What does it infer?

THE Fourth National Family Health Survey (NFHS 4) was conducted in 2015 and preliminary results from a few states are now available. NFHS 4 follows similar countrywide surveys conducted in 1992 (NFHS 1), 1998 (NFHS 2), 2005 (NFHS 3).

While the full report of the 2015 survey is still awaited, some preliminary inferences can be drawn from the reports now available. Till date, preliminary data has been released for the following states and union territories: Andhra Pradesh, Andaman & Nicobar, Bihar, Goa, Haryana, Karnataka, Madhya Pradesh, Meghalaya, Pudduchery, Sikkim, Tamil Nadu, Telangana, Tripura, Uttarakhand and West Bengal.

It is possible to comment on certain trends on progress made in the last couple of decades by comparing the data from 2015 in selected states with data from 1992 (NFHS 1) and 2005 (NFHS 3). Here we have selected a few parameters in only the big states, for which data is available, and compared this data with data from 1992 and 2005.

Trends In Child Mortality

The first set of data that we have are of the trends in Infant Mortality Rate (number of deaths of children below one year for every 1,000 live births) and Child Mortality Rate (number of deaths of children below five years for every 1,000 live births). Infant and child death rates are acknowledged as important indicators of overall development and not just of health services, as mortality among children is very sensitive to a variety of social and economic determinants. Table 1 provides the comparison.

The Table indicates that there has been a gradual decline in mortality, which is generally good news. The comparison also indicates that some states have done much better than others (among the selected states). Tamil Nadu and West Bengal have done the best with a two-thirds reduction, and in the other states child mortality rates have been approximately halved. This correlates well with overall progress in social protection policies in Tamil Nadu and West Bengal, as compared to the other states.

It also needs to be noted that while there has been an overall decline in child mortality, all regions lag behind what has been achieved not just in high income countries, but also in a number of low and middle income countries even in South Asia. Overall Child Mortality Rate in Bangladesh stands at 38 in 2015, down from 109 in 1996, which is less than in AP, Bihar, Haryana, and MP. Nepal has done better, with the rate dropping from 102 in 1996 to 36 in 2015.

Sri Lanka’s Child mortality Rate is much lower, at 10 in 2015. Sri Lanka, Bangladesh and Nepal are countries that have been rocked by natural calamities and political upheavals and strife, yet have progressed better than India. Bangladesh and Nepal are also considered less economically advanced, thus depicting the fallacy in the argument that economic growth automatically translates into social progress.

Worrying Signals Even AsChild Sex Ratio Improves In Some States

Pprovides data regarding trends in sex ratio at birth. Overall the signals are mixed. The earlier worse performing states (those with a ratio of below 900), like Haryana, Tamil Nadu, Bihar and AP have made significant progress. Unfortunately states with a relatively better ratio (over 900) like MP, Karnataka and West Bengal have shown declines in sex ratio.

This is a particularly worrying trend and shows that the heinous practice of sex determination followed by killing of the unborn girl child is spreading to new areas. One hopes that these trends will act as a reminder to policy makers in the present government who are inclined to weaken legislations against the practice of sex-determination and murder of the girl child.

Immunisation Coverage Points ToDeficiencies In Public System

Provides comparative data on immunisation coverage, a useful indicator of the state of public health services. Clearly the news is not good. While some states have shown improvement, all other states show a coverage for complete immunisation of less than 70 percent.

Worryingly the otherwise good performing state of Tamil Nadu has reported a drop in coverage from 80.9 percent in 2005 to 69.7 percent in 2015. The other state which has reported a decline in coverage is Haryana.

This data should act as a sobering influence on the urgency being shown to include new vaccines in the national programme, in the face of data that even the present vaccines in the national programme are not reaching a significant number of children. The data also points to the floundering state of public services, which suffered due to restricted resources.

Too Little Progress In Improving Child Nutrition

Pprovides a comparison of child malnourishment rates in the last decade – from 2005 to 2015. While a majority of states have shown significant decline, AP and Karnataka have shown almost no decline. Overall child malnutrition levels remain unacceptably high and India, which reported a countrywide child malnutrition rate of 29.4 percent in 2014, is doing worse than some of the poorest countries in the world such as Haiti (11.6 percent malnourished), Laos (26.5 percent), Malawi (16.7 percent), Mali (27.9 percent) and Myanmar (22.6 percent).

The tragedy of poor nutrition that afflicts millions of children every year (the highest number of malnourished children in the world live in India) has been sought to be underplayed by planners. The reality is that a toxic combination of extreme poverty, gender discrimination and poor sanitation and poor access to safe drinking water is preventing a third of our children from living fulfilling lives. Early data from the NFHS survey once again proves that we are doing too little to save our children.

Rise In Caesarian Deliveries: Evidence Of Unethical Practices In Private Facilities

Provides data regarding institutional deliveries, ie, deliveries taking place in medical facilities rather than at home, the type of facilities in which deliveries are being conducted (public or private) and on the incidence of caesarian deliveries. A push for institutional deliveries has been a major focus of the National Rural Health Mission, instituted in 2005.

Clearly the strategy is working and there has been a secular and significant scale up of institutional deliveries. The data also shows how a very high percent of institutional deliveries are taking place in private facilities – over 30 percent in all states studied and over 60 percent in AP. This is a consequence of the drive to outsource healthcare to the private sector even when public funds are used and the practice is leading to a number of negative consequences.

A clear example of this is evident from the data on the incidence of caesarian sections. All states report a much higher incidence of caesarians in private facilities – ranging from 25.3 percent in Haryana to 70.9 percent in West Bengal.