National Family Health Survey: A Landmark in Indian Surveys

Author(s): Pravin Visaria and S. Irudaya Rajan

Source: Economic and Political Weekly , Oct. 16-29, 1999, Vol. 34, No. 42/43 (Oct. 16-29,
1999), pp. 3002-3007
Published by: Economic and Political Weekly

Stable URL: https://www.jstor.org/stable/4408530

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 SPECIAL ARTICLES

National Family Health Survey: A Land

in Indian Surveys
Pravin Visaria
S Irudaya Rajan

What is the rationalefor conducting surveys like the National Family Health Survey when there are alr
available reliable data sets from the census and the sample registration system which provide
acknowledged data-base for planning and policy making? In this paper a brief examination of the
from the other surveys and their particular limitations precedes an overview of the NFHS, specif
designed to provide the information that social scientists need, and the nature and quality of the data
has generated.
THE successful completion of the Na- The reasons for conducting a NFHS or The 1971 Census had initially aimed to
tional Family Health Survey (NFHS) in its various rounds are not adequately continue the approach of the 1961 Census,
India during the early 1990s was a land- understood. It is sometimes suggested thatwith some elaboration of the questions on
mark in the history of collection of demo- the Indian censuses and the sample reg- migration and the questions on children
graphic data through surveys. Encouraged istration system provide an adequate data ever born and surviving as well as births
by the success of the effort and the use- base for planning and policy-making.during the year preceding enumeration
fulness of findings, a second round of (that had been tried out by William Brass
Unfortunately, this view is not correct. To
NFHS has also been launched during the in Africa). On the suggestion of scholars
gain a proper perspective, a brief overview
latter half of 1998. Originally, the second of the post-independence developments like the senior author of this piece, the
round was to be initiated five years after in the statistical data base will probablyBrass questions were pre-tested during the
the first survey, which was conducted be of some help. preparations for the 1971 Census and no
broadly during 1992-93. (Some minor de- difficulty was encountered in collecting
CENSUS DATA
viations from this period are not really of the data. The Brass questions had the
much consequence and can be ignored.) Since 1947, India has conducted five potential, under certain assumptions, to
Unfortunately, quite apart from the usual provide reasonably valid approximate
decennial censuses and the plans for the
bureaucratic wrangles, the sanctions im- next census to be conducted in 2001 are estimates of the level of fertility as well
posed after the Pokhran tests delayed the now being made. The 1951 Census wasas child mortality at the district and pos-
start of the second round. The ministry of planned during the dawn of planning insibly the sub-district level. However, in
health and family welfare was convinced, the country and attempted an elaborate1969, a meeting of 'experts' in the Plan-
however, of the usefulness of the survey tabulation on the economic activities of
ning Commission suggested some changes
and was willing to fund it from the Indian the population. Unfortunately, the con-in the questions on economic activity, to
resources. As the concerned secretary put ceptual framework was constrained by the separate out persons whose primary
it, in a budget of nearly Rs 2,300 crore ap- earlier notions of distinguishing betweenactivity was work from others for whom
proved for the family welfare programme 'self-supporting persons' and others; the work was a secondary activity or who
for 1999-2000, it would not be difficult latter worked and earned an income but
worked in addition to some other pri-
were 'dependent' on another presumablymary activity. Also, a reputed British
to find a sum of Rs 6 to 10 crore required
for the NFHS II. In other words, while self-supporting person in the household. scholar, close to an influential senior bu-
external funding is welcome, the NFHS II The feasibility of collecting such data in reaucrat in the Planning Commission,
is not conditional on the availability a predominantly agricultural economy,persuaded the latter that the Brass ques-
of external resources. The same was with a high proportion of self-employedtions need not be included in the census.
true for the first round of the NFHS, and was debatable under the best of He argued that the Sample Registration
persons,
foreign funds were not a prerequisite circumstances.
for After careful deliberations, Scheme (started on a pilot basis in 1964 but
the survey. this archaic conceptual framework wasextended to rural India in 1967 and urban
The 10 papers included in this special replaced in the 1961 Census by an effortareas in 1969), had the potential to provide
issue illustrate the rich potential of the to make an inventory of the economic all the information that the Brass questions
excellent data set of NFHS I for a wide activities of all individual workers. Simul-
would provide. These views prevailed.
variety of research studies. This introduc-taneously, a welcome effort was begun to Subsequent caveats by Indian scholars
tory paper also outlines the rationale of collect data on rural-urban migration, land against the modification of the economic
surveys like the NFHS to minimise the tenures, housing and the key characteris-questions and the dropping of Brass ques-
misunderstanding and unwarranted fears tics of all enterprises engaged in manu-tions proved ineffective. The former change
about the presumed limitations of the facturing activities. Despite manual tabu- in the questions on economic activity prov-
NFHS. The community of scholars en- lations, the 1961 Census produced moreed most costly and led to gross underesti-
gaged in the study of Indian population than 1400 volumes, some of which weremates of the number and proportion of
as well as social change in India needs to published only after the next census wasfemale workers in the country. Those who
look at such efforts in proper perspective.conducted in 1971. designed the 1981 and 1991 censuses only

3002 Economic and Political Weekly October 16-23, 1999

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slightly modified the framework of the number of working females or the childdiffered from the estimates based on service
1971 Census relating to the economic labourers in the country. Little do theystatistics. While the differences could be
activities and sought to attain comparabil- understand that given the widespread age- explained, a four- district survey in Guj arat
ity with the earlier estimates instead of misreporting and the likelihood of a net in 1989 also indicated the need to improve
aiming at dependable or credible estimates undercount in the census, there is no singlethe sampling procedures used by the ORG
of the number of workers and the worker- estimate even of the size of population,staff. It was also evident that an indepen-
population ratios. The Brass questions were or the number of women, children, youth,dent nationwide survey that could gene-
finally introduced in the 1981 Census; but or the aged in the country. (Demographersrate valid estimates for a large number of
a valuable opportunity of assessing the and statisticians have to smooth the data correlates of contraceptive use and mater-
pre-transition demographic situation in and the differences in the smoothing nal and health care at the state level, by
different parts of the country was lost. procedures adopted by different individu- rural-urban residence would be of great
als lead to differences in these estimates.)use. Neither the NSS nor the SRS staff
SRS DATA AND ORG SURVEYS
A major international demographic datahad any comparative advantage in under-
The Sample Registration Scheme (which collection effort during the 1960s andtaking such a survey. Therefore, it was
later acquired the name of a system) was 1970s was the World Fertility Survey decided to launch the NFHS, with the field
introduced because the estimates of birth (WFS), supported by the US Agency forwork entrusted to consulting organisations,
and death rates based on the civil regis- International Development (USAID). in collaboration with the Population
tration data understated the level of fer- India did not participate in the WFS, partlyResearch Centres, which had an extensive
tility and mortality. It is sometimes argued because of its link with the USAID but experience of district level surveys.
as though the SRS and the census data also because it did not want to share its In any case, it would be a serious mistake
together provide all the information neces- data with the sponsoring external agen- to dismiss the value of a survey on the
sary for planning on the topics covered by cies. However, the ministry of health and ground that its results conform to what
them. It is overlooked that all such data family planning (later family welfare) was known earlier. The consistency be-
need external validation and the best means assigned to the Operations Research Group tween alternative sources of estimates
to do so is to secure similar estimates (a private sector market research firm at enhances the credibility of estimates and
through an alternative system. In fact, a time and now a large consulting the discrepancies point to the identifica-
that
basic strength of the Indian statistical
organisation), a national survey on the tion of areas where remedial intervention
system is the availability of alternative
level and correlates of use of family plan- might be necessary. Likewise, it is wrong
estimates for various key indicators. The
ning during 1970. A similar assignment to condemn a survey because it did not
bureaucrats often dislike the debates and was given to ORG in 1980 and 1989, collect data on difficult and highly sub-
discussion arising from this situation; but
mainly to check the estimates derived from jective factors such as the quality of ser-
they are a part of a healthy democraticthe service statistics about sterilisations, vices. Many experienced friends describe
system. On the number and proportion of the offtake or use of other contraceptives such criticism as illustrating a 'heads I
workers, for example, the National Sampleand the couple protection rates. The re- win, tails you lose' approach; and if any
Survey has provided alternative estimatesports of ORG surveys were treated like effort is made to collect some qualitative
at the national and state level, by gendermost sensitive secret documents and were data, many a times the results are dis-
and rural-urban residence since 1972-73, not easily accessible to non-officials or missed as soft, highly subjective and
which are substantially higher than thoseresearchers. Subsequently, the 1970 sur- possibly misleading.
given by the censuses of 1971, 1981 and vey data were placed in the data archives During the early 1980s, the WFS sched-
1991. The so-called invisibility of the workof the ICSSR for use by other scholars; ules were, in a sense, tested out in
participation by women of India is there-but the data collected in the 1980 and 1989 Maharashtra state, through the Population
fore a problem only for those who do notsurveys have simply been lost, partly Research Centre located at the Gokhale
know about the NSS data or who do not because the ministries tend to be poor Institute of Politics and Economics, Pune.
know how the NSS data can be used to custodians of the survey data. (This issue includes a paper that draws on
calibrate the census-based estimates. On (During the early 1970s, the several 'area the Maharashtra survey.) Efforts to rep-
vital rates, however, the NSS could notprojects' undertaken in different states licate the survey throughout the country
provide dependable estimates. The esti-with external assistance had sponsored through an USAID grant of up to 10 million
mates of birth, death and infant mortalitybaseline surveys of the level of fertility, dollars were caught in an unending am-
rates, obtained in the 1973-74 survey were mortality and contraceptive prevalence in bivalence about the condition of open
so low, relative to the SRS rates, that theyseveral states of the country. But the reports access to the data after the results were
were not published. The data relating toas well as the data remained confined to published. A part of the grant was to be
the practice of family planning by thethe MoHFW, the organisations conduct- used to strengthen the 17 Population
respondent households were, however,ing the surveys and the family planning/ Research Centres set up in different parts
published partly because they were cross-family welfare departments of the con- of the country with high expectations and
tabulated by monthly per capita expendi-cerned states. As a result, the investments ambitious objectives but poor resource
ture of the household, a variable on which made in the surveys did not really yield support. The gradual openness of the late
no other source of information was avail- the benefits that could have been reaped 1980s and the post-1991 climate of liberal-
able. The effort required to separate wheatfrom the effort. In all probability, the poor isation helped to go ahead with the NFHS.
from chaff often exceeds what the well- institutional memory would ensure that no
EXTERNAL ASSISTANCE
motivated members of the non-govern-one would be able to lay hands on these
mental organisations are able to make. Out reports. It was certainly not a creditable The NFHS is sometimes criticised on
of sheer exasperation, they blame the data situation and it needed to be corrected.) the basis of deep-rooted xenophobia. We
collection agencies for not providing a The level and method mix of contracep- do not see anything wrong in close asso-
'single correct estimate', forexample, of thetive use reported by the ORG surveys ciation with the overseas experts, if they

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make a useful contribution to help im- sub-sample of the initial sample. With the which levy a fixed daily charge, irrespec-
prove the methodology of data collection, National Sample Survey staff pre-occu- tive of the distance actually covered during
processing or dissemination. The Indian pied with their pre-designated workload, a day. There has been some talk in the
experts, particularly statisticians and de- the resurvey work was assigned to the Department of Statistics in recent months
mographers, have often served as advisers Indian Council of Medical Research. A re- to adopt the same procedure for the NSS
to many other countries of the world. The survey has some inherent problems be- surveys; but it remains to be seen whether
tables are now turned; and the Indian cause it must allow for genuine change in and how far the resources will become
statistical work is guided by the Special the situation between the initial visit and available to provide the exclusive trans-
Data Dissemination Standards (SDDS) the revisit. However, as has been reported port facility to investigators and the ac-
prescribed by the International Monetary in one of the papers in this issue, the NFHS companying supervisor.
Fund, to which India has subscribed came through with flying colours. There
QUALITY OF NFHS DATA
(without adequate consultation with thewere also some baseless and unwarranted
professionals, according to a widely held allegations as to how the NFHS reports The papers included in this special issue
view). A project on the modernisation of were completed with an unusual speed demonstrate the use of both internal and
the statistical system of India with theafter the end of field work. But they were external checks on the data. There are clear
support of the World Bank is under active generally ignored as illustrating the jeal- indications that the field work left some-
consideration. It would probably enhance ousies in a country with relatively limited thing to be. desired in the difficult states
the timeliness of processing and dissemi- opportunities. (The careful planning and of Madhya Pradesh and Rajasthan; but
nation of the data to a large extent and the availability of good data processing overall, the NFHS has made a solid con-
would prove a great gain for all those who equipment were the real contributory tribution to our understanding of the socio-
use the data for policy formulation andfactors.) Also, the NFHS adopted an ex- demographic situation in India and its
discussion. The important thing is to ensureemplary open approach to the dissemina- states as well as regions. The assessment
that the additional resources are used tion of its reports and household level data about MP and Rajasthan is based on a
for worthwhile pursuits and not for rela- and has encouraged considerable addi- comparison of the NFHS and the SRS data
tively trivial activities, such as can be tional research. (Over the past two years, on the total fertility rates. However, one
justified in the name of some Unitedthe NSS data have also become easily can debate whether the SRS itself secures
Nations' recommendation (which would accessible to researchers, both Indian and a reasonably complete coverage of the vital
in all probability be optional for develop- foreign, under the data dissemination events. As noted above, the comparative
ing countries, that face severe scarcity policy
of cleared by the cabinet.) method can be an excellent aid for judi-
resources). cious and balanced assessments, provided
COST OF NFHS
The critical issue in such matters is the that the analysts do not succumb to the
transparency and adequate debate among It is a common refrain of many critics temptation of claiming spectacular suc-
Indian scholars and policy-makers. There of the NFHS that it cost too much. It is cess in lowering fertility in such difficult
can always be legitimate complaints that conveniently overlooked that the survey states (by ignoring the contrary evidence)!
some particular person(s), groups or in- was funded out of a grant that was intend- The NFHS data can be evaluated partly
stitutions were not consulted; and the ed to strengthen the Population Research by comparing the rates and ratios reported
bureaucrats are certainly capable of cre- Centres (PRCs), which had been starved by them with the census data as well.
ating a facade of consultation, while keep- of the requisite infrastructure (including However, such comparisons must allow
fng key information close to their chest. adequate library support) for a long time. for the large numberof inadequately trained
Even the academics can feel threatened by The NFHS indirectly provided these PRCs enumerators, who have to be enlisted in
(and therefore exclude) possible voices of with some modest funds to undertake theirthe massive task of census-taking. If the
dissent or those who would not easily be regular activities without the usual stress.sex ratios reported by a survey like the
shut up. But this is our own Indian prob- The per household cost of field work for NFHS and the census differ, the discrep-
lem; we must not blame it on the ex- the NFHS is widely regarded as very high;ancy can be due also to the greater omis-
patriates (particularly the American/west- and on the ground of the ratchet effect, sion of females in the census and the
ern scholars or the World Bank staff). The it is alleged to have raised the cost of all NFHS need not be the culprit. (The 1991
USAID and the World Bank necessarily survey work to a new high. While thereCensus seems to have faced serious prob-
work with the bureaucrats whose permis- may be some truth in this charge, the high lems in this respect in Bihar in particular
sion and collaboration are essential pre- costs are partly a result also of the fact thatand in regard to the older population almost
requisites of work in India. However, rural field work is no longer as easy as throughout the country. However, identi-
unlike a private sector survey agency that it perhaps was in the past; and like all fication of such problems requires ardu-
implements a contract from a ministry research, it no longer attracts committed ous and patient exploration of the data
with a claim to be knowing all that needs ?souls. Also, the hidden costs of surveys without the glare of publicity that can be
to be known, the western tradition gen- conducted by governmental agencies (par- earned by sensational claims about aggra-
erally welcomes wide consultation and ticularly the highly subsidised accommo- vation of the deficit of women in the
candid discussion among all stakeholders dation) are seldom assessed properly. population.)
as the key to securing the best input from The cost of the NFHS was high, partly There are clear differences between the
all sources, both official and non-official, also because it insisted on the small teams average size of a household reported by
and not missing out useful caveats about of investigators (usually four women) being the NFHS and the 1991 Census or the
the things to avoid. accompanied by a supervisor and an editor, various rounds of the NSS. The NFHS has
In fact, some complaints were made to who checked and edited the data on site. reported a higher average household size
the ministry of health and family welfare Few surveys in India have ever considered than the 1991 Census in rural India but
about the quality of field work in the such a concern for quality. Also, most the reverse is true in estimates for urban
NFHS. It led to a decision to resurvey a survey organisations had to hire jeeps,India; the differences are, offset and the

3004 Economic and Political Weekly October 16-23, 1999

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all-India eatimates are very close. The and March 1994 in 13 more populouslection by the state are motivated by, or
quinquennial surveys of the NSS seem to states of the country and Delhi. It is involve, or can be the instruments of the
report a lower household size than the published with the encouragement of theoppression of the people.
census. However, these differences can- former secretary, family welfare, who There is obviously a wide gap between
not be explained without considerable preferred transparency to secrecy about economists or demographers (who have
investment of time and effort. The avail- the results of the resurvey. The resurveybeen involved in designing several na-
ability of the household-level data to the faced the expected non-response fromtional surveys over the years) and the
analysts from the NFHS as well as the NSS about 5 per cent of the rural households guardians of people's rights who may not
will facilitate such additional work. How- and 25 per cent of the urban households want the government to collect any data.
ever, the census authorities must now movebecause of out-migration (possibly tem-However, the NFHS did collect data on
with the times and make available to the porary), or non- availability of any respon-caste; and at least in theory, the data are
researchers a copy of the tape of (at leastdent, at the time of the revisit. The re- available for the 90,000 households to any
a sample of) the census data. Simulta-survey validated the total fertility rateone who may want to use them. Of course,
neously, the Indian social science research-reported by the NFHS except for Rajasthan;the detailed caste codes are not a part of
ers need to be given the resources to but found discrepancies in the estimates the normally distributed codebook, and
undertake intensive data-based research,of immunisation levels in 10 of the 14 special effort has to be made to get,
with due attention to alternative data sets states. The resurvey found higher level ofunderstand and use them. Fortunately,
and their comparative analysis. immunisation in five states of Uttar K Srinivasan (who was the director of the
Pradesh, MadhyaPradesh, Rajasthan, West International Institute of Population Sci-
DECISION-MAKING FOR THE NFHS:
Bengal, and Bihar; whereas for the ences four when the NFHS was planned) and
AN INSIDE VIEW
states of Gujarat, Karnataka, OrissaSanjay
and Kumar have demonstrated the
Turning now to the papers included in Haryana, the NFHS had reported a higher fascinating potential of the caste data to
assess and evaluate the impressions of
this issue, Tara Kanitkar, one of the co- level of immunisation than the post survey
ordinators of the NFHS, provides an check. association between caste and backward-
excellent authentic overview of the key The post-independence censuses and ness. Their most interesting paper covers
features of the NFHS, including its scope, surveys, conducted under governmentthe three states of Uttar Pradesh, Bihar,
coverage, the decision-making process and auspices have avoided collection of de- and Tamil Nadu, which together covered
the role of expatriate consultants. As an tailed data on the caste of an individual a population of 281 million (33 per cent
insider looking back, she would have citizen, except for the statutory require-of the total) in 1991. From tile categories
preferred separate estimates for the slum ment to record the scheduled castes and of scheduled castes and tribes, other
and non-slum areas in metropolitan cities tribes, for whom the Constitution had backward castes and other castes, for the
as well as regional estimates, an issue on provided reserved seats in the parliament three states they first identified the castes
which we have been fortunate to get a and in the services. The.reservation for for which the NFHS had surveyed at least
paper by Mari Bhat and Xavier. 'other backward castes' has been a burn- 50 households. Next, for each of these
The painstaking work of Mari Bhat and ing issue in several states and the state- castes, they have identified (a) the literacy
Xavier demonstrates the rich potential of appointed commissions in Karnataka state rates among adults, and (b) the economic
the NFHS data for studying the differen- have also conducted censuses of the castes condition of the household in terms of (i)
tials in demographic and socio-economic and their characteristics. Yet, during thethe quality of the house - kutcha or pucca,
situation in 76 regions of the country. It past year and a half, a suggestion to re-(ii) access to electricity and toilet facility,
compares the NFHS estimates with those introduce a question on caste in the 2001 (iii) possession of irrigated land, and (iv)
based on the census on several character- Census had led to a surprising debate in possession by any household member of
istics; and demonstrates how the processthe newspapers and periodicals. Unwar- a watch, a radio, or a bicycle. The analysis
of fertility decline has been evidentranted assertions were made by reputedsuggests wide differentials between the
throughout the country, including thescholars that a question on caste would castes in terms of literacy as well as poverty
demographically backward states. It alsomake it a caste-based census and that any in all the three states. The authors come
examines the regional estimates of child such effort would lead to bloodshed and to the startling conclusion that despite the
mortality, malnourishment among chil- battles throughout the country. The em- 75-year old history of reservations in Tamil
dren, access to and use of ante-natal care,piricists, who have found no difficulties Nadu, the inter-caste differentials in lit-
etc, and poverty measured in terms of thein recording the caste of respondent fami-. eracy and economic conditions had not
assets owned by the people. The paperlies in their rural field work, were baffled disappeared. A most depressing finding
attempts to identify the most backwardby the basic validity of this discussion. Ofindeed! As the authors themselves note,
region in each 'major' state and the fivecourse, the tabulation and use of the caste analysis of the type attempted by them was
most backward regions of the country withdata as well as the priority to be assigned not an objective of the NFHS; but the
respect to eight indicators of develop-to such tabulation were another matter. availability of the household level data
ment. Enriched by geo-mapping of the An obvious answer to these questionsfacilitates their ingenious use for various
variables, this paper is an excellent andseemed to be that these matters could be purposes. Presumably, we shall soon see
more comprehensive sequel to the por-decided according to the felt needs ofa monograph by the authors on their most
trayal by late Asok Mitra of the levels ofsocial scientists or the data users rather interesting use of the NFHS data.
regional development in India with thethan any official agency such as the Office The social science literature dealing with
help of 1961 census data. of the Registrar General and Census fertility decline and demographic transi-
This special issue is privileged to in-Commissioner. However, such options tion has often focused on whether the
clude a paper on the results of a uniquedisappear and one is left speechless when poor shall inherit the earth because of dif-
resurvey of a 5-per cent sub-sample of theone learns that under the Fukovian frame- ferentials in fertility. Of course, the de-
NFHS, conducted during December 1993work of discourse, all efforts at data col- cline in fertility is also a consequence of

Economic and Political Weekly October 16-23, 1999 3005

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the people's aspirations for a better life The difference between the median age The analysis based on the model sug-
for themselves and for their children; and at first and the last birth or the estimated gests that use of contraception has made
the cause-effect linkage is not easy to average reproductive life was 14 years for a sizeable contribution towards a transi-
establish. However, Roy, Jayachandran Muslims, three years longer than among tion from natural to controlled fertility in
and Banerjee present an interesting analy- Hindus. Despite the higher incidence of states such as Kerala, Punjab and Tamil
sis of the association in the four states of knowledge of at least one method of family Nadu. In Punjab and Kerala, this transition
Punjab, Maharashtra, Kerala and Uttar planning among the Muslims, the level of has been accompanied by a shorter dura-
Pradesh between fertility and the living current use of any method (particularly tion of post-partum amenorrohea, which
standard of the household. The living permanent methods) was considerably enhances fertility. In Punjab, post-partum
standard is measured through an index lower among Muslims than among infecundability depresses the total fecun-
that took account of the access to and/or Hindus. The use of a modem temporary dity rate by about two births, compared to
ownership of certain amenities and live- method was, however, higher among more than four births in Gujarat, Maha-
stock as well as durable goods. The vari-Muslims than among Hindus in all edu- rashtra and West bengal, where total fe-
ables included: type of house, availabilitycational categories. The data confirm that cundity rates are similar. In these latter
of electricity, sources of drinking water,Muslims prefer modem temporary meth- states, there is considerable scope for a
nature of toilet facility, and the possessionods over sterilisations or abortions. The change in infant feeding practices and a
of livestock and consumer durables. The reported level of unmet need for contra- resulting increase in fertility. It is essen-
negative relationship between the level of ception was also higher among Muslims tial, therefore, that reversible methods of
living and fertility appeared stronger than among the Hindus. contraception are promoted to compen-
among educated couples. Fertility mea- In India, data on marriage, use of con- sate for the likely increase in post-partum
sured in terms of births of different ordertraception, duration of breast-feeding and infecundability.
per 1000 women did not differ muchthe length of post-partum amenorrhoeaAn interesting hypothesis links the
according to living standard among the and outcome of pregnancies have for the observed regional differences in the level
less educated, except in Punjab. Also, the first time become available from one source of fertility with the deep-seated preva-
urge to adhere to the two-child norm did - the NFHS conducted during 1992-93. lence of son preference. The NFHS data
not diminish but childlessness declined Leela Visaria has used these data to es- on the subject, analysed by P M Kulkami,
with an increasing standard of living. The timate the 'proximate determinantsconfirm of a broad regional diversity in the
desired family size among the'younger fertility' (in terms of the model evolved level of son preference. It is quite high in
women declined with a rise in standard the north-central and eastern states
by John Bongaarts) for the 15 major states.
of living in Punjab, Maharashtra and Uttar Bongaarts has empirically shown that(Rajasthan, Uttar Pradesh, Madhya
Pradesh; but in Kerala, the state with the
the values of total fecundity rate (TF)Pradesh, Assam, West Bengal, Orissa,
lowestfertility, relationship was not clear. Bihar as well as in Punjab), moderate in
range between 13 and 17 births per woman
Reported fertility declined with a rise in the western-northern states (Karataka,
with an average near 15; and that values
the standard of living in Punjab andoutside this range are very likely due Himachal
to Pradesh, Haryana, Gujarat,
Maharashtra. The unmet need for family Maharashtra) and low in the southern
some data errors or estimation procedures.
planning was higher among households While the estimates of TF in nine states states (Kerala, Tamil Nadu, Andhra
with a low level of living. As the family fall between 13 and 15, the TF values for Pradesh as well as Goa and Delhi). Al-
planning programme meets the unmet need four large North Indian states, Andhra though parents value sons much more than
Pradesh, and Orissa are lower than 11. daughters in all the states, the tendency
for fertility regulation, the negative rela-
tionship between the level of living and (These low values remain to be confirmed is less strong in the southern region. The
fertility measures will weaken. by the second phase of the survey, but theyprevalence of consanguinity and the fact
There has been widespread concern in suggest the possibility that several factorsthat a married woman maintains frequent
India about the consequences of religious such as a relatively high secondary steril-contact with her natal home in the south-
differentials in fertility for the composi- ern region [Dyson and Moore 1983]
ity, low coital frequency, and early termi-
nal abstinence may be depressing the totalperhaps contributes to the relatively high
tion of population, which can have serious
political implications. The international
fecundity rate in these states.) value attached to daughters in the south
experience (including that of Bangladesh)
suggests that even the Muslim popula-
tions do not remain excluded from the
process of demographic transition for long.
K Moulasha and G Rama Rao analyse the
responses of 69,570 Hindu and 10,070
Muslim women aged 13-49 and find thatBy well known Pune based Public Trust. The Trust is a nodal agency
on an average, Muslim women had 1.1 currently partnering NGO in nearly 80 Reproductive and Child Health
children more than the Hindu women. The
Projects funded by the Government. Selected candidate should have
differential persisted within each level of
outstanding track record, proven managerial ability and a commitment
education, with a higher TFR among
Muslims than among the Hindus. Differ-
to develop the NGO sector to its full potential. Knowledge of Marathi
entials in the number of children ever born will be an advantage. Age and Sex no bar. Attractive compensation
and surviving indicates that Muslim package. Apply within fifteen days to:
women had given birth to 0.6 child more
than their Hindu counterparts; but the Economic & Political Weekly, Box No. 0199,
extent of child loss was the same among Hitkari House, 284 Shahid Bhagat Singh Rd., Mumbai 400001.
both the groups.

3006 Economic and Political Weekly October 16-23, 1999

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than in the north. decline in fertility was observed among
or man faces in seeking Contraceptive and
Kulkami estimates that in the absence women aged above 35. follow-up services.
of any son-preference, the percentage of Using the National Fertility and Morta- The NFHS data on the incidence of
couples of reproductive ages using lity a Surveys, 1980 and the NFHS, 1992-93, induced abortions are gross underestimates
modem contraceptive would have been 41the author observes a decline of 24 per and the awareness about the legality of
abortions has not been ascertained. Like-
cent in the TFR in the entire state, 26 per
per cent, 4.7 percentage points higher than
the observed figure of 36.7 per cent. The wise, infertility, a serious reproductive
cent in rural areas and 14 per cent in urban
contraceptive prevalence in the western- areas. The decline in TFR was much higher concern, with serious implications in terms
than in CBR. (This difference arises from
northern states, Gujarat, Himachal Pradesh, of determinants and consequences, ha
Haryana, Maharashtra, is severely de-the fact that TFR is estimated with equal been neglected in the NFHS. Another major
pressed by 8-10 percentage points be- weights assigned to different age groups, gap in the NFHS has been its neglect of
cause of son preference; but the effect iswhereas the crude birth rates takes due data on the quality of care in the area of
minor (two to four points) in the southernaccount of the weights of different age maternal and child health.
states as well as in Delhi, Assam, Uttar groups in the population). Over the years,
CONCLUSION
Pradesh and Goa. the Hindu-Muslim differentials have
increased quite significantly. Among
The elimination of son preference would To conclude, the second phase of the
reduce the TFR for India from 3.39 to various regions, Marathwada regionNFHS,
has that is now in progress and has
3.13, a decline of 8 per cent. For stateslagged behind the other regions with been completed in several states, is likely
like Himachal Pradesh, Maharashtra, respect to both the demand for family to open up many opportunities for inter-
Gujarat and Punjab, the decline would beplanning and the efficiency of provision esting analysis. Some non-official press
large, over 15 per cent. The elimination of services. reports have indicated sensational declines
of son preference would lower fertility in The son preference is quite strong in in the level of fertility in Bihar, Madhya
these four states to a level comparable toMaharashtra. The proportion of sterilised Pradesh and Uttar Pradesh during the
that in Tamil Nadu-Andhra Pradesh and couples with two children increased from 1990s. Prima facie, wishful thinking rather
accelerate the process of fertility transi-16.6 in 1980to 37.4 in 1992-93; but among than careful analysis forms the basis of
tion. Unfortunately, the policy instrumentscouples with two sons, the same percent- these claims, which are not corroborated
to eliminate the deep-seated son prefer- age increased from 21.6 to 55.2 for the by the SRS data. There is no doubt that
ence from the Indian society are not easy same period. The slow pace of decline in an irreversible process of fertility decline
to devise; but it is to be hoped that with birth rate is due to an increase in fertility is in progress throughout the country; and
the spread of literacy and education, the as well as son preference. that it has been faster in urban India than
mass media can play an effective role inThe NFHS was conducted before the in rural areas. During 1998, the rate of
social transformation. emphasis of family planning programme natural increase in urban and rural-India
Until the 1950s, there were hardly any shifted from targets for different methods has reportedly dropped to about 1.4 and
estimates of the actual age pattern of of contraception to a more holistic con- 1.8 per cent, respectively, with a national
fertility in India. The population projec- cern with the reproductive health of average the of about 1.7 per cent. A replace-
tions in the seminal work of Coale and population at all ages and the health ment and level of fertility may be reached in
Hoover published in 1958 had to use the survival of children. Given this shift in urban India within the next five years; but
fertility pattern suggested by the surveys emphasis, Shireen J Jejeebhoy seeks to it is still a distant goal for the country as
conducted at the Gokhale Institute of assess the contribution of NFHS to the a whole. The recent indications (from the
Politics and Economics and the information base on reproductive health1995-96 NSS survey of literacy and edu-
Ramanagaram Health Centre near Banga-
in India and finds it to be quite limited. cation) of an accelerated progress since
lore. These surveys conducted by the
Of course, it has provided estimates of thethe 1991 Census in literacy rates in rural
Gokhale Institute during pre- 1970 level period,
of contraception and methods used areas, including the scheduled castes and
merit a close look to identify by theageextent
and parity and of unmet need for tribes, inspire hope of .a similar accelera-
to which their estimates conformcontraception.
to those Also, it has expanded and tion of the fertility decline, but it niay
of the subsequent SRS and other state-
systematised the knowledge about mater- partly be offset by the expected decline
level surveys. Such a comparison has and health, access to ante-in mortality rates as well. Given the
nal mortality
been attempted by Sanjeevani Mulay,
natal and delivery services, and compli- momentum for growth built into the young
who concludes that the contribution of cations at the time of delivery. Inadequate age distribution of the Indian population,
the observed increase in age marriage to access to ante-natal care from a doctor or the rate of population growth will drop
the fertility decline has been offset byother
a health professional and the gaps in below 1 per cent per year only during
fall in the incidence of widowhood. In immunisation against tetanus and iron 2016-20. Also, unless the AIDS epidemic
supplementation, and. access to safe de-assumes unexpected afarmingproportions,
fact, the sharp decline in mortality, espe-
cially adult mortality, has led to an in- livery have been identified. However, gaps a zero rate of population growth is nm-
crease in fertility. persist with respect to morbidity in the likely to be realised before 2055-60.
In the post-1970 period, specially dur-ante-natal and post-natal periods; circum-Therefore, until we achieve complete regis-
ing 1971-77, fertility had declined mainly
stances during pregnancy, childbirth and tration of vital events throughout the
the post-partum period; and the content country, surveys such as the NFHS will
due to the strong push given to the family
planning (sterilisation) programme duringof ante-natal care received. The NPHS has continue to be a valuable asset for under-
the emergency, which was followed byalso a not addressed critical issues such as standing the demographic dynamics of
backlash. However, women in younger the extent to which women exercise choicesIndian society.
age groups (below 35 years of age) had in these matters without coercion; whether
not lowered their fertility; in fact, their,women actually obtain a method of choice[Thanks are due to P N Man Bhat for his com-
fertility had significantly increased. A sharp
and the constraints that the average womanments on an earlier draft of this paper.]

Economic and Political Weekly October 16-23, 1999 3007

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