How India’s health profile has changed over the last four years, explained in 5 charts
(AFP PHOTO/Marine SIMON)SummaryThe latest NFHS-6 data shows India making progress in child immunization and marriage reduction, yet facing a double burden of stagnant child malnutrition alongside sharply rising adult obesity and private C-sections. India is in the middle of a complex health transition. Child marriage declined over the years, but is still prevalent for 20% of girls. Maternal health shows signs of improvement, but caesarean deliveries surged sharply, driven by private facilities. Malnutrition remains critical, while lifestyle diseases like obesity and diabetes are rising rapidly. Immunization rate has increased 83%. These findings in the latest National Family Health Survey (NFHS-6), conducted in 2022-23, were released last week for all states and union territories, except Manipur, where the survey could not be conducted. Mint explores the trends in detail.Child marriage: High, but downChild marriage is a key determinant of high fertility, poor maternal and child health, and the lower social status of women. The share of women aged 20-24 years, married before turning 18, declined from 23% to 20% over the last four years. This also means that every fifth girl still gets married underage. Although the decline was seen across rural and urban areas, disparities persist. While 11% of women aged 20-24 years in urban areas were married before turning 18, the share was 23% in rural areas. West Bengal (36%) and Bihar (35%) reported the highest prevalence of girl child marriage, followed by Tripura (34%), Jharkhand (28%), Assam (25%), Andhra Pradesh (25%), and Rajasthan (24%)—all above the national average.While child marriage was the highest in West Bengal and Bihar, the two states reported different fertility rates. Bihar, at 2.7, was significantly higher than the replacement level of 2.1, while West Bengal was significantly lower at 1.6. The replacement level fertility rate is the average number of children a woman needs to have to keep the population size stable.Maternal health: C-section surgesMaternal health indicators show continued improvement. Mothers receiving at least four antenatal care visits increased from 59% in NFHS-5 to 65% in NFHS-6, while institutional births rose from 89% to 91%. Caesarean deliveries have risen sharply from 22% to 27% in four years. The rise is largely driven by private facilities—caesarean deliveries among private-facility births increased from 47% to 54%, compared with 14% to 17% in public facilities.Every other birth was by surgery in Punjab, Tamil Nadu, Jammu & Kashmir, Andhra Pradesh, and Telangana. In private facilities, the share crossed 75% in Odisha, Tripura, Assam, Telangana, West Bengal, and Jammu and Kashmir. Overall, 25 states and UTs reported caesarean births above 20% across all facilities, while 19 reported public-facility caesarean levels above 20%. In private facilities, caesarean delivery was far more common, with almost every third or more institutional birth delivered by surgery in all states. The public-private gap is striking: at the all-India level, caesarean delivery was 37 percentage points higher in private facilities than in public facilities. Nine major states reported a gap of more than 40 percentage points.Immunization: northeast catches upImmunization is critical for child survival and improved child health as it protects children from major vaccine-preventable diseases. Full immunization coverage among children aged 12-23 months improved from 77% in NFHS-5 to 83% in NFHS-6, a six percentage-point increase. The gains are particularly visible in the northeast, where several states appear to be catching up. Assam recorded the sharpest rise, from 67% to 82%, followed by Meghalaya, Arunachal Pradesh, and Sikkim, each registering an increase of more than 10 percentage points. Nagaland also improved, though it continued to report
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