Some of India’s health, social gains have percolated down to district-level: Survey

The Ministry of Health and Family Welfare on Friday released the provisional district-wise factsheets for the 2023-24 round of the National Family Health Survey (NFHS), one important source of data on demographic, health, economic, and social indicators that updates faster than census data. They show that some favourable trends – such as an improvement in child nutrition and financial inclusion of women – has percolated down to almost every district. This trend also holds true for some adverse trends, such as the proportion of overweight or obese women.

To be sure, the district factsheets only add another geographic detail on trends that the national and state-level factsheets released on May 29 had already shown. They also need to be read with some caveats, such as the creation of several new districts since the previous 2019-21 round in Chhattisgarh, Tamil Nadu, Telangana, West Bengal, and Arunachal Pradesh, which makes testing district-level trends in these states meaningless without unit-level data, which has not been released yet. Similarly, not all districts had comparable data in both rounds because the sample was too small.

Excluding the states with a drastically different district count and those with small samples, there were 564 districts (out of over 700 surveyed) that reported the proportion of under-five children who were underweight. Only 84 of these districts (15% of 564) saw this proportion increase since 2019-21. Only 41 of them saw the proportion of underweight children increase by more than 1 percentage point. This proportion was the highest in Aizawl in Mizoram (12.6%) in 2023-24, only 0.3 percentage points higher than in 2019-21. The highest growth in this number was recorded in Nicobar, where the number increased by 10 percentage points to 11.6%.

Similarly, 560 districts reported the proportion of women who have bank accounts that they themselves use. This proportion increased in 523 of these districts, suggesting financial inclusion of women increased in almost all districts. However, the number decreased by over six percentage points in six districts: Panchkula in Haryana, Varanasi in Uttar Pradesh, Malkangiri, Koraput and Kendrapara in Odisha, and Udupi in Karnataka. However, the proportion was still over 80% in all these districts.

To be sure, this widespread percolation also extends to some adverse trends, such as the proportion of obese or overweight women. This number increased in 510 of 565 districts that reported the number, with 478 recording a growth of more than one percentage point. Srinagar in Jammu and Kashmir, Visakhapatnam in Andhra Pradesh, and Navsari in Gujarat, and Mumbai in Maharashtra recorded the biggest growth: each of more than 20 percentage points since 2019-21.

On the other hand, one favourable trend – the growth in institutional births – is reaching downstream slower. The share of institutional births decreased in 181 of 566 districts, with 125 recording a decline of more than a percentage point. The top five districts with the biggest decline – East, South, and West Garo Hills districts in Meghalaya; Barwani in Madhya Pradesh, and Udaipur in Rajasthan – recorded a decline of 15 percentage points or more.

To be sure, the NFHS surveys households on a wider range of variables and offers details of these indicators also along economic, social, or religious groups. However, these details will be available only when the report of the survey or its unit-level data is published.