Indian Express Editorial Analysis
07 December 2021

1) When numbers hide

GS1: Issues related to Women


  • The authors talk about NFHS-5 & its results on sex ratio.

Editorial Insights:

  • The recent publication of the NFHS-5 key results has evoked the attention of researchers, government agencies & the media.

    • This is because of the range of topics covered in the summary factsheets released.

National Family Health Survey-5:

  • The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted in a representative sample of households throughout India.

  • All National Family Health Surveys have been conducted under the stewardship of the Ministry of Health and Family Welfare, Government of India, with the International Institute for Population Sciences, Mumbai, serving as the nodal agency.

  • The NFHS was conducted in two phases, one before the pandemic & the other from January 2020 to April 2021.

Significance of NFHS:

  • The National Family Health Surveys (NFHS), brought out by the International Institute for Population Sciences (IIPS), provide some of the most critical information on the demographic, health, nutrition, and socio-economic status of people in the country.

  • The surveys draw on the experience of experts from national and international organizations, besides that of the Government of India.

  • NFHS’s strength lies in technical innovation in data collection due to its high-end organizational machinery and technically trained personnel to conduct interviews and supervise fieldwork.

  • It uses a bio-marker questionnaire in which entries are recorded after actual clinical, anthropometric and biochemical testing.

  • Its results are important not just for monitoring the health and family welfare schemes, including the SDGs, but also in situating the country’s development globally.

The Findings of NFHS-5 Phase 2:

  • Women outnumber men: For the first time in India, between 2019-21, there were 1,020 adult women per 1,000 men.

  • However, the data shall not undermine the fact that India still has a sex ratio at birth (SRB) more skewed towards boys than the natural SRB (which is 952 girls per 1000 boys).

    • Uttar Pradesh, Haryana, Punjab, Rajasthan, Bihar, Delhi, Jharkhand, Andhra Pradesh, Tamil Nadu, Odisha, Maharashtra are the major states with low SRB.

  • Fertility has decreased: The Total Fertility Rate (TFR) has also come down below the threshold at which the population is expected to reproduce next generation.

    • TFR was 2 in 2019-2021, just below the replacement fertility rate of 2.1.

  • Worsening Anaemic situations: The incidence of anaemia in under-5 children (from 58.6 to 67%), women (53.1 to 57%) and men (22.7 to 25%) has worsened in all States of India (20%-40% incidence is considered moderate). Except for Kerala, all other states are in severe anaemic conditions.

  • Children’s nutrition improved but at a slower pace: The share of stunted (low height for age), wasted (low weight for height), and underweight (low weight for age) children have all come down since the last NFHS conducted in 2015-16.

    • However, the share of severely wasted children has not, nor has the share of overweight (high weight for height) or anaemic children.

NFHS-5 & the Sex-Ratio results:

The sex ratio result has evoked particular attention overshadowing most other indicators because:

  • The sex ratio shows that there are 1020 females/1000 males (985 in rural & 1037 urban) in the country.

    • This ratio was 991 in the NFHS-4 & 1000 in NFHS-3, while in the 2011 census it is recorded as 940.

    • Further another interesting finding is that the sex ratio for Kerala in the 2011 Census was the highest at 1084 while NFHS-5 has estimated it to be 1121.

  • Positive results from NFHS-5:

    • There is a secular increase in the sex ratio at birth (SRB) for children born in the last 5 years.

    • The number of girls/1000 boys has gone up from 818 in 2015-16 to 929 in 2019-21.

      • With a significant rise in rural areas against a marginal increase in towns & cities.

        • This is because the availability of medical facilities in urban areas though reduces maternal mortality & death rate for girl children, increase gender-selective termination of pregnancies.

      • Further, the sex ratio of children up to the age of six in NFHS-3 is much lower than that of the 2001 Census, this is the opposite for NFHS-5 & 2011 Census.

      • Additionally, while the child sex ratio has gone down from 927 to 919 as per the 2011 Census, while SRB-5 shows a continuous rise.

      • Finally, the high increase in SRB-5 in rural areas in NFH-5 is due to a significant fall in this ratio between the period 3rd & 4th NFHS.

  • Why such variations?

    • The variations are just due to sampling error margins.

    • The fact is that NFHS was not designed to estimate a key population characteristic like sex ratio or even the total population of the country that is needed to estimate the national sex ratio.

    • Further, the survey concentrates on collecting data from specific age groups of men, women & children.

    • At the same time, there is a lack of information on how NFHS selects a household.

    • The variation of sex ratio/high sex ratio in NFHS is maybe possible because it selects household that excludes those living in hostels, workers, camps or place that predominantly house men.

      • Because in NFHS-4, 14.6% of the household were headed by females, in NFHS-3 it is 14%, while in the NFHS-5, most of the states have high figures such as 24% for Kerala & 23% for Bihar.

        • This shows that NFHS’s household count excludes the male members staying away from home.

    • At the same time, major lacunae in NFHS are that it publishes just fact sheets with no metadata.

      • The statistical validity of the indicators needs to be supported by the appropriateness of the survey design.

    • At the same time, NFHS-4 seems to be out of trend &hence needs to be investigated.

  • Possible Consequences of these results:

    • The impression that is given by NFHS-5 of women outnumbering men could adversely affect:

      • Ongoing programmes against sex-selective abortions,

      • Projects that focus on removing neglect of women in education & health

      • Initiatives that aims to remove discrimination in access to property rights.

Concluding Remarks:

  • For a highly populated & diversified country like India, the data such as NFHS plays a major role in policy & decision making. Therefore it is high time to resolve the anomalies in the survey & to develop a system of robust data generation.