J&K: The NHFS5 Results

The National Family Health Survey-5 (NFHS5) based on the interviews of 3087 men and 23037 women from 18318 households offers key statistics about major trends in women’s health and family. Changes in comparison to earlier surveys indicate that the public investment in the sector is bringing about a shift in peoples’ priorities in Jammu and Kashmir.

Lt Governor interacts with Members of J&K’s First Women Cycling Club

The survey suggests that 62% of households were nuclear families and 38% lived in a joint family set-up. Jammu and Kashmir (JK)’s 24% population is under age 15 and 6% is age 65 and over. The overall sex ratio is 948 females per 1000 males. Ninety-three per cent of persons have an Aadhaar card. Among children below 18 years of age, 3% have lost one or both parents; 96% live with parents, 3% live with one parent, mostly a mother, and the remaining 1% live with neither parent.

In JK, 75% of households have a pucca house; 99% have electricity; 92% use an improved drinking water source; 69% use clean fuel for cooking, and 94% have access to toilet facilities. Shopian is the only district with 100% access to toilets. Household possessions include 97.2% having a mobile phone; 97% have a bank account; 30% owning a motorcycle or a scooter; 23.7% owning a car; 55% having a BPL card, and 62% own agricultural land.

On the literacy front, it was found that 21% of women and 9% of men in the 15-49 age group have never been to school. Only 33% of women have completed 12 or more years of schooling, compared with 46% of men.

A group of young Kashmir women talking on their cell phones in Srinagar. KL Image: Bilal Bahadur

Media exposure is impressive as 55% of men and 47% of women watch television at least once a week. However, 32% of men are more likely than women (15%) to read a newspaper or magazine at least once a week. 31% of men and 45% of women are not regularly exposed to print media or other forms of media.

Women are more likely than men to be currently married (61% versus 55%) or widowed (1% versus 0.4%), while men are more likely than women to be never married (44% versus 38%).

As many as 71% of women and 27% of men (15-49) were not employed in the 12 months preceding the survey. Nine per cent of women and 18% per cent of men were engaged in an agricultural occupation, while 19% of women and 52% of men were employed in non-agricultural occupations.

Only 24% of boys and 25% of girls’ (2-4 years) attend pre-school. Pre-school attendance is a little higher among children in non-nuclear households (26%) than nuclear households (23%). Pre-school attendance among children is higher in households headed by Hindus (31%) than Muslims (22%). Overall, urban households (30%) show higher pre-school attendance than rural households (23%). By district, pre-school attendance is most elevated in Kathua district (49%) and lowest in Reasi district (9%).

High and higher Secondary Schools across the Kashmir valley re-opened after the outbreak of the COVID19 pandemic, on Monday, March 1, 2021. KL Image by Bilal Bahadur

94% of children (6-17 years) attend school (97% in urban areas and 94% in rural areas). School attendance dropped to 87% at age 15-17 years. No gender disparity was found in school attendance in the 6-14 year age group; however, in the age group 15-17 years, 85 per cent of girls compared with 89 per cent of boys attended school.

The median age at first marriage is 23.6 years among women aged 25-49 years. In the 20-49 year age group, 21% of women have never married, compared with 35% of men. Five per cent of women aged 20-24 years got married before attaining the legal minimum age of 18 years, down from 9% in NFHS-4. Nine per cent of men (25-29) were married before they turned 21.

The total fertility rate (TFR) is 1.4 children per woman, which is below the replacement level of fertility. Fertility has decreased by 0.6 children between NFHS-4 and NFHS-5.

Lal Ded hospital is the main gynaecological and obstetrics hospital in Kashmir. KL Image: Bilal Bahadur

91% of last pregnancies in the five years preceding the survey ended in a live birth, and the remaining 8% per cent terminated in foetal wastage (abortion, miscarriage, or stillbirth). Miscarriage is the most commonly reported type of foetal wastage, accounting for 5 per cent of all pregnancies, and abortions accounted for 2 per cent.

The three main reasons for abortion reported by women were complications in pregnancy (26%), health did not permit (19%) and unplanned pregnancy (17%). The most common methods used for performing abortions were medicines (69%), manual vacuum aspiration (MVA) (1%), and other surgical methods (23%). A large majority (79%) of abortions were performed in the public health sector, and 14 per cent were performed in the private health sector. 36% of women reported an abortion reported having complications from the abortion. 82% of abortions are performed by a doctor.

Among young women (15-19), only per cent have already begun childbearing. That is, they have already had a live birth or are pregnant with their first child, down from 3 per cent in NFHS-4. The proportion of women who have started childbearing rises sharply from 1 per cent at age 18 years to 4 per cent among women age 19 years. The proportion who have begun childbearing is much higher among young women who had no schooling (6%) than those with 12 or more years of schooling (0.6%).

Women carry water pitchers over their heads in the snow-covered Kokernag area of south Kashmir after a fresh spell of snowfall in Kashmir. KL Images: Bilal Bahadur

Knowledge of contraception is almost universal; however, some methods are still less known. Only 55% of currently married women know about the lactational amenorrhoea method (LAM), 27% know about female condoms and only 48% know about emergency contraception.

The contraceptive prevalence rate (CPR) among currently married women aged 15-49 is 60%, which is an increase from NFHS-4 (57%). The use of modern family planning methods (53%) has also increased from its level in NFHS-4 (46%). The level of use of female sterilization has decreased slightly, from 24% to 21% between NFHS-4 and NFHS-5; the share of female sterilization in overall contraceptive use has declined to 35% in NFHS-5 from 43% in NFHS-4. Contraceptive use in NFHS-5 increases sharply with age, from 19% for women aged 15-19 to 65% for women aged 40-49. Interestingly, women with little or no schooling (27%) are much more likely to use female sterilization than women with higher levels of schooling (14%). The most common modern spacing methods used by currently married women are condoms (12%), followed by pills (9%).

The infant mortality rate is estimated at 16 deaths before the age of one year per 1,000 live births, down from the NFHS-4 estimate of 32, the NFHS-3 estimate of 45 and the NFHS-2 estimate of 65. The under-five mortality rate (U5MR) is estimated to be 28 deaths before five years of age per 1,000 live births, almost the same as U5MR in NFHS-4 (29 per 1,000). All infant and child mortality rates are higher for boys than girls. Children born to mothers aged 30-39 are more likely to die during infancy than children born to mothers in the prime childbearing age (20-29 years).

Kashmiri women participating in the Baby Show held at Srinagar on September 25, 1949, during the meeting of the National Conference.

Among mothers who gave birth in the five years preceding the survey, more than 9 in 10 received antenatal care for their last birth from a health professional (86% from a doctor and 8% from an auxiliary nurse midwife (ANM), lady health visitor (LHV), nurse, or midwife). Four per cent did not receive any antenatal care (ANC). Among mothers who gave birth in the five years preceding the survey, 98 per cent registered the pregnancy for the most recent live birth. Among the registered pregnancies, 97 per cent received a Mother and Child Protection Card (MCP Card).

87% (against 77% in NHFS4) of women received antenatal care during the first trimester of pregnancy, and 84% had four or more antenatal care visits. Urban women were more likely to have four or more antenatal care visits than rural women. An ultrasound test was performed during 94% of pregnancies in the five years preceding the survey.

92% (86% in NHFS4) of births take place in a health facility (mostly a government facility) and 8% take place at home. For 85% of home births, a clean blade was used to cut the cord. A disposable delivery kit was used for 55% of deliveries and in 84% of home births, the baby was immediately wiped dry and then wrapped without being bathed first.

Almost 87% of mothers had a postnatal check after their last birth and 85% had a postnatal check within two days of the birth. Postnatal care for the mother within two days of birth is most common in a health facility; 89 per cent of births in a private health facility, 88 per cent in a public health facility, followed by 42 per cent of home births.

Director Health Services Kashmir Dr Saleem administering oral polio drops at JLNM hospital Rainawari Srinagar

86% of children (12-23 months) received all basic vaccinations against six major childhood illnesses (tuberculosis, diphtheria, pertussis, tetanus, polio, and measles). However, 96 per cent of children are at least partially vaccinated; only 4 per cent have not received any vaccinations at all. 95% of children have received a BCG, 88% have received three doses of the polio vaccine, 93% have received DPT or Penta vaccine, and 92% have been vaccinated against measles. There is a dropout between the first and third doses of the DPT vaccine (from 95% to 93%) and the polio vaccine (from 94% to 88%). Trends are encouraging since last survey – DPT (from 88% to 93%), measles (from 86% to 92%), polio (84% to 88%). However, BCG fell by one per cent to 95%. Coverage with all basic vaccinations is higher for girls than boys (88% versus 85%) and for rural than urban areas (87% versus 83%).

Almost 91% are put to the breast within the first day of life, but only 57 per cent started breastfeeding in the first hour of life (as recommended). Overall, 88% of children continue breastfeeding at one year, and 76% continue breastfeeding at two years.

Children’s nutritional status has worsened since NFHS-4. The percentage of children who are stunted (27%) has not changed in the four years. The percentage of children who are underweight increased from 12% to 19%.

Almost 35% of women and 36% of men are either too thin or overweight, or obese. Among women aged 15-49, the proportion of overweight or obese is 29 per cent, which is the same as in NFHS-4. More men are overweight or obese (32%) than thin (4%), similar to the pattern observed in NFHS-4. Five per cent of women in Jammu & Kashmir are too thin. Over three-fifths of women and men are at a healthy weight for their height.

88% of women and 61% of men have a waist-to-hip ratio (WHR) that puts them at a substantially increased risk of metabolic complications. Ninety-eight per cent of households with tested salt were using iodized salt at the time of the survey.

73% of children (6-59 months) are anaemic (low levels of haemoglobin in the blood) – 25% are mildly anaemic, 44% are moderately anaemic, and 4% have severe anaemia. The overall prevalence of anaemia in children increased from 43% to 73% in four years. 66% of women have anaemia – 25% mild, 38% moderate and 3% severe anaemia.

173 persons per 100,000 are estimated to have been medically treated for tuberculosis. The prevalence of medically treated tuberculosis is lower among men (135) than among women (214) and is higher in urban areas (222) than in rural areas (156).

As many as 2862 women and 2093 men (15-49 years) per 100,000 have diabetes. Overall, 365 women and 505 men per 100,000 suffer from asthma. Goitre or any thyroid disorder is much more common than asthma, especially among women (6,809 women and 773 men). The prevalence of any heart disease is lower among men (1,377 per 100,000) than among women (2,286 per 100,000). Among the five diseases, cancer is the least common, with 132 women and 90 men per 100,000 reportedly having cancer.

11% of women and 10% of men (15-49) have hypertension.

A ward of the 500-bedded Covid19 Hospital that DRDO set up. at Khonmoh. It was integrated by Lt Gov Manoj Sinha on June 8, 2021. Pic: DIPR

Only 13% of households have any kind of health insurance that covers at least one member of the household. The coverage is higher in urban areas (19% ) than in rural areas (10%).

In Jammu and Kashmir, 32% of men and one per cent of women (15-49) use some form of tobacco – cigarettes (27%), bidis (4%), hookah and cigars or pipe (2% each). 35% of men smoke 5 to 9 cigarettes in the past 24 hours. Only 0.2% of women and 4% of men drink alcohol. 43% drink once a week, 39% less than once a week and 19% drink almost daily.

84% of women and 89% of men have heard of HIV or AIDS, more in urban than rural areas. Only 17% of women and 18% of men (15-49) had ever been tested for HIV prior to NFHS-5. Only 7% of women and 12% of men have ever had a blood transfusion.

Higher-risk sex is sexual intercourse with someone who is neither a spouse nor a cohabiting partner. Among those who had sex in the past 12 months, no women and only 2% of men reported having had higher-risk sex during the past 12 months. The percentage of men who had higher-risk sexual intercourse in the past 12 months is almost the same in urban and rural areas. Even fewer respondents said that they had multiple sex partners in the past 12 months (0.5% of men and 2% of women). More than two-thirds (71%) of men who had higher-risk sex in the past 12 months reported using a condom the last time they had higher-risk sex. Less than one per cent (0.6%) of men said they had paid for sex in the past year.

51% of women use sanitary napkins, 58% use cloth, 23% use locally prepared napkins, and 3% use tampons. Overall, 74% of women (15-24) use a hygienic method of menstrual protection, up from 67% in NFHS-4

Only 29% of all women (15-49), compared to 73% of men, were employed in the 12 months preceding the survey. Among employed women, 63% per cent earned cash, including 17% per cent who earned both cash and in-kind and 31% were not paid at all. A large majority of employed women (70%) and men (76%) work in non-agricultural occupations.

Women are somewhat more likely to participate in decisions about visits to their own family and relatives (76%) than decisions about their own health care (74%) or about major household purchases (69%). Overall, 63% of currently married women participate in making all three of these decisions, and 18% do not participate in making any of the three decisions.

As many as 52% of women have money and decide how to use it, mostly in urban than rural areas. Eighty-five per cent of women have a bank or savings account that they themselves use. 21% of women know of a microcredit programme in their area, but only 4% have ever taken a loan from a microcredit programme. 28% of women who have a mobile phone use it for financial transactions.

51% of women and 79% of men (15-49) own a house alone or jointly with someone else, and 51% of women and 70% of men own land alone or jointly with someone else. Among men and women, ownership of a house and land is more common in rural than urban areas.

Almost three-fourths of women have a mobile phone that they themselves use, and 70% can read SMS messages.

Acid Attacks devour the individuality and the identity of a woman and push her to live her life in the shadows. KL artwork: Kaisar Malik

49% of women agree that a husband is justified in hitting or beating his wife under some circumstances. Women are most likely to agree that wife-beating is justified if a woman shows disrespect for her in-laws (35%), if she neglects the house or children (30%) and if she goes out without telling him (29%). Men are more likely to agree: 45% say that wife-beating is justified in some circumstances, especially if the wife shows disrespect for in-laws (34%) or if she is being unfaithful (32%) and if she goes out without telling him (25%).

Three-fifths of women and 61% of men believe that a woman is justified in refusing to have sex with her husband if she knows he has a sexually transmitted disease if she knows he has intercourse with other women and if she is tired or not in the mood. Slightly less than two-thirds of men (65%) agree that if a wife refuses to have sex with her husband he does not have a right to get angry and reprimand her, refuse to give her financial support, use force to have sex even if she doesn’t want to, or have sex with another woman.

10% of women (18-49) have ever experienced physical violence, and 3% have ever experienced sexual violence. One per cent of women have ever experienced physical violence during one or more of their pregnancies. 9% of ever-married women have experienced any form of physical violence committed by their husband, 4% have experienced any form of sexual violence committed by their husband, and 8% have experienced any form of emotional violence committed by their husband.

Only 14% of women 49 who have ever experienced physical or sexual violence sought help, while 2% never sought help but told someone. More than four-fifths (84%) never sought help and never told anyone. Among women who sought help, the main sources of help were their own family (54%), their husband’s family (44%), or a friend (24%). Four per cent sought help from the police.

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