The fifth round of the National Family Health Survey, released by the Ministry of Health and Family Welfare on November 24, has revealed startling reversals in nutrition and health indicators.
The data shows an increase in severe wasting in children under five – from 7.5% in 2015-’16, when the previous round of the survey was conducted, to 7.7% in 2019-’21. Wasting, or low weight compared to height, could be caused by prolonged weight loss and poor nutrition. Stunting, or children being shorter than normal for their age, improved slightly – from 38.4% in the previous survey to 35.5% now.
Anaemia, another indicator of poor nutrition levels, has also risen among men and women aged 15-49 years. Over one in two women, or 57% of those surveyed, and one in four men were found anaemic. Anaemia, or low haemoglobin in blood, is caused by iron deficiency. It can cause fatigue and complications during pregnancy and reduces fitness levels overall.
Obesity has also risen among adults. The data shows 22.9% of the men and 24% of the women surveyed were obese, up from 18.9% and 20.6%, respectively, in 2015-’16. Obesity hampers lung function and lowers immunity, making it a risk factor for a range of health problems, including severe Covid-19 infection. According to Centre for Disease Control data, 30.2% of the Covid-19 hospitalisations in the United States in 2020 were necessary because obesity was a risk factor.
The latest National Family Health Survey was conducted by the International Institute for Population Sciences in two phases – first from June 2019 to January 2020, and then from January 2020 to April 2021.
Across India, 6.36 lakh households, including 7.24 lakh women and 1.01 lakh men, were surveyed. Some states fared worse than others.
Two states, Maharashtra and Gujarat, have over 10% severely wasted children aged under five years, while the Union Territory of Chandigarh has the lowest, under 3%.
Maharashtra and Gujarat have the largest number of malnourished children in the country. However, Rajlakshmi Nair, a nutrition specialist who works with the United Nations Children’s Fund, suggested Maharashtra had made other health gains. “Within Maharashtra, overall health indicators have improved, although the wasting and anaemia levels have declined,” she said. “More children are getting covered under nutrition programmes.”
At least 17 states and Union Territories, mostly in North and North Eastern India, saw a significant rise in severe wasting among children under five. In Ladakh, Lakshadweep, Telangana, Nagaland, and Mizoram, the number has nearly doubled since 2015-’16.
Other states that saw a steep rise in severe wasting rates for children under five were Jammu and Kashmir (from 5.6% to 9.7%) and Assam (from 6.2% to 9.1%).
In Uttar Pradesh, India’s most populated state, severe wasting among children under five increased to 7.7-% from 6% in 2015-16. However, in five states and Union Territories, wasting levels have nearly halved in the last five years. They are Puducherry, Dadra and Nagar Haveli and Daman and Diu, Andaman and Nicobar Islands, Uttarakhand, and Haryana.
The survey reflects poor nutrition levels among children overall. Along with malnourishment, obesity has also risen in children aged less than five years – 3.4%, up from 2.1% in 2015-’16. This suggests that even if children do not go hungry, their diet consists of junk food and few micronutrients.
In 22 states and Union Territories, more women have slipped into anaemia over the last five years. Anaemia levels ranged between 30% to 90% in most states.
In at least 12 states, over 60% of women surveyed were anaemic. The Union Territory of Ladakh fared particularly poorly, with 92.8% women surveyed being anaemic.
States and Union Territories that registered a 10-15% rise in anaemia among women are Ladakh, Assam, Chhattisgarh, Tripura, Mizoram, Jammu and Kashmir and Odisha.
The latest survey shows anaemia rates among adults are worse in rural areas than in urban areas across India. They have also risen among all age groups: 67.1% children under five years were found anaemic, an 8.5%-jump from 2015-’16. Anaemia in men aged 15 to 49 years has gone up to 25% in 2019-21 from 22.7% in 2015-’16.
Uttar Pradesh saw slightly lower anaemia rates among adults: 50.4% women were found anaemic, down from 52.4% in the last survey, and 21.5% men were found anaemic, down from 23.7%. Anaemia rates for children under five, however, have deteriorated from 63.2% to 66.4%.
Government measures to tackle anaemia do not seem to have yielded significant results either. Data from the National Health Mission shows a budget of Rs 940.1 crore was approved for “Anaemia Mukt Bharat” in 2020-’21, up from Rs 851 crore in 2019-20. This was a programme to offer better nutrition to reduce anaemia rates. Madhya Pradesh received the largest share of funds this year but its anaemia rates for women have deteriorated from 52.5% in 2015-’16 to 54.7% now.
Obesity among men
Five years ago, southern and western states had higher levels of obesity among men aged 15-49. In this round of the survey, Northern and North Eastern states appear to have caught up. In 21 states, more than a quarter of the men surveyed were obese.
Except for Andhra Pradesh, Goa, and Dadra and Nagar Haveli and Daman and Diu, all states and Union Territories have reported a rise in obesity levels in the last five years.
In the Andaman and Nicobar Islands, Puducherry and Lakshadweep, over 40% men surveyed were found obese. In India’s capital, Delhi, 38% men surveyed were found obese. The sharpest rise was in Ladakh and Lakshadweep, where 20% more men were obese than in the latest survey.
Obesity levels are higher in men than women. Across India, obesity among men aged 15-49 years rose from 18.9% to 22.9%,and among women, from 20.6 to 24%. More adults in urban areas were obese than rural. Sedentary lifestyles and poor dietary habits are believed to be responsible for obesity.
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