Opinion - News Analysis   

Some progress, some stagnation

Kalpana Sharma

From the preliminary data of the third National Family Health Survey emerges a mixed picture.

OBESITY AND malnourishment, more antenatal care and infants still dying before they complete one year. This is the picture of contrasts that emerges from the preliminary findings of the third National Family Health Survey (NFHS-3) of five States — Chhattisgarh, Gujarat, Maharashtra, Orissa, and Punjab. The summary of the findings in these States was released recently. Even the tentative details available so far are worth examining for they shed light on the nature of development in India in the last seven years, between the NFHS-2 (1998-99) and the latest (2005-06). The final NFHS-3 will have data from all the States.

The preliminary data reveal several encouraging trends. Unfortunately, these are undercut by the static or minimal progress in other sectors.

The NFHS has become an important tool to measure the efficacy of health and family welfare policies. It provides data relating to fertility, infant and child mortality, maternal and child health, and the practice of family planning. It also gives insights into the quality of health care, including the specific problems women face. One of the disturbing findings of NFHS-2, for instance, was the extent of domestic violence women faced in India and the impact this had on their health. It had concluded: "The experience of violence and the silent acceptance of violence by women undermines attempts to empower women and will continue to be a barrier to the achievement of demographic, health and socio-economic goals." NFHS-3 also records spousal violence, physical and sexual, of between 25 per cent (Punjab) and 39 per cent (Orissa).

Encouraging trends

There are several encouraging trends to be noted in NFHS-3. Most important is the fact that fertility rates are declining steadily. Of the States surveyed, two have reached replacement levels — Maharashtra (2.1) and Punjab (2.0); two are progressing in that direction Gujarat and Orissa (2.4); and Chhattisgarh (2.6) has still some way to go.

The other significant finding is that over 80 per cent of women in all five States say they do not want to have more than two children. The picture changes, however, when you ask the question in relation to family composition. When women were asked whether they wanted any more children if they had two sons, an overwhelming majority ranging from 88 per cent in Chhattisgarh to 97 per cent in Punjab said they did not. The percentages were only slightly lower when they were asked how they would feel if they had one boy and one girl. But when asked whether they would like to stop with two children even if they had two girls, the percentage of women answering in the affirmative dropped dramatically. The fall is most significant in Punjab where from 97 per cent of women with two boys saying they want no more to just 43 per cent with two girls giving the same answer. Punjab has the lowest sex ratio in India. So this marked preference for sons is not surprising.

Despite this rather predictable trend, it has to be noted that the percentage of women saying they wanted no more children even if they had two girls has steadily increased between NFHS-2 and NFHS-3. Even in Punjab, where only 24 per cent of women said they wanted no more children after two girls during NFHS 2, the percentage today is 43 per cent. There is a similar and significant increase in the other four States. However, whether what the women want is also what the men decide in terms of family size is not self-evident.

Discouraging fact

What is discouraging is that despite a steady increase in the percentage of women going in for institutional deliveries, that is having babies in a hospital or nursing home, and also despite the increase in the number of women receiving antenatal care, the infant mortality rate (IMR) continues to remain higher than it should. It is as high as 71 per 1,000 live births in Chhattisgarh and although Punjab has an IMR of 42 and Maharashtra of 38, both below the national average of 66, they are still some way from the target set by the National Population Policy (2000) of achieving an IMR of 30 by 2010.

Similarly, the percentage of children below three who are underweight is disturbing. In Gujarat, the percentage has actually increased from 45 per cent to 47 per cent between NFHS-2 and NFHS-3 while in the other four States it has declined. In Punjab it is 27 per cent while in Chhattisgarh it is 52 per cent.

The percentage of children between six and 35 months who are anaemic has also increased in Gujarat from 75 per cent in NFHS-2 to 80 per cent today and in Orissa from 72 to 74 per cent. In Punjab it is 80 per cent and remains unchanged. It is the highest in Chhattisgarh at 81 per cent.

The number of women who are anaemic, particularly pregnant women, in all five States is also unacceptably high. This is despite targeted interventions to deal with anaemia in pregnant women. Clearly, this is an area that will need to be investigated more closely as it reflects on other forms of economic deprivation in a large percentage of our population. One of the direct outcomes of this is the impact on women's health, particularly during pregnancy when they deny themselves food in preference to feeding the rest of the family. Thus the cycle of anaemic mothers giving birth to underweight babies, who die before they complete one year, remains unbroken.

Health problems relating to prosperity, such as obesity, are also noticed now and ironically, women are more affected by obesity as well as undernourishment than men. In Punjab, for instance, 38 per cent of the women are obese as compared to 30 per cent of men. Similarly, in Gujarat 20 per cent of women are obese compared to 15 per cent men.

More details will emerge when the final NFHS-3 data are released around the end of the year. But already one can see that there is a mixed picture. With increasing contraceptive prevalence, and a slow but steady change in attitude about the ideal family size, the population graph is flattening. At the same time, the problems of anaemia amongst women and children, and the slow rate in the decline of infant mortality remain worrying trends that clearly need much more attention.

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