Recently Ministry of Health and Family welfare have released the report of Phase I of National Family Health Survey (NFHS) -V. The report covers findings from across 22 states and union territories. It is expected that the report for the phase II which will cover remaining 14 states and union territories will be released by mid-2021, as COVID 19 emerged to be the major cause of delay in data collection. The report gives data on 131 indicators in total including indicators on household and population profile, health, family planning, maternal child health and nutrition, immunization, nutrition, HIV, gender-based violence, and tabaco and alcohol use.
What has worked?
Looking at the outcome indicators such as the Under-Five Mortality Rate (U5MR) and Infant Mortality Rate (IMR) it is much evident that situation has progressed across majority of the state. Other than 4 states out of 22, all the states have reported a considerable decline in the mortality among under five children. North eastern states of Mizoran and Sikkim and union territory of Jammu and Kashmir are among the states showing best results. The IMR and U5MR decline is much backed by the progress in full vaccination coverage, increased rates of institutional delivery and ante natal services in majority of the states.
What are the Pain Points?
Desired progress is witnessed in the mortality rates. However, declining these further to reach the targets of sustainable development goals looks challenging as the nutrition indicators are indeed a pain point. It is a well-established fact that nutrition is an indispensable aspect in the efforts essential to reduce the infant mortality at large. Undernutrition among children have worsened when compared to the last NFHS survey. More than half of the state surveyed have reported an increase in stunting (i.e. height for age of children under five) however pleasantly Bihar has shown a decline in it. To add to the trouble, overweight and obesity has shown an increase in 20 out of 22 states among children and in 16 out of 22 states among women.
Anemia again has emerged as a major challenge, in about close to 70% of the states prevalence of anaemia has increased across different age groups including, children, adolescent, women of reproductive age. NHFS-V data suggest that in 18 states at least 1 in every 3 pregnant women is anaemic, and 13 states reported increase in anaemia prevalence among pregnant women. There are ample studies globally which indicate that maternal anaemia is one of the key determinants of foetal undernutrition and thereafter in childhood as well. Hence it is evident that undernutrition cannot be tackled without correcting the nutrition status of women of reproductive age as well as those who are pregnant.
Where does the hope lie?
While the outcome indicators may not be promising nevertheless noticeable progress is seen in program delivery and uptake of services. There is substantial improvement in regular consumption of iron and folic acid tablets among pregnant women. A total of 19 states reported an increase in the percentage of women who consumed desired dose of iron and folic acid supplements during their pregnancy.
Another fact well acknowledged globally is that diarrhoea is one of the leading causes of death among children and the impact is further detrimental for malnourished children. More than half of the states surveyed have shown an increase in the number of children with diarrhoea who were taken to health facility for treatment and were treated with Zinc and ORS.
Timely initiation of breastfeeding and exclusive breastfeeding during the first six moths of life are key determinants for preventing malnutrition. While exclusive breastfeeding rates have improved in 16 states, only 10 states witnessed an improvement in the rates of early initiation of breastfeeding.
Infants receiving adequate diet has been one of the most challenging indicators when it comes to improving nutrition status. While 17 states have shown an improvement in infants receiving adequate diet, yet in all states only one fourth of the infants have been getting adequate diet.
Drinking water and sanitation are underlying determinants for health and nutrition. Sizeable headway is seen in access to drinking water and coverage of improved sanitation facility at the household level. All states other than Sikkim has shown improvement in improved drinking water access and improved sanitation facility.
What has emerged as key priority?
While health indicators as well as service delivery has shown considerable progress yet ensuring adequate nutrition for the large section remains a hurdle. Data suggests that both under as well as over nutrition has worsened since 2015-16 in majority of the states. Along with malnutrition elevated prevalence of anaemia is worrisome and required great deal of attention and action. While the survey findings do not reflect on the progress of national flagship schemes namely POSHAN Abhiyaan and Anemia Mukt Bharat, what it does highlight the gaps on which swift and intensive work is required. NFHS -V further reiterates that, resolving the nutrition challenges in the country requires multidimensional and a systems approach. It is imperative to focus on ensuring nutrition security for all, which does require meticulous delivery of nutrition services for ensuring high coverage at the household level, which will happen with effective monitoring, setting accountability and effective use of data for course correction. Alongside, looking at the magnitude of the issue it is timely to involve other private players and roll out of large-scale food fortification program and develop models of agri nutrition across different geographies in the country. Diverse diets for all are surely a cause of concern and on the other hand easy access to cheap junk foods high in carbs, sugar, fats, and salt are also yielding alarming statistics in the prevalence of overweight and obesity. As efforts for ensuring nutrition security is a must, nothing is more crucial than making communities aware about the benefits of diverse diet and harmful impact of junk food consumption. The battle against malnutrition in India is a tough one, nothing but due contribution from government, development partners, frontline workers and communities can only change the scenario for good!
(The author is a Nutrition Expert with WeCan, a coalition for nutrition. Views expressed are personal.)