Demographic Transitions Captured: NFHS-5

In News

• The fifth edition of the National Family Health Survey (NFHS) confirmed signs of a demographic shift in India.

National Family Health Survey 5 (NFHS 5)

• It was conducted in 2019-2020.
• Sample size: 
  • The NFHS-5 survey work has been conducted in around 6.1 lakh sample households from 707 districts (as on March, 2017) of the country; covering 724,115 women and 101,839 men to provide disaggregated estimates up to district level.
• It was done on 17 states on indicators related to: 
  • Population,
  • Health and nutrition,
  • Access to infrastructure, and 
  • Gender.

Key Findings of the NFHS-5

• Women to men Ratio:
  • For the first time since the NFHS began in 1992, the proportion of women exceeded men: there were 1,020 women for 1,000 men. In the last edition of the survey in 2015-16, there were 991 women for every 1,000 men.
  • States that had fewer women than men included:
    • Gujarat, Maharashtra, Arunachal Pradesh, Haryana, Madhya Pradesh, Punjab and 
  • Union territories such as: 
    • Jammu & Kashmir, Chandigarh, Delhi, Andaman and Nicobar islands, Dadra and Nagar Haveli, and Ladakh.
• Sex ratio at birth:
  • However, sex ratio at birth for children born in the last five years only improved from 919 per 1,000 males in 2015-16 to 929 per 1,000, underscoring that boys, on average, continued to have better odds of survival than girls.
• Population stabilisation and TFR: 
  • India has achieved a total fertility rate of 2.0, dropping further from the figure of 2.2 during NFHS-4, indicating that India has contained the population explosion.
  • A State-wise breakup of the NFHS data also shows that India is on its way to stabilising its population, with most States and UTs having a Total Fertility Rate (TFR) of less than two. 
  • A TFR of less than 2.1, suggests that an existing generation of people will be exactly replaced. 
  • Anything less than two suggests an eventual decline in population over time. 
  • Only six States have a TFR above two: 
    • Bihar, Meghalaya, Manipur, Jharkhand and Uttar Pradesh. 
    • Bihar has a TFR of three which, however, is an improvement from the 3.4 of the NFHS-4. 
  • The TFR in all States has improved in the last five years.
• Exception: 
  • A notable exception is Kerala, a State with among the highest ratios of women to men at 1,121 and improvement over 1,049 recorded in the NFHS-4. 
  • However the TFR in Kerala has increased to 1.8 from 1.6. 
  • The State has also reported a decline in the sex ratio of children born in the last five years. There were 1,047 females per 1,000 males in 2015-16 that has now declined to 951 per 1,000 males.
• Institutional Births:
  • A greater proportion of births than ever before is now happening in institutions, more children in the 12-23 months age group have received their vaccinations.
• Economic and social status of Women:
  • Women with Bank Accounts:
    • All 14 states surveyed in the second phase of National Family Health Survey-5 (NFHS-5) reported a significant jump over the last five years in the number of women having a bank account that they themselves use.
    • The all-India figures show close to 80% women now have a bank account that they use — from 53 per cent in 2015-16 to 78.6 per cent in 2019-21.
  • Mobile usage:
    • The all-India figure for phone use among women went up from 45.9% in 2015-16 to 54% in 2019-21.
  • Land/House ownership:
    • The data show that among the 14 states, barring five states/UTs — MP, Odisha, Uttarakhand, Delhi NCT and Puducherry- have seen an increase in ownership by women.

Image Courtesy: TH

Concerns & Way ahead

• Timely assessment: 
  • A periodic assessment of health and social development indicators is crucial for any country that is still clawing its way towards achieving ideal standards in the Human Development Index. 
• Coercive policies for sex ratio at birth:
  • Policies, some even coercive, as in the case of the family planning sector, seem to have borne fruit, years after they were implemented. 
  • While gender ratio has, for the first time, recorded more women per 1,000 men, gender ratio at birth in the last five years still underlines the persistence of a deep-rooted son preference, one that has to be countered, through policy and law. 
• Major gains required in field of nutrition: 
  • There are other areas too, especially in the case of childhood nutrition where marginal gains in say, wasting and severe wasting, are deemed insufficient, and require renewed corrective efforts. 
• Pandemic impact and threat of lifestyle diseases:
  • The impact of the pandemic may also be noted, the disruption it caused to services such as balanced nutrition for children must be acknowledged. 
  • Having measured blood sugar and hypertension in the population for the first time, NFHS-5 highlighted the looming threat from lifestyle diseases.
• Capable infra: 
  • While this set of circumstances underscores the need for building resilient and fortified systems capable of delivering in the most trying circumstances.

Conclusion

• This massive exercise aims at providing data that will help shape the policies in a manner that will correct deficiencies, and ensure equitable access to services, particularly those with impact on social determinants that improve the quality of life. 
• State-level indices are also released, to provide comparisons, but also to allow States to launch course correction, or to be inspired by success stories in other regions. 
• Inputs on marriage and fertility, family planning, access to education and health services are provided by the NFHS, arguably second only to the exhaustive data that the decennial population census throws up. 
• States need to treat it as such, and while they might dispute some assessments, the greater idea is to recognise it as a matrix to work on, to improve the development indicators further. 

Source: TH