BENGALURU: Rural Karnataka has fared worse than urban parts of the state in multiple factors of the National Family Health Survey - 5, released by the Union Government on Saturday, with the data collected between July 10, 2019 and December 11, 2019.
In sex ratio for children born over the last five years, child marriage, pregnancy, fertility among minors, under-five mortality, maternal health, nutrition among children and anaemia among men, women and children, the state’s rural areas have done poorly.
“Policymaking in healthcare is centralised around big hospitals in cities. Because of this, villagers have to travel to big cities. They spend from their own pocket and if their cases are complicated, their treatment is often left out of free health care government schemes. We need a three-tier system, starting with a self-sufficient Primary Health Centre and trained doctors in rural areas,” said Sylvia Karpagam, public health doctor and researcher.
Nutrition status
Children under three years being breastfed under one hour of birth has gone down from 56.3 per cent to 49.1 per cent. It is worrisome in rural areas at 47.5 per cent and better off in urban areas with 51.8 per cent. Children aged 6 to 8 months receiving solid or semi-solid food and breast milk has reduced from 46 per cent to 45.8 per cent and is worse in rural areas at 43.6 per cent and in urban areas it is at 50.4 per cent.
Lesser number of stunted children under 5 yrs now
Dr Hema Divakar, former president, Federation of Obstetric and Gynaecological Societies of India (FOGSI) and FOGSI ambassador to The International Federation of Gynaecology and Obstetrics (FIGO), said, “The concept of breastfeeding within one hour of birth should be initiated as many people are not aware of it. Healthcare workers assume that mothers will breastfeed within one hour, but that is not the case. However, the medical reason for not feeding is the rising number of C-sections, where the patient is kept under observation for one hour and by the time she feeds her baby, it is late.
In normal deliveries, mothers do not want to start feeding while taking IV drips, which is a misconception. The staff nurses are not around to educate them.” She added that breastfeeding in time can increase immunity. In the survey, children under 5 who are stunted (less height for age) have reduced from 36.2 per cent to 35.4 per cent which is good. It is worse in rural areas with 37.2 per cent and better in urban areas with 32.2 per cent.
Children under 5 who are severely wasted have gone down from 10.5 per cent to 8.4 per cent, again an improvement. But the situation is worse in rural areas with 8.3 per cent and better in urban areas at 8.6 per cent. Children under 5 who are underweight (weight for age) have gone down from 35.2 per cent to 32.9 per cent. Rural areas are worse off with 34.9 per cent and urban areas better placed at 29.4 per cent.
Neonatal, infant, under-5 mortality
Neonatal mortality rate has reduced from 18.5 per cent to 15.8 per cent. But it is still higher in rural areas with 16.2 per cent and better in urban areas with 15.1 per cent. Infant Mortality Rate has reduced from 26.9 per cent to 25.4 per cent. In rural areas, it is 27.8 per cent and urban areas, 21.4 per cent. Under 5 mortality rate too has decreased from 31.5 per cent to 29.5 per cent, but it is more in rural areas at 32.5 per cent and better in urban areas at 24.5 per cent.
“If adolescent girls are getting pregnant too frequently, it will lead to the child being small for date, premature, suffering risk factors, also leading to the baby’s death. If the mother is anaemic, has complications during labour, did not get adequate antenatal, perinatal and postnatal facilities, it will lead to infant mortality,” Dr Sylvia said, adding that the public healthcare system has to be seamless right from the adolescent girl getting pregnant till the baby is five years old.
Sex ratio of adults, children at birth
Sex ratio, that is females per 1,000 males has improved from 979 in National Family Health Survey -4, (2015-2016) to 1,034 in NFHS-5. Sex ratio for children at birth, born in the last five years has increased from 910 to 978, but still remains less in rural areas at 931. Women aged 20-24 married before 18 years has reduced marginally from 21.4 per cent to 21.3 per cent which is a promising sign.
In rural areas, however, it is 24.7 per cent and in urban areas, 16.1 per cent. Women aged 15 to 19 who were already mothers or pregnant at the time or survey has reduced from 7.8 per cent to 5.4 per cent. In rural areas, it is 6.6 per cent and urban areas 3.4 per cent. The adolescent fertility rate for women aged 15 to 19 has reduced from 51 per cent to 40 per cent. Again, it remains worse in rural parts at 47 per cent and better in urban areas 27 per cent.
Family planning
Any method of family planning for married women aged 15 to 49 has improved from 51.8 per cent to 68.2 per cent, but rural areas stand at a lower position at 68.2 per cent, as opposed to the figures for urban areas at 69.6 per cent. Modern methods of family planning have also improved from 51.3 per cent to 68.2 per cent, but rural areas stand at 67.7 per cent and urban at 68.8 per cent. Female sterilisation has improved from 48.6 per cent to 57.4 per cent and is surprisingly better in rural areas with 58.9 per cent than urban which is only at 55.2 per cent.
However, male sterilisation has gone from a minuscule 0.1 per cent in the last NFHS survey to 0 now. Use of IUD, PPIUD, pill, condom and injectables has improved, with rural areas equal to or lesser than urban areas. Mothers who had antenatal check-up in the first trimester have improved from 65.9 per cent to 71 per cent, with the situ- ation worse off in rural areas at 69.3 per cent and better at urban areas at 73.7 per cent.
Mothers who consumed IFA (Iron Folic Acid used especially for anaemia and during pregnancy) for 100 or more days when pregnant have gone down from 45.2 per cent to 44.7 per cent, with the situation worse off in rural areas at 40.9 per cent than urban areas with 50.7 per cent. Mothers who consumed IFA for 180 or more days when pregnant have gone down from 32.6 per cent to 26.7 per cent, with rural areas worse off at 23.7 per cent than urban parts with 31.5 per cent. Dr Sylvia pointed out that IFA tablets are difficult to consume as they lead to gastritis. The government needs to look beyond dependence on tablets, to treat anaemia, she advised.