Women in India: Better Care, yet Poorer Health

Women in India: Better Care, yet Poorer Health

Published on :- March 12th, 2021

International Women’s Day was celebrated worldwide on 8th March. Amidst inspirational stories and messages and initiatives, we take a data-driven look at how an average woman in India is doing.

Over 88% 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. The health of women forms a cornerstone in overall public health, having a cyclical influence on newborn and child health. 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 2006 (NFHS 3), 2016 (NFHS 4) and 2020 (NFHS 5) to get a glimpse.

We must keep in mind that the latest iteration of NFHS has been conducted prior to the COVID-19 pandemic and nation-wide lockdown. The extent of influence of the pandemic on health services and women’s health remains to be seen. We look at 22 states/UTs for which data is currently available:

Among many systemic factors that influence a woman’s health, her access to money and knowledge, and the agency to make decisions are important factors in her ability to take care of her health. This survey looks at the autonomy of women through 4 major lenses – education, financial inclusion, digital literacy and participation in household decisions. Over the years, we see a good improvement on all parameters.

General Health & Nutrition

Has this positive change led to improvement in their health overall though? Here are some indicators:

Just about 60% of women fall in the normal weight (BMI) category, 40% are either overweight or underweight. A staggering number - above 50% - of women are anaemic.

The proportion of women who are overweight surpasses those who are underweight in all the surveyed states, except for Bihar, Assam and Gujarat. 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 62% of women fall under high-risk category. Along with an overall increase in BMI, 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, one in two women in the surveyed states is 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.

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. The teenage pregnancies are on the decline overall, but rural areas need to improve further.

Among the contraceptives used, female sterilization ranks as the highest, contributing to over half the contraception methods used in India, while male sterilization ranks as the lowest. The Male to Female Sterilization ratio stands at a staggering 1:60. While 30% of women in the reproductive age are sterilised, only 0.5% 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. While folic acid consumption has increased over the years, anemia in pregnant women continues to go up. 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 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. And that would be an apt action and celebration for women’s day!

Click here to access our Interactive Dashboard with data from NFHS 5 Phase 1

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