There is quite a bit that is reassuring about the results of the first phase of the National Family Health Survey (NFHS) for 2015-16, covering 13 states and two Union territories. Most states have registered significant improvements in maternal and child health indicators compared to the last survey that was carried out in 2005-06. Bihar, for instance, has seen a reduction in both infant as well as under-five child mortality rates from 61 and 84 per 1,000 live births to 48 and 58, respectively. This has been accompanied by a drop in total fertility rate — the average number of children born to a woman during her reproductive life span — from 4 to 3.4 and an increase in deliveries happening in hospitals from 19.9 to 63.8 per cent. Similar progress has been recorded in other states, too, be it Madhya Pradesh, West Bengal, Tripura or Haryana.
True, there’s still a long way for much of India to come anywhere near the infant mortality rate levels of Kerala (13) and Tamil Nadu (21). The latter two have also succeeded in bringing down their fertility rates to 1.7 children per woman and achieving near-100 per cent institutional births. Yet, the fact that fewer children are dying and more women are becoming mothers after their teenage years while largely delivering in hospitals — and this is taking place even in states that seemed eternally condemned to backwardness not so long ago — is something to be welcomed. One could credit this, partially at least, to interventions such as the National Health Mission and state-level initiatives that have significantly helped boost child immunisation and access to antenatal care. Rising female literacy, new welfare schemes (including MNREGA and an expanded public distribution system) and the trickle-down effects of high growth over the last decade may also have played no small role in all this.
But on the negative side, we are also witnessing the emergence of “new” diseases linked mainly to unhealthy diets and sedentary lifestyles of people. The latest NFHS shows more than a third of men and women in Andhra Pradesh to be obese. Roughly a tenth of its men also suffer from hypertension and high blood sugar levels. These problems may not be as serious right now in poorer states like Bihar. But virtually all states have a high proportion of men consuming alcohol — from a quarter to well over half — alongside a worrying decline in sex ratios between the 2005-06 and 2015-16 surveys. These are indicative of a deeper social malaise in a country where growth and rising incomes also create tensions and uncertainties of a different kind. Public health policy cannot afford to ignore them, even while continuing the fight against the “old” problems of mortality and under-nutrition.