There are at least four heart-warming takeaways from the fifth round of the National Family Health Survey (NFHS) — conducted in two phases between June 2019 and April 2021, covering 6.3 lakh rural and urban households. First, the sex ratio of the population stands at 1,020 women for 1,000 men, a historic high and a major turnaround from 991:1,000 in NFHS 4 conducted in 2015-16. Second, there has been a fall in total fertility rate (TFR) below replacement levels of 2.1 children per woman, to two, against 2.2 in NFHS 4. In simple terms, this means India’s population may have begun to fall, which is also borne out by the reduced proportion of people below 15 years of age. This should put paid to alarmism over India’s population — although this is still growing in a few States. Third, infant mortality and maternal mortality rates continue to fall, while access to institutional care has improved. Fourth, gender indices such as female literacy, operating a bank account, use of clean cooking fuel and menstrual hygiene have shown a major improvement. This perhaps points to the outreach of flagship welfare schemes. Health insurance coverage has improved as well. Empowerment through literacy becomes the stepping stone for gains in other spaces.

However, some stylised truths never seem to change, such as the north-south divide in social indices. There is also an intriguing mismatch between sex ratio at birth (SRB) and the sex ratio of the population, which the NFHS 5 researchers should explain. Both, the poor and the rich northern States lag behind the national average in reproductive indices. Uttar Pradesh and Bihar have above-replacement TFRs but favourable sex ratios, whereas Punjab has a low TFR but an alarming sex ratio of 938 per thousand and an SRB of 904. The NFHS factsheet cautions that comparisons are subject to the problem of sample sizes being small in certain States. Maharashtra and Gujarat have a TFR below replacement levels, but sex ratios well below 1:1. These figures reiterate a truism: that economic growth may not translate into gender well-being. The latter is brought about through social change. Some demographers argue that declining fertility rates can trigger adverse sex ratios in societies where son-preference is common. Policies that promote education and job prospects for women need to be promoted to negate these attitudes. However, there is less dispute over the link between female education levels and reduced fertility. The rise in female education levels over the last decade or so is finally making its effects felt.

The survey throws up some pain points on the health front, such as a rise in anaemia, hypertension and obesity. Lifestyle-related disorders have come into focus in the context of the pandemic. Overall, the improvement in social indices should not detract from the fact that higher investments in health and education are a pre-requisite for a robust economy and society. There’s no other route to get there.