In 2017, India saw much uproar over the state of health facilities and medical services in the country. Rumours about vaccine safety dogged immunisation campaigns in some states, child deaths in government hospitals have raised questions about the state of public health facilities across the country, and large corporate hospitals have come under the scanner for negligence and overbilling.

These events might well be indications that the state of healthcare in India has not improved much in the last decade.

The newly released National Family Health Survey data – the first comprehensive set of health data for India in 10 years – has a breakdown of the health parameters in which progress has been made and those where the country, or sections of the country, are lagging behind.

One of the more alarming public health trends that the NFHS 4 reveals is the slowdown and stagnation of immunisation rates in some communities. The percentage of children who have been fully immunised increased from 44% in 2005-’06 to 62% in 2015-’16. Full immunisation means that the child has received the BCG, measles, and three doses each of DPT and polio vaccines. However, progress has been uneven. Vaccination coverage has grown only by six percentage points in urban India in the last 10 years while it has grown by 22 percentage points in rural areas. While there has been a 29 percentage point rise in vaccinations among the poorest one-fifth of the population, full immunisation among the wealthiest one-fifth has actually fallen slightly.

Meanwhile, an increasing proportion of children across economic groups, castes, religious commnities, and urban and rural populations have received no vaccines whatsoever.

These broad trends do not bode well for the government’s aim under the renewed immunisation programme Intensified Mission Indradhanush to achieve 90% full immunisation coverage by the end of 2018.

The C-section trend

In July 2017, the health ministry ordered all private hospitals to display data on caesarean sections or c-sections performed while delivering babies. The order followed widespread concern about doctors performing unnecessary c-sections and a citizens petition to the government to make hospitals declare their c-section rates. The petitioners alleged that hospitals were giving into profiteering, with the convenience of being able to schedule a birth via c-section superseding medical requirement. They also said that hospitals were pushing c-sections as being the new “normal” and a pain-free, risk-free instead of telling pregnant women that it is an emergency recourse.

By international norms, c-section rates of between 10% and 15% are related to improved maternal and child mortality. Rates higher that this show no corresponding improvement in maternal and child mortality.

According to NFHS data, c-section rates across India have doubled in the last 10 years, from 9% in 2005-’06 to 17% in 2015-’16.

Moreover, the NFHS 4 shows that c-sections are more common in private health facilities at 41% of all deliveries as opposed to 28% in 2005-’06. The c-section rate is also much higher in urban areas than in rural areas. A greater number of more educated women and households in the highest wealth quintile are likely to undergo c-sections.

Anaemic women

Anaemia, an indicator of poor nutrition, continues to be as prevalent as it was 10 years ago. In fact, rates of anaemia in both men and women have shown little improvement since 2005-’06.

Anaemia is a condition marked by low levels of haemoglobin in the blood, most often caused by iron deficiency. Other causes of anaemia include malaria, hookworm and other parasitic worms, other nutritional deficiencies, chronic infections, and genetic conditions. Women are also more likely to develop anaemia because of chronic blood loss during menstruation as well as hormonal changes in the body during adolescence, pregnancy, lactation and menopause that increase the demand for iron in the body.

According to NFHS 4, women with no schooling are more likely to be anaemic than women who have had 12 or more years of schooling. Women from wealthier households are also less likely to be anaemic compared to poorer women.

Seeking treatment

While the majority of Indians still seek healthcare at private medical facilities, the proportion of Indians going to public healthcare centres has increased in the last 10 years.

Still, about 55% of households in India do not generally seek health care from the public sector, the most common reason being poor quality of care. The next most commonly reported reasons, according to the NFHS, is the lack of nearby government health facilities and long waiting times at these facilities.