New Delhi: Findings from the first phase of the fourth National Family Health Survey (NFHS), released by the Union health ministry on Tuesday, show the overall health of Indians has improved, but not enough headway has been made in addressing the health needs of children.
In almost all 13 states and two Union Territories covered by the survey, child nutrition rates surpassed those in the third round of NFHS done in 2005-06. But the number of stunted children, or whose height doesn’t match the norm for their age—a key indicator of malnutrition—has remained high in some states although it has dropped slightly in the past decade.
In Bihar, Madhya Pradesh and Meghalaya, more than 40% of children were found to be stunted. In 2005-06, Bihar had 55.6% of its children stunted, which fell to 48.3% in 2014-15. In Madhya Pradesh, stunting reduced from 50 to 42 and in Meghalaya from 55.1 to 43.8.
Anaemia continues to affect children as well as women. In Goa, the percentage of anaemic children has gone up from 38.2% in 2005-06 to 48.3% in 2014-15. In Madhya Pradesh, there has been a marginal decline from 74% to 68.9.
In Meghalaya, the percentage of anaemic women in the productive age group has gone up from 46.2% in NFHS-3 to 56.2% in NFHS-4. Haryana followed a similar trend—from 56.1% to 62.7%.
Awareness about HIV/AIDS has reduced substantially, indicated the latest survey. Also, while increased institutional deliveries are seen to reflect the success of Janani Suraksha Yojana (JSY), the flagship programme of National Rural Health Mission, it is far from enough for reduction in maternal mortality, separate studies suggest.
Another worrying factor is reduced awareness among women about HIV/AIDS. The percentage of women with comprehensive knowledge of HIV/AIDS in Madhya Pradesh declined from 20.3% to 18.1%. Similarly, in Bihar, it decreased from 11.7% to 10.1%.
Tripura is an exception; it reported an increase from 11.8% to 28%. India’s HIV programme has been facing government apathy in recent times. Last year, massive shortages in medicines for treatment of HIV/AIDS in government facilities were reported across the country. It was only after it became a national issue that problems in procuring medicines were resolved.
Institutional deliveries rose in most states and UTs. In Bihar, they rose three-fold—from 19.9% in 2005-06 to 63.8 % in 2014-15. Similarly, over the same period, institutional deliveries rose from 35.7% to 80.5% in Haryana and 26.2% to 80.8% in Madhya Pradesh.
But what the NHFS data does not cover is this does not automatically translate into reduction in maternal mortality rates (MMR). A Ph.D thesis submitted in Umea University of Sweden shows low level of correlation between institutional deliveries and MMR in India.
Doctoral student Bharat Randive at the Department of Public Health and Clinical Medicine at the university found that the JSY programme successfully increased births at facilities, but due to its implementation in a fragile health infrastructure, it was less effective in reducing fatalities.
In his research, Randive looked at 284 districts of nine Indian states and compared access to care and health outcomes in rich and poor areas. The poor areas of these nine less developed states had 135 more maternal deaths for every 100,000 births and the decline in maternal deaths during the programme in these areas was four times slower than in rich areas.
“The cash transfer programmes are by themselves inadequate to improve health outcomes," said Randive. “While the programme can improve service utilisation, it will not reduce maternal and neo-natal deaths unless the socio-economic inequalities in access to facility-based care are also addressed and the care is of good quality."