India overall healthy, but can do better

Though there are more reasons to feel satisfied with the improvement of the state of the health of young Indians and mothers as portrayed by the National Family Health Survey (NFHS-6), some areas still raise concern over the trajectory of the delivery of health services. The rise of institutional deliveries (90.6%) and expanded cover age of vaccination (87.1%) are heartening statistics from results that were made public by the Ministry of Health and Family Welfare (MoFHW) last Wednesday (May 27).

The fact that Total Fertility Rate (TFR) has stabilised at 2.0, comfortably below the global replacement thresh old of 2.1, should also be a reason for a sigh of relief for an India holding the dubious distinction of being the most populous nation. But the decline in share of infants under six months who are exclusively breastfed from 63.7 per cent in the NFHS -5 to 55.8 per cent in the latest survey, a fall of nearly eight percentage points in four years, is dismaying.

No wonder the Breastfeeding Pro motion Network of India (BPNI) has flagged it as a cause for concern. It must be viewed against the World Health Organization’s (WHO) advisory which rec ommends exclusive breastfeeding for the first six month of life when a new-born should receive only breast milk without any other food or water.

It holds the key to optimal growth, development and immunity even while suggesting that breastfeeding should continue beyond up till two years of age together with complementary foods. Part of the blame for inadequate breastfeeding could also be laid with aggressive marketing of infant milk substitutes and baby foods which undermine optimal infant feeding practices.

Steep increase in C-section deliveries from 21.5 per cent to 27.2 per cent between the two surveys, should engage attention of those guiding the policies on public health. The fact that private hospital clocked an astonishing 54.1 per cent C-section delivery rate does confirm the commercialisation of health in corporate hospitals.

It is useful to be reminded that the WHO considers a C section birth rate above 10-15 per cent a signal of over use rather than a medical necessity. This may, however, provide some scope of debate in today’s context as pregnancies happen in more complex conditions as urban and working women opt to get pregnant at a higher age and some even after onset of conditions such as diabetes and obesity.

Even the figures pertaining to nutrition of infants—only 15.3 per cent of those in 6 to 23 months receiving ade quate nutrition—makes a poignant commentary on the state of health of infants. All that it means is that nearly 85 per cent of young kids remain deprived of nutritionally sufficient complementary feeding.

There is no gain saying that undernutrition is a variant of malnutrition and no wonder why nearly one in three children suffer either from stunting—a condition in which a child is too short for its age, or long-term poor health or nutrition.