Women and child welfare under Chandy, Pinarayi: What the National Family Health Survey says

Representative image: Manorama

When NITI Aayog's first-ever Multidimensional Poverty Index (NMPI) revealed that Kerala had the lowest poverty, the opposition UDF was quick to deny the Pinarayi Vijayan government any credit. It was argued that the Index was prepared using the 2015-16 figures, a period when the UDF government led by Oommen Chandy was in power.

True, the NMPI is based on the National Family Health Survey 2015-16 (NFHS-4), carried out during the fag end of the Chandy ministry. However, NFHS-5, the fifth in the NFHS series that was released simultaneously with NITI Aayog's NMPI Baseline Report and based on 2019-20 figures, demonstrates that Kerala had considerably improved health and women empowerment under the LDF government.

While the population and household profile of Kerala remained largely the same between 2015-16 and 2019-20, there were three major improvements. One, sex ratio (females per 1000 males) increased from 1,049 to 1,121. Two, households using clean fuel for cooking (electricity, LPG/natural gas, biogas), went up from 57.4% to 72.1%. Three, the number of households with a member covered under a health insurance scheme saw an increase from 47.7% under Chandy to 51.5% under Pinarayi; the big jump was in the rural areas where the covered households increased from just under 50% to 55%.

Women empowerment

Indicators of women empowerment also look better than under the UDF government. Married women in Kerala who usually participate in three household decisions (decisions about health care for herself, making major household purchases, and visits to her family or relatives ) is 94.1% in 2019-20. It was 92.1% in 2015-16.

Women having a bank or savings account that they themselves use have grown from 70.6% to 78.5%. Experts say the Union Government's financial inclusion programme, Jan Dhan Yojana, has contributed to the increase.

Women (between 15 and 24 years) who use hygienic methods of protection during their menstrual period have also increased, from 90% to 93%. Women having a mobile phone that they themselves use constitute 86.6%. When Chandy bowed from office, it was 81.2%.

Violence against women

Gender violence has waned, too. Married women (between 18 and 49 years) who have ever experienced spousal violence declined from 14.3% to 9.9%. Violence during pregnancy seems to have been virtually eradicated. Married women (between 18 and 49 years) who have experienced physical violence during any pregnancy declined from 1.2% to 0.5%.

There was also a dramatic fall in the number of young women (between 18 and 29 years) who had experience sexual violence before they turned 18. From 5% during the last year of Chandy, it fell to 1.6% in 2019-20.

Late marriages

Marriage and fertility indices, too, improved under the Pinarayi dispensation. The percentage of women (between 20 and 24 years of age) married before 18 years have fallen to 6.3% in 2019-20 from 7.6% during the last fiscal under Chandy. The number of males (between 25 and 29) married before 21 has also fallen: from 2.8% to 1.4%.

The decline in women marrying before they reach 18 has shown a consistent decline over the years; the percentage was 15.4% in 2005-06. However, the drop in the number of males tying the knot before the marriageable age of 21 is seen to be dramatic after the LDF came to power. In the ten years from 2005-06 to 2015-16, the percentage had fallen only negligibly, from 2.9% to 2.8%. In the four years hence, it dropped more than a percent to 1.4%.

Infant mortality

Significantly, infant and child mortality rates also dropped. Neonatal mortality rate fell from 4.4% to 3.4% and infant mortality rate dropped from 5.6% to 4.4%. Under-five mortality rate also showed a commendable decline, from 7.1% to 5.2%.

Maternity care also looked better under the LDF government. Mothers who consumed iron folic acid for 100 days or more when they were pregnant rose from 67.1% during the UDF tenure to 80% under the LDF rule. Mothers who consumed iron folic acid for 180 days or more when they were pregnant also rose, from 47.4% under Chandy to 67% under Pinarayi.

Neonatal mortality rate fell from 4.4% to 3.4% and infant mortality rate dropped from 5.6% to 4.4%.

The cost of delivery has also plummeted. From Rs 6,901, the average out-of-pocket expenditure per delivery in a public health facility fell to Rs 6,710.

The use of family planning methods have increased from 53.1% to 60.7%. But the number of males opting for sterilisation has remained stagnant, 0.1%. Females opting for sterilisation has gone up from 45.8% to 46.6%.

Falling vaccination drive

Nonetheless, the Pinarayi Vijayan government has fared poorly in comparison when it comes to child vaccinations (BCG, measles-containing vaccine, three doses each of polio, excluding polio vaccine given at birth, and DPT or penta vaccine). The children (12-23 months) fully vaccinated constitute just 77.8%. In 2015-16, under Chandy, it was 82.1%.

However, under Pinarayi, it was found that people depended more on government hospitals for their vaccination needs. The number of children who received most of their vaccinations in a public health facility was 87.3% in 2019-20. In 2015-16, it was 77.6%. Children vaccinated in private facilities came down to 12.3% in 2019-20 from 22.4% in 2015-16.

Flood effect

Childhood diseases, especially diarrhoea, increased during the LDF tenure. The prevalence of diarrhoea among children under five years of age increased from 3.4% to 4.3%. Experts attribute this to the consecutive floods and natural disasters in Kerala.

The NHFS-5 data shows that the LDF government had indeed stepped up its preventive support. For instance, children with diarrhoea who received oral rehydration salts had increased to 61.1% from 49.4% under the Chandy dispensation. Diarrhoea-affected children who received zinc improved from 14.1% to 22.4%.

Increase in stunting and obesity

While child feeding practices like breastmilk and an adequate diet have shown an improvement, the nutritional status of both children and adults deteriorated in the four years of the first Pinarayi Vijayan ministry.

The number of stunted (height-for-age), wasted (weight-for-height), severely wasted (weight-for-height), underweight (weight-for-age) and overweight (weight-for-height) children increased.

Women whose Body Mass Index (BMI) is below normal and men whose BMI is below normal have also increased. There has also been a staggering rise in overweight men and women. While the percentage of obese women has increased from 32.4% to 38.1%, the percentage of obese men has risen from 28.5% to 36.4%.  

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