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The National Family Health Survey-6 (NFHS-6/2023-24) data has a mixed bag for Kerala, with the State making significant gains in immunisation coverage, child nutrition and maternal and child health, while it deepens the concerns about the steep rise in the burden of non-communicable diseases and obesity, especially amongst women.

NFHS-6 also reveals a very dark side of Kerala society, with reported spousal violence going up from 9.8% in NFHS-5 (2019-21) to 17.7% in NFHS-6. Another shameful revelation is the increase in physical violence during pregnancy, which has increased from 0.5% in NFHS-5 to 1.7% in NFHS-6. However, it needs close examination whether this increase is due to increased reporting of violence or an increase in actual violence against women.

Kerala’s ageing demographic profile sharpens further in NFHS-6, with the proportion of the population aged above 60 years rising from 18.6% in NFHS-5 (2019-21) to 20.7% in NFHS-6 (2023-24), which is significantly above the national average of 12.9%. This demographic profile has deep implications for the State’s health system planning, social security spending and elderly care and welfare policies, something that the State has only begun to take cognisance of.

Nearly half of the adult women population in Kerala are obese or overweight—NFHS-6 puts the proportion of obese or overweight women in Kerala at a whopping 46.7%, up from 38.2% recorded in NFHS-5. This is way above the national average of 30.7% (which also showed an increase from 24% in NFHS-5).

About 37% of men in Kerala are also overweight or obese, against the national average of 27.3%.

The rising burden of NCDs in the State is well documented in many previous studies. NFHS-6 data shows that Kerala is far ahead of the national average when it comes to the prevalence of NCDs.

NFHS-6 puts the proportion of women in the 15-49 years years with high (systolic 141-160 mg/dl) or very high (above systolic 160mg/dl) blood sugar and already on medication at 28.9% (national average is 17.8%) and the proportion of men in the same category at 31.9% (national average is (20.9%)

A rapidly ageing population and high prevalence of NCDs indicate that Kerala’s public health challenges ahead are immense and that this will have significant implications on the State’s health expenditure as well as the out-of-pocket expenditure on health.

Kerala, however, has made significant gains when it comes to immunisation, child nutrition status according to NFHS-6. The proportion of fully immunised children in the 12-13 months age group has improved from 78.4% in NFHS-5 to 84.9%. The rotavirus vaccination coverage (the vaccine was made part of the national immunisation schedule in 2019) has shown a leap from 9.5% to 87.2% .The second dose of measles-containing vaccine (MCV2) coverage has also jumped from 31.9 % to 83.3 % between the two NFHS rounds. About 95.2% of the immunisation in the State takes place in public hospitals.

When it comes to child nutrition, among children under 5 years, the proportion of stunting has come down from 23.4% to 20.1%; wasting shows a drop from 15.8% to 10.9%; the proportion of underweight children has come down slightly from 19.7% to 17.8% and that of overweight children shows a marginal drop from 4% to 2.1% between NFHS 5 and 6.

Male alcohol consumption in the State is now at 22.7%, a slight increase from 19.9% in NFHS-5, while tobacco use shows a slight decline from 16.9% to 15.9% in NFHS-6

The NFHS-6 survey covered 6,79,238 households, 7,16,397 women, and 1,00,977 men across the country. In Kerala, the households surveyed was 13,005, with 11,187 female and 1,542 male participants.

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