Battle with stunting, obesity

The latest nationwide health survey has shown gains in maternal and child health over the past decade, but underscored gaps in immunisation and antenatal care for pregnant women and highlighted India's paradoxical challenge of simultaneously combating poor nutrition and growing obesity.

By Our Special Correspondent
  • Published 21.01.16
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New Delhi, Jan. 20: The latest nationwide health survey has shown gains in maternal and child health over the past decade, but underscored gaps in immunisation and antenatal care for pregnant women and highlighted India's paradoxical challenge of simultaneously combating poor nutrition and growing obesity.

The National Family Health Survey for 2015-16 has also documented in the 13 states and two Union territories surveyed a drop in tobacco use, a rise in overweight or obese people and highlighted lingering challenges of reducing households' out-of-pocket expenses on health care.

Despite significant investments by the Union health ministry over the past decade to improve maternal and child health and rural healthcare infrastructure, the survey has revealed persistent and dramatic differences in key indicators across states.

Only three of 100 pregnant women in Bihar, for instance, had access to full prescribed antenatal care - four antenatal checkups, at least one anti-tetanus shot, and iron and folic acid tablets for 100 days. In contrast, 22 of 100 pregnant women in Bengal, 45 in Tamil Nadu, and 63 in Goa had access to full antenatal care.

The survey has also revealed wide variations in immunisation coverage - only 54 per cent children under two years of age were fully immunised against tuberculosis, measles, polio, diphtheria, pertussis, and tetanus in Madhya Pradesh, 62 per cent in Bihar, 84 per cent in Bengal, and 88 per cent in Goa.

Paediatricians suspect sections of the public in states with large gaps aren't demanding vaccinations. "Lack of awareness is a major factor, people in states such as Bihar and Uttar Pradesh aren't sensitised enough (on the need for immunisation)," said Vandana Prasad, a paediatrician specialising in community health and national convenor of NGO Public Health Resource Network.

The survey released by the Union health ministry on Tuesday has also found persistent levels of stunted growth. In Bihar, Madhya Pradesh, and Meghalaya, four of 10 children under five are stunted, a condition resulting from poor nutrition that could have long-term impacts on growth and even intellect. Anaemia, too, remains widespread among children, according to the first phase of the 2015-16 survey which, when completed, would have covered over 570,000 households across the country.

But the survey has shown an increasing proportion of overweight or obese women and men from a decade ago. Nutrition experts have long cautioned about this paradoxical challenge where India needs to fight poor nutrition while coping with the consequences of rising obesity.

The obesity trend is visible even in states with poor nutrition and stunting, such as Bihar and Madhya Pradesh.

Another uniform trend across states is a decline in tobacco use -the survey found a nine to 10 percentage point decline in the proportion of men using tobacco among those sampled in Haryana, Karnataka, Madhya Pradesh, Tamil Nadu, Uttarakhand, and Bengal from levels observed a decade ago.

"We're happy to see this trend," said Bhavna Mukhopadhyay, executive director of the Voluntary Health Association of India, a Delhi-based NGO campaigning against tobacco. "It's probably the result of a package of measures - the ban on smoking in 2008, the ban on gutka (chewable tobacco)," she added.

The survey has also shown an increase in the proportion of households under health coverage schemes or health insurance, but the vast majority of households will still need to use personal, out-of-pocket expenses on healthcare expenses.

In Bihar, the proportion of households with some type of health cover increased from one per cent in 2005-06 to 12 per cent in 2015-16. In most states, less than 40 per cent of households have any kind of cover to pay for hospitalisation charges. Andhra Pradesh, Tamil Nadu, and Telangana are exceptions, with over 60 per cent households protected by some type of health scheme.