Nutrition Concerns

Sep 11th 2006, Jayati Ghosh
The 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.

The 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 Chhattisgarh).

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 the young.

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.


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