Data from the NFHS indicates that while there has been improvement in nutrition related indicators, and reduction in out-of-pocket-expenditure at public health facilities per delivery, the share of anaemic pregnant women increased to 52.2% in NFHS-5 at an all-India level compared to 50.4% during NFHS-4.
In the first part of the series of time-series stories on National Family Health Surveys (NFHS), we looked at various aspects of maternal health care. The primary focus was on the average out-of-pocket expenditure per delivery in a public health facility, and the correlation between this and the institutional births in a public health facility. Other than that, the growth in births by Caesarean section in a public health facility was also looked at. The second part of the series focused on malnutrition among children.
In this story, we look at similar aspects of maternal health, primarily the factors that are crucial before giving birth. The aim is to see the impact of women’s health conditions on maternity.
More than half of pregnant women suffer from anaemia.
Anaemia is a condition characterized by a lower-than-normal concentration of red blood cells or a decrease in the amount of haemoglobin in the blood. Anaemia and maternal health are closely linked, and anaemia can have significant implications for the health of pregnant women and their unborn children. Anaemia is increasingly seen as a factor that can be modified and is linked to the risk of postpartum haemorrhage, a primary contributor to maternal health problems and fatalities. It is estimated that anaemia directly causes 20% of maternal deaths in India and indirectly accounts for another 20% of maternal deaths.
Such maternal health problems during pregnancy are also one of the leading causes behind the rise in out-of-pocket expenditures (OOPE) per delivery. Some studies also point out that anaemic pregnant women are more likely to have Caesarean delivery than non-anaemic pregnant women, which in turn raises the OOPE per delivery.
The data from the NFHS indicate that the percentage of pregnant women aged 15-49 years who are anaemic has declined from 58.7 during NFHS-3 to 50.4 during NFHS-4. It again rose slightly to 52.2 in NFHS-5 at an all-India level. Analysing both rounds, out of the 433 districts for which data for both rounds is available, 264 districts (~61%) have a lower percentage of pregnant women who are anaemic than the national level. States like Assam, Madhya Pradesh, Rajasthan, and Uttar Pradesh account for half of the districts where the percentage of anaemic pregnant women is above the national level.
Out of the 501 districts for which the data was available during NFHS-4, a total of 256 districts (51%) were below the national level. In contrast, 285 districts (50%) were below the national level out of the 568 districts during NFHS-5. If we compare the districts of NHFS-5 to the national level of NFHS-4 (to get a better understanding of the performance since there is an increase in the national level in NFHS-5), the percentage of districts that are below the national level comes down to 47%, that is 266 districts.
This indicates poor performance in terms of combating anaemia among pregnant women aged 15-49 years.
Improvement in the iron folic acid consumption during pregnancy.
It’s well-established that over half of pregnant women in India are anaemic. Approximately half of this anaemia burden is attributed to a lack of iron, while the remaining cases are linked to factors such as folate deficiency, vitamin deficiencies, and other causes. Consequently, the distribution of iron and folic acid (IFA) tablets to pregnant women to prevent nutritional anaemia is an integral component of safe motherhood. It is recommended that pregnant women take iron folic acid tablets for 100 days or more throughout their pregnancy.
On a national scale, IFA tablet coverage has seen an improvement, increasing from 30.3 percent during the NFHS-4 to 44.1 percent during the NFHS-5. At a state level, considering larger states only, Tamil Nadu tops with 82% followed by Kerala at 80%. Bihar has the worst performance, with only 18% who took IFA for at least 100 days (approximately 3 months), followed by Uttar Pradesh with 22%, and Jharkhand with 28%. Interestingly, all states in the southern and western regions have a better performance than the national level.
For analysing the performance at the district level, the performance of the district is compared to the national level performance in each round. Out of the 567 districts for which data is available for both rounds, 41 districts have shown a decline in their performance compared to the national level, while 76 districts improved between NFHS-4 and NFHS-5. A total of 227 districts (40%) have their performance above the national level in both surveys and 223 districts (40%) have their performance below the national level in both surveys.
Around 40% pregnant women still do not have four or more ANC visits.
Antenatal care (ANC) encompasses the healthcare provided to pregnant women from conception until childbirth and serves the purpose of identifying any pre-existing issues that might arise and impact the well-being of both the mother and the unborn child. The significance of effective antenatal care during pregnancy cannot be overstated.
The guidelines for pregnancy care of the Ministry of Health and Family Welfare recommend that every pregnant woman should make at least four visits for ANC. On a national level, more than half (59%) of women had at least four ANC visits during their last pregnancy during NFHS-5 as compared to 51% during NFHS-4. Six percent of women had no ANC visits in NFHS-5, down from seventeen percent in NFHS-4. It is observed that urban women are more likely to have four or more ANC visits than rural women.
The percentage of women who attended a minimum of four antenatal care (ANC) visits during their pregnancy varies significantly across Indian states. The lowest rates are observed in Nagaland (21%) and Bihar (25%), while the highest rates are found in Goa (93%), Lakshadweep (92%), and Tamil Nadu (91%).
At a district level, during NFHS-5, out of the 707 districts in India, 254 of them have reported that over 70% of mothers who gave birth within the five years preceding the survey received at least four ANC visits during NFHS-5. Conversely, there are a few districts, particularly in Bihar and certain states in the Northeastern region, where fewer than 30% of mothers received a minimum of four ANC visits.
