December 6, 2022

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For the first time in India’s history, women surpass males in the National Family and Health Survey

Image Courtesy: Hindustan Times

The Union health ministry issued the summary findings of the fifth round of the National Family and Health Survey (NFHS) on November 24, which included all three radical findings.

India today has 1,020 women for every 1000 men, is not getting any younger, and is no longer in danger of exploding.

The Union health ministry issued the summary findings of the fifth round of the National Family and Health Survey (NFHS) on November 24, which included all three radical findings. To be fair, the NFHS is a sample survey, and whether these figures apply to the entire population will only be known with confidence when the next national census is done, though many states and Union territories are quite likely to do so.

The figures show that India is no longer a country of “missing women,” a term used by Nobel Laureate economist Amartya Sen in a 1990 essay published in the New York Review of Books. In India at the time, there were 927 women for every 1,000 men. The ratio was 1000:1000 in NFHS-3, which was conducted in 2005-06; it was 991:1000 in NFHS-4, which was conducted in 2015-16. The sex ratio is skewed in favour of women for the first time in either NFHS or Census.

“The improved sex ratio and sex ratio at birth is also a significant achievement; while the true picture will emerge from the census, we can say for now that our measures for women empowerment have steered us in the right direction based on the results,” said Vikas Sheel, additional secretary, Union ministry of health and family welfare and mission director, National Health Mission.

To be sure, the gender ratio at birth for children born in the last five years is still 929, implying that son-preference in its various macabre forms persists. However, the sex ratio is a significant milestone achieved as a result of policies aimed at reducing sex selection practises and female infanticide, as well as the fact that women in India live longer than men.

According to data from the Census of India website, the average life expectancy at birth for males and women in 2010-14 was 66.4 years and 69.6 years, respectively.
Other intriguing results from the survey can be found here.

The proportion of the population under the age of 15 years has decreased from 34.9 percent in 2005-06 to 26.5 percent in 2019-21. India is still a young country, with a median age of 24 years according to Census data in 2011, but it is ageing, which brings with it policy issues.

“Because we now have an older population, our approach to women’s health needs to be more holistic than one that focuses solely on reproductive health,” said Yamini Aiyar, president of the Centre for Policy Research. “The fact that more women completed ten years of schooling in 2019-20 than in previous years, as well as a reduction in female labour force participation, indicates to serious structural issues in India’s labour market.” If India is to prosper, these issues must be addressed immediately, according to Aiyar.

Finally, India’s total fertility rate (TFR), or the average number of children per woman, is presently just 2, well below the internationally accepted replacement level fertility rate of 2.1, which is the point at which a population precisely replaces itself from one generation to the next. This suggests that India’s population has peaked — another data point that can only be determined by the Census, but which is virtually probably true for at least the southern states, as well as some of the wealthier ones.

“There is usually a 30-40 year gap between total fertility rates falling below replacement levels and a decline in overall population,” said Dr. KS James, director and senior professor at the International Institute for Population Sciences. “This is because the population that will give birth in the next 10-15 years was already born in the past when fertility levels were higher,” he added. “Of course, population growth in southern states will slow faster than the rest of the country,” he continued.

Between 2019 and 2021, NFHS-5 was done in two waves, covering 650,000 households in 707 districts across the country. Arunachal Pradesh, Chandigarh, Chhattisgarh, Haryana, Jharkhand, Madhya Pradesh, NCT of Delhi, Odisha, Puducherry, Punjab, Rajasthan, Tamil Nadu, Uttar Pradesh, and Uttarakhand were among the states and union territories surveyed in Phase-II.

In December 2020, the findings of NFHS-5 in relation to the 22 States and UTs covered in Phase-I were announced.

The National Family Health Survey (NFHS) is the most comprehensive database on a variety of socioeconomic and health indicators focusing on women – NFHS-5 covered 720,000 women and just over 100,000 men – and its basic results can be compared to the previous four rounds, which were conducted in 1992-93, 1998-99, 2005-06, and 2015-16.

To be sure, subsequent NFHS rounds have broadened their scope, both in terms of sample size and the number of indicators for which data is gathered.

While the above numbers mark a turning point in India’s socioeconomic and demographic transition, other NFHS findings have a similar message. Going forward, the socioeconomic issues that India faces will require more nuanced responses, and some of the stereotypes and political ideas that currently dominate public debate (such as the political obsession with population control laws) will need to be abandoned.

For Example, Balanced diets, require just as much attention as adequate diets, because obesity and anaemia (which affects more than half of women and children) are on the rise, even while national undernourishment continues to drop. To be sure, there is some evidence that the fight against malnutrition is losing steam.

“Overall, the NFHS-5 shows a decrease in stunting, a sign of chronic undernutrition, from 38.4 percent to 35.5 percent, a decrease of only approximately 3 percentage points in five years, or roughly 0.6 percentage point each year.” We witnessed a 1 percentage point improvement between NFHS-3 and NFHS-4, from 48 percent to 38.4 percent. So there is obviously a slowing in progress, and this is much below the expectations established under Poshan Abhiyaan,” said Dipa Sinha, an assistant professor of economics at Ambedkar University who is also involved with the Right to Food movement. “We also know that stunting has reversed in several states, so a more thorough investigation is required.” “An increase in anaemia as well as an increase in overweight/obesity are other alarming dietary results in NFHS-5,” Sinha added.

“The fertility reduction findings are encouraging for maternal and child health and nutrition.” However, progress on fertility reductions is still needed in the high fertility-high undernutrition states of Uttar Pradesh, Bihar, and Jharkhand – improvements in those high burden states are critical to moving the all-India average for all outcomes,” said Purnima Menon, senior research fellow at the International Food Policy Research Institute. “The improvements in undernutrition in UP and Bihar that are signalled in the NFHS-5 are also quite promising and require additional analysis,” Menon noted.

Despite the government’s claims that at least two of its policy-level programmes have succeeded in eliminating open defecation and ensuring the switch to clean fuel, there are still gaps on both fronts: 70.2 percent of households use improved sanitation and 58.6 percent use clean fuel for cooking, respectively. These figures are nevertheless significantly higher than the results from the previous round of the study, which were 48.5 percent and 43.8 percent, respectively.

Other initiatives, such as financial inclusion and health insurance coverage, appear to have been successful. The percentage of women with their own bank account increased from 53 percent in NFHS-4 to 78.6 percent in NFHS-5. Between NFHS-4 and NFHS-5, health insurance coverage increased from 28.7% to 41% (the NFHS-5 may not have covered the entire gains of the central government’s health insurance scheme, according to the ministry).

The full database of NFHS-5 has yet to be released by the government. At the time of writing this piece, a detailed all-India report as well as reports for the states and union territories that were canvassed in the second round, as well as unit level statistics, had not been provided. This means that a disaggregated study by caste, wealth, religion, and other factors is currently unavailable.

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