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The Union Health Ministry finally released the findings of National Family Health Survey (NFHS4 ). It has 6 great news about Indian women. Here’s a brief analysis.
After a prolonged wait, the Union Health Ministry finally released the findings of the fourth National Family Health Survey (NFHS-4) data last week. The release of the new NFHS data made headlines in leading media forums across the country. But why is the NFHS data so crucial?
The NFHS is India’s main source for detailed health statistics, derived from a large-scale household sample survey. Commissioned by the Ministry of Health and Family Welfare, funded jointly by USAID and the Indian government, and conducted by the Mumbai-based International Institute for Population Sciences (IIPS), NFHS produces internationally accepted estimates of fertility and mortality, reproductive health, female literacy, contraceptive use and violence against women among other indicators. It, therefore, is a crucial periodic assessment of the progress made by India’s women. The first round of NFHS survey took place in 1992-93, the second round in 1998-99 and the third round in 2005-6.
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The recent data released comes from a fourth round of NFHS survey conducted in 13 Indian states and two Union Territories. Coming after a gap of a decade, the NFHS-4 (2015-16) data was awaited with much apprehension and its release has caught immediate media attention. The data released so far has generated a positive response from the media, policy makers and general public alike, since it shows optimistic changes in many of the crucial health and development indicators, especially the ones which focus on women’s health and empowerment. If the data is to be believed then Indian women seem to have finally embarked on their journey to empowerment.
Data shows a significant increase in the percentage of women in the age group of 15-49 years having a savings account that they use personally. Compared to the statistics of the NFHS-3 survey (2006-6), all 13 states registered a positive increase in the numbers of women who manage their finances independently. According to the data report, the Jan Dhan Yojana, launched in 2014 to ensure every Indian household has access to a banking facility, also strived to ensure that in most cases, the account is opened in the name of the female member of the household. The government was of the view that women are more responsible and will be more careful in managing finances.
NFHS-4 has added a new indicator to measure women’s empowerment—women owning a house and/or land (alone or jointly with others). Once again the data throws up encouraging numbers. A state like Bihar, which otherwise is at the bottom in other indicators, tops the list with 58.8% women owning some form of property. The data also attempts to break the myth that women do not have a say in decision-making in what is perceived to be an inherently patriarchal society. At 95.3%, Sikkim tops the indicator—in the number of married women who usually participate in household decisions. West Bengal has shown the maximum increase from 70.2% in NFHS-3 to 89.8% in NFHS-4.
On other standard indicators, like percentage of literate women, the NFHS-4 survey shows an overall improvement in the 13 states and two Union territories. Goa takes the lead with 89% literate women in the age group of 15-49 years. This is closely followed by Sikkim. States like Haryana, Madhya Pradesh, West Bengal, Tamil Nadu and Bihar have registered some of the most significant growth rates in literacy of women in comparison to the NFHS-3 numbers.
The data from the fourth round of NFHS survey shows fewer women are getting married early. Findings indicate a steep decline in underage marriages of women across the states surveyed. Bihar and Haryana have fewer women under 18 getting married, as compared to the third round of survey in 2005-2006. In Bihar, less than 40 per cent of women were married before 18 years of age.
The survey also shows significant improvements in the reproductive health of women. The fertility rate or the number of children each woman has is dropping, a finding that is expected to bring cheer to policymakers given India’s already sizeable population standing at 1.27 billion population and its youth bulge. Some of the sharper declines in fertility rates (compared to NFHS-3) were found in states with significant populations like Haryana, Madhya Pradesh and West Bengal—with the numbers coming down from 2.7 to 2.1, 3.1 to 2.3 and 2.3 to 1.8, respectively. Data also indicates that more women are adopting family planning methods. For instance, women were the ones opting for methods like
For instance, women were the ones opting for methods like sterilization rather than men. In the case of Haryana, the female sterilization rate was 38.1% compared to 0.6% among men. Institutional deliveries shot up in most states and Union territories. Data, from all 13 states and two Union Territories, indicates that there are less than 51 deaths per 1,000 live births. More mothers are receiving healthcare during pregnancy. Though still widespread, anaemia has also declined among both women and children according to the survey. The data also notes significant improvement in child nutrition.
NFHS -4 added a new category to women’s empowerment section- women having a mobile phone that they themselves use. Like the other indicators, this pointer also registers positive changes under the survey data. Connected Women 2015, a report by Groupe Speciale Mobile Association (GSMA), an international grouping of mobile operators and related companies, showed that only Only 28% women in India own a mobile phone as against 43% men. The gender gap
The gender gap of mobile ownership, the report said, is as much as 114 million. However, the NFHS-4 survey data indicates that these trends might be changing. According to the NFHS-4 more women across the states and union territories own and use a mobile phone of their own. Goa tops the list once again with 80.9%, while Sikkim closely follows at 79.8%. There have been significant gains in other states such as Meghalaya, Tamil Nadu and Uttarakhand.
The numbers and statistics offered by the NFHS-4 (2015-16) are optimistic and encouraging. They go to show that women are finally making progress in the Indian society.
But before we go overboard with our optimism, it is important to balance it out with a little bit of reality check. Crucial questions can be raised about the data of the NFHS-4, when considered parallel to other statistical evidences and reports on similar indicators, published by international and national agencies during the last decade. Also it is to be remembered that numbers and statistics often override the ground realities and stories which are holding off women’s empowerment in our country. Let us look at two examples to understand how the optimism projected by the NFHS-4 survey data needs to be taken with a pinch of reality.
The survey results focus on women’s financial independence. Seen parallely with a World Bank report which was published in 2014, the statistics of the NFHS-4 survey on women’s financial empowerment may not appear very promising. This report suggests that only 26% of female adults in India have an account with a formal financial institution compared to 44% of male adults (World Bank 2014). A Reserve Bank of India (RBI) 2013 report indicates that women’s credit outstanding from commercial banks accounts for only 5% of all credit outstanding. Women have very low institutional savings. The RBI 2013 report states that only 13% of total deposits (savings) held at scheduled commercial banks belong to women. Women in Indian still lack significantly when it comes to formal ownership of material assets which constraint their credit access. Almost 91 per cent women in central India reported that their names are not included in the land/house titles, a study conducted by Institute of Financial Management and Research states.
A Reserve Bank of India (RBI) 2013 report indicates that women’s credit outstanding from commercial banks accounts for only 5% of all credit outstanding. Women have very low institutional savings. The RBI 2013 report states that only 13% of total deposits (savings) held at scheduled commercial banks belong to women. Women in Indian still lack significantly when it comes to formal ownership of material assets which constraint their credit access. Almost 91 per cent women in central India reported that their names are not included in the land/house titles, a study conducted by Institute of Financial Management and Research states.
Though financial inclusion initiatives such as the Jan Dhan Yojna are targeted towards the general population (including women), most of these initiatives are introduced without comprehensive understanding about women’s socio-economic conditions, intra-household bargaining position, and restrictions on mobility. Saving accounts opened in the name of women might actually have the husband’s savings getting institutionalised.
Property in the name of the women might in reality be controlled and managed by the male members of the family. Using the women’s name in such instances then becomes only a formality on paper. Thus, while we celebrate the NFHS-4 results on women taking more control of their personal financial assets we need to rethink actually how ‘personal’ are these assets to the women?
Even in issues of women’s productive health we need to really look at the ground realities and nuances and not just the encouraging numbers that the NFHS-4 survey tries to show us. For instance, the survey claims that more women have opted for family planning. The sterilisation rates among women have gone up significantly. The statistics are correct, but do these figures guarantee that women are controlling their bodies and reproductive health? If we look closely at the sterilisation programme in India during the recent decades a little more closely the bubble might burst. Women’s
Women’s so called ‘independent’ choice of opting for sterilisation can be seen as a political policy which as always targets the weakest to achieve easy statistical success. Population control policies in India have been political game changers. They have reappeared time and again with changed rhetoric and targets. From ‘population control’ policies have shifted to ‘family welfare’, and the target group has changed from men to women. But the process of sterilisation advocated as a way to achieve family welfare has failed to deliver health rights to the targeted population. Governments have increased incentives for health workers to bring in ‘cases’ for sterilisation. And most health workers find it easier to persuade or force women than men even though is it well-known that a vasectomy is less complicated, and reversible; it is so much convenient to coax them into accepting a permanent solution to repeated pregnancies.
Policy requires the patients be counselled about the consequences of tubectomy before they undertake the process. Also there are several medical procedures which need to be followed before and after the operation. However, these rules are violated almost always. Sterilisation camps organised by the government only focus on achieving numbers. In such camps women are often treated and operated publicly violating their right to privacy; they are not given any counselling or information about the process before they ‘opt’ for it; single medical instruments are used on more than one woman at a time; in some camps organised in Odisha, Chattisgarh and Uttar Pradesh doctors have been reported to use bicycle pumps to pump in air into the abdomen instead of an insufflator that pumps carbon dioxide; medical check-ups both before and after the sterilisation are often not conducted properly.
These are not just found in rural medical camps, but in several government hospitals in urban centres like Faridabad district in Haryana. Sterilisation of women conducted in such dismal conditions has had grave consequences. Several women have died after the process. In 2014, 14 women died in a government sterilisation camp in Chattisgarh. Many women have reported that their sterilisation processes have failed. The compensation to which they are entitled legally has also not reached them. Lack of dignity, violation of health rights and denying the opportunity to make informed choices- these are not what we would claim as control of women on her own body and health.
The NFHS-4 data offers hope, and hope is important. But hope should not be unfounded. Statistics gives an important but a very partial view of the reality. There are still wide gaps in the policies aimed at women’s empowerment. These gaps need to be plugged. The focus should be oriented more towards policy implementation in a way which offers actual empowerment to women on ground and is not limited to achieving statistics and numbers on paper.
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