New Delhi: In its terse rebuttal to the WHO report on global Covid mortality, the Government of India claimed Thursday that in 2020, the level of death registration in India stood at 99.9 per cent. However, the national report of the National Family Health Survey-5 (2019-21) says that 71 per cent of deaths of household members were registered with the civil authorities. The figure is 83 per cent for urban households and 66 per cent for rural ones.
The NFHS-5 national report was released by health minister Mansukh Mandaviya Thursday in Gujarat. NFHS-5 fieldwork for India was conducted in two phases: Phase-I from 17 June 2019 to 30 January 2020, covering 17 states and five Union territories, and Phase-II from 2 January 2020 to 30 April 2021, covering 11 states and three Union territories.
The survey was carried out by 17 field agencies and gathered information from 6,36,699 households, 7,24,115 women, and 1,01,839 men.
For death registration, the report presents information on the deaths of usual household members in the three years preceding the survey that were registered with the civil authorities.
The Ministry of Health and Family Welfare had drafted its rebuttal to the WHO, issued Thursday, based on the report of the Civil Registration System (CRS) for 2020. However, the CRS report, released Tuesday, does not give a death registration level. Its last report, which had data from 2019, pegged death registration levels at 92 per cent.
In 2020, India saw 81.2 lakh deaths registered, according to the CRS data. The health ministry Thursday said that of an estimated 81,20,268 deaths that occurred in 2020, 81,15,882 were registered — putting the registration level at a very high 99.9 per cent.
The estimated deaths, according to sources in the health ministry, were calculated based on the death rate of six per cent given in the Sample Registration System (SRS) data for 2019. The SRS data for 2020, which will give the exact death rate for that year, is yet to arrive.
According to NFHS-5, among states and Union territories, death registration is lowest in Bihar (36 per cent), followed by Arunachal Pradesh (37 per cent) and Nagaland (39 per cent). The data show 100 per cent death registration in Goa, 97.8 per cent in Kerala, 97.4 per cent in Lakshadweep and 94.7 per cent in Himachal Pradesh.
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59% of households use clean fuel for cooking
The NFHS-5 data show that only 59 per cent of households in India use clean fuel for cooking. Forty-one per cent of households in India use some type of solid fuel for cooking, with virtually all being wood or dung cakes. The ambitious Pradhan Mantri Ujjwala Yojana that aims at providing clean fuel to all households was launched in 2016.
The report also draws correlations between the kind of cooking fuel used and the incidence of tuberculosis. “There is a great deal of variation in the prevalence of medically treated TB according to the type of cooking fuel the household uses, ranging from a low of 179 persons per 1,00,000 usual residents in households using electricity, liquid petroleum gas, natural gas, or biogas to a high of 490 persons per 1,00,000 in households using straw, shrubs, or grass for cooking,” it says.
6.8% children aged 15-19 years have begun childbearing
The report highlights the prevalence of child marriages and early motherhood. It shows that 6.8 per cent of children in the 15-19 years age group have had a live birth or are pregnant with their first child. The percentage is the highest in Tripura at 21.9, followed by 16.4 in West Bengal and 12.6 in Andhra Pradesh. None of these children is unmarried.
The report says: “In India, the median age at first sexual intercourse is 18.9 years for women age 25-49. Ten per cent of women age 25-49 had sex before age 15, and 39 per cent before age 18. By age 20, 60 per cent of women age 25-49 have had sexual intercourse. The median age of first sexual intercourse for men age 25-49 in India is 24.8, six years older than women. One per cent of men age 25-49 years first had sexual intercourse before age 15, and 6 per cent had sexual intercourse before age 18. By age 25, 52 per cent of men age 25-49 have had sexual intercourse.”
Despite being the most complex option, the report says that female sterilisation remains the most popular modern contraceptive method. “Among currently married women age 15-49, 38 per cent use female sterilisation, followed by male condoms (10 per cent) and pills (5 per cent). Ten per cent use a traditional method, mostly the rhythm method (Figure 5.1). Among sexually active unmarried women, male condoms are the most commonly used method (27 per cent), followed by female sterilisation (21 per cent),” says the report.
While this is the first family health survey that shows that India has dipped below the replacement fertility level of 2.1, it also shows that the fertility level could be even lower had there not been unmet contraceptive needs. “The total wanted fertility rate in India is 1.6 children per woman, compared with the actual total fertility rate of 2.0 children,” it says.
Unmet need for family planning methods is highest in Meghalaya (27 per cent) and Mizoram (19 per cent). It’s less than 10 per cent in most other states except Maharashtra, Punjab, Gujarat, Assam, Jharkhand, Sikkim, Manipur, Arunachal Pradesh, Kerala, Uttar Pradesh, and Bihar, where it varies between 10 and 15 per cent. Unmet need is lowest in Andhra Pradesh (5 per cent) and in Delhi, Karnataka, and Telangana (6 per cent each)
Spousal violence
The report shows that 32 per cent women who have ever been married have experienced spousal physical, sexual, or emotional violence. Of the women surveyed, 27 per cent had experienced at least one of these forms of violence in the 12 months preceding the survey.
A quarter of married women in the 18-49 years age group who have experienced spousal physical or sexual violence report having physical injuries, including 7 per cent who have had eye injuries, sprains, dislocations, or burns and 6 per cent who have had deep wounds, broken bones, broken teeth, or any other serious injury. Only 14 per cent sought help to stop the violence.
Consanguinity
Of the women surveyed, 13 per cent of married women were related to their husband before their marriage, and 11 per cent of marriages were consanguineous (with someone descended from a common ancestor). The most common type of consanguineous marriage was to first cousins (8 per cent of all marriages).
“Women in all the southern states except Kerala are much more likely to be in consanguineous marriages than women in other states. More than one-fourth of women in Tamil Nadu, Andhra Pradesh, and Karnataka, and almost one-fifth of women in Telangana and Puducherry, reported being in consanguineous marriages,” says the report.
(Edited by Rohan Manoj)
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