National Family Health Survey-5

The first set of findings from the fifth National Family Health Survey (NFHS), conducted in 2019-20, was released by the Ministry of Health and Family Welfare on December 12, four years after the last survey (NFHS-4, 2015-16).
The results of 17 States and 5 UTs (Assam, Bihar, Manipur, Meghalaya, Sikkim, Tripura, Andhra Pradesh, Andaman and Nicobar Islands, Gujarat, Himachal Pradesh, Jammu & Kashmir, Ladakh, Karnataka, Goa, Maharashtra, Telangana, West Bengal, Mizoram, Kerala, Lakshadweep, Dadra Nagar Haveli and Daman & Diu) were released as Phase-I.

Major Findings

Population is Stabilising

India’s population is stabilising, as the total fertility rate (TFR) has decreased across majority of the states.
Of 17 states analysed in the fifth round of National Family Health Survey (NFHS), 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.
Sikkim recorded the lowest TFR, with one woman bearing 1.1 children on average; Bihar recorded the highest TFR of three children per woman.
In 19 of the 22 surveyed states, TFRs were found to be ‘below-replacement’ — a woman bore less than two children on average through her reproductive life.

Family Planning

All 17 states have witnessed an increase in the use of modern contraceptives of family planning. The proportion of women with unmet need for family planning, who want to stop or delay child-bearing 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.

Contraception

Female sterilisation continues to dominate as the modern method of contraception.
Male engagement in family planning continues to be limited and disappointing as seen by the low uptake of condoms and male sterilisation across states.

Anaemia

Anaemia among women remains a major cause of concern. In all the states, anaemia is much higher among women compared to men.

Child Marriages

Despite the efforts being made, it is alarming to see the increase in child marriages in a number of states, reveals the data.
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.

Teenage Pregnancies

States such as Manipur, Andhra Pradesh, Himachal Pradesh and Nagaland have also shown increase in teenage pregnancies.
Along with increase in child marriages, Tripura has also shown an increase in teenage pregnancies, from 18.8 per cent in 2015-16 to 21.9 per cent in 2019-20.

Nutritional Status of Children

NFHS-5 data also showed a decline in nutritional status of children under five years in a number of states.
Child Stunting: The proportion of stunted children has risen in several of the 17 states and five UTs surveyed, putting India at risk of reversing previous gains in child nutrition made over previous decades. Worryingly, that includes richer states like Kerala, Gujarat, Maharashtra, Goa and Himachal Pradesh.
Child Wasting: The share of underweight and wasted children has also gone up in the majority of the states. Telangana, Kerala, Bihar, Assam and Jammu-Kashmir witnessed an increase and Maharashtra and West Bengal have been stagnant.

Under 5 and Infant Mortality Rate

The Under 5 and infant mortality rate (IMR) has come down in 18 states and union territories but in parallel 16 states recorded an increase in underweight and severely wasted under 5 children among 22 states.

Out of Pocket Expenditure

There is 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%), Mizoram (63%), Bihar (60%), Assam (42%) and Manipur (40%).

Spousal Violence

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-5.

Sexual Violence

Sexual violence has increased in five states (Assam, Karnataka, Maharashtra, Meghalaya and West Bengal), as per the data.

Disparity in Access to the Internet

NFHS-5 depicts a stark disparity in access to the internet by men, in contrast to women in a number of 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%) and women (76.7%) is almost equal.

Clean Fuel for Cooking

Less than 45% of households use clean fuel for cooking in five states, including Bihar and West Bengal.
The five states where less than 45% households use clean fuel for cooking are Assam (42.1%), Bihar (37.8%), Meghalaya (33.7%), Nagaland (43%) and West Bengal (40.2.
Over 80% of households use clean fuels in Andhra Pradesh (83.6%), Goa (96.5%), Mizoram (83.8%) and Telangana (91.8 %). Electricity, LPG or natural gas and biogas are considered as clean fuel in the survey.
The survey also showed that the use of clean fuel increased in all the 22 surveyed states and UTs in comparison to NFHS-4 (2015-16).

Sanitary Facility

Over 70% of the population in 16 states is living in households that use an improved sanitation facility.
Lakshadweep (99.8%) and Kerala (98.7%) have the highest percentage of population living in households with an improved sanitation facility, while Bihar (49.4%) and Ladakh (42.3%) have the lowest.

Water & Electricity

Over 90% of the population was living in households with electricity, and more than 70% with improved drinking water sources.

Vaccination

The survey found considerable improvement in vaccination coverage among children age 12-23 months across all states and UTs.

Women Empowerment

Women’s empowerment indicators (including women with bank account) also portray considerable progress.