Mumbai and Kolkata: In 2019-21, more children were born in healthcare facilities and more mothers took folic acid during pregnancy but more women were anaemic and had high blood pressure, when compared to 2015-16, show data from the latest National Family Health Survey.

NFHS-5 data for 22 states and union territories (UTs), that were collected between June 1, 2019 and January 30, 2020, were released in December 2020. The second phase of the survey was conducted between January 2, 2020 and April 30, 2021, and its data released on November 24, 2021.

Our data viz gives you a glimpse into the state of women's health in India, as the year comes to a close.

Maternal Healthcare

Institutional births, that is, children born in health facilities, increased across most states. The highest increase was in Arunachal Pradesh (52.2% to 79.2%), followed by West Bengal (75.2% to 91.7%) and Uttar Pradesh (67.8% to 83.4%). At the same time, the national average for out-of-pocket expenditure per delivery in a public health facility reduced by 8.8%, from Rs 3,197 in 2015-16 to Rs 2,916 in 2019-21. It decreased the most in Delhi (70% drop from Rs 8,518 to Rs 2,548) and West Bengal (66% drop from Rs 7,919 to Rs 2,683).

Other indicators for maternal healthcare have also seen improvement. The percentage of mothers who consumed iron and folic acid for 100 days or more when they were pregnant has increased from 30.3% to 44.1% across India.

The proportion of women taking folic acid increased the most in West Bengal, Madhya Pradesh and Odisha while Jammu and Kashmir (J&K) and Karnataka are the two states which have seen a drop in this indicator.

Nutrition

Despite the Government of India's Anemia Mukt Bharat programme which comes under the Prime Minister's Overarching Scheme for Holistic Nourishment (POSHAN) Abhiyaan and its target to reduce anaemia by 3% per year, anaemia among women has increased across most states. Overall, the prevalence of anaemia--measured as the proportion of women who have less than 11.0 grams of haemoglobin per decilitre of blood--increased by 4 percentage points from 53.1% in 2015-16 to 57% in 2019-21.

The prevalence of anemia in India has remained more or less stagnant over the last few decades and the Anemia Mukt Bharat was launched in 2018 but the implementation only began in the last year or so, said Kapil Yadav, a Nodal Officer for National Centre of Excellence and Advanced Research on Anemia Control (NCEAR-A) at AIIMS, New Delhi. He said that the Government of India has allocated a huge amount of financial resources for this programme. "Usually public health programmes take around five to ten years. Intervention for anaemia is pretty long and more or less the whole population of India is affected by this condition. I think a lot more needs to be done," Yadav further explained.

In 25 of 36 states and UTs, over half the women in the age group of 15-49 were anaemic. The highest prevalence was in West Bengal at 71%, followed by Tripura(67.2%) , J&K (65.9%), Assam (65.9%), Jharkhand (65.3%) and Gujarat (65%). Anaemia rose the most in Assam (increase of 19.9 percentage points) followed by Jammu & Kashmir (increase of 25.6 percentage points), Chhattisgarh (increase of 13.8 percentage points) and Odisha (increase of 13.3 percentage points).

"Since anaemia is an underlying condition for poor birth outcomes, low birth weight, delivery of premature and possibly cognitively impaired babies, addressing this problem is of utmost importance," said public health nutritionist Shweta Khandelawal of the Public Health Foundation of India (PHFI).

Anaemia is multifactorial, and consuming iron by itself will not take care of this condition, Khandelwal explained. "Overall, poor diet quality can result in anaemia and unfortunately, NFHS does not include indicators which help us assess the quality of diets," she added. She said that indicators, such as stunting and wasting in the NFHS, are computed based on weight and height but weight could be gained even on a calorie-rich diet without the necessary micronutrients. During the pandemic, grain-heavy rations were made available in households, while a micronutrient rich diet is key to counter anaemia, she explained.

Folate deficiency, B-12 deficiency and hook worm infestation can all lead to anaemia, Khandelwal said. Apart from nutrition and health measures, improving women's education could be the single most important intervention in diminishing India's anaemia burden, we reported in February 2019.

Across India, nearly 18.7% women have a low body mass index (BMI), below 18.5 kg per m2. This has reduced from 22.9% in 2015-16. The World Health Organization (WHO) says that a prevalence rate over 20% for women with low BMI indicates that it is a serious situation requiring special attention. This is the case in Jharkhand (26.2%), Bihar (25.6%), Gujarat (25.2%), Chhattisgarh (23.1%), Madhya Pradesh (23%), Maharashtra (20.8%) and Odisha (20.8%).

At the same time, more women (24%) were overweight or obese--measures as 25 kg or more per m2--in the latest survey, compared to 20.6% in 2015-16. Over three in 10 women in urban areas and almost two in 10 in rural areas were obese, the survey found. The highest proportion was in Punjab (40.8%) and Tamil Nadu (40.4%).

Climate change could further exacerbate the problem of access to nutritious food, especially for women, said Shweta Narayan, a climate & health Campaigner at Health Care Without Harm. Extreme climate events in India, such as droughts, floods and cloudbursts, will affect food production, and some studies say that global warming could decrease the nutrition in food, she explained. "All of this has a direct impact on women's health, because of the way our society is, where our women get access to food last. So there is less access to food and there is even less access to nutritious food."

Noncommunicable diseases

More women now have hypertension and high blood sugar, in both rural and urban areas.

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