Lower Fertility Rate, Anaemia on the Rise: Findings From NFHS-5

While NHFS-5 shows strides made in women's healthcare, it reports rise in anaemia and female sterilization in India.

The Ministry of Health and Family Welfare, on 5 May, released detailed findings of India's fifth National Family and Health Survey.

Some findings were released in a fact sheet back in November 2021. The encouraging highlights being,

• The use of modern contraceptives has gone up, especially among working women.

• The sex ratio of the total population (females per 1,000 males) increased to 1,020 compared to 991 in 2015-16. This is the first time that females have outnumbered males.

• India's fertility rate has declined from 2.2 children per woman in 2015-16) to 2 children in 2019-21.

The MoHFW has now released details of more granular data from the report that provides information on population, health, and nutrition for India and each of its state and union territory (UT).

FIT breaks down the findings.

The Key Findings

The NFHS-5 is similar to the NFHS-4 report from 2015-16, however, this time there is more data on topics previously unaccounted for like preschool education, disability, access to a toilet facility, death registration, bathing practices during menstruation, and methods and reasons for abortion.

Here's a quick run through of some of the key findings of the NFHS-5 report.

• The total sex ratio at birth for children born in the last five years (females per 1,000 males) went up from 919 (2015-16) to 929 (2019-2021)

• Households with at least one member covered under a health insurance/financing scheme went up from 28.7 percent to 41 precent.

• 20-24 year old women who got married before the age of 18 has gone down from 26.8 percent to 23.3 percent.

• Adolescent fertility rate (women between 15-19 years of age) also saw a decline from 51 percent to 43 percent. In rural India, the number was nearly twice (49) that of urban India (27).

• The neonatal mortality rate (NNMR) is down to 24.9 per 1000 live births.

• The infant mortality rate (IMR) is down to 35.2 per 1000 live births.

• Family planning has gone up, with 66.7 of currently married women in the age group of 15 to 49 opting for contraceptives. 53.5

• The use of modern methods of contraceptives including condoms, pills, IUDs and injectables has also gone up from 47 to 56.5 percent of married women opting for them.

NFHS-5: What It Found & What It Means

• Contraceptive use has gone up

The highlight of the survey has been the positive up tick in modern contraceptive usage. However, it also finds that the “Unmet need for family planning methods” remains highest among the lowest wealth quintile (11.4 percent).

Only 50.7 percent of women in the lowest wealth quintile used modern contraceptives, compared to 58.7 percent of women in the highest quintile.

Women who are employed were also found to be more likely to use them.

What it means:

While the data shows that the knowledge of contraceptives is pretty much universal (99 percent of married men and women in both rural and urban India knew of them), only a little over 50 percent of the currently married population opts for contraceptives.

Their usage is also determined by employment status and income level.

“This data adds to the mountain of evidence that proves that development is the best contraceptive,” said Poonam Muttreja, the Executive Director of Population Foundation of India.

• Female sterilisation is still the most popular method of contraception.

37.9 percent of married women between the ages of 15 to 49 underwent female sterilisation. This is nearly 2 percent more than in 2015-16.

While more women in rural India (38.7 percent) went through with it than in urban India (36.3 percent), the difference is small.

What it means: The onus of family planning still heavily leans on women, and far from modern conctraceptives easing the burden of female steralisation, the practice has only gone up.

There isn't much difference in this as far as rural and urban spheres are concerned.

• Lower fertility rate

India's total fertility rate has seen a decline from 2.2 children per woman in 2015-16) to 2 children in 2019-21.

The trends in fertility of residence (TFR) is down across communities, however, the fall in TFR among Muslims has been the sharpest at 2.36 children per woman as compared to 2.62 kids per woman in 2015-16.

What this means: The numbers are lower, yet vary across caveats of religious groups, communities, and states.

The decline continues the downward trend in India's fertility rate over the last few decades.

• Anaemia remains a major concern

57 percent of all women aged 15-49 years were found to be anaemic, whereas 25 percent of men in the same age group have anaemia.

In fact, the prevalence of Anaemia has gone up in all categories, including men and women of all ages.

What it means: While there has been a 4 percent rise in anaemia in women compared to 2015-16, there has been a 3 percent rise among men.

India has not been effectively able to tackle the burden of anaemia, and remains a concern across age groups, sexes and social strata. The government will have to priorotise a more aggressive approach to tackle this issue going forth.

• Obesity is on the rise

24 percent of women and 22.9 percent of men were found to be overweight or obese (BMI ≥25.0 kg/m2), which is 4 percent higher than in 2015-16.

What it means: While obesity seems to have gone up in both men and women, fewer people in the same age groups are underweight as compared to 2015-16.

The Way Forward

The data paints a mix-bag of both positives and setbacks.

While things seem to be looking up as far as reproductive health, neonatal healthcare and vaccination among children are concerned, there is much work to be done to close the disparity between the rural and urban spheres as far as accessibly and reception to modern healthcare services is concerned.

“While there is much to celebrate in the NFHS-5 data, especially the fact that the Total Fertility Rate has come down to 2.0, our focus should now be to reach the unreached. We must do more for the marginalized sections of the society, who may be underprivileged on the basis of class, identity or geography.”

Poonam Muttreja, Executive Director of Population Foundation of India

Some of the big concerns that this data highlight are the high prevalence of Anaemia, poor nutrition, and high prevalence of Non-Communicable Diseases (NCDs) which were not previously recorded.

“Considering the huge population size and profound demographic diversity in the country, context-specific policy and programmes will be needed for states, passing through different stages of the demographic transition,” added Poonam Muttreja.