Check out the family’s pulse: Updates of National Family Health Survey (NFHS-3)

[Guest guest]

Check out the family's pulse

The National Family Health Survey 2005-06 has many firsts to it. For

the first time, the survey has zeroed in on spousal violence, HIV

prevalence and violence against unmarried women, says Kajal Basu

The third National Family Health Survey (NFHS-3) — due to be out in

by the first quarter of 2007 — has already had a dry run. Provisional

data from five states — Orissa, Maharashtra, Chhattisgarh, Gujarat

and Punjab — is in, and the data from seven more is due by early 2007.

While the survey is not big enough to cull district and village level

data, and the union territories were not included, it did cover all

29 states and was buttressed by more than 30 organisations involved

in it. The approximate sample sizes for interview at the national

level are 1,10,000 ever-married women (i.e. women who have been

married at any point in their lives), 33,000 never-married women and

78,000 men.

The complete survey — for which fieldwork was conducted between

December 2005 and August 2006 — will have extensive data on women's

empowerment and the minutiae of domestic violence. For the first time

since the NFHS began in 1992-93, it will also be possible to

extrapolate information on violence against non-married women. Non-

married women and men have been included for the first time.

These surveys are conducted under the stewardship of the Ministry of

Health and Family Welfare. The International Institute for Population

Studies, which was the nodal agency for the first and second survey,

is also the nodal agency for this third survey. ORC Macro of the US —

which implements Measure DHS (demographic and health surveys), the

most widely accepted source of health and population data in the

developing world — provided technical assistance to the survey.

Of as much pertinence as health information related to women is that

HIV prevalence is being measured for the first time. Of course, the

112,000 tests conducted might seem a drop in the bucket (given that

the government accepts that 5.2 million are living with HIV/AIDS in

the country). Said Laurie Liskin, ORC Macro's Senior Advisor for

Communication, " In every country we've surveyed, being surveyed

doesn't translate into HIV testing. "

Then, again, for this survey, one in six households inhaled deep and

went in for blood testing anyway. More than 200,000 anaemia tests

were carried out on women aged 15-49, men aged 15-54 and children

under five years using a small, hand-held, `field-friendly' device.

It was battery-operated and required no refrigeration — the one

aspect that nearly proved fatal for India's pulse polio programme. It

was also non-intrusive, needed only a small drop of blood for

analysis and came up with results within a minute.

In all categories of gender indicators in the five states whose

results are out, the statistics on women were indicative of social

infirmity: Body mass index (BMI) was low, ranging from 41 per cent of

the women in Orissa and Chhattisgarh (compared to 32 per cent for

men) to the relative `normalcy' of 14 per cent of the women in Punjab

(compared to 12 per cent in men). The only consolation was that,

relative to the second survey, the BMI normalised by an average of

seven per cent in the said states.

Most parameters, in fact, show an improvement over the previous

surveys, says Fred Arnold, Vice-President, ORC Macro, " Child

marriage, for instance, declined drastically from the first to the

third survey. It's very rare, nationally. " The improvement is

entirely relative, though: anaemia among women is still endemic,

ranging from a `low' of 38 per cent in Punjab to a `high' of 63 per

cent in Orissa; the percentage of ever-married women who have

experienced spousal violence ranges from 25 per cent in Punjab to 39

per cent in Orissa. (This being the first time that spousal violence

has been configured as part of the survey, there are no comparable

statistics for the second survey.)

But unprecedented data on violence against women in the context of

health might permit the reworking of policy decisions. " The survey

found that infant mortality, for instance, is higher among abused

women, as are other juvenile problems, and those of families and

women themselves, " said Sunita Kishor, senior gender specialist, ORC

Macro.

Detailed data on HIV could also determine how the National AIDS

Control Organisation (NACO) handles the future course of the disease

in the country. The organisation will use three sources of

information: sentinel survey data on women; NFHS-3 data on the

general population; surveillance data on high-risk groups. The

HIV/AIDS part of the survey — which left out women in brothels and

truckers on the move on the debatable ground that the former were a

minuscule proportion of the population and the latter impossible to

nail down — found that more men than women had heard of AIDS (men: 92

per cent in Punjab to 67 per cent in Chhattisgarh; women: 70 per cent

in Punjab to 41 per cent in Chhattisgarh).

The survey's HIV content is expansive but not exhaustive: it includes

knowledge on disease and treatment, discussions of it during

antenatal visits, previous tests, stigma and discrimination,

medically safe injections, male circumcision, sexual behaviour (which

the surveyors concede is probably under reported), and condom use.

Samples for HIV testing were collected using the carrot approach:

vouchers for free testing at any local clinic were given to those who

agreed to provide the samples, but there was no monitoring to check

how many actually went to the clinics. No names or personal

identifiers were placed on the filter paper that carried the blood

sample, so no one was at risk of being identified. While this might

permit a more fine-tuned macro approach to the issue, it prevents

interested organisations from approximating a spot-focus that could

enable them to take prophylaxis and rehab to specific locations.

For obvious reasons, ORC Macro preferred to keep out of the ongoing

Government of India versus WHO controversy on HIV statistics in

India. " All that we found in the 15 countries we'd already surveyed, "

said Arnold, " was that HIV/AIDS figures actually fell from what had

previously been conjectured. "

Nonetheless, the survey's new or expanded content areas should be of

interest to various organisations: NACO would be interested in family

life education, as should be UNICEF in child labour. Among the other

new areas are birth registration, contraceptive continuation and

failure rates, prenatal mortality, male involvement in family

planning and maternal health, malaria prevention, tuberculosis-

related knowledge and stigma, nutritional status of man and never-

married women, and Vitamin A supplementation during pregnancy.

If the survey can provide all this, it might — despite the small

survey corpus — redirect the government to a new exploration of

family health, one of the plinths of a workable developmental policy.

Furthermore, since all the data sets will be publicly available, they

might help interested global and national organisations — government

and otherwise — to formulate a developmental strategy that doesn't

have much of India's population falling through the cracks.— WFS

http://www.tribuneindia.com/2006/20061203/society.htm#1

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" Dr. Avnish Jolly " <avnishjolly@...>