What does the NFHS show about women’s health in India?
Published on :- December 17th, 2021How are Indian women doing? Here's a data-driven look at the state of women's well-being in India. From adolescence to motherhood, the health of the woman forms a cornerstone in overall public health, having a cyclical influence on newborn and child health as well. However, the health of women cannot be relegated to maternal health alone - it must be looked at holistically to consider the whole life cycle and various social determinants of health from education to financial independence. Over 71% of women are literate today. Women in India are on par with men in educational performance and participation at higher education level. However, their labour force participation remains abysmally poor. At 17.6% it is among the lowest globally. Women’s access to education has improved significantly, but not their employment. Similarly, women’s access to healthcare has improved but not their health unfortunately. We turn to the National Family Health Survey (NFHS), a large-scale, multi-round survey conducted in a representative sample of households throughout India, of 2005-06 (NFHS 3), 2015-16 (NFHS 4) and 2019-21 (NFHS 5) to get a glimpse. While many systemic factors influence a woman’s health, her access to money (financial), to knowledge (education) and ability to choose (decision-making) form the foundations through which she may prioritize her health. Over the years, we see a steep increase in the woman’s decision-making power along with her access to land and bank accounts. Financial independence, along with empowerment through education on the rise may bolster the ability of a woman to seek health enhancing behaviors, have autonomy over her sexual health and well-being and plan her family. But do we see a proportional betterment of health? Just about 57% of women fall in the normal weight (BMI) category, 43% are either overweight or underweight. In a worrisome trend, the proportion of women who are obese has more than doubled since 2006, while the proportion of women who are underweight has gone down 20% which is a positive sign. In addition to BMI, the latest NFHS also looks at a new indicator - high risk waist-to-hip ratio (WHR), a determinant of heart disease along with BMI - and close to 57% of women fall under the high-risk category. Along with an overall increase in obesity, we also see an increase in blood pressure and blood sugar levels. Overall, urban women have higher BMI and WHR, higher blood pressure and blood sugar than women in rural areas. This is even more pronounced in the southern states of India. Further, 57% women in India are anaemic, with an upward trend over the last 5 years. Rural women have higher rates of anemia and higher rates of low BMI than urban. There seems to be a decline in overall wellness based on general health indicators, and the urban and rural areas pose very different challenges. We also notice an increase in health compromising behaviors among women including tobacco and alcohol consumption, with the rural areas having a higher consumption rate. The comprehensive knowledge of HIV/AIDS however, has seen a steep increase. Sexual & Reproductive Health The good news here is that the good menstrual hygiene among women has seen a rise, with rural areas showing a steeper increase. Teenage pregnancies are on the decline overall, but rural areas need to improve further. Among the contraceptives used, female sterilisation ranks as the highest, contributing to over half the contraception methods used in India, while male sterilization ranks as the lowest. Women are 125 times more likely to get sterilized compared to men. While 38% of women in the reproductive age are sterilised, only 0.3% of men are. The burden of contraception falls disproportionately on women, though the male sterilisation process is a lot less invasive as a medical procedure. Maternal Health Total Fertility Rate (number of children per woman) has declined from 2.7 in 2006 to 1.8 in 2020. Maternal Mortality Rate (MMR) has seen a welcome change from 20.07 in 2007 to 8.17 in 2018 (source : SRS) . Yet much more needs to be achieved when it comes to healthier pregnancies and thus healthier offspring. As folic acid consumption has increased over the years, anemia in pregnant women has come down. Anemia is known to significantly raise the risk of death during pregnancy and of poor motor and mental growth in children. Anemia in non-pregnant women is actually higher than in those pregnant, underlining the need for sustained supplementation and better nutrition for women longer term and not just during pregnancy! Malnutrition has been a widespread and chronic problem in India. Particularly in the case of women, it creates a vicious 'malnutrition trap' with cycles of malnourished mothers and malnourished babies over generations. Women's good health is a combination of many factors including the right nutrition, good healthcare, menstrual hygiene, good sexual and reproductive health, sanitation facilities and more. Today with half the women in India being anemic, increasing numbers outside of the normal weight category, and the rising incidence of elevated blood pressure and sugar – we certainly need a wider focus on women’s health beyond maternal care alone. For more state-level data from the NHFS click here