The National Health Family Health Survey (NFHS) 2015-16 has some fascinating news for us.
Women have a high literacy rate of 81% in Nagaland State, with a healthy sex ratio of 968 females per 1000 males. Similarly men in Nagaland State have a high literacy rate of 85.6%. As per the NFHS-4 (2015-16), men and women are almost at par in making household decisions—97.4% married women from 15-49 years of age said they take part in decision making at home—joint decision making has seemingly had no impact on family planning in Nagaland State with only 26.7% making any effort at all.
Meanwhile, a Morung Express report, published on April 4, revealed that Infant Mortality Rate in Nagaland State stands at 29% in contrast to the 38% during 2005-06.
The NFHS-4 gathered information from 11,213 households, 10,790 women and 1,440 men from all districts of Nagaland State. This Survey was started by Government of India in 1992-93 as the first large-scale, multi-round household survey conducted at a national level. It was the first survey to collect information on fertility, infant and child mortality, the practice of family planning, maternal and child health, reproductive health, nutrition, anaemia, utilization and quality of health and family planning services. NFHS-4 is the fourth such survey—its primary purpose is to provide essential data on health and family welfare for policy making and planning, and throw light on important emerging health and family welfare issues.
What are the emerging issues in Nagaland?
Only 2.4% women received full antenatal care (at least four antenatal visits, at least one tetanus toxoid (TT) injection and iron folic acid tablets or syrup taken for 100 or more days) for their last birth in five years before the survey. Only 22.3% mothers received any postnatal care from a doctor/nurse/LHV/ANM/midwife/other health personnel within 2 days of delivery. This could be because only 32.8% women chose to, or were able to, give birth in an institution with only 25.1% at a public facility. Out of the latter, only 29.9% could access their right to the Janani Suraksha Yojana meant to incentivize institutional deliveries for women Below Poverty Line. Instead, households are spending Rs. 5834 on an average out of their own pockets for each institutional delivery!
Plagued with road networks that do not connect villages to government hospitals, and missing doctors or nurses when mothers manage to get there, women in Nagaland State are faced with a helpless situation with an unknown number dying at child birth or facing a difficult delivery. Indigenous child delivery and care mechanisms may be excellent but without support to develop these in keeping with the times (for instance the emergence of new diseases or other complications), women are faced with a major health hazard at child birth.
Could this be averted through better family planning? Perhaps, but no such indication is seen in Nagaland State yet. NFHS-4 notes that married couples stay away from contraception (whether pills or condoms), and when sterilization is involved, it is women who opt for it. Male sterilization cases in Nagaland State were recorded at zero.
If literacy rates are high and joint decision making is the norm in Nagaland’s households, as the report suggests, there is some reason that is making women put their health into hazardous grounds despite knowing the health risks they face with repeated child bearing.
Will the all-male Nagaland Legislative Assembly and apex bodies care to shed some light on this?