Dehradun: The National Family Health Survey-6 (NFHS 2023-24) has revealed a decline in the proportion of births taking place at public health facilities in Uttarakhand, with the figure falling from 53.3% in NFHS-5 (2019-21) to 49.9% in NFHS-6. This decline comes even as overall institutional deliveries and births attended by skilled health personnel have improved in the state.
Rise in Overall Institutional Births
According to the survey, overall institutional births increased from 83.2% in NFHS-5 to 88.9% in NFHS-6, while births attended by skilled health personnel rose from 83.7% to 90.3%. These figures suggest that while more women are opting for institutional births, a growing proportion are doing so outside the public health system.
Caesarean Section Rates on the Rise
The survey also recorded a rise in caesarean section births. The overall rate increased from 20.4% in NFHS-5 to 25.9% in NFHS-6. As seen nationally, the highest proportion of surgical births was recorded in private facilities, where the rate rose from 43.3% to 47.7%. In public facilities, the increase was marginal, from 14% to 14.7%.
Comparison with Other Himalayan States
Among Himalayan states, institutional births at public health facilities in NFHS-6 stood at 75.6% in Assam, 74.7% in Mizoram, 74.6% in Tripura, 71.7% in Sikkim, 70.6% in Himachal Pradesh, 55.7% in Meghalaya, and 44.7% in Nagaland. Like Uttarakhand, Tripura, Himachal Pradesh, and Sikkim also recorded a decline in deliveries at public facilities. In Tripura, the figure fell from 78.6% in NFHS-5 to 74.6% in NFHS-6, in Himachal Pradesh it declined from 71.7% to 70.6%, and in Sikkim it plunged from 78.6% to 71.7%.
Uttarakhand's Socio-Economic Context
The figures are noteworthy given Uttarakhand's relatively better socio-economic profile compared to several other hill states. NFHS-5 data had shown Himachal Pradesh recording significantly higher institutional delivery rates at public facilities, while Sikkim reported strong utilisation of government health services, supported by better infrastructure connectivity in a smaller and more manageable terrain.
Reasons for the Decline
Health officials attributed the decline in public facility deliveries to a combination of factors, including inadequate infrastructure in remote hill areas, poor road connectivity limiting access to district hospitals, a shortage of specialist doctors, and migration to the plains. They said some women continue to deliver at home, particularly in districts such as Haridwar and Udham Singh Nagar, while others increasingly prefer private healthcare facilities.
Positive Trends in Skilled Birth Attendance
Despite the decline in deliveries at public health facilities, the survey recorded improvement in skilled birth attendance, indicating continued progress in access to maternity care across the state.
About the Author
Shivani Azad is a TOI journalist who covers Environment, Wildlife, Medical, and Social subjects.
