Insightful survey

Issues and Aspects of NFHS 5

Context:

The Authors raise some general queries and answer them widely, regarding THE FINDINGS OF the recently released NFHS-5 on population and health indicators.

Editorial Insights:

Findings of the recently released NFHS-5 on population and health indicators have received extensive attention. The finding that there are 1,020 women for 1,000 men, an improvement over the last round of surveys, has led to a wide-ranging conversation.

The finding, of course, has implications for a range of other issues, especially those related to gender equality — they carry pointers for those wishing to gauge the success of government programmes that aim to remove gender-based discrimination. Some have also questioned the data.

It is important to state that the correct interpretation of data has been lacking in both these cases.

Considering the overwhelming anxiety over the reported sex ratio of a surveyed population, it is pertinent to clarify the limitation of generalisations, and caution against drawing firm conclusions while also showing how these surveys help understand certain trends.

The progress in sex ratio as evidenced by the comparison between the last and the latest round of NFHS clearly conveys the improving sex ratio situation in the country. The design of the NFHS, explicated in all final reports that are in the public domain, clearly indicates its representativeness. There is no reason for any misgiving on the ability of NFHS to provide household representativeness.

Facts Regarding NFHS 5

National Family Health Survey 5

• The main objective of successive rounds of the NFHS is to provide reliable and comparable datasets on health, family welfare, and other emerging issues.
• Earlier the Health Ministry itself used to conduct District Level Health Survey (DLHS) and Annual Health Survey (AHS). MoHFW has decided to conduct integrated NFHS with a periodicity of three years in lieu of different surveys from 2015-16 onwards to meet the evolving requirements for frequent, timely, and appropriate data at the National, State, and District levels.
• The all-India and State/UT level factsheet released includes information on 131 key indicators. It provides information on important indicators which are helpful in tracking the progress of Sustainable Development Goals (SDGs) in the country. NFHS-4 (2015-16) estimates were used as baseline values for a large number of SDG indicators. Many indicators of NFHS-5 are similar to NFHS-4carried out in 2015-16 to make possible comparisons over time.
• NFHS-5 includes some new focal areas, such as death registration, pre-school education, expanded domains of child immunization, components of micro-nutrients to children, menstrual hygiene, frequency of alcohol and tobacco use, additional components of non-communicable diseases (NCDs), expanded age ranges for measuring hypertension and diabetes among all aged 15 years and above, which will give requisite input for strengthening existing programmes and evolving new strategies for policy intervention.

Concerns & Confusions:

At the outset, it is important to remember that an indicator like the sex ratio of a surveyed population can never be a replacement for the population sex ratio obtained in a complete enumeration — the Census, for instance— that includes population beyond the household. Household surveys will not capture the population living in institutions — these have more men than women.

The household-based approach of the NFHS might leave out male migrants—though there are possibilities of them getting included in their place of destination if they live in a household.

The sex ratio, characteristics, and composition of a surveyed population are often compared to the Census figures to justify the representational aspects of the survey. But, these sets of figures are by no means comparable.

Considering the overwhelming anxiety over the reported sex ratio of a surveyed population, it is pertinent to clarify the limitation of generalisations, and caution against drawing firm conclusions while also showing how these surveys help understand certain trends.

Way Ahead

• Given its huge sample size, perhaps the world’s largest household survey, (over 6, 36,699households), the NFHS has better reliability than any other national survey.
• The NFHS-5 results indicate an improvement over the last four years from 991 women in 2015-16 to 1,020 women in 2019-21 for every 1,000 men. This is also indicative of the fact that the life expectancy of women has improved considerably over the period in India. According to the latest data, for 2014-18, women live 2.5 years more than men.
•  Thus, the use of sex ratio trends to make a case for the progress India has made on gender justice and women’s empowerment is not entirely wrong. While this ratio may not be a sole indicator of gender balance, there can be no denying the fact that the gender divide in many areas has narrowed. That women’s share in the population is getting balanced also owes to the reduced sex differential in early age mortality, and progress in several women-centric indicators captured in the survey.

Conclusion 

Finally, though it is perhaps premature to confirm a balanced sex ratio in India, the NFHS results do indicate progress towards that end.