons remains a barrier to more rapid decline in fertility, an increasing number of women who have only daughters say that they want no more children. In NFHS-3, 62 per cent of women with two daughters and no sons say that they want n o more children, compared with 47 per cent in NFHS-2.

Declining fertility could be attributed largely to women’s increased use of contraception. For the first time ever, more than half of currently married women in India are using contraception, and their use of modern contraceptive methods increased from 4 3 per cent to 49 per cent between NFHS-2 and NFHS-3.

A rise in the average age at marriage is also contributing to the drop in fertility. Forty-five per cent of women between 20-24 were married before the legal age of marriage of 18, compared with 50 per cent seven years earlier.

A substantial proportion of married women reported that they experienced physical or sexual violence at some time in their lives. Overall, 40 per cent of ever-married women experienced violence, with large variations among the States.

The experience of spousal violence ranges from a low of six per cent in Himachal Pradesh to a high of 59 per cent in Bihar.

Married women with no education were much more likely (46 per cent) than other women to have suffered spousal violence. However, spousal violence extended to women who have 12 or more years of higher education, with 12 per cent reporting violence.

More than three-quarters of pregnant women in India received at least some antenatal care (ANC), but only half of women had at least three ANC visits with a health provider during their pregnancy.

The disparity between urban and rural women was especially pronounced, with 74 per cent of urban women having ANC at least three times, compared with 43 per cent of rural women.

Births assisted by a health professional increased to 49 per cent from 42 per cent, with 75 per cent of urban women but only 39 per cent of rural women in NFHS-3 receiving assistance.

Institutional births increased from 34 per cent to 41 per cent, but most women still deliver their children at home. Only about one-third of women received post-natal care within two days of delivery.

Infant mortality continues to decline, dropping from 68 per thousand births in 1998-99 to 57 in 2005-06.

There were particularly notable drops in Bihar, Goa, Haryana, Jammu and Kashmir, Meghalaya, Orissa, Punjab, Rajasthan, Tamil Nadu and Uttar Pradesh.

The situation regarding child immunization rates during this period has not been very encouraging. Overall, there was only a marginal improvement in full vaccination coverage, with 44 per cent of children 12-23 months old receiving all recommended vaccin ations, up from 42 per cent seven years ago.

Diarrhoea continues to be a major health problem for many children. Only 58 per cent of children with diarrhoea were taken to a health facility, down from 65 per cent seven years earlier.

Malnutrition continues to be a significant health problem for children and adults in India. NFHS-3 also found high prevalence of anaemia – 70 per cent – in children aged 6-59 months. Anaemia in India is primarily linked to poor nutrition.

Virtually all Indian adults agree that children should be taught moral values in school and most adults think that children should learn about the changes that occur in their bodies during puberty.

Men and women differ somewhat on whether children should be taught in school about contraception. About half of women and two-thirds of men think that girls should learn about contraception in school. Both women and men are slightly less likely to say th at contraception should be part of boys’ school education.

Most men and women believe that information on HIV/AIDS should also be part of the school curriculum. About 80 per cent of men think boys and girls should learn about HIV/AIDS, compared with 63 per cent of women.

More than 60 per cent of men say that both boys and girls should be taught about sex and sexual behaviour in school, but slightly less than half of women felt that this was an appropriate topic to be taught to girls or boys in school.

For the first time, the survey measured community-level HIV prevalence at the national level and for selected States.

New evidence from NFHS-3 has provided crucial information for understanding India’s HIV epidemic. The survey found an HIV prevalence rate of 0.28 per cent for the population aged 15-49.

Prevalence is more than 60 per cent higher among men than women, at 0.36 per cent and 0.22 per cent respectively. NFHS-3 found HIV prevalence to be particularly high in Manipur (1.1 per cent ) and Andhra Pradesh (one per cent).

NFHS-3, the third in the NFHS series of surveys, provides information on population, health and nutrition in India and each of its 29 states. For the first time, NFHS-3 collected information on men and unmarried women. The survey is based on a sample of households that is representative at the national and state levels. It conducted interviews with around 200,000 women age 15-49 and men age 15-54 throughout India. NFHS-3 also tested more than 100,000 women and men for HIV and 215,000 adults and young ch ildren for anaemia.

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