DR. NANDKUMAR M. KAMAT
The National Family Health Survey (NFHS-6) surveyed Goa on August 30, 2024—covering 1,469 sampled households, of which 1,126 were successfully interviewed—it produced the most granular health portrait this state has received in half a decade. I have read every round since NFHS-1 (1992-93). This sixth edition left me
genuinely unsettled.
Many of these numbers carry the long shadow of SARS-CoV-2, whose third and fourth waves continued disrupting Goa’s health system well into 2024, with a true epidemiological endpoint reached only after October 2024—after this survey was conducted. The population aged 60 years and above has surged from 14.2% in NFHS-5 to 17.2%—a three-point jump in barely four years. Children below 15 years have declined from 19.1% to 18.1%, and only 5.5% of Goa’s population is now under age five.
Goa is ageing faster than its institutions are prepared for. No state-level geriatric care policy, expanded elder-welfare budget, or revised health-workforce plan commensurate with this shift exists on the table. The total fertility rate stands at 1.6 children per woman—well below the replacement threshold of 2.1—but I was surprised to see it rise from NFHS-5’s 1.3. The rural TFR of 1.8 versus an urban figure of only 1.4 deserves attention. This may reflect a pandemic-era rebound in births deferred during peak COVID years, or genuine fertility behaviour among Goa’s growing migrant communities. Either way, a TFR of 1.6 combined with a rapidly greying population creates a dependency arithmetic that will stress every social sector within
two decades.
The caesarean delivery data requires careful, contextualised reading. Goa’s overall C-section rate has risen to 46.2%—up from 39.5% in NFHS-5. In private facilities it stands at 69.7%; in public facilities at 31.4%. The WHO population-level benchmark is 10 to 15%. Goa substantially exceeds it across both sectors. I am mindful that COVID-19 in pregnancy was associated with elevated rates of foetal distress and maternal compromise, legitimately increasing operative delivery rates during the survey period. However, the public health system now bears the regulatory obligation to build audit infrastructure so that evidence-based decision-making, not pandemic-era inertia, drives delivery choices going forward. Modern contraceptive use has collapsed from 60.1% to 39.0% while traditional method use has exploded from 7.8% to 33.8%. Overall prevalence rose modestly from 67.9 to 72.8%, masking this dangerous compositional reversal. The pandemic severely disrupted contraceptive supply chains through government facilities in 2021 and 2022, and couples pushed toward traditional alternatives have not returned to modern methods.
Goa’s maternal health process indicators are genuinely impressive. First-trimester antenatal registration has risen from 70.3% to 92.1%. Institutional births remain at 99.6%. Postnatal care within 48 hours stands at 96.9% for mothers and 97.3% for newborns. But the iron-folic acid data punctures that satisfaction. Only 80.1% of pregnant women consumed IFA supplements for 100 or more days—down from 87.5% in NFHS-5. In a state where antenatal visits are nearly universal, this is not a supply problem. It is a compliance and counselling failure inside government health facilities. Women are reaching the facility. The supplement is available. The interaction between provider and patient is failing at the point of prescription and follow-up. That is last-mile adherence failure, and correcting it is the government’s job.
Stunting has fallen from 25.8% to 19.4%. Severe wasting has declined from 7.5% to 2.4%. Underweight prevalence has improved from 24.0% to 19.9%. I record these figures with respect for the frontline workers and Anganwadi functionaries who produced them through years of pandemic disruption. Yet wasting persists at 16.3%—one in six Goan children under five is acutely malnourished. Its persistence in one of India’s most prosperous states reflects a failure of programme delivery within the government’s own Integrated Child Development Services network. Breastfeeding initiation within one hour of birth has declined from 61.6% to 47.9%—less than half of Goan newborns receive this most protective of neonatal interventions. Pandemic-era infection control protocols disrupted immediate skin-to-skin contact and rooming-in across maternity wards, creating institutional habits that outlasted the emergency and were never reversed by government administrators. Only 33% of children aged six to 23 months receive a diet of adequate quality and diversity. Two out of three Goan toddlers are nutritionally underserved because the government counselling ecosystem designed to address this has not delivered.
Among women aged 15 to 49, 45.1% are overweight or obese—up from 36.1% in NFHS-5. Among men, 43.6%, up from 32.6%. A nine-point rise in male overweight prevalence within four years is an epidemic trajectory, accelerated by pandemic-era physical inactivity and disrupted routines. Among women aged 15 and above, 27.5% have high blood sugar or are on anti-diabetic medication—up from 20.8%. Among men, 32.1%, up from 24.1%. Nearly one in three Goan adult men is diabetic or pre-diabetic. This is a present catastrophe already loading hospitals with preventable complications—diabetic foot, retinopathy, nephropathy, stroke. Goa’s primary care system must pivot from episodic curative care to structured chronic disease management. There is no evidence that pivot is underway. Hypertension affects 26.2% of women and 27.5% of men when those on medication are included—a massive, combined cardio-metabolic risk pool that our public health system is structurally unequipped to manage.
Alcohol consumption among men has declined from 36.8% to 22.4%—14 percentage points, the most positive behavioural finding in the survey, though self-reported figures in household surveys are known to under-report. Among women, alcohol use has fallen from 5.5 to 2.1%. Tobacco use among men has declined modestly from 18.1 to 17.1%—welcome, but insufficient given the oncological and cardiovascular burden in a population already metabolically compromised.
The most uncomfortable number in the entire fact sheet is this: 11.3% of married women aged 18 to 49 reported spousal violence—up from 8.3% in NFHS-5. The urban figure is 16.2%. One in six urban Goan women lives with or has lived with spousal violence—embedded not in poverty but in the suburbs and professional households of a state that prides itself on progressiveness. Women’s empowerment indicators are strong: 91.1% have personal bank accounts, 89.9% have mobile phones, 97.5% use hygienic menstrual protection. Economic access has not translated into physical safety within marriage. This finding has received virtually no public attention from government or civil society.
NFHS-6 is a precise diagnostic instrument. On process indicators Goa performs near the national frontier. On outcomes—child wasting, adult diabetes, breastfeeding, spousal violence, contraceptive method quality—it is failing in ways that wealth, education, and pandemic disruption together cannot fully excuse. The government must now respond with specificity: build C-section audit infrastructure within the Directorate of Health Services; restructure primary care for chronic disease management; restore baby-friendly hospital protocols in every government maternity ward; audit IFA counselling at every antenatal contact point; review contraceptive supply chains across all primary health centres; treat spousal violence as the public health emergency this survey has formally documented.
Goa does not need another survey. It needs officials and public health professionals who will read this one, sit with its discomfort, and act before NFHS-7 records what happens when they do not.
