National Family Health Survey (NFHS 3) Report

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National Family Health Survey (NFHS 3) Report

[Report by AIEF]

[The details of the survey data and reports are available from

http://www.nfhsindia.org/]

According to the Press Information Bureau (PIB) of India, the much

anticipated the 3rd National Family Health Survey report is released.

The Final Report of the National Family Health Survey (NFHS-3), 2005-

06 released by the Ministry of Health and Family Welfare offers a

comprehensive picture of the health, nutrition and population in the

country. Releasing the Report, the Mission Director, National Rural

Health Mission, Ministry of Health and Family Welfare, Shri G. C.

Chaturvedi, said findings from NFHS-3 have added substantially to the

knowledge base about the health and family welfare situation of the

country and will be a valuable source of information for making

further improvements in health and family welfare policies and

programmes.

The national report paints a mixed picture of India's overall

reproductive health status. On the one hand, women are having fewer

children and infant mortality has dropped in the seven-year period

since the last NFHS survey in 1998-99. On the other hand, anaemia and

malnutrition are still widespread among children and adults. And, in

an unusual juxtaposition, more adults, especially urban women, are

overweight or obese than they were seven years ago.

NFHS-3, the third in the NFHS series of surveys, provides information

on population, health and nutrition in India and each of its 29

states. For the first time, NFHS-3 collected information on men and

unmarried women. The survey is based on a sample of households that

is representative at the national and state levels. It conducted

interviews with around 200,000 women age 15-49 and men age 15-54

throughout India. NFHS-3 also tested more than 100,000 women and men

for HIV and 215,000 adults and young children for anaemia.

The data set on key indicators provides a trend that includes

information on several new topics, such as HIV/AIDS-related attitudes

and behaviour, male involvement in family welfare and attitudes about

family life education for children in school.

Key findings:

Family Planning Use Up, Fertility Down

Smaller families are slowly becoming the norm in India. Fertility

has continued to decline since NFHS-2, dropping to an average of 2.7

children from 2.9 children. Ten states, mostly in Southern India,

have reached replacement level or below replacement level fertility.

While son preference remains a barrier to more rapid decline in

fertility, an increasing number of women who have only daughters say

that they want no more children. In NFHS-3, 62% of women with two

daughters and no sons say they want no more children, compared with

47% in NFHS-2.

Declining fertility could be attributed largely to women's increased

use of contraception. For the first time ever, more than half of

currently married women in India are using contraception, and their

use of modern contraceptive methods increased from 43% to 49% between

NFHS-2 and NFHS-3. A rise in the average age at marriage is also

contributing to the drop in fertility. Forty-five percent of women

ages 20-24 were married before the legal age of marriage of 18 years,

compared with 50% seven years earlier. This shift in age at marriage

also influences the median age at first birth, which increased by six

months to 19.8 years.

Half of Women Lack Proper Care during Pregnancy and Delivery

More than three-quarters of pregnant women in India received at least

some antenatal care (ANC), but only half of women had at least three

ANC visits with a health provider during their pregnancy. The

disparity between urban and rural women was especially pronounced,

with 74% of urban women having ANC at least three times, compared

with 43% of rural women. Births assisted by a health professional

increased to 49% from 42%, with 75% of urban women but only 39% of

rural women in NFHS-3 received assistance from a health professional.

Institutional births increased from 34% to 41%, but most women still

deliver their children at home. Only about one-third of women

received postnatal care within two days of delivery.

Infant Mortality Drops, but Full Immunization Coverage Shows Little

Progress

Infant mortality continues to decline, dropping from 68 in 1998-99 to

57 in 2005-06 per thousand births. There were particularly notable

drops in the infant mortality rate in Bihar, Goa, Haryana, Jammu and

Kashmir, Meghalaya, Orissa, Punjab, Rajasthan, Tamil Nadu, and Uttar

Pradesh. The situation regarding child immunization rates during this

period has not been very encouraging. Overall, there was only a

marginal improvement in full vaccination coverage, with 44% of

children ages 12-23 months receiving all recommended vaccinations, up

from 42% seven years earlier. Substantial improvements in coverage

have been made in all vaccinations except DPT, which did not change

at all between NFHS 2 and NFHS-3. Gains are particularly evident for

polio vaccination coverage, but nearly one-quarter of children age 12-

23 months did not receive three recommended doses.

Progress in vaccination coverage varies markedly among the states. In

11 states, there has been a substantial deterioration in full

immunization coverage in the last seven years, due to a decline in

vaccination coverage for both DPT and polio. Large decline were seen

in Maharashtra, Mizoram, Andhra Pradesh, and Punjab. On the other

hand, there was major improvement in full immunization coverage in

Bihar, Chhattisgarh, Jharkhand, Sikkim, and West Bengal. Other states

with marked improvements in full immunization coverage were Assam,

Haryana, Jammu and Kashmir, Madhya Pradesh, Meghalaya, and

Uttaranchal.

Diarrhoea continues to be a major health problem for many children.

Although knowledge about Oral Rehydration Salts (ORS) for the

treatment of diarrhoea is widespread among mothers, only 58% of

children with diarrhoea were taken to a health facility, down from

65% seven years earlier.

Domestic Violence Widespread

A substantial proportion of married women reported that they

experienced physical or sexual violence at some time in their lives.

Overall, 40% of ever-married women experienced violence, with large

variations among the states. The experience of spousal violence

ranges from a low of 6% in Himachal Pradesh to a high of 59% in

Bihar. Married women with no education were much more likely (at 46%)

than other women to have suffered spousal violence. However, spousal

violence extended to women who have 12 or more years of higher

education, with 12% reporting violence.

Malnutrition Persists; Anaemia Widespread

Malnutrition continues to be a significant health problem for

children and adults in India. While there have been some improvements

in the nutritional status of young children in several states,

nutritional deficiencies are still widespread. There has been the

increase in wasting, or weight for height, among children under age 3

years. Around 23% of children were wasted. At the same time, there

has been very marginal change in the percentage of children who are

underweight (43% in NFHS-2 and 40% in NFHS-3).

NFHS-3 also found high prevalence of anaemia – 70% – in children age

6-59 months. Anaemia in India is primarily linked to poor nutrition.

Women and men suffer a dual burden of overnutrition and

undernutrition. More than one third of women are too thin, while 13%

are overweight or obese. In all, nearly half of married women are

either underweight or overweight. One-third of men are too thin, and

9% are overweight or obese. The states with the largest percentage of

overweight women and men are Punjab, Kerala, and Delhi, especially

among the more educated.

Anaemia is also disturbingly common among adults. More than half of

women in India (55%) are anaemic. Anaemia among pregnant women

during that period has also increased. Even though men are much less

likely than women to be anaemic, anaemia levels in men are at around

24%.

Most Adults Support Family Life Education

Virtually all Indian adults agree that children should be taught

moral values in school, and most adults think that children should

learn about the changes that occur in their bodies during puberty.

Men and women differ somewhat on whether children should be taught in

school about contraception. About half of women and two-thirds of men

think that girls should learn about contraception in school. Both

women and men are slightly less likely to say that contraception

should be part of boys' school education.

Most men and women believe that information on HIV/AIDS should also

be part of the school curriculum. About 80 percent of men think boys

and girls should learn about HIV/AIDS, compared with 63 percent of

women. More than 60 percent of men say that both boys and girls

should be taught about sex and sexual behaviour in school, but

slightly less than half of women felt that this was an appropriate

topic to be taught to girls or boys in school.

Two-thirds of Married Women Don't Know That Condoms Prevent HIV

Given that people living with HIV in India is substantial, findings

from NFHS-3 on the extent and sex differentials in knowledge of

HIV/AIDS are of concern. Only 84% of men and 61% of women have ever

heard of AIDS. Further, only 70% of men and 36% of women know that

consistent condom use can reduce the chances of getting HIV/AIDS. The

results underscore the pressing need to educate women and men about

the virus, how it is transmitted, and how it can be prevented.

Increasing HIV/AIDS education will be a critical step to curbing the

number of new HIV cases in India.

HIV Prevalence

For the first time, the survey measured community level HIV

prevalence at the national level and for selected states. New

evidence from NFHS-3 has provided crucial information for

understanding India's HIV epidemic. The survey found an HIV

prevalence rate of 0.28 percent for the population ages 15 to 49.

Prevalence is more than 60 percent higher among men than women, at

0.36 percent and 0.22 percent, respectively. NFHS-3 found HIV

prevalence to be particularly high in Manipur (1.1%) and Andhra

Pradesh (1.0%).

About NFHS

The National Family Health Survey (NFHS-3) 2005-06 is the third in a

series of national surveys; earlier NFHS surveys were carried out in

1992-93 (NFHS-1) and 1998-99 (NFHS-2). All three surveys were

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.

Macro International, Calverton, land, USA, NACO and NARI provided

technical assistance. Besides the Government of India, funding for

NFHS-3 was provided by the United States Agency for International

Development, the Department for International Development (United

Kingdom), the Bill and Melinda Gates Foundation, UNICEF, the United

Nations Population Funds.

18 research organizations were engaged to conduct the fieldwork for

interviewing 199,000 women age 15-49 and men age 15-54 throughout

India. NFHS-3 also tested more than 100,000 women and men for HIV and

215,000 adults and young children for anaemia. Fieldwork for NFHS-3

was conducted in two phases from December 2005 to August 2006.

Obtaining the data and the research tools

NFHS administered three types of questionnaires: the Household

Questionnaire, the Woman's Questionnaire and the Village

Questionnaire. The Village Questionnaire was administered only in the

rural areas. For each state and at national level three data files

are associated with these questionnaires. Also available are data

files with information on children born during the three years

preceding the survey (last two children only) along with mother's

basic characteristics.

Data files are available in user-friendly formats for SPSS, SAS, and

STATA users. Data files are available in three formats: the flat

format, the rectangular format and the hierarchical format. The SPSS,

SAS, and STATA include files are also distributed with the data set.

The data set comes with elaborate documentation regarding variables

and related descriptions.

All the data files for 24 states and the National Capital Territory

of Delhi, as well as the National data set of NFHS-1 are published by

1995. The data files for NFHS-2 are published for the states for

which final report has been published. Announcements regarding

release of data set will be given regularly on this site in our

What's New? section.

All the data published so far are available for download through

Demographic Health Survey data distribution system. The DHS website

belongs to ORC Macro. For more details on obtaining and downloading

NFHS data please visit:

http://www.measuredhs.com

http://pib.nic.in/release/release.asp?relid=31835