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	'id' => (int) 61585,
	'title' => 'Kerala and Tamil Nadu bucked the trend of falling Total Fertility Rate, indicates the latest NFHS data',
	'subheading' => null,
	'description' => '<p style="text-align:justify"><br />
After the release of the second phase data of the National Family Health Survey Fifth Round <em>(NFHS-5)</em>, media commentators and experts have written that the Total Fertility Rate (TFR) for India has gone down just below the replacement-level fertility. The TFR for the entire nation was 2.2 in 2015-16, which decreased to 2.0 in 2019-21. &nbsp;</p>

<p style="text-align:justify">According to the <a href="https://im4change.org/upload/files/Total%20Fertility%20Rate%20Methodology.pdf">United Nations</a>, the replacement-level fertility is reached when the TFR of a place <em>(i.e., a region or a country)</em> becomes 2.1 children per woman. This value represents the average number of children a woman would need to have to reproduce herself by bearing a daughter who survives to childbearing age. If replacement-level fertility is sustained over a sufficiently long period, each generation will exactly replace itself in the absence of migration. If the TFR is <a href="https://www.britannica.com/topic/fertility-rate">greater than 2.1</a>, then the population of a place or region <a href="https://www.britannica.com/topic/fertility-rate">will increase</a>, and if <a href="https://www.britannica.com/topic/fertility-rate">it is less than 2.1</a>, then the population of that place or region will <a href="https://www.britannica.com/topic/fertility-rate">eventually decrease</a>, although it may take a while because factors such as<a href="https://www.britannica.com/topic/fertility-rate"> age structure, emigration, or immigration</a> should also be taken into account.&nbsp;</p>

<p style="text-align:justify">A <a href="/upload/files/Chapter%205%20Fertility%20NFHS%201%20India%20Main%20Report.pdf">document related to NFHS-1</a> says that the <a href="/upload/files/Definition%20of%20TFR.png">numerator of each age-specific fertility rate</a> is <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">live births in a five-year age group</a>, and the <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">denominator is the number of woman-years lived</a> in the <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">same five-year age interval</a> <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">during the three-year time period</a>. The <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">TFR is a summary measure</a> that is calculated as <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">five times the sum </a><em>(over five-year age groups) </em>of the <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">age-specific fertility rates</a>. The <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">TFR is interpreted</a> as the <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">number of children a woman would bear</a> during her <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">reproductive years</a> <em>(15-49 years or 15-44 years) </em>if she were to <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">experience the age-specific fertility rates</a> prevailing <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">during the three-year period</a> preceding the survey.</p>

<p style="text-align:justify">The TFRs in various NFHS Rounds are expressed as the number of children per woman aged 15-49 years. Put simply, TFR is the average number of children a woman gives birth to in her lifetime.</p>

<p style="text-align:justify">Experts have opined that there is a distinction between Phase-I states/ UTs and Phase-II states/ UTs if we compare the average performance <em>(i.e., change in the value/s of some indicators with respect to the NFHS-4 levels)</em> between these two groups.&nbsp;</p>

<p style="text-align:justify">In her <a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece">article</a> titled &#39;<a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece">A close reading of the NFHS-5</a>, <a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece">the health of India</a>&#39;, <a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece">Ashwini Deshpande</a> of Ashoka University,&nbsp;among other things, has made two observations:</p>

<p style="text-align:justify"><strong>*</strong>&nbsp;&quot;[C]omparing the changes in anaemia in Phase 1 States (survey done pre-COVID) to Phase 2 States, we see that if anything, the increase in the former (which include Andhra Pradesh, Assam, Bihar, Gujarat, Kerala, Maharashtra, West Bengal, among others) is on average higher than the increase in Phase 2 States (Delhi, Uttar Pradesh, Chhattisgarh, Jharkhand, Rajasthan, Haryana, Tamil Nadu, Madhya Pradesh, Odisha, Punjab, among others). The discrepancy between Phase 1 and Phase 2 could reflect differences in actual incidence or survey-related issues.&quot;</p>

<p style="text-align:justify"><strong>*</strong> &quot;There are other instances of clear differences between Phase 1 and Phase 2 results. The three indicators of malnutrition: stunting (low height-for-age), wasting (low weight-for-height) and underweight (low weight-for-age): show an overall improvement. These conditions often occur together. Together, these reflect chronic or recurrent undernutrition, usually associated with poverty, poor maternal health and nutrition, frequent illness and/or inappropriate feeding and care in early life. These prevent children from reaching their physical and cognitive potential.</p>

<p style="text-align:justify">However, the overall reduction in national estimates of these three measures masks an anomaly. In Phase 1, several States revealed a worsening in one or more of these, whereas in Phase 2, none of the States showed a worsening. It would be good to understand if the novel coronavirus pandemic affected the survey in Phase 2, leading to undercounting of incidence, or whether by pure chance, all States in Phase 2 happen to be better performers on the malnutrition count (something that could not have been known at the start of the survey in 2019).&quot;</p>

<p style="text-align:justify">In our analysis, we find that the average TFR for Phase-I states/ UTs reduced from 2.05 in 2015-16 to 1.76 in 2019-20 i.e. by -0.28 points. Please see table-1. The average TFR for Phase-II states/ UTs <em>(barring India) </em>fell from 2.07 in 2015-16 to 1.84 in 2020-21 i.e. by -0.23 points.&nbsp;Kindly see table-2. Clearly, the distinction between Phase-I and Phase-II states/ UTs in terms of the average change in TFRs between NFHS-4 and NFHS-5 is not much.</p>

<p style="text-align:justify"><strong>Table 1: Total fertility rate (children per woman), NFHS-4 and NFHS-5, Phase-I states/ UTs</strong></p>

<p style="text-align:justify"><img alt="" src="/upload/images/Table%201%20Total%20fertility%20rate%20children%20per%20woman%20NFHS-4%20and%20NFHS-5%20Phase-I%20states%20UTs.png" style="height:625px; width:669px" /></p>

<p style="text-align:justify"><em><strong>Source: </strong>Combined Factsheet Compendium (States/UTs from Phase-I), Ministry of Health and Family Welfare, please <a href="https://im4change.org/upload/files/NFHS-5_India_and_State_Factsheet_Compendium_Phase-I.pdf ">click here</a> to access</em>&nbsp;<br />
<strong>---</strong></p>

<p style="text-align:justify">The highest level of TFR in NFHS-5 among the Phase-I states/ UTs was found in Bihar <em>(3.0)</em>, followed by Meghalaya <em>(2.9)</em>, and Manipur <em>(2.2)</em>. The rest of the states/ UTs of Phase-I had TFRs lower than the replacement-level fertility i.e., less than 2.1. The highest decrease in TFR among the Phase-I states/ UTs between 2015-16 and 2019-20 was noted for Ladakh and Nagaland <em>(-1.0 point each)</em>, followed by Jammu and Kashmir <em>(-0.6 point)</em>, and Bihar, Goa, Lakshadweep, Manipur and Mizoram <em>(-0.4 point each)</em>. Please consult table-1.</p>

<p style="text-align:justify">The <a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece">fieldwork for the Phase-I</a> of the National Family Health Survey Fifth Round (NFHS-5) was conducted during <a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece">June 2019-January 2020</a>, and the results <em>(i.e., factsheets for 22 states/ UTs, and subsequently the detailed reports and the district level factsheets)</em> were released in <a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece">December 2020</a>. Those <a href="https://im4change.org/upload/files/Press%20Release%20Phase%20I%20NFHS-5%2015%20Dec%202020.pdf">22 states/ UTs</a>, which were <a href="https://im4change.org/upload/files/Press%20Release%20Phase%20I%20NFHS-5%2015%20Dec%202020.pdf">surveyed in Phase-I</a>, are Andhra Pradesh, Assam, Bihar, Goa, Gujarat, Himachal Pradesh, Karnataka, Kerala, Maharashtra, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, Telangana, Tripura, West Bengal, Andaman Nicobar Island, Dadra and Nagar Haveli and Daman and Diu, Jammu &amp; Kashmir, Ladakh and Lakshadweep.</p>

<p style="text-align:justify"><strong>Table 2: Total fertility rate (children per woman), NFHS-4 and NFHS-5, Phase-II states/ UTs</strong></p>

<p style="text-align:justify"><img alt="" src="/upload/images/Table%202%20Total%20fertility%20rate%20children%20per%20woman%20NFHS-4%20and%20NFHS-5%20Phase%20II%20states%20UTs.png" style="height:489px; width:687px" /></p>

<p style="text-align:justify"><em><strong>Source: </strong>Combined Factsheet Compendium (States/UTs/ India from Phase-II), Ministry of Health and Family Welfare, please <a href="https://im4change.org/upload/files/NFHS-5_India_and_State_Factsheet_Compendium_Phase-II.pdf">click here</a> to access</em><br />
<strong>---</strong></p>

<p style="text-align:justify">The highest level of TFR in NFHS-5 among the Phase-II states/ UTs was found in Uttar Pradesh <em>(2.4)</em>, followed by Jharkhand <em>(2.3)</em>. The rest of the states/ UTs <em>(including Rajasthan and Madhya Pradesh)</em> of Phase-II had TFRs lower than the replacement-level fertility i.e., less than 2.1. The highest decrease in TFR among the Phase-II states/ UTs between 2015-16 and 2020-21 was observed for Rajasthan and Chhattisgarh <em>(-0.4 point each)</em>, followed by Arunachal Pradesh, Jharkhand, Madhya Pradesh, Odisha, and Uttar Pradesh <em>(-0.3 point each)</em>. Please see table-2.&nbsp;<br />
&nbsp; &nbsp; &nbsp;<br />
The <a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece">fieldwork for Phase-II</a> of the NFHS-5 was conducted during <a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece">January 2020-April 2021</a>, and the results <em>(i.e., factsheets for 14 states/ UTs/ districts as well as the India factsheet)</em> were released in November 2021. The states and UTs, which were <a href="https://im4change.org/upload/files/Press%20Release%20Phase%20II%20NFHS-5%2024%20Nov%202021.pdf">surveyed in the Phase-II</a>, are Arunachal Pradesh, Chandigarh, Chhattisgarh, Haryana, Jharkhand, Madhya Pradesh, NCT of Delhi, Odisha, Puducherry, Punjab, Rajasthan, Tamil Nadu, Uttar Pradesh and Uttarakhand.</p>

<p style="text-align:justify"><strong>Kerala and Tamil Nadu are the odd ones out&nbsp;</strong></p>

<p style="text-align:justify">The data analysis done by Inclusive Media for Change shows that while most states / UTs have shown a declining trend in TFR between NFHS-4 and NFHS-5 <em>(both Phase-I and Phase-II states/ UTs)</em>, two states i.e., Kerala and Tamil Nadu &ndash; considered to be leaders among states in terms of human development &ndash; emerged as exceptions.&nbsp;</p>

<p style="text-align:justify">While for Kerala, the TFR increased from 1.6 to 1.8 between 2015-16 and 2019-20, for Tamil Nadu&nbsp;TFR went up from 1.7 to 1.8 between 2015-16 and 2020-21. The TFRs of both these states were lower than the replacement-level fertility of 2.1 in NFHS-5. It should be noted that Kerala was a Phase-I state, whereas Tamil Nadu was a Phase-II state for NFHS-5. Please check table-3.</p>

<p style="text-align:justify"><strong>Table 3: Trends in Total Fertility Rates for India, Kerala and Tamil Nadu, from NFHS-1 to NFHS-5</strong></p>

<p style="text-align:justify"><img alt="" src="/upload/images/Table%203%20Trends%20in%20Total%20Fertility%20Rates%20for%20India%20Kerala%20and%20Tamil%20Nadu%20from%20NFHS-1%20to%20NFHS-5.png" style="height:175px; width:1000px" /></p>

<p style="text-align:justify"><em><strong>Source: </strong>Key indicators for India from NFHS-5, India Factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/docs/India_National_Fact_Sheet.pdf">click here</a> to access &nbsp;</em></p>

<p style="text-align:justify"><em>Key indicators for Kerala from NFHS-5, Kerala Factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/docs/Kerala%20NFHS-5%20Factsheet.pdf">click here</a> to access &nbsp;</em></p>

<p style="text-align:justify"><em>Key indicators for Tamil Nadu from NFHS-5, Tamil Nadu Factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/docs/NFHS-5%20Tamil%20Nadu.pdf">click here</a> to access &nbsp;</em></p>

<p style="text-align:justify">**<br />
<em>Key indicators for India from NFHS-4, India Factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/docs/130India%20Fact%20Sheet%20NFHS-4%202015-16.pdf">click here</a> to access &nbsp;</em></p>

<p style="text-align:justify"><em>Key indicators for Kerala from NFHS-4, Kerala Factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/docs/697Kerala%20Fact%20Sheet%20NFHS-4%202015-16.pdf ">click here</a> to access</em></p>

<p style="text-align:justify"><em>Key indicators for Tamil Nadu from NFHS-4, Tamil Nadu Factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/docs/163Tamil%20Nadu%20Fact%20Sheet%20NFHS-4%202015-16.pdf ">click here</a> to access</em></p>

<p style="text-align:justify">**<br />
<em>Key indicators for India from NFHS-3, India Factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/docs/200India%20NFHS%203.pdf ">click here</a> to access </em></p>

<p style="text-align:justify"><em>Key indicators for Kerala from NFHS-3, Kerala Factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/docs/984Kerala%20NFHS%203.pdf ">click here</a> to access</em></p>

<p style="text-align:justify"><em>Key indicators for Tamil Nadu from NFHS-3, Tamil Nadu Factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/docs/745Tamil%20Nadu%20NFHS%203.pdf ">click here</a> to access&nbsp;</em></p>

<p style="text-align:justify">**<br />
<em>Chapter 4: Fertility and Fertility Preferences, NFHS-2, India, please <a href="/upload/files/Chapter%204%20Fertility%20and%20Fertility%20Preferences%20NFHS-2%20India.pdf">click here</a> to access&nbsp;&nbsp;</em></p>

<p style="text-align:justify"><em>Chapter 4: Fertility and Fertility Preferences, NFHS-2, Kerala, please <a href="/upload/files/Chapter%204%20Fertility%20and%20Fertility%20Preferences%20NFHS-2%20Kerala.pdf">click here</a> to access&nbsp;</em></p>

<p style="text-align:justify"><em>Chapter 4: Fertility and Fertility Preferences, NFHS-2, Tamil Nadu, please <a href="/upload/files/Chapter%204%20Fertility%20and%20Fertility%20Preferences%20NFHS-2%20Tamil%20Nadu.pdf">click here</a> to access&nbsp; &nbsp;</em></p>

<p style="text-align:justify">**<br />
<em>State factsheet, NFHS-1, please <a href="/upload/files/NFHS%201%20State%20factsheet.pdf">click here</a> to access&nbsp;</em></p>

<p style="text-align:justify"><em>Chapter 5: Fertility, NFHS-1, India Main Report, please <a href="/upload/files/Chapter%205%20Fertility%20NFHS%201%20India%20Main%20Report%281%29.pdf">click here</a> to access</em><br />
<strong>--------</strong></p>

<p style="text-align:justify">Media reports have stated <em>(please click <a href="https://timesofindia.indiatimes.com/india/indias-total-fertility-rate-declines-to-2-0-nfhs-5-data/articleshow/87892831.cms">here</a>, <a href="https://indianexpress.com/article/india/contraception-use-india-fertility-rate-fall-7654159/">here</a>, <a href="https://www.hindustantimes.com/india-news/indias-fertility-rate-drops-below-2-1-population-stabilising-nfhs-data-101637751803433.html">here</a>, and <a href="https://www.livemint.com/news/india/nfhs5-data-is-out-where-does-india-stand-11637748286907.html">here</a> to access)</em> that there are two main factors <em>(among others) </em>behind the falling trend in TFR for the country as a whole: the increase in the use of contraception and the increase in the age of marriage.&nbsp;</p>

<p style="text-align:justify">For <a href="https://im4change.org/upload/files/India_National_Fact_Sheet.pdf">India</a>, the <a href="https://im4change.org/upload/files/India_National_Fact_Sheet.pdf">Contraceptive Prevalence Rate-CPR <em>(any method)</em></a> increased from 53.5 percent in 2015-16 to 66.7 percent in 2019-21. The <a href="https://im4change.org/upload/files/India_National_Fact_Sheet.pdf">Contraceptive Prevalence Rate-CPR <em>(any modern method)</em></a> for the country soared up from 47.8 percent in 2015-16 to 56.5 percent in 2019-21.&nbsp;</p>

<p style="text-align:justify">The <a href="https://im4change.org/upload/files/India_National_Fact_Sheet.pdf">proportion of women aged 20-24</a> years who got <a href="https://im4change.org/upload/files/India_National_Fact_Sheet.pdf">married before age 18 years</a>&nbsp;decreased from 26.8 percent to 23.3 percent between NFHS-4 and NFHS-5. The <a href="https://im4change.org/upload/files/India_National_Fact_Sheet.pdf">proportion of women aged 15-19</a> years who were <a href="https://im4change.org/upload/files/India_National_Fact_Sheet.pdf">already mothers or pregnant</a> at the time of the survey fell from 7.9 percent to 6.8 percent between 2015-16 and 2019-21.</p>

<p style="text-align:justify">Now, let us turn our attention to understand what happened in the case of Tamil Nadu and Kerala. For <a href="https://im4change.org/docs/NFHS-5%20Tamil%20Nadu.pdf">Tamil Nadu</a>, the <a href="https://im4change.org/docs/NFHS-5%20Tamil%20Nadu.pdf">CPR <em>(any method)</em> </a>increased from 53.2 percent in NFHS-4 to 68.6 percent in NFHS-5. The <a href="https://im4change.org/docs/NFHS-5%20Tamil%20Nadu.pdf">CPR <em>(any modern method)</em></a> for Tamil Nadu climbed up from 52.6 percent in 2015-16 to 65.5 percent in 2020-21.&nbsp;</p>

<p style="text-align:justify">For <a href="https://im4change.org/docs/NFHS-5%20Tamil%20Nadu.pdf">Tamil Nadu</a>, the <a href="https://im4change.org/docs/NFHS-5%20Tamil%20Nadu.pdf">proportion of women aged 20-24 years</a> who got <a href="https://im4change.org/docs/NFHS-5%20Tamil%20Nadu.pdf">married before age 18 years</a> fell from 16.3 percent to 12.8 percent between 2015-16 and 2020-21. Unlike India, in the case of Tamil Nadu, the <a href="https://im4change.org/docs/NFHS-5%20Tamil%20Nadu.pdf">proportion of women aged 15-19</a> years who were <a href="https://im4change.org/docs/NFHS-5%20Tamil%20Nadu.pdf">already mothers or pregnant at the time</a> of the survey rose from 5.0 percent to 6.3 percent between NFHS-4 and NFHS-5.</p>

<p style="text-align:justify">In the case of Kerala, the four indicators -- &#39;Contraceptive Prevalence Rate-CPR <em>(any method)</em>&#39;, &#39;Contraceptive Prevalence Rate-CPR <em>(any modern method)</em>&#39;, &#39;the proportion of women aged 20-24 years who got married before age 18 years&#39;, and &#39;the proportion of women aged 15-19 years who were already mothers or pregnant at the time of the survey&#39; -- are unable to explain the increase in TFR between NFHS-4 and NFHS-5.&nbsp;</p>

<p style="text-align:justify">For <a href="https://im4change.org/docs/Kerala%20NFHS-5%20Factsheet.pdf">Kerala</a>, the <a href="https://im4change.org/docs/Kerala%20NFHS-5%20Factsheet.pdf">CPR <em>(any method)</em></a> jumped from 53.1 percent in 2015-16 to 60.7 percent in 2019-20. The <a href="https://im4change.org/docs/Kerala%20NFHS-5%20Factsheet.pdf">CPR <em>(any modern method)</em> for Kerala</a> increased from 50.3 percent in 2015-16 to 52.8 percent in 2019-20.&nbsp;</p>

<p style="text-align:justify">For Kerala, the <a href="https://im4change.org/docs/Kerala%20NFHS-5%20Factsheet.pdf">proportion of women aged 20-24 years</a> who got <a href="https://im4change.org/docs/Kerala%20NFHS-5%20Factsheet.pdf">married before age 18</a> years fell from 7.6 percent to 6.3 percent between 2015-16 and 2019-20. For Kerala, the proportion of <a href="https://im4change.org/docs/Kerala%20NFHS-5%20Factsheet.pdf">women aged 15-19 years</a> who were already <a href="https://im4change.org/docs/Kerala%20NFHS-5%20Factsheet.pdf">mothers or pregnant at the time of the survey</a> fell from 3.0 percent to 2.4 percent between NFHS-4 and NFHS-5.</p>

<p style="text-align:justify"><strong>A piece of advice</strong></p>

<p style="text-align:justify">At the time of writing this news alert, the unit-level data <em>(or the metadata)</em> for all the states/UTs/India-level <em>(in Phase-I and Phase-II)</em> has still not been released. In the <a href="https://indianexpress.com/article/opinion/columns/nfhs-survey-data-gaps-sex-ratio-7659775/">absence of the metadata</a>, it is hard to independently verify the results <em>(i.e., the factsheets/ detailed reports)</em> that have been released so far by the Mumbai-based International Institute for Population Sciences (IIPS), the organisation that conducted the survey.&nbsp;It is also not possible to analyse the data for further research without the availability of metadata or unit-level data.</p>

<p style="text-align:justify">With the fall of TFR at the national level, experts have suggested the government not to coercively control population growth by implementing compulsory sterilisation policies. It should be added here that the Uttar Pradesh State Government introduced a <a href="https://www.livelaw.in/pdf_upload/up-population-control-bill-draft-396420.pdf">population control bill in July this year</a> that <a href="https://thediplomat.com/2021/12/a-snapshot-of-indias-population/">denies government jobs</a>, <a href="https://thediplomat.com/2021/12/a-snapshot-of-indias-population/">promotions</a>, <a href="https://thediplomat.com/2021/12/a-snapshot-of-indias-population/">subsidies</a> and the <a href="https://thediplomat.com/2021/12/a-snapshot-of-indias-population/">right to contest elections</a> to a citizen <em>(more likely to be the poor and the marginalised citizens)</em> who has over two children. Like <a href="https://indianexpress.com/article/opinion/columns/national-family-health-survey-demographic-transition-7649702/">Sweden</a>, all the southern states in India have a <a href="https://indianexpress.com/article/opinion/columns/national-family-health-survey-demographic-transition-7649702/">TFR of 1.7-1.8</a>. States like Uttar Pradesh and Bihar, which have still not attained the replacement-level fertility, are expected to move in that direction, mention <a href="https://indianexpress.com/article/opinion/columns/national-family-health-survey-demographic-transition-7649702/">Sonalde Desai</a> and <a href="https://indianexpress.com/article/opinion/columns/national-family-health-survey-demographic-transition-7649702/">Debasis Barik</a> in their recent <a href="https://indianexpress.com/article/opinion/columns/national-family-health-survey-demographic-transition-7649702/">article</a> titled &#39;<a href="https://indianexpress.com/article/opinion/columns/national-family-health-survey-demographic-transition-7649702/">With India&rsquo;s demographic transition</a>, <a href="https://indianexpress.com/article/opinion/columns/national-family-health-survey-demographic-transition-7649702/">come challenges</a>&#39;.</p>

<p style="text-align:justify"><strong><em>References</em></strong></p>

<p style="text-align:justify">NFHS-5 India factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/upload/files/India_National_Fact_Sheet.pdf">click here</a> to access</p>

<p style="text-align:justify">Combined Factsheet Compendium <em>(States/UTs from Phase-I)</em>, Ministry of Health and Family Welfare, please <a href="https://im4change.org/upload/files/NFHS-5_India_and_State_Factsheet_Compendium_Phase-I.pdf">click here</a> to access&nbsp;</p>

<p style="text-align:justify">Combined Factsheet Compendium <em>(States/UTs from Phase-II)</em>, Ministry of Health and Family Welfare, please <a href="https://im4change.org/upload/files/NFHS-5_India_and_State_Factsheet_Compendium_Phase-II.pdf">click here</a> to access&nbsp;</p>

<p style="text-align:justify">Union Health Ministry releases NFHS-5 Phase-II Findings, Press Information Bureau, Ministry of Health and Family Welfare, 24 November, 2021, please <a href="/upload/files/Press%20Release%20Phase%20II%20NFHS-5%2024%20Nov%202021.pdf">click here</a> to access&nbsp;</p>

<p style="text-align:justify">Phase-I Findings, National Family Health Survey-5, Press Information Bureau, Ministry of Health and Family Welfare, 15 December, 2020, please <a href="/upload/files/Press%20Release%20Phase%20I%20NFHS-5%2015%20Dec%202020.pdf">click here</a> to access</p>

<p style="text-align:justify">A Note on Total Fertility Rate, United Nations, please <a href="/upload/files/Total%20Fertility%20Rate%20Methodology.pdf">click here</a> to access&nbsp;&nbsp;</p>

<p style="text-align:justify">Proposed Draft Bill: Uttar Pradesh Population (Control, Stabilization and Welfare) Bill, 2021, Livelaw.in, 19 July, 2021 please <a href="https://www.livelaw.in/pdf_upload/up-population-control-bill-draft-396420.pdf">click here</a> to access</p>

<p style="text-align:justify">Thanks to data gaps, NFHS provides a limited picture -Amitabh Kundu and PC Mohanan, The Indian Express, 8 December, 2021, please <a href="https://indianexpress.com/article/opinion/columns/nfhs-survey-data-gaps-sex-ratio-7659775/">click here</a> to read more</p>

<p style="text-align:justify">8.7% contraception use jump key factor in India&rsquo;s fertility rate fall -Esha Roy, The Indian Express, 3 December, 2021, please <a href="https://indianexpress.com/article/india/contraception-use-india-fertility-rate-fall-7654159/">click here</a> to read more&nbsp;&nbsp;</p>

<p style="text-align:justify">With India&rsquo;s demographic transition, come challenges -Sonalde Desai and Debasis Barik, The Indian Express, 2 December, 2021, please <a href="https://indianexpress.com/article/opinion/columns/national-family-health-survey-demographic-transition-7649702/">click here</a> to read more</p>

<p style="text-align:justify">A Snapshot of India&rsquo;s Population -Sudha Ramachandran, The Diplomat, 1 December, 2021, please <a href="https://thediplomat.com/2021/12/a-snapshot-of-indias-population/">click here</a> to read more</p>

<p style="text-align:justify">A close reading of the NFHS-5, the health of India -Ashwini Deshpande, The Hindu, 27 November, 2021, please <a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece?homepage=true">click here</a> to read&nbsp;more</p>

<p style="text-align:justify">NFHS data is out: Where does India stand? -Nandlal Mishra and Akancha Singh, Livemint.com, 26 November, 2021, please <a href="https://www.livemint.com/news/india/nfhs5-data-is-out-where-does-india-stand-11637748286907.html">click here</a> to read more&nbsp;</p>

<p style="text-align:justify">India&rsquo;s fertility rate drops below 2.1, contraceptive prevalence up: NFHS -Rhythma Kaul and Anonna Dutt, Hindustan Times, 25 November, 2021, please <a href="https://www.hindustantimes.com/india-news/indias-fertility-rate-drops-below-2-1-population-stabilising-nfhs-data-101637751803433.html">click here</a> to read more&nbsp;</p>

<p style="text-align:justify">India&rsquo;s total fertility rate declines to 2.0: NFHS-5 -Sushmi Dey, The Times of India, 24 November, 2021, please <a href="https://timesofindia.indiatimes.com/india/indias-total-fertility-rate-declines-to-2-0-nfhs-5-data/articleshow/87892831.cms">click here</a> to read more&nbsp;&nbsp;</p>

<p style="text-align:justify">More hospital births, but limited gains in childhood nutrition: National Family Health Survey-5 -Jacob Koshy and Jagriti Chandra, The Hindu, 24 November, 2021, please <a href="https://www.thehindu.com/news/national/more-hospital-births-but-limited-gains-in-childhood-nutrition-national-family-health-survey-5/article37668503.ece">click here</a> to read more &nbsp;</p>

<p style="text-align:justify"><br />
<strong>Image Courtesy: UNDP India</strong></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><strong><em>*&nbsp;Inclusive Media for Change is grateful to Peeyush Sharma who painstakingly helped her in converting the NFHS data given in the PDF files into excel format.</em></strong></p>
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	'id' => (int) 61585,
	'title' => 'Kerala and Tamil Nadu bucked the trend of falling Total Fertility Rate, indicates the latest NFHS data',
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	'description' => '<p style="text-align:justify"><br />
After the release of the second phase data of the National Family Health Survey Fifth Round <em>(NFHS-5)</em>, media commentators and experts have written that the Total Fertility Rate (TFR) for India has gone down just below the replacement-level fertility. The TFR for the entire nation was 2.2 in 2015-16, which decreased to 2.0 in 2019-21. &nbsp;</p>

<p style="text-align:justify">According to the <a href="https://im4change.org/upload/files/Total%20Fertility%20Rate%20Methodology.pdf">United Nations</a>, the replacement-level fertility is reached when the TFR of a place <em>(i.e., a region or a country)</em> becomes 2.1 children per woman. This value represents the average number of children a woman would need to have to reproduce herself by bearing a daughter who survives to childbearing age. If replacement-level fertility is sustained over a sufficiently long period, each generation will exactly replace itself in the absence of migration. If the TFR is <a href="https://www.britannica.com/topic/fertility-rate">greater than 2.1</a>, then the population of a place or region <a href="https://www.britannica.com/topic/fertility-rate">will increase</a>, and if <a href="https://www.britannica.com/topic/fertility-rate">it is less than 2.1</a>, then the population of that place or region will <a href="https://www.britannica.com/topic/fertility-rate">eventually decrease</a>, although it may take a while because factors such as<a href="https://www.britannica.com/topic/fertility-rate"> age structure, emigration, or immigration</a> should also be taken into account.&nbsp;</p>

<p style="text-align:justify">A <a href="/upload/files/Chapter%205%20Fertility%20NFHS%201%20India%20Main%20Report.pdf">document related to NFHS-1</a> says that the <a href="/upload/files/Definition%20of%20TFR.png">numerator of each age-specific fertility rate</a> is <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">live births in a five-year age group</a>, and the <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">denominator is the number of woman-years lived</a> in the <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">same five-year age interval</a> <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">during the three-year time period</a>. The <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">TFR is a summary measure</a> that is calculated as <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">five times the sum </a><em>(over five-year age groups) </em>of the <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">age-specific fertility rates</a>. The <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">TFR is interpreted</a> as the <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">number of children a woman would bear</a> during her <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">reproductive years</a> <em>(15-49 years or 15-44 years) </em>if she were to <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">experience the age-specific fertility rates</a> prevailing <a href="https://im4change.org/upload/files/Definition%20of%20TFR.png">during the three-year period</a> preceding the survey.</p>

<p style="text-align:justify">The TFRs in various NFHS Rounds are expressed as the number of children per woman aged 15-49 years. Put simply, TFR is the average number of children a woman gives birth to in her lifetime.</p>

<p style="text-align:justify">Experts have opined that there is a distinction between Phase-I states/ UTs and Phase-II states/ UTs if we compare the average performance <em>(i.e., change in the value/s of some indicators with respect to the NFHS-4 levels)</em> between these two groups.&nbsp;</p>

<p style="text-align:justify">In her <a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece">article</a> titled &#39;<a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece">A close reading of the NFHS-5</a>, <a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece">the health of India</a>&#39;, <a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece">Ashwini Deshpande</a> of Ashoka University,&nbsp;among other things, has made two observations:</p>

<p style="text-align:justify"><strong>*</strong>&nbsp;&quot;[C]omparing the changes in anaemia in Phase 1 States (survey done pre-COVID) to Phase 2 States, we see that if anything, the increase in the former (which include Andhra Pradesh, Assam, Bihar, Gujarat, Kerala, Maharashtra, West Bengal, among others) is on average higher than the increase in Phase 2 States (Delhi, Uttar Pradesh, Chhattisgarh, Jharkhand, Rajasthan, Haryana, Tamil Nadu, Madhya Pradesh, Odisha, Punjab, among others). The discrepancy between Phase 1 and Phase 2 could reflect differences in actual incidence or survey-related issues.&quot;</p>

<p style="text-align:justify"><strong>*</strong> &quot;There are other instances of clear differences between Phase 1 and Phase 2 results. The three indicators of malnutrition: stunting (low height-for-age), wasting (low weight-for-height) and underweight (low weight-for-age): show an overall improvement. These conditions often occur together. Together, these reflect chronic or recurrent undernutrition, usually associated with poverty, poor maternal health and nutrition, frequent illness and/or inappropriate feeding and care in early life. These prevent children from reaching their physical and cognitive potential.</p>

<p style="text-align:justify">However, the overall reduction in national estimates of these three measures masks an anomaly. In Phase 1, several States revealed a worsening in one or more of these, whereas in Phase 2, none of the States showed a worsening. It would be good to understand if the novel coronavirus pandemic affected the survey in Phase 2, leading to undercounting of incidence, or whether by pure chance, all States in Phase 2 happen to be better performers on the malnutrition count (something that could not have been known at the start of the survey in 2019).&quot;</p>

<p style="text-align:justify">In our analysis, we find that the average TFR for Phase-I states/ UTs reduced from 2.05 in 2015-16 to 1.76 in 2019-20 i.e. by -0.28 points. Please see table-1. The average TFR for Phase-II states/ UTs <em>(barring India) </em>fell from 2.07 in 2015-16 to 1.84 in 2020-21 i.e. by -0.23 points.&nbsp;Kindly see table-2. Clearly, the distinction between Phase-I and Phase-II states/ UTs in terms of the average change in TFRs between NFHS-4 and NFHS-5 is not much.</p>

<p style="text-align:justify"><strong>Table 1: Total fertility rate (children per woman), NFHS-4 and NFHS-5, Phase-I states/ UTs</strong></p>

<p style="text-align:justify"><img alt="" src="/upload/images/Table%201%20Total%20fertility%20rate%20children%20per%20woman%20NFHS-4%20and%20NFHS-5%20Phase-I%20states%20UTs.png" style="height:625px; width:669px" /></p>

<p style="text-align:justify"><em><strong>Source: </strong>Combined Factsheet Compendium (States/UTs from Phase-I), Ministry of Health and Family Welfare, please <a href="https://im4change.org/upload/files/NFHS-5_India_and_State_Factsheet_Compendium_Phase-I.pdf ">click here</a> to access</em>&nbsp;<br />
<strong>---</strong></p>

<p style="text-align:justify">The highest level of TFR in NFHS-5 among the Phase-I states/ UTs was found in Bihar <em>(3.0)</em>, followed by Meghalaya <em>(2.9)</em>, and Manipur <em>(2.2)</em>. The rest of the states/ UTs of Phase-I had TFRs lower than the replacement-level fertility i.e., less than 2.1. The highest decrease in TFR among the Phase-I states/ UTs between 2015-16 and 2019-20 was noted for Ladakh and Nagaland <em>(-1.0 point each)</em>, followed by Jammu and Kashmir <em>(-0.6 point)</em>, and Bihar, Goa, Lakshadweep, Manipur and Mizoram <em>(-0.4 point each)</em>. Please consult table-1.</p>

<p style="text-align:justify">The <a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece">fieldwork for the Phase-I</a> of the National Family Health Survey Fifth Round (NFHS-5) was conducted during <a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece">June 2019-January 2020</a>, and the results <em>(i.e., factsheets for 22 states/ UTs, and subsequently the detailed reports and the district level factsheets)</em> were released in <a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece">December 2020</a>. Those <a href="https://im4change.org/upload/files/Press%20Release%20Phase%20I%20NFHS-5%2015%20Dec%202020.pdf">22 states/ UTs</a>, which were <a href="https://im4change.org/upload/files/Press%20Release%20Phase%20I%20NFHS-5%2015%20Dec%202020.pdf">surveyed in Phase-I</a>, are Andhra Pradesh, Assam, Bihar, Goa, Gujarat, Himachal Pradesh, Karnataka, Kerala, Maharashtra, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, Telangana, Tripura, West Bengal, Andaman Nicobar Island, Dadra and Nagar Haveli and Daman and Diu, Jammu &amp; Kashmir, Ladakh and Lakshadweep.</p>

<p style="text-align:justify"><strong>Table 2: Total fertility rate (children per woman), NFHS-4 and NFHS-5, Phase-II states/ UTs</strong></p>

<p style="text-align:justify"><img alt="" src="/upload/images/Table%202%20Total%20fertility%20rate%20children%20per%20woman%20NFHS-4%20and%20NFHS-5%20Phase%20II%20states%20UTs.png" style="height:489px; width:687px" /></p>

<p style="text-align:justify"><em><strong>Source: </strong>Combined Factsheet Compendium (States/UTs/ India from Phase-II), Ministry of Health and Family Welfare, please <a href="https://im4change.org/upload/files/NFHS-5_India_and_State_Factsheet_Compendium_Phase-II.pdf">click here</a> to access</em><br />
<strong>---</strong></p>

<p style="text-align:justify">The highest level of TFR in NFHS-5 among the Phase-II states/ UTs was found in Uttar Pradesh <em>(2.4)</em>, followed by Jharkhand <em>(2.3)</em>. The rest of the states/ UTs <em>(including Rajasthan and Madhya Pradesh)</em> of Phase-II had TFRs lower than the replacement-level fertility i.e., less than 2.1. The highest decrease in TFR among the Phase-II states/ UTs between 2015-16 and 2020-21 was observed for Rajasthan and Chhattisgarh <em>(-0.4 point each)</em>, followed by Arunachal Pradesh, Jharkhand, Madhya Pradesh, Odisha, and Uttar Pradesh <em>(-0.3 point each)</em>. Please see table-2.&nbsp;<br />
&nbsp; &nbsp; &nbsp;<br />
The <a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece">fieldwork for Phase-II</a> of the NFHS-5 was conducted during <a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece">January 2020-April 2021</a>, and the results <em>(i.e., factsheets for 14 states/ UTs/ districts as well as the India factsheet)</em> were released in November 2021. The states and UTs, which were <a href="https://im4change.org/upload/files/Press%20Release%20Phase%20II%20NFHS-5%2024%20Nov%202021.pdf">surveyed in the Phase-II</a>, are Arunachal Pradesh, Chandigarh, Chhattisgarh, Haryana, Jharkhand, Madhya Pradesh, NCT of Delhi, Odisha, Puducherry, Punjab, Rajasthan, Tamil Nadu, Uttar Pradesh and Uttarakhand.</p>

<p style="text-align:justify"><strong>Kerala and Tamil Nadu are the odd ones out&nbsp;</strong></p>

<p style="text-align:justify">The data analysis done by Inclusive Media for Change shows that while most states / UTs have shown a declining trend in TFR between NFHS-4 and NFHS-5 <em>(both Phase-I and Phase-II states/ UTs)</em>, two states i.e., Kerala and Tamil Nadu &ndash; considered to be leaders among states in terms of human development &ndash; emerged as exceptions.&nbsp;</p>

<p style="text-align:justify">While for Kerala, the TFR increased from 1.6 to 1.8 between 2015-16 and 2019-20, for Tamil Nadu&nbsp;TFR went up from 1.7 to 1.8 between 2015-16 and 2020-21. The TFRs of both these states were lower than the replacement-level fertility of 2.1 in NFHS-5. It should be noted that Kerala was a Phase-I state, whereas Tamil Nadu was a Phase-II state for NFHS-5. Please check table-3.</p>

<p style="text-align:justify"><strong>Table 3: Trends in Total Fertility Rates for India, Kerala and Tamil Nadu, from NFHS-1 to NFHS-5</strong></p>

<p style="text-align:justify"><img alt="" src="/upload/images/Table%203%20Trends%20in%20Total%20Fertility%20Rates%20for%20India%20Kerala%20and%20Tamil%20Nadu%20from%20NFHS-1%20to%20NFHS-5.png" style="height:175px; width:1000px" /></p>

<p style="text-align:justify"><em><strong>Source: </strong>Key indicators for India from NFHS-5, India Factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/docs/India_National_Fact_Sheet.pdf">click here</a> to access &nbsp;</em></p>

<p style="text-align:justify"><em>Key indicators for Kerala from NFHS-5, Kerala Factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/docs/Kerala%20NFHS-5%20Factsheet.pdf">click here</a> to access &nbsp;</em></p>

<p style="text-align:justify"><em>Key indicators for Tamil Nadu from NFHS-5, Tamil Nadu Factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/docs/NFHS-5%20Tamil%20Nadu.pdf">click here</a> to access &nbsp;</em></p>

<p style="text-align:justify">**<br />
<em>Key indicators for India from NFHS-4, India Factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/docs/130India%20Fact%20Sheet%20NFHS-4%202015-16.pdf">click here</a> to access &nbsp;</em></p>

<p style="text-align:justify"><em>Key indicators for Kerala from NFHS-4, Kerala Factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/docs/697Kerala%20Fact%20Sheet%20NFHS-4%202015-16.pdf ">click here</a> to access</em></p>

<p style="text-align:justify"><em>Key indicators for Tamil Nadu from NFHS-4, Tamil Nadu Factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/docs/163Tamil%20Nadu%20Fact%20Sheet%20NFHS-4%202015-16.pdf ">click here</a> to access</em></p>

<p style="text-align:justify">**<br />
<em>Key indicators for India from NFHS-3, India Factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/docs/200India%20NFHS%203.pdf ">click here</a> to access </em></p>

<p style="text-align:justify"><em>Key indicators for Kerala from NFHS-3, Kerala Factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/docs/984Kerala%20NFHS%203.pdf ">click here</a> to access</em></p>

<p style="text-align:justify"><em>Key indicators for Tamil Nadu from NFHS-3, Tamil Nadu Factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/docs/745Tamil%20Nadu%20NFHS%203.pdf ">click here</a> to access&nbsp;</em></p>

<p style="text-align:justify">**<br />
<em>Chapter 4: Fertility and Fertility Preferences, NFHS-2, India, please <a href="/upload/files/Chapter%204%20Fertility%20and%20Fertility%20Preferences%20NFHS-2%20India.pdf">click here</a> to access&nbsp;&nbsp;</em></p>

<p style="text-align:justify"><em>Chapter 4: Fertility and Fertility Preferences, NFHS-2, Kerala, please <a href="/upload/files/Chapter%204%20Fertility%20and%20Fertility%20Preferences%20NFHS-2%20Kerala.pdf">click here</a> to access&nbsp;</em></p>

<p style="text-align:justify"><em>Chapter 4: Fertility and Fertility Preferences, NFHS-2, Tamil Nadu, please <a href="/upload/files/Chapter%204%20Fertility%20and%20Fertility%20Preferences%20NFHS-2%20Tamil%20Nadu.pdf">click here</a> to access&nbsp; &nbsp;</em></p>

<p style="text-align:justify">**<br />
<em>State factsheet, NFHS-1, please <a href="/upload/files/NFHS%201%20State%20factsheet.pdf">click here</a> to access&nbsp;</em></p>

<p style="text-align:justify"><em>Chapter 5: Fertility, NFHS-1, India Main Report, please <a href="/upload/files/Chapter%205%20Fertility%20NFHS%201%20India%20Main%20Report%281%29.pdf">click here</a> to access</em><br />
<strong>--------</strong></p>

<p style="text-align:justify">Media reports have stated <em>(please click <a href="https://timesofindia.indiatimes.com/india/indias-total-fertility-rate-declines-to-2-0-nfhs-5-data/articleshow/87892831.cms">here</a>, <a href="https://indianexpress.com/article/india/contraception-use-india-fertility-rate-fall-7654159/">here</a>, <a href="https://www.hindustantimes.com/india-news/indias-fertility-rate-drops-below-2-1-population-stabilising-nfhs-data-101637751803433.html">here</a>, and <a href="https://www.livemint.com/news/india/nfhs5-data-is-out-where-does-india-stand-11637748286907.html">here</a> to access)</em> that there are two main factors <em>(among others) </em>behind the falling trend in TFR for the country as a whole: the increase in the use of contraception and the increase in the age of marriage.&nbsp;</p>

<p style="text-align:justify">For <a href="https://im4change.org/upload/files/India_National_Fact_Sheet.pdf">India</a>, the <a href="https://im4change.org/upload/files/India_National_Fact_Sheet.pdf">Contraceptive Prevalence Rate-CPR <em>(any method)</em></a> increased from 53.5 percent in 2015-16 to 66.7 percent in 2019-21. The <a href="https://im4change.org/upload/files/India_National_Fact_Sheet.pdf">Contraceptive Prevalence Rate-CPR <em>(any modern method)</em></a> for the country soared up from 47.8 percent in 2015-16 to 56.5 percent in 2019-21.&nbsp;</p>

<p style="text-align:justify">The <a href="https://im4change.org/upload/files/India_National_Fact_Sheet.pdf">proportion of women aged 20-24</a> years who got <a href="https://im4change.org/upload/files/India_National_Fact_Sheet.pdf">married before age 18 years</a>&nbsp;decreased from 26.8 percent to 23.3 percent between NFHS-4 and NFHS-5. The <a href="https://im4change.org/upload/files/India_National_Fact_Sheet.pdf">proportion of women aged 15-19</a> years who were <a href="https://im4change.org/upload/files/India_National_Fact_Sheet.pdf">already mothers or pregnant</a> at the time of the survey fell from 7.9 percent to 6.8 percent between 2015-16 and 2019-21.</p>

<p style="text-align:justify">Now, let us turn our attention to understand what happened in the case of Tamil Nadu and Kerala. For <a href="https://im4change.org/docs/NFHS-5%20Tamil%20Nadu.pdf">Tamil Nadu</a>, the <a href="https://im4change.org/docs/NFHS-5%20Tamil%20Nadu.pdf">CPR <em>(any method)</em> </a>increased from 53.2 percent in NFHS-4 to 68.6 percent in NFHS-5. The <a href="https://im4change.org/docs/NFHS-5%20Tamil%20Nadu.pdf">CPR <em>(any modern method)</em></a> for Tamil Nadu climbed up from 52.6 percent in 2015-16 to 65.5 percent in 2020-21.&nbsp;</p>

<p style="text-align:justify">For <a href="https://im4change.org/docs/NFHS-5%20Tamil%20Nadu.pdf">Tamil Nadu</a>, the <a href="https://im4change.org/docs/NFHS-5%20Tamil%20Nadu.pdf">proportion of women aged 20-24 years</a> who got <a href="https://im4change.org/docs/NFHS-5%20Tamil%20Nadu.pdf">married before age 18 years</a> fell from 16.3 percent to 12.8 percent between 2015-16 and 2020-21. Unlike India, in the case of Tamil Nadu, the <a href="https://im4change.org/docs/NFHS-5%20Tamil%20Nadu.pdf">proportion of women aged 15-19</a> years who were <a href="https://im4change.org/docs/NFHS-5%20Tamil%20Nadu.pdf">already mothers or pregnant at the time</a> of the survey rose from 5.0 percent to 6.3 percent between NFHS-4 and NFHS-5.</p>

<p style="text-align:justify">In the case of Kerala, the four indicators -- &#39;Contraceptive Prevalence Rate-CPR <em>(any method)</em>&#39;, &#39;Contraceptive Prevalence Rate-CPR <em>(any modern method)</em>&#39;, &#39;the proportion of women aged 20-24 years who got married before age 18 years&#39;, and &#39;the proportion of women aged 15-19 years who were already mothers or pregnant at the time of the survey&#39; -- are unable to explain the increase in TFR between NFHS-4 and NFHS-5.&nbsp;</p>

<p style="text-align:justify">For <a href="https://im4change.org/docs/Kerala%20NFHS-5%20Factsheet.pdf">Kerala</a>, the <a href="https://im4change.org/docs/Kerala%20NFHS-5%20Factsheet.pdf">CPR <em>(any method)</em></a> jumped from 53.1 percent in 2015-16 to 60.7 percent in 2019-20. The <a href="https://im4change.org/docs/Kerala%20NFHS-5%20Factsheet.pdf">CPR <em>(any modern method)</em> for Kerala</a> increased from 50.3 percent in 2015-16 to 52.8 percent in 2019-20.&nbsp;</p>

<p style="text-align:justify">For Kerala, the <a href="https://im4change.org/docs/Kerala%20NFHS-5%20Factsheet.pdf">proportion of women aged 20-24 years</a> who got <a href="https://im4change.org/docs/Kerala%20NFHS-5%20Factsheet.pdf">married before age 18</a> years fell from 7.6 percent to 6.3 percent between 2015-16 and 2019-20. For Kerala, the proportion of <a href="https://im4change.org/docs/Kerala%20NFHS-5%20Factsheet.pdf">women aged 15-19 years</a> who were already <a href="https://im4change.org/docs/Kerala%20NFHS-5%20Factsheet.pdf">mothers or pregnant at the time of the survey</a> fell from 3.0 percent to 2.4 percent between NFHS-4 and NFHS-5.</p>

<p style="text-align:justify"><strong>A piece of advice</strong></p>

<p style="text-align:justify">At the time of writing this news alert, the unit-level data <em>(or the metadata)</em> for all the states/UTs/India-level <em>(in Phase-I and Phase-II)</em> has still not been released. In the <a href="https://indianexpress.com/article/opinion/columns/nfhs-survey-data-gaps-sex-ratio-7659775/">absence of the metadata</a>, it is hard to independently verify the results <em>(i.e., the factsheets/ detailed reports)</em> that have been released so far by the Mumbai-based International Institute for Population Sciences (IIPS), the organisation that conducted the survey.&nbsp;It is also not possible to analyse the data for further research without the availability of metadata or unit-level data.</p>

<p style="text-align:justify">With the fall of TFR at the national level, experts have suggested the government not to coercively control population growth by implementing compulsory sterilisation policies. It should be added here that the Uttar Pradesh State Government introduced a <a href="https://www.livelaw.in/pdf_upload/up-population-control-bill-draft-396420.pdf">population control bill in July this year</a> that <a href="https://thediplomat.com/2021/12/a-snapshot-of-indias-population/">denies government jobs</a>, <a href="https://thediplomat.com/2021/12/a-snapshot-of-indias-population/">promotions</a>, <a href="https://thediplomat.com/2021/12/a-snapshot-of-indias-population/">subsidies</a> and the <a href="https://thediplomat.com/2021/12/a-snapshot-of-indias-population/">right to contest elections</a> to a citizen <em>(more likely to be the poor and the marginalised citizens)</em> who has over two children. Like <a href="https://indianexpress.com/article/opinion/columns/national-family-health-survey-demographic-transition-7649702/">Sweden</a>, all the southern states in India have a <a href="https://indianexpress.com/article/opinion/columns/national-family-health-survey-demographic-transition-7649702/">TFR of 1.7-1.8</a>. States like Uttar Pradesh and Bihar, which have still not attained the replacement-level fertility, are expected to move in that direction, mention <a href="https://indianexpress.com/article/opinion/columns/national-family-health-survey-demographic-transition-7649702/">Sonalde Desai</a> and <a href="https://indianexpress.com/article/opinion/columns/national-family-health-survey-demographic-transition-7649702/">Debasis Barik</a> in their recent <a href="https://indianexpress.com/article/opinion/columns/national-family-health-survey-demographic-transition-7649702/">article</a> titled &#39;<a href="https://indianexpress.com/article/opinion/columns/national-family-health-survey-demographic-transition-7649702/">With India&rsquo;s demographic transition</a>, <a href="https://indianexpress.com/article/opinion/columns/national-family-health-survey-demographic-transition-7649702/">come challenges</a>&#39;.</p>

<p style="text-align:justify"><strong><em>References</em></strong></p>

<p style="text-align:justify">NFHS-5 India factsheet, Ministry of Health and Family Welfare, please <a href="https://im4change.org/upload/files/India_National_Fact_Sheet.pdf">click here</a> to access</p>

<p style="text-align:justify">Combined Factsheet Compendium <em>(States/UTs from Phase-I)</em>, Ministry of Health and Family Welfare, please <a href="https://im4change.org/upload/files/NFHS-5_India_and_State_Factsheet_Compendium_Phase-I.pdf">click here</a> to access&nbsp;</p>

<p style="text-align:justify">Combined Factsheet Compendium <em>(States/UTs from Phase-II)</em>, Ministry of Health and Family Welfare, please <a href="https://im4change.org/upload/files/NFHS-5_India_and_State_Factsheet_Compendium_Phase-II.pdf">click here</a> to access&nbsp;</p>

<p style="text-align:justify">Union Health Ministry releases NFHS-5 Phase-II Findings, Press Information Bureau, Ministry of Health and Family Welfare, 24 November, 2021, please <a href="/upload/files/Press%20Release%20Phase%20II%20NFHS-5%2024%20Nov%202021.pdf">click here</a> to access&nbsp;</p>

<p style="text-align:justify">Phase-I Findings, National Family Health Survey-5, Press Information Bureau, Ministry of Health and Family Welfare, 15 December, 2020, please <a href="/upload/files/Press%20Release%20Phase%20I%20NFHS-5%2015%20Dec%202020.pdf">click here</a> to access</p>

<p style="text-align:justify">A Note on Total Fertility Rate, United Nations, please <a href="/upload/files/Total%20Fertility%20Rate%20Methodology.pdf">click here</a> to access&nbsp;&nbsp;</p>

<p style="text-align:justify">Proposed Draft Bill: Uttar Pradesh Population (Control, Stabilization and Welfare) Bill, 2021, Livelaw.in, 19 July, 2021 please <a href="https://www.livelaw.in/pdf_upload/up-population-control-bill-draft-396420.pdf">click here</a> to access</p>

<p style="text-align:justify">Thanks to data gaps, NFHS provides a limited picture -Amitabh Kundu and PC Mohanan, The Indian Express, 8 December, 2021, please <a href="https://indianexpress.com/article/opinion/columns/nfhs-survey-data-gaps-sex-ratio-7659775/">click here</a> to read more</p>

<p style="text-align:justify">8.7% contraception use jump key factor in India&rsquo;s fertility rate fall -Esha Roy, The Indian Express, 3 December, 2021, please <a href="https://indianexpress.com/article/india/contraception-use-india-fertility-rate-fall-7654159/">click here</a> to read more&nbsp;&nbsp;</p>

<p style="text-align:justify">With India&rsquo;s demographic transition, come challenges -Sonalde Desai and Debasis Barik, The Indian Express, 2 December, 2021, please <a href="https://indianexpress.com/article/opinion/columns/national-family-health-survey-demographic-transition-7649702/">click here</a> to read more</p>

<p style="text-align:justify">A Snapshot of India&rsquo;s Population -Sudha Ramachandran, The Diplomat, 1 December, 2021, please <a href="https://thediplomat.com/2021/12/a-snapshot-of-indias-population/">click here</a> to read more</p>

<p style="text-align:justify">A close reading of the NFHS-5, the health of India -Ashwini Deshpande, The Hindu, 27 November, 2021, please <a href="https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece?homepage=true">click here</a> to read&nbsp;more</p>

<p style="text-align:justify">NFHS data is out: Where does India stand? -Nandlal Mishra and Akancha Singh, Livemint.com, 26 November, 2021, please <a href="https://www.livemint.com/news/india/nfhs5-data-is-out-where-does-india-stand-11637748286907.html">click here</a> to read more&nbsp;</p>

<p style="text-align:justify">India&rsquo;s fertility rate drops below 2.1, contraceptive prevalence up: NFHS -Rhythma Kaul and Anonna Dutt, Hindustan Times, 25 November, 2021, please <a href="https://www.hindustantimes.com/india-news/indias-fertility-rate-drops-below-2-1-population-stabilising-nfhs-data-101637751803433.html">click here</a> to read more&nbsp;</p>

<p style="text-align:justify">India&rsquo;s total fertility rate declines to 2.0: NFHS-5 -Sushmi Dey, The Times of India, 24 November, 2021, please <a href="https://timesofindia.indiatimes.com/india/indias-total-fertility-rate-declines-to-2-0-nfhs-5-data/articleshow/87892831.cms">click here</a> to read more&nbsp;&nbsp;</p>

<p style="text-align:justify">More hospital births, but limited gains in childhood nutrition: National Family Health Survey-5 -Jacob Koshy and Jagriti Chandra, The Hindu, 24 November, 2021, please <a href="https://www.thehindu.com/news/national/more-hospital-births-but-limited-gains-in-childhood-nutrition-national-family-health-survey-5/article37668503.ece">click here</a> to read more &nbsp;</p>

<p style="text-align:justify"><br />
<strong>Image Courtesy: UNDP India</strong></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><strong><em>*&nbsp;Inclusive Media for Change is grateful to Peeyush Sharma who painstakingly helped her in converting the NFHS data given in the PDF files into excel format.</em></strong></p>
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After the release of the second phase data of the National Family Health Survey Fifth Round (NFHS-5), media commentators and experts have written that the Total Fertility Rate (TFR) for India has gone down just below the replacement-level fertility. The TFR for the entire nation was 2.2 in 2015-16, which decreased to 2.0 in 2019-21. &nbsp;

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