India’s impressive economic growth and revenues over the past three and a half decades have allowed it to overcome some of its most acute social sector challenges, and no longer have to worry about population growth that is already on a downward trajectory.
This is the message from the findings of the latest National Family and Health Surveys (NFHS) – the sixth round, conducted in 2023-24 – released on Friday by the Ministry of Health and Family Welfare.
The results also highlight the success of government programs – such as those in the areas of financial inclusion and health insurance.
Details: Only 25.5% of births were institutional deliveries in the first round of the National Health Insurance Program, conducted in 1992-1993. This proportion rose to 38.7% by NFHS-3 (2005-06), 78.9% by NFHS-4 (2015-16), and is now at 90.6%. India’s total fertility rate (TFR) – the average number of births a woman expects – has decreased from 3.4 in NFHS-1 to 2 in NFHS-5 (2019-21) and remains 2 in NFHS-6 as well. A total fertility rate of 2.1 is considered an alternative fertility level below which a country will suffer from population decline in the long term. The proportion of underweight children decreased from 53.4% to 31.8% between NFHS-1 and NFHS-6.
The findings are particularly important because one of the most important and reliable sources of filling the demographic information void in the past decade and a half has been the National Household and Health Surveys, which have undergone three iterations since the 2011 census. India conducted its last census in 2011. It is now in the process of conducting its next census. Data for the next census will be available from 2027 onwards.
The latest NFHS shows that success is almost universal in some measures, such as institutional births. In other areas, such as child nutrition, challenges remain but progress is unambiguous.
To be sure, the NFHS numbers also have some red flags. In 2005-2006, more than a third of Indian men and women were underweight or had a body mass index below normal. The percentage of men and women who were overweight was only 9.3% and 12.6%. By 2023-2024, less than 20% of men and women will be underweight, but more than that – 27.3% and 30.7%, respectively – will be overweight. Nearly one-fifth of men and women have high blood sugar, and about a similar percentage report high blood pressure. The burden of lifestyle diseases is now a bigger problem than the lack of reproductive health and antenatal care facilities. This trend is consistent with the rising burden of deaths from cardiovascular disease in the country, as seen in cause of death statistics from Sample Registration System (SRS) reports.
As the country’s demographic profile moves slowly but surely towards an older population – the proportion of the population over 60 years of age increased from 9% in 2005-06 to 12.9% in 2023-24 according to the NFHS Sixth National Report – it will also need to focus on managing emerging health challenges.
There is certainly more to the NHS data released on Friday than just a story of long-term reforms. NFHS-6 and NFHS-5 rounds have the smallest gaps between two successive rounds of scanning. However, they show impressive achievements on some indicators, which tell the story of the successes achieved by both the country and the markets.
The proportion of men and women who ever used the Internet increased from 51.2% and 33.3% in 2019-2021 to 80.5% and 64.3% in 2023-2024. The proportion of households with any usual member covered by the health insurance/financing program increased from 41% in the period 2019-2021 to 60% in the period 2023-2024. The proportion of women with a bank account that they use increased from 15.1% in 2005-2006 to 53% in 2015-2016 to 89% in 2023-2024.
All these achievements are in line with government-led programs for financial inclusion, the spread of DBT-based cash transfer schemes for women across states, the role played by the central government’s health insurance program Ayushman Bharat Yojana, and India becoming one of the fastest growing and cheapest mobile internet markets in the world.
To be sure, the latest round of NFHS published data on lower standards than its predecessor, and the National Fact Sheet does not contain critical health indicators such as the proportion of men and women with anemia. In purely numerical terms, the NFHS-5 fact sheet provided data on 131 indicators while the NFHS-6 contains information on 101.
As expected, there are large differences in the numbers between states, but the general trends, at least with regard to the aspirational indicators, remain the same: an improving trend.
The NFHS also offers a treasure trove of data beyond the fact sheet, including indicators across social and religious demographics. However, this analysis will not be possible until after the issuance of reports and data at the unit level from the current round.
