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Mainstream, Vol XLVI No 38

National Family Health Survey III, Punjab: A Brief Account

Wednesday 10 September 2008, by Shaik Iftikhar Ahmed


THE National Family Health Survey (NFHS) conducted in 2005-06 provides information on fertility, family planning, health, nutrition, health care, HIV/AIDS and women’s empowerment. This survey is the third in the series. The earlier two were conducted in 1992-93 and 1998-99. These were coordinated by the International Institute for Population Sciences (IIPS) under the stewardship of the Ministry of Health and Family Welfare (MOHFW). The preliminary findings of the National Family Health Survey 2005-06 were released in the form of fact sheets by the Ministry of Health and Family Welfare, Government of India. Based on these fact sheets, the present study focused on the current status of health in Punjab vis-a-vis the change in health parameters in the State since NFHS 1. An attempt has also been made to highlight the key health issues in the state of Punjab.

On the whole, 3169 households from 65 rural and 34 urban primary sampling units (PSUs) were selected for NFHS 3 in Punjab and interviews were conducted in 2968 households with a response rate of 98 per cent. It covered 3681 women and 1329 men in the age of 15-49 years. Unmarried women and men were covered for the first time. The survey was conducted through three types of questionnaires, that is, for Household, Women and Men.


THE discussion on the available data carries both good news and bad news for Punjab. On the positive side, the State has attained the replacement fertility level of two children per women. The comparable figure yielded by the first survey in 1992-93 was three. This commendable fall in total fertility rate is attributed primarily to the rise in adoption rate of family planning from 51 to 56 per cent and reduction in unmet need for family planning services from 13 to 7 per cent. The currently married women tend to rely more on terminal methods than on spacing methods. Equally important is to note that terminal methods are more prevalent among rural and illiterate women of Punjab. The use of condom and pill is on the upswing. The share of condom users has gone up from nine to 16 per cent during 1992-2006. Likewise, some rise in the share of pill users from two to three per cent has also been recorded.

Another positive feature of the demographic scene has been a sharp decline in the infant mortality rate from 54 to 42 per thousand during 1992-2006. A fall of approximately one point every year is represented. This is attributed, among other factors, to a commendable increase in the share of births attended by a doctor/nurse/ANM and other health personnel which have risen from 47 to 69 per cent. The rise in the income and educational level of the people, coupled with the participation of both public and private sectors in the provision of health services, are the main contributory factors.

Alongwith this, the percentage of underweight children under the age of three also recorded a steep fall from 46 to 27 per cent from 1992-2006. The percentage of children, who were too thin for their height, also came down from 21 to nine per cent. Similarly, the percentage of stunted children decreased from 38 to 28 during this period. Thus, improvement in the nutritional level of children is indicated, not withstanding a vast scope for improvement.

The proportion of women who have heard of AIDS has increased from 54.6 to 69.7 in Punjab since 1998. The knowledge of use of condom to reduce HIV/AIDS is more among men.

On the negative side, 80 per cent of the children in the age group of six months to three years are recorded as suffering from anaemia. Even among women in the 15-49 age group, 38 per cent are anaemic. For men in the same age group, the anaemia incidence is 13 per cent. Anaemia is of significantly higher order in urban places than in the rural areas. The malady is endemic in Punjab and calls for a full blooded effort to mitigate it.

On the other side, as many as 38 per cent of the women and 30 per cent of the men are obese in Punjab. The obesity level is distinctly higher in urban places than in rural areas. Nearly one in every two women in urban areas and one in every three in rural areas were recorded as obese or overweight. The obesity has been on the rise by one per cent point every year since 1998-99. The emerging lifestyle is to be held responsible for this.

A sharp decline has also been observed in children below three years who have undergone treatment for diarrhoea or ARI since NFHS 2. There is, of course, an impressive increase in the percentage of children who are breastfed within one hour of birth but this proportion still remains low. Only half of the infants in Punjab are exclusively breastfed, and about 50 percent of infants at the age of six months are fed with supplementary food.

The fall in the percentage of fully immunised children is another area of concern in respect of the issue of child care in Punjab. Decline in polio and DPT vaccines and a very small proportion of children getting Vitamin A supplementation have emerged as the primary reasons. Along with child health care, certain issues in maternal health also need immediate corrective intervention. Indifferent consumption of IFA tablets during pregnancy, coupled with less institutional deliveries, and poor post natal care put mothers at risk. According to NFHS 3, only one out of two women delivered their babies in health institutions in Punjab.

Equally critical is to note the decline in IUD among spacing methods and male sterilisation among the terminal methods. Awareness about HIV/AIDS and the use of condoms as a preventive measure is fairly widespread but not to the desired degree. One-third of the rural women in Punjab have not heard about HIV/AIDS and this proportion was nearly two-thirds among the illiterate ones. Similarly, more than one-half of the rural women are ignorant of the use of condom as a precautionary imperative against this disease and this proportion rises to about four-fifths among the illiterate ones.

In terms of women’s empowerment Punjab has a long way to go. Only half of the women in Punjab participate in household decisions. No less than one-fourth among them who have experienced spousal violence were candid enough to admit it. Finally the study summarises the health scenario in Punjab in terms of both the avenues of satisfaction and areas of concern.

Avenues of Satisfaction

• Fertility level now below the replacement level.
- • Rise in the use of family planning methods.
- • Spacing methods of family planning becoming more popular.
- • Children suffering from diseases (Diarrhoea and ARI) making greater use of health facility.
- • Proportion of undernourished children on decline.

Areas of Concern

• Alarming rate of children suffering from anaemia.
- • High prevalence of anaemia among women, particularly pregnant ones.
- • Low consumption of IFA tablets and poor post natal care.
- • Institutional deliveries only fifty per cent of the total.
- • Proportion of children exclusively breastfed is very low. Delay in initiation of breastfeeding and use of supplementary foods.
- • Substantial decline in the percentage of fully immunized children, with special reference to Polio, DPT vaccine and Vitamin A supplementation.
- • Obesity among adults is on a big rise.
- • Strong son preference persists.
- • Incidence of spousal violence is worrisome.

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