'Contraception Makes Women Promiscuous'; Fertility Rate Declines: Finds Family Health Survey

The latest Nationa Family Health Survey (NFHS-5) includes some new topics, such as preschool education, disability, access to a toilet facility, death registration, bathing practices during menstruation, and methods and reasons for abortion.

METHODOLOGY - The NFHS-5 survey work has been conducted in around 6.37 lakh sample households from 707 districts of the country from 28 states and eight Union Territories, covering 7,24,115 women and 1,01,839 men to provide dis-aggregated estimates up to the district level.

The latest findings highlight India's sanitation facilities, general health, and well-being, literacy rate, tobacco and alcohol consumption trends, etc.

However, key findings of the NFHS-5 reveal that Indians are far from ideal living conditions and that a misogynistic and patriarchal mindset still prevails across the country.

19% of households do not use any toilet facility

Even though India was declared Open Defecation Free by the government in 2019, the latest NFHS survey conducted in 2019-21 showed that 19 percent of households do not use any toilet facility. However, the report said the percentage of households practising open defecation decreased from 39 percent in 2015-16 to 19 per cent in 2019-21.

Access to a toilet facility is lowest in Bihar (62 per cent), followed by Jharkhand (70 per cent) and Odisha (71 per cent). The NFHS-5 found that 69 percent of households use an improved sanitation facility that is not shared with other households. Eight percent use a facility that would be considered improved if not shared.

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¡°Nineteen percent of households have no facility, which means that the household members practice open defecation," the report said.

¡°Eighty-three percent of households have access to a toilet facility. Sixty-nine percent of Indian households use improved toilet facilities, which are non-shared facilities that prevent people from coming into contact with human waste and can reduce the transmission of cholera, typhoid, and other diseases," it said.

The survey found that 11 percent of urban households use a shared facility, compared with seven percent of rural households. Access to a toilet facility ranges from 69 percent among scheduled tribe households to 93 percent among households that are not scheduled caste, scheduled tribe, or other backward class households.

Nearly 50% women use cloth during menstruation

About 50 per cent of women aged 15-24 years still use cloth for menstrual protection, according to the latest National Family Health Survey (NFHS) report, with experts attributing it to a lack of awareness and taboo existing around menstruation.

The experts also said that if an unclean cloth is reused, it increases exposure to multiple local infections.

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In the recently released NFHS-5, women aged 15-24 years were asked what method or methods they use for menstrual protection if anything.

In India, 64 per cent of women use sanitary napkins, 50 per cent use cloth, and 15 per cent use locally prepared napkins, the report stated. Overall, 78 per cent of women in this age group use a hygienic method of menstrual protection.

Locally prepared napkins, sanitary napkins, tampons and menstrual cups are considered to be hygienic methods of protection.

66% men believe it's OK for wife to refuse sex

In a new revelation, which also signals a change in the mindset of Indian men, the NFHS found that a large section of men believe a woman refusing sex to her husband is justified if she's had a long day.

While 80 per cent of women participants believe refusing sex to their husband is justified for any or all of these three reasons -- if he has a sexually transmitted disease; he has sex with other women; or because she is tired/not in the mood. As many as 66 per cent of Indian men agree.

However, eight per cent of women and 10 per cent of men do not agree that a wife can refuse sex to her husband for any of these reasons. This comes at a time when the debate over the criminalisation of marital rape is still hot.

Fertility rate declines

India's total fertility rate (TFR) has declined from 2.2 in 2015-16 to 2.0 in 2019-21, indicating the significant progress of population control measures.

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The TFR is the average number of children born to a woman in her lifetime. The governments set targets for TFR for the purpose of population control. TFR of 2.1 is considered the replacement level fertility rate at which population stability is achieved.

According to the report, India has made significant progress in population control measures in recent times with the TFR, but there are wide inter-regional variations with five states still not having achieved a replacement level of fertility of 2.1. Bihar (2.98), Meghalaya (2.91), Uttar Pradesh (2.35), Jharkhand (2.26) and Manipur (2.17) are the five states, according to the NFHS-5 conducted from 2019-21.

In seven states, more than 90 per cent of the births in the last five years were institutional births. In Kerala, nearly 100 per cent of the births were institutional births. Only 46 per cent of the births in Nagaland were institutional births, according to PRS.

India becoming a land of obese

One in every four Indians is now obese, shows official data from the National Family Health Survey-5 (NFHS-5). Obesity has increased at a national level from 21 per cent to 24 per cent among women, and 19 per cent to 23 per cent among men.

Obesity, however, is a growing concern. It is the leading cause of several non-communicable and progressive diseases such as hypertension, diabetes, and those related to liver and increased risks of stroke (see box).

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The survey found that rural men and women are thinner than their urban counterparts. The percentage of obese population is more in urban (33 per cent) than rural areas (20 per cent). Also, there is a steady increase in the proportion of overweight or obese men and women as household wealth increases ¡ª from 10 per cent in the lowest wealth quintile to 39 per cent in the highest wealth quintile for women, and from 10 per cent in the lowest wealth quintile to 37 per cent in highest wealth quintile for men.

Puducherry (46 per cent), Chandigarh (44 per cent), Delhi, Tamil Nadu, and Punjab (41 per cent each) have the highest proportion of obese women.

On the other hand, Andaman and Nicobar Islands have the highest proportion of overweight men (45 per cent), followed by Puducherry (43 per cent) and Lakshadweep (41 per cent).

35% men say contraception is ¡°women¡¯s business¡±

About 35.1 per cent of men believe that contraception is ¡°women¡¯s business¡± while 19.6 per cent men think that women who use contraceptives may become promiscuous.

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Among the states and Union Territories, Chandigarh has the highest percentage of men at 69 per cent who believe that contraception is women¡¯s business and a man should not have to worry about it while 44.1 per cent of the surveyed men from Kerala agreed that women who use contraception may become promiscuous, the report said.

Also, 55.2 per cent of men say that if a male condom is used correctly, it protects against pregnancy most of the time, it said.

Among the surveyed men, about 64.7 per cent of Sikhs believed that contraception is women¡¯s business and a man should not have to worry about it while the number stood at 35.9 per cent for Hindus and 31.9 per cent for Muslims.

The data showed that women who are employed are more likely to use modern contraception as 66.3 per cent of them use a modern contraceptive method, compared with 53.4 per cent of women who are not employed.

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