The latest National Family Health Survey (NFHS-4) data for Karnataka presents a mixed bag. While it shows some gains in infant and under five mortalities, the State has actually slipped back in sex ratio and continues to face serious challenges in the quality of maternal care and prevention of nutritional deficiencies and anaemia.
Some critical indicators related to women’s reproductive health which were reported in the District-level Health Survey Round-4 in 2012– 13 are missing in the NFHS-4.
Maternal careAccording to the data, while quality of antenatal care continues to be poor, the proportion of women registering within the first trimester has actually decreased from 70.9 per cent to 66 per cent. Although only 32.9 per cent of pregnant women received all components of antenatal care, this figure is higher than 24.8 per cent that was reported in NFHS-3 (2005–06).
The proportion of pregnant women who consumed iron folic acid tablets (critical for tackling anaemia) for 100 days or more during pregnancy has increased from 28.2 per cent to 45.3 per cent.
Child healthCompared to the NFHS-3, there has been improvement in terms of infant and under five mortality rates. While the infant mortality rate has reduced from 43 per 1,000 live births to 28 per 1,000 live births, mortality rate among children under five years of age has reduced from 54 to 32 in a decade.
However, the data does not have any information on neonatal mortality which continues to be under-reported.
Akhila Vasan from Karnataka Janarogya Chaluvali said it was surprising that only 22.3 per cent of children received attention from trained persons within two days of birth despite 94.3 per cent of women delivering in institutions (hospitals). “This illustrates poor quality of newborn care, which, in turn, explains why neonatal mortality has not decreased,” she said.
Pointing out that the data reflected that the State was “not doing enough” to prevent malnutrition, Ms. Vasan said the proportion of children given supplementary food at age six to eight months had actually reduced to 52.7 per cent from 69.7 per cent. Shockingly, only 10.9 per cent of children (aged six to 23 months) receive adequate nutrition, she said.
No data on pregnancy complications
The NFHS-4 does not give a break-up of what proportion of pregnant women are seeking antenatal care in private. The latest survey also does not indicate the proportion of pregnant women who suffered complications during pregnancy, delivery or the postpartum period. These proportions in the DLHS-4 (2012–13) were 37.6 per cent, 26.7 per cent, and 12.8 per cent respectively. These are critical quality indicators of maternal health care.
The DLHS-4 also reported on the proportion of women who suffered vaginal discharge (6.2 per cent) and menstrual problems (11.8 per cent) which are critical to understand status of women’s reproductive health issues and would help in understanding the rash of hysterectomies in the State. But the NFHS-4 does not report this data.
Increase in C-sections
The data shows that private hospitals have reported a higher number of C-section and institutional deliveries.
Births delivered by caesarean section have seen a rise from 15.5 per cent to 23.6 per cent in a decade. While a drastic increase has been recorded in C-section births in the private sector (from 31.9 per cent to 40.3 per cent), C-section deliveries in government hospitals has come down marginally from 17.2 per cent in 2005–06 to 16.9 per cent in 2015–16.
While institutional deliveries have increased from 64.7 per cent to 94.3 per cent, a point to be noted is that only 61.4 per cent of this was reported in government hospitals.
