National Family Health Surveys (NFHS) are extremely
useful indicators of many basic conditions of life and
health among our population. Two such Surveys were conducted
in the previous decade, in 1996-97 and in 1998-99. The
latest survey, hereafter NFHS-3, was conducted over
2005-06 and covered all 29 states.
preliminary results for five states have just been released,
and they give important insights into health and nutrition
conditions in Chhattisgarh, Gujarat, Maharashtra, Orissa
and Punjab. More significantly, they also provide some
information on trends over time, and particularly since
the NFHS-2 in the late 1990s.
First, the good news. In all the five states, fertility
rates have come down. They have reduced most sharply
in Punjab, Maharashtra and Orissa, while the fall has
been the least in Gujarat, but nevertheless these very
different states now all show internationally respectable
fertility rates at between 2 (for Punjab) and 2.6 (for
Similarly, modern contraceptive prevalence rates have
increased since the last NFHS, in all states. Another
good sign is the increase in the proportion of women
with two children who want no more children, which is
more than three-fourths of all, and around half of those
who have only girls. Access to antenatal care and the
proportion of institutional deliveries also appear to
have increased in all the five states. Infant mortality
rates are also down slightly in all these states, after
the uneven performance reported in NFHS-2.
However, the bad news comes quite soon after this, and
covers a wide range of concerns. The low age at marriage
remains a major area of concern. It has gone up slightly
in four states since NFHS-2, but is still unacceptably
low, with more than half of the women aged 20-24 years
getting married before the age of 18 years in Chhattisgarh,
and nearly 40 per cent in Maharashtra, Orissa and Gujarat.
In Punjab, where the proportion of such women was relatively
low at 12 per cent during NFHS-2, the share has actually
increased to 19 per cent!
One striking failure of public health systems comes
out in the evidence on immunisation. In the less developed
states of Orissa and Chhattisgarh, immunisation coverage
of children (the percentage of children aged 13 to 23
months who have received DPT plus 3 Polio plus 3 BCG
plus measles vaccinations) improved to reach around
50 per cent. But in the more ''developed'' states of Maharashtra,
Gujarat and Punjab, the immunisation coverage rate has
actually fallen since the previous Survey! In both Punjab
and Maharashtra the decline has been quite sharp, from
78 and 72 per cent to around 60 per cent.
The real concerns come from the information on trends
in nutritional status. Remember that the period between
NFHS-2 and NFHS-3 is supposed to be the period of economic
boom, the period when the Indian economy (and therefore
presumably Indians) have never had it so good. Aggregate
GDP growth rates have been around 8 per cent and per
capita GDP has increased by around 6 per cent per year.
In this ''take-off phase'' it would be normal to expect
that calorie consumption and nutritional indicators
would show some improvements, even if not dramatic improvements,
at least substantial.
But already the data from the National Sample Survey
Rounds on consumption expenditure had told us that per
capita calorie consumption, far from rising, has actually
decreased, even for the poorest groups. And now NFHS-3
provides some depressing reminders of the very poor
nutrition status of most of our citizens, especially
Take the proportion of children below 3 years of age
who are underweight. Despite all the economic growth,
only Punjab among these five states shows a substantial
decline in this proportion, from 46 per cent in NFHS-1
to 27 per cent in NFHS-3. But even here, the real decline
had already occurred by the time of NFHS-2, when the
proportion was 29 per cent, and since then, that is
over the past 7 years, has been broadly stable.
In the other four states, the proportion of underweight
children remains appallingly high, from 52 per cent
in Chhattisgarh to 44 per cent in Orissa and 40 per
cent in Maharashtra. In Gujarat, which is one of the
richest states and has shown one of the highest rates
of economic growth over this period, the proportion
of underweight children actually increased slightly
between NFHS-2 and NFHS-3, from 45 to 47 per cent.
The statistics on anaemia are even worse. The NFHS-3
shows that the percentage of children in the age group
6-35 months who are anaemic is as high as 80 per cent
or more in Chhattisgarh, Gujarat and Punjab. It is only
slightly lower - around 72-74 per cent - in Orissa and
Maharashtra. And in both Gujarat and Orissa, it has
increased from the time of the previous survey. For
adults, while anaemia is high among both sexes, it is
very high among women, with the prevalence of anaemia
among women more than double that among men in all states.
Except in Punjab, the share of underweight women is
also very high. In the other four states, the proportion
of ever-married women with BMI (Body Mass Index) less
than 18.5, which indicates under-nutrition, was between
32 and 41 per cent. Among these five states, Punjab
is the only one which is showing the flip side of prosperity,
with the proportion of obese persons (BMI more than
25) at around one-third, significantly more than the
proportion of underweight persons at 13 per cent.
It has been evident for some time now that concerns
about food security are not relics of the past, but
unfortunately only too contemporary. The preliminary
and partial results of the latest NFHS should certainly
cause alarm bells on the state of public nutrition to
ring very loudly in the corridors of power.