Although the latest National Family Health Survey (NFHS-5) data for Karnataka presents an improved scenario on some counts, the State has slipped in prevention of nutritional deficiencies and anaemia.
While anaemia in children aged 6-59 months has increased from 60.9% in 2015-16 to 65.5% in 2019-20, it has shot up from 44.8% to 47.8% in all women aged 15-49 years. Anaemia in men aged 15-49 years has also gone up from 18.3% to 19.6%.
On a positive note, the data shows some gains in infant and under-five mortalities. While the overall sex ratio has significantly improved from 979 to 1,034, sex ratio at birth for children born in the last five years in rural areas continues to be worrisome.
Maternal care
According to the data, while quality of antenatal care continues to be poor, the proportion of women registering within the first trimester has increased 65.9% to 71%, the proportion of pregnant women who consumed iron folic acid tablets (critical for tackling anaemia) for 100 days or more during pregnancy has decreased from 45.2% to 44.7%. Mothers who consumed iron folic acid for 180 days or more when they were pregnant fell from 32.6% to 26.7%.
Compared to the NFHS-4, there has been improvement in terms of infant and under-five mortality rates. While the infant mortality rate has reduced from 26.9 per 1,000 live births to 25.4 per 1,000 live births, mortality rate among children under five years of age has also reduced from 31.5 to 29.5. Neonatal mortality has also decreased from 18.5 to 15.8.
‘Not priority’
Sylvia Karpagam, a public health doctor and researcher, who is part of the Right to Food Campaign and Jan Swasthya Abhiyan campaigns said, “While anaemia continues to be a challenge, it is not the government’s priority. For instance, the decision to bring in an anti-cow slaughter bill will also take away an important dietary source of heme iron (that comes from animal proteins in our diet) and other essential nutrients.”
‘C-Section continues to be high in private’
While institutional deliveries in government hospitals have increased from 61.2% in 2015-16 to 64.8% in 2019-2020, Caesarean section deliveries in private hospitals have seen a huge jump from 40.3% to 52.5%, according to the survey.
The overall births delivered by C-section have increased from 23.6% to 31.5%. Likewise, births in a public health facility that were delivered by caesarean section have also increased from 16.9% to 22.6%. “This is a substantial increase and should be seen as a red flag,” said Akhila Vasan from Karnataka Janarogya Chaluvali.
“Despite 97% of women delivering in institutions (hospitals), it is surprising that only 85.5% of children received attention from trained persons within two days of birth. This illustrates poor quality of newborn care, which, in turn, explains why neonatal mortality is still a concern,” she said.
Delivery charges
The average out of pocket expenditure (OOP) per delivery in a public hospital has also gone up from ₹ 4,824 to ₹ 4,954. Women in urban areas continue to spend over ₹5,000 per delivery, according to the data.
While institutional deliveries have increased from 94% to 97%, a point to be noted is that only 64.8% of this was reported in government hospitals.
Expressing concern over this, Ms Vasan said: “Why are women spending nearly ₹5,000 for deliveries that are supposed to be free in public hospitals? The average OOP in private hospitals should have been included in the NFHS-5.”
Breastfeeding
Breastfeeding within an hour of birth has decreased from 56.3% to 49.1% with the lowest in rural areas at 47.5%. Sylvia Karpagam, a public health doctor and researcher, said this is of concern and more intensive efforts should be made to ensure that women are facilitated to feed their babies. “Weaning at 6-8 months is still very low and can contribute to malnutrition in the child,” she said.
Huge jump in domestic violence
There has been a massive jump in the reporting of gender-based violence in the State. Ever-married women aged 18-49 years who have experienced spousal violence has increased from 20.6% in 2015-16 to 44.4%. Young women aged 18-29 years, who experienced sexual violence by 18 years has also gone up from 10.3% to 11%.
Akhila Vasan from Karnataka Janarogya Chaluvali said although a large proportion of women (67.6%) own land, more of them are subjected to violence. She also pointed out that the proportion of men consuming alcohol is “unbelievably low” at 16.5%.
Male sterilsation zero
Male sterilization, which has always been absymal in Karnataka, has further dipped from 0.1% in 2015-2016 to 0% in 2019-2020. Health activists allege that the system has stopped making attempts to encourage men to undergo Nonscalpel vasectomy (NSV).
“It shows the intrinsic gender prejudice within the health system and also the society in general. NSV being less complicated and safer than female sterilization, all efforts should be made to increase this,” said Sylvia Karpagam, a public health doctor and researcher.
“Intrauterine device (IUD) use is still very low even though it has gone up from 0.8% to 2.9% . This means that more women are opting for permanent than temporary methods. It would be important to understand how this affects spacing between pregnancies,” she pointed out.
