The recently released National Family Health Survey (NFHS) 2019–21 points to some interesting and positive developments in India’s demography and health trends, especially pertaining to women. It also indicates associated policy issues and point to the direction where interventions would be required in order to maintain the positive momentum.
The most heartening trend seen in NFHS-5 is a reverse skew in favour of women for the first time. Thus, the number of females per 1,000 males (called the sex ratio of the total population) has increased from 991 in 2015–16 in the NFHS-4 to 1,020 in NFHS-5. The survey points to the number of females per 1,000 males to be even better in rural areas at 1,037, which though heartening is a little surprising, since the urban sex ratio continues to be less than 1,000 (at 985). The number of girls born per 1,000 boys in the last five years (sex ratio at birth) has similarly improved at the overall level, from 919 in NFHS-4 to 929 in NFHS-5, with rural areas outperforming their urban counterparts on this statistic as well.
Women in India seem to have become more literate compared to a decade ago. The survey points to a literacy rate amongst women at 71.5%, which is greater than the national female literacy rate at 65.46% in the 2011 census. More importantly, literacy among rural women has improved marginally compared to even the national female literacy level in 2011. Women’s education has improved, with the proportion of women with 10 years or more of schooling increasing from 35.7% in 2015–16 to 41% in 2019–21. Women also seem to have acquired digital savviness, especially in the urban areas where 51.8% of women surveyed have used the internet. The proportion of married women in the 15–49 age group currently using family planning methods has increased significantly from 53.5% in 2015–16 to 66.7% in 2019–21. This trend is matched by a decline in the number of children per woman (total fertility rate) to 2 in 2019–21, which is below the internationally accepted replacement level fertility rate of 2.1. This fertility rate, which was 2.2 in 2015–16, indicates that in just four-five years, women’s social preferences regarding contraception and reproduction seem to have changed significantly. This development has the potential to nullify India’s perceived advantage of a demographic dividend going forward and would need to be closely monitored.
While these results are only from a sample and will need to be corroborated by the decennial census, the trends point to two urgent areas of attention for policymakers. One, academics and policymakers will need to understand the reasons for such changes (especially gains) in a relatively short time span of five years. For instance, can the improvement in the sex ratio at birth be attributed to government policies that have banned sex determination tests? Is it due to the awareness drive that possibly Non-Governmental Organisations (NGOs) and other agencies have undertaken? And have such campaigns been more successful in the rural areas? Two, it is clear that policymakers will need to divert their attention to ensure that the hard-earned gains in the domain of female well-being are not lost and that women can contribute as productive assets in the economy.
It is no secret that the female labour force participation rate (women of the age 15 years and above working or actively looking for a job) in India is one of the lowest in the world and has been declining. This rate, which was 20.3% in 2019 (compared to 30.5% in Bangladesh and 33.7% in Sri Lanka) as per the World Bank estimates, had fallen to 16.1% in the July-September quarter of 2020 due to the pandemic. The reasons for this decline in labour force participation has to do with the low-skilled jobs on farms and factories or in the domestic sector (as maids) that most Indian women are engaged in; these sectors have been among the most vulnerable to the pandemic.
Policymakers will need to pay attention to improving labour market outcomes for women. This would involve several measures. Women will need to be provided access to relevant education and training programmes and skill development, which go beyond just tailoring and knitting skills. The decline in the fertility rate and increased adoption of contraception, including sterilisation, points to the need to rethink facilities for childcare and provisions such as maternity and paternity leave, not just for the skilled and educated women but also for the informal sector. There would also be a need to provide transport facilities that are safe and accessible, besides just job opportunities for women desirous of working. Women entrepreneurs need to be nurtured.
The survey also points to certain disturbing trends regarding women’s general health even as maternal health indicators have significantly improved. Thus, the prevalence of anaemia among women in the 15–49 age group has increased and that of high blood sugar and hypertension among the 15+ age group is also high, pointing to the need for affordable health facilities for women going forward. Policy measures will need to start looking at women’s general health, besides just maternal health in the future.
The NFHS-5 points to an improvement in the status of Indian women in certain critical areas, which will need to be protected and consolidated.
(Views are personal)
Tulsi Jayakumar
Professor, Economics, & Chairperson, Family Managed Business at Bhavan’s SPJIMR
(tulsi.jayakumar@spjimr.org)