State of Health

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The National Family Health Survey-5 that was released last week offers a clear improvement in the overall health of women and the child and exposes the propaganda and myths that the women in Kashmir are disempowered

A female DDC candidate in north Kashmir busy in talking to the women in a room. Off-road interactions were a major part of the women who contested the DDC polls in 2020.

Held for the first time in 1992, the National Family Health Survey (NFHS) offers key details about the state of health of a place and the factors that apparently help societies to stay healthy. Women continue to remain the prime focus of this survey for obvious reasons. The better-educated woman with improved facilities in and around the household will be able to raise a better family.

Last week, the fifth edition of the survey was made public in Delhi. Though the status of the Jammu and Kashmir changed since the NFHS-4 was carried out, the population, however, remains the same. These are the key findings of the survey and for better understanding comparisons have been mentioned.

While the NFHS-3 pertains to 2005-06, the NFHS-4 belongs to the period of 2015-16. The latest survey, the NFHS-5 offers the data about 2019-20. This is what the survey has found out in Jammu and Kashmir.

The sex ration, females per 1000 of men are slightly compromised. It was 976 in NFHS-3 and then fell to 972. Now it is at 948. Though not low, there is a possibility of some district or a few blocks actually not implementing anti-sex determination law seriously. A campaign and a harsh system helped undo the mess in two tehsils of Jammu and Kashmir last time.

Students at Women College MA Road Srinagar.

On the female literacy front, the situation has improved. The NFHS-5 has found out that 70.1% of females above the age of six years have been to school. It was 57.5% in NFHS-3 and 65.7% in NFHS-4. The latest survey has actually found 77.3% females literate, which is a net improvement in comparison to 53.9% and 69% in the earlier two surveys. In fact, 51.3% of women said they have spent no less than a decade in school, which a huge shift in comparison to 26.5% and 37.1% in the earlier two surveys. Under a new parameter, 43.3% women in Jammu and Kashmir have accessed the internet and in the case of urban, the figure is of 55%. Obviously, male literacy is much better and hugely improved. However, only a fraction of 1.6% children have access to pre-primary education.

The survey takes care of some of the basic facilities as well. As many as 99.3% population surveyed had access to electricity. It was 93.2% and 97.4% for NFHS-4 and NFHS-3, respectively. 91.9% have access to the improved drinking water source. It was available to 80.8% and 89.1% respondents to the last two surveys. The NFHS-5 found improved sanitary facility available to the tune of 75.7% respondents, an improvement over 53.8% and 24.5% in the earlier two surveys. 69.2% of respondents said they have access to clean fuel for cooking. This figure was only 57.5% in NFHS-4 and 38.4% in NFHS-3. As many as 98.1% of respondents use iodised salt. However, the Jammu and Kashmir families are suffering for lack of insurance cover. The NFHS-5 has said only 12.7% of respondents said they have one or more than one member in the family having an insurance cover. Family insurance was found to be available in 4.9% and 4.2% of families respectively in the earlier two surveys.  The prevalence of smoking of women in Jammu and Kashmir is merely 3.6% and drinking is negligible at 0.2%.

JKEDI Poonch Group Photo EDP

On the Women Empowerment front, the survey has offered phenomenal insights. On three key issues – about health care for herself, making major household purchases, and visits to her family or relatives, women in Jammu and Kashmir are part of the decision decision-making up to 81.6%. It has slightly gone down as the figure for this was 84% in NFHS-4 and 60% in NFHS-3. As many as 18.4% of women worked in the last 12 months of the survey and were paid in cash. It had fallen to 12.3% in NFHS-4 from 16.4% in NFHS-3. Contrary to the propaganda, the women in Jammu and Kashmir own immovable properties (house and land). The NFHS-5 found 57.3% owning properly solely or jointly. This parameter was at 33.1% last time. In Jammu and Kashmir, 84.9% women have and operate bank accounts, which is an improvement from 60% in NFHS-4 and 21.9% in NFHS-3 period. Interestingly 75.2% of women own a mobile phone for their exclusive use, a figure that was at 53.9% during NFHS-4 period.

Brides at a mass marriage event in Kashmir in July 2018. KL Image: Mehraj Bhat

For sustaining life, marriage has remained the oldest institution. The NFHS-5 has got some key data or the marriage and fertility. Marrying girls before the age of 18 is getting down. It was found to be at 4.5% which is an improvement over 8.7% recorded during NFHS-4 and 14.4% in NFHS-3. At the time of the survey, only one per cent of women of 19 years of age were married or pregnant which was 3% last time and 4.2% during the NFHS-3 survey. The number of children per women is also falling from 2.4 to 2 and now to 1.4 in NFHS-5.

Women in Jammu and Kashmir are using a huge basket to ensure family planning. The NFHS-5 suggest that 59.8% of women know and use family planning methods which is an improvement over 57.1% in NFHS-4 and 52% earlier. Male sterilization is below one per cent and now female sterilization has gone down from 24.4% to 21.1%. It was 26.3% in NFHS-3 period. IUD/PPIUD use has more than doubled from 2.4% to 5.9%. The pill is also up from 4.7% to 6.3% to 9% now. Interestingly injectables have shot up from 0.9% to 3.6%. However, condom remains the leader – from 8% to 11.3% and now 11.7% of couples use it. AS many as 65.3% of women are aware that condom use is protection against diseases like HIV/AIDS.

The improvement in health services has led to major shifts in infant and child mortality. The NFHS-5 suggest that the neonatal mortality rate has fallen from 23.1% to 9.8%, which is phenomenal. The infant mortality rate has nosedived from 45% to 32.4% to 16.3% in three respective surveys. The under-5 mortality rate has gone down from 51% to 37.6% to finally 18.5% in the latest survey.

File image of LD hospital, an exterior view (KL Image: Bilal Bahadur)

For the improvement in child health and reduction in the mortality, maternity care holds the key. As many as 86.6% of mothers have an antenatal check-up in the first trimester (against 76.7% in NFHS-4), 80.9% mothers have at least four antenatal care visits (a fall from 81.2% last time); 91.9% of mothers are protected against neonatal tetanus; 97.3% mothers registered for Mother and Child Protection card. The survey found that families increased their expenditure from Rs 4225 per delivery in a public facility to Rs 5145 during NFHS-5.

An expecting mother waits for her turn to offer samples for Covid-19 test. All the expecting mothers in most of Kashmir were tested for the virus in anticipation of the childbirth. KL Image: Bilal Bahadur

The survey offers great insights about the child delivery systems in Jammu and Kashmir. As many as 92.4% of babies were delivered in hospitals and in 95% cases, the births were managed by trained personnel. The survey suggests that caesarean births are getting up. From 13.5% during NFHS-3 to 33.4% in NFHS-4, the caesarean births have reached a phenomenal 41.7% during the NFHS-5.

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

What is tragic is that the private health sector is using it as the main way-out. The survey found that against 42.5% caesarean births that took place in the public sector hospitals, the caesarean births were as huge as 82.1%. The figure for caesareans in the private sector was 35.8% in NFHS-3 and 75.5% during NFHS-4 against 24.9% and 35.5% in state-run hospitals, respectively.

Rep Picture

Jammu and Kashmir, however, will have to work to reduce gender-based violence. The NFHS-5 suggest that women in 18049 age group who experienced spousal violence fell from 12.6% in NFHS-3 to 9.4% ad increased to 9.6%. Young women (18-29) who faced sexual violence by the age of 18 has increased from 3.1% to 4%.

Jammu and Kashmir women police wearing face masks as a precautionary measure to spread of COVID-19 during full-dress Rehearsal for Independence Day celebrations, at Sher-i- Kashmir Cricket Stadium in Srinagar on Thursday 13 August 2020. KL Image by Bilal Bahadur

The other issue that the NFHS-5 has highlighted is the increase in anaemic women, the loss of red blood cells. The percentage of women in 18-49 age group who are anaemic fell from 52% during NFHS-3 to 48.9% and jumped to 65.9% in NFHS-5. In the young women in 15-19 age group, it has increased hugely – 49.9% to 76.2% in NFHS-5. As many as 87.8% of women respondents had high-risk waist-to-hip ratio in Jammu and Kashmir.

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