October 20, 2007
ECONOMIC
Time to Act
T
he final report of the third National Family Health
Survey (NFHS-3) conducted in 2005-06 in the
country’s 29 states contains good news and bad
as compared to the NFHS-2 of 1998-99. While women
are having fewer children and infant mortality has
declined over the seven-year period, anaemia and
malnutrition are still widespread among children and
adults. For the first time the NFHS has collected in-
formation relating to men and unmarried women. The
exercise involved interviews with around 2,30,000
women (15-49 years) and men (15-54 years), the test-
ing of more than 1,00,000 women and men for HIV
and 2,15,000 adults and young children for anaemia.
Infant mortality has dropped from 68 per thousand
live births in 1998-99 to 57 per thousand live births in
2005-06, with Bihar, Goa, Haryana, Jammu and Kashmir,
Meghalaya, Orissa, Punjab, Rajasthan, Tamil Nadu, and
Uttar Pradesh showing considerable improvement.
Fertility too has decreased to an average of 2.7 children
from 2.9 children following a rise in the age at marriage.
The other heartening finding here is that 62 per cent
of the women with two daughters and no sons said
they want no more children, compared with 47 per cent
in NFHS-2.
However, children and women continue to be the
worst off sections. Wasting (deficit in weight for height)
among children less than three years is around 23 per
cent and the percentage of underweight children has
improved very marginally. Anaemia has actually
increased in children aged 6 to 59 months (a high
prevalence of 70 per cent) and in women (a prevalence
rate of 55 per cent), including pregnant women. This
gives India the dubious distinction of having the largest
number of anaemic women and children in the world.
Another alarming finding is that only 44 per cent of
children between the age of 12 and 23 months are
receiving all the recommended vaccinations. In 11
states, including the better off Maharashtra, Andhra
Pradesh and Punjab, there has been a substantial
AND POLITICAL WEEKLY
deterioration in full immunisation coverage in the last
seven years, due mainly to a decline in vaccination
coverage for both DPT and polio. And not surpris-
ingly, Indians in rural areas are worse off than their
urban counterparts in terms of access to healthcare
provisions as well as other health indicators.
The low social status of women means that they are
the last priority when limited resources are available
to access nutrition and healthcare facilities. The survey
also found that though there are great variations among
the states, overall, 40 per cent of married women
experienced domestic violence and abuse and 54 per
cent of them felt this was justified on certain grounds.
Expectedly, the abuse was higher in states where the
position of women is abysmal.
Generally, the indicator of proportion of underweight
children is considered a comprehensive measure of
malnutrition as it has elements of stunting and wasting
too. Comparisons show that in the four states with the
lowest proportion of underweight children – Punjab,
Kerala, Jammu and Kashmir and Tamil Nadu – health
services, care of newborns and the nutritional status of
women are better than in Chhattisgarh, Bihar, Jharkhand
and Madhya Pradesh, the states at the other end of the
spectrum. A rather depressing finding is that two of the
more well off states, Gujarat and Maharashtra show 47
per cent and 40 per cent of underweight children res­
pectively. K R G Nair’s study (EPW, April 14) of
interstate differentials shows that in the three more
economically developed states – Gujarat, Haryana and
Maharashtra – substantial reductions in poverty in 1993-
94 and 1999-2000 were not accompanied by similar
reductions in child malnourishment as it was the
woman’s age of marriage, awareness of health issues
and newborn rearing practices that were more important
than poverty per se.
The poor showing on women’s and children’s health
fronts perhaps calls for a critical assessment of government-
run schemes and programmes like the Integrated Child
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Development Scheme and the mid-day meal. A recent gov-
ernment order has called upon all departments to set up a
gender budget cell to monitor the mandated special gender
quotas for several of its development programmes. Though
the union government has started presenting a gender budget,
not much is known about the outcome of the order.
The NFHS surveys are meant to provide the basis for
developmental schemes and to pinpoint their inadequacies.
There have been suggestions for a less centralised survey
that provides district-wise information since there are huge
differences not just between states but also in regions
within a state. It is high time the government act to combat
malnutrition, especially among women and children, and in
the most backward districts. EPW

4196 Economic and Political Weekly  October 20, 2007