Recently the fourth round of the National Family Health Survey 4 (NFHS-4) report on the variations in the total fertility rate (TFR) of different communities was released. The population-based surveys are an invaluable source of health information. A key aim of these surveys is to provide high-quality data for policy development and programme planning, monitoring and evaluation. Population-based surveys have been used extensively to gather information on fertility, mortality, family planning, maternal and child health, and some other aspects of health, nutrition and health care in India.

According to the survey the fertility rate in 23 states and Union territories—including all the southern states—is below the replacement rate while it is higher in a number of states in central, east and north-east India. Bihar has the highest rate at 3.41, followed by Meghalaya at 3.04 and Uttar Pradesh and Nagaland at 2.74.

the lack of education robs women of reproductive control, feeding into India’s maternal and child health problem

Total fertility rate in rural areas was 2.4 while in urban areas it was 1.8. The nature and scope of the fertility-related public health challenge facing state governments varies widely. The most effective way of combating this variance could be assigning a greater role for local bodies in both urban and rural areas.

Impact of Education

Women with 12 years or more of schooling have a fertility rate of 1.7, while women with no
schooling have an average rate of 3.1 while the lack of education robs women of reproductive control, feeding into India’s maternal and child health problem.

Also Read: All You Need to Know About National Medical Commission Bill

Combined with younger pregnancies and higher childbearing rates, it also constrains women’s economic choices. This, in turn, reinforces a lack of reproductive control—44%
of women who are unemployed use modern contraceptives while 60% of women who are employed for cash do so—perpetuating a vicious cycle.

Skewed pattern of contraceptive usage

Despite increasing knowledge of contraceptive methods men have not taken up the responsibility of managing fertility. The most popular contraceptive method by far, at 36%,
is female sterilization. Male sterilization accounts for a mere 0.3%.

Impact of religion

Cultural and geographical factors and the level of development of different states seem
to be more important determinants of TFR. In states with higher TFR, all groups show high levels and vice versa.

Impact of income/ wealth

The section with the lowest income had the highest number of children at 3.2 and the richest had the least, 1.5. Scheduled tribes, the least developed among social categories, had the highest fertility rate of 2.5, followed by 2.3 for scheduled castes and 2.2 for other backward classes. The upper castes had the lowest fertility rate of 1.9.

Other key findings of National Family Health Survey 4

  • This is the first time the government has conducted a survey to find out the incidence of diabetes and hypertension.
  • More than a fifth of India’s 125-crore population suffers from diabetes and hypertension.
  • The overall incidence of diabetes was 20.3 % and that of hypertension 22.2 %.
  • States with a higher incidence of hypertension include Punjab (35%), Sikkim (44.8%) and Maharashtra (26%).
  • States with the incidence of diabetes to be higher than the national average include Goa (33.7%), West Bengal (28.2 %), Assam (34.6 %) and Odisha (27.2 %).
  • The deliveries by caesarean section are disproportionately high in private hospitals as compared to government ones making it way above the WHO’s expected rate in any population i.e 25 %.
  • The percentage of caesarean sections is the highest in private hospitals of urban Tripura — 87.1 %.
  • Urban private hospitals of Telangana are a close second with 74.8 % caesarean deliveries, and West Bengal comes third with 74.7 %.
  • The sex ratio improved from 914 to 919 at the national level over the last decade, with the top three states being Kerala (1,047), Meghalaya (1,009) and Chhattisgarh (977).
  • In Haryana the sex ratio went down from 897 in NFHS-3 to 876.
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