India remains the country with the highest prevalence of anaemia globally. This medical condition, characterized by a deficiency in red blood cells, predominantly affects vulnerable populations, particularly women and children. One of the primary causes of anaemia is believed to be iron deficiency, often linked to inadequate nutrition.
However, the National Family Health Survey (NFHS-6) has removed several key indicators related to anaemia, sanitation, and access to clean cooking fuel. A total of 43 significant indicators that were previously included in earlier NFHS reports have been excluded from this latest survey. These indicators included important health and sanitation metrics such as anaemia prevalence, child mortality rates, sex ratios at birth, and access to clean cooking fuel.
The absence of reliable data can hinder policymakers’ ability to assess public health and social development in India. To understand the implications of these omissions, it is essential to have a brief overview of the NFHS.
The National Family Health Survey (NFHS) collects vital information on various aspects including fertility, family planning, maternal and child health, reproductive health, and nutrition. The NFHS has a long-standing history of contributing to discussions surrounding social sector growth in India.
Initiated in 1992, the NFHS is part of a global initiative by the United States Agency for International Development (USAID) under its Demographic and Health Survey (DHS) program. The first NFHS (NFHS-1), conducted in 1992-93, was managed by the Ministry of Health and Family Welfare, with the Indian Institute of Population Studies (IIPS) serving as the principal research agency.
This inaugural survey provided crucial national and state-level data on fertility rates, family size preferences, and family planning, aimed at assisting researchers and policymakers in evaluating family welfare initiatives.
The second survey, NFHS-2, conducted in 1998-99, expanded the scope to include additional topics such as reproductive health, women’s autonomy, domestic violence, women’s nutrition, anaemia, and salt iodization. The timing of NFHS-2 was delayed due to the Pokhran nuclear tests, which postponed its launch by five years.
NFHS-3, carried out in 2005-06, continued to explore similar themes while introducing a questionnaire for men regarding family planning and health. It is noteworthy that NFHS-3 employed a more comprehensive methodology for assessing domestic violence compared to its predecessor.
Subsequent surveys, including NFHS-4 (2015-16), NFHS-5 (2019-21), and the current NFHS-6 (2023-24), have upheld this tradition of collecting significant data. Over the years, NFHS data has sparked engaging discussions surrounding fertility trends, family planning, and maternal and child health.
Global fertility discussions have increasingly centered on a “fertility crisis,” as birth rates continue to decline worldwide. According to NFHS-6, India’s Total Fertility Rate (TFR), which indicates the average number of children a woman is expected to have, has stabilized at 2.0, below the replacement level of 2.1 necessary to maintain population levels.
Urban areas of India report a TFR of 1.6, whereas rural areas stand at 2.1. However, notable regional disparities exist; for example, Bihar and Uttar Pradesh have TFRs around 2.7 and 2.2, respectively, while states such as Assam and Kerala report TFRs of approximately 1.6 and 1.8.
Adolescent fertility also remains a critical issue. NFHS-6 indicates that 6.7% of women aged 15-19 were either mothers or pregnant at the time of the survey, showing a slight decrease from the 6.8% recorded in NFHS-5. Nevertheless, NFHS-6 does not provide direct figures on adolescent fertility rates for this age group, a departure from the previous survey.
Experts argue that the so-called “fertility crisis” should not solely be interpreted as declining birth rates but should also consider the obstacles that prevent individuals from achieving their desired family size. Issues such as women’s reproductive rights, including access to abortion, as well as economic factors like rising living costs, stagnant wages, and increased childcare expenses, are central to these debates.
Additionally, NFHS-6 has revealed important trends regarding child and maternal health. The percentage of stunted children, defined as those too short for their age due to chronic malnutrition, has decreased from 35.5% in 2019-21 to 29.3%. Furthermore, the rate of underweight children has slightly declined from 32.1% to 31.8%.
Despite these improvements, significant regional differences persist. Stunting remains more prevalent in rural areas (30.9%) compared to urban settings (23.9%), with states like Bihar and Jharkhand exhibiting high rates of 35.6% and 35%, respectively.
NFHS-6 data also indicate an increase in institutional births, rising from 88.6% to 90.6%, along with a rise in immunization rates for children aged 12-23 months, which improved from 83.8% to 87.1%.
While these statistics reflect progress, concerns regarding the nutritional health of women and children persist. NFHS-5 reported that 67% of children under five were anaemic, an increase from 58.6% in NFHS-4. For women aged 15-49, the anaemia rate was 57% in NFHS-5.
Alarmingly, more than half of pregnant women in India are also anaemic. The previous survey included seven specific indicators related to anaemia, all of which have been omitted from NFHS-6. These indicators encompassed the prevalence of anaemia among children aged 6-59 months, as well as various groups of women and men aged 15-49 and adolescent boys and girls aged 15-19.
In summary, India continues to grapple with the highest levels of anaemia globally, raising significant public health concerns.
