National Family Health Survey

Imagine you’re trying to understand the health of a country, not from guesswork or headlines, but from actual, ground-level data collected door-to-door from Indian households. That’s exactly what the National Family Health Survey (NFHS) does.

Definition:

NFHS is a large-scale, multi-round survey that collects reliable data on population, health, and nutrition across India. Think of it as India’s detailed “health report card” done every few years.

✅ Objective:

To gather up-to-date and representative data on:

• Fertility
• Family Planning
• Mortality
• Maternal and Child Health

All this is essential for evidence-based policymaking.

🔷 Institutional Framework: Who Conducts It?

🏢 Conducted under:

The stewardship of the Ministry of Health and Family Welfare (MoHFW), Government of India.

🎓 Nodal Agency:

International Institute for Population Sciences (IIPS), Mumbai – an autonomous research and training institute in population studies.

💵 Funding Agencies:

• USAID (United States Agency for International Development)
• UNICEF (provided supplementary support)

So, this is an India-led but globally-supported survey mechanism.

🔷 Evolution of NFHS: From NFHS-1 to NFHS-6

Let’s understand each round like different volumes of a research encyclopedia—each adding more layers of depth.

NFHS Round	Year	Key Features
NFHS-1	1992-93	First baseline data on health, nutrition, fertility—focused on women and children.
NFHS-2	1998-99	Added: domestic violence, reproductive health, anaemia, women’s status.
NFHS-3	2005-06	Added: HIV/AIDS data (with help from NACO & NARI)
NFHS-4	2014-15	First time data collected for all States and UTs
NFHS-5	2019–21	Added C-Section data, child malnutrition parameters like stunting, wasting, anaemia.
NFHS-6	2023–24	Latest. Offers district-level estimates for major indicators.

So from basic health indicators, NFHS has grown into a multidimensional demographic tool.

🔷 Key Demographic Findings (As per NFHS-5)

Let’s now decode the key indicators reported by NFHS-5. We’ll explain each indicator, its significance, and India’s current status.

🔹 Total Fertility Rate (TFR):

• Meaning: Average number of children a woman is expected to have in her reproductive years.
• Replacement level: 2.1 (to keep population stable)
• India (NFHS-5): 2.0 – ✅ Below replacement level → India’s population is stabilizing.

🔹 Infant Mortality Rate (IMR):

• Definition: Deaths of infants (under 1 year) per 1,000 live births.
• Significance: Lower IMR = better neonatal care & maternal health.
• NFHS-5 IMR: 35.2 (was 40.7 in NFHS-4) → 📉 Positive decline.

🔹 Under-5 Mortality Rate (U5MR):

• Definition: Deaths of children under 5 years per 1,000 live births.
• NFHS-5 U5MR: 41.9 (down from 49.7)
• Tells us how well India is doing in sanitation, immunization, and child nutrition.

🔹 Sex Ratio:

• Definition: Number of females per 1,000 males.
• NFHS-5:1020 females per 1000 males
  🟢 Highest since NFHS started!
  • Rural India: 1037
  • Urban India: 985

Compare with 2011 Census figure: 943 → So, considerable improvement.

🔹 Child Sex Ratio (0–6 years):

• NFHS-5: 920 girls per 1000 boys
  (Better than 914 in 2011 Census)

Still a concern → shows societal bias hasn’t fully gone.

🔹 Life Expectancy at Birth:

• Definition: Average number of years a newborn is expected to live if current mortality rates persist.
• India (SRS 2011–16): 68.3 years
• Influenced by healthcare access, nutrition, and hygiene.

🔹 Literacy Rate:

• Definition: People above 15 years who can read & write.
• India (2011 Census):74.04%
  • Gender and regional disparities still exist.

🔷 Child Nutrition Indicators: The Triple Burden

Think of this as India’s “malnutrition report card”:

Indicator	Meaning	NFHS-5 % (under 5 years)
Stunting	Low height-for-age → Chronic malnutrition	35.5%
Wasting	Low weight-for-height → Acute malnutrition	17%
Underweight	Low weight-for-age → Cumulative nutrition failure	32.8%

🧠 Remember this order (Severity of root causes):
Stunting > Underweight > Wasting

• Stunting affects cognition and physical growth → long-term impact.
• Wasting signals urgent medical attention.