National Family Health Survey (NFHS) – 5

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About NFHS-5-

• NFHS is a country-wide survey conducted by Ministry of Health and Family Welfare, Government of India, with the International Institute for Population Sciences(Mumbai) serving as the nodal agency.
• The report comprises detailed information on key domains of population, health and family welfare and associated domains like characteristics of the population; fertility; family planning; infant and child mortality; maternal and child health; nutrition and anaemia; morbidity and healthcare; women’s empowerment etc.
• It is a collaborative project of the International Institute for Population Sciences(IIPS), Mumbai, India; ICF, Calverton, Maryland, USA and the East-West Center, Honolulu, Hawaii, USA. 
• NFHS was funded by the United States Agency for International Development (USAID) with supplementary support from United Nations Children’s Fund (UNICEF). 
• The First National Family Health Survey (NFHS-1) was conducted in 1992-93. 
• The main objective of successive rounds of the NFHS has been to provide reliable and comparable data relating to health and family welfare and other emerging areas in India. 
• The NFHS-5 survey work has been conducted in around 6.37 lakh sample households from 707 districts (as on March, 2017) of the country from 28 States and 8 UTs.
• The national report also provides data by socio-economic and other background characteristics useful for policy formulation and effective programme implementation.
• The scope of NFHS-5 is expanded in respect of earlier round of the survey (NFHS-4) by adding new dimensions such as death registration, pre-school education, expanded domains of child immunization, components of micro-nutrients to children, menstrual hygiene, frequency of alcohol and tobacco use, additional components of non-communicable diseases (NCDs), expanded age range for measuring hypertension and diabetes among all aged 15 years and above. 
• NFHS-4 (2015-16) estimates were used as baseline values for a large number of SDG indicators and NFHS- 5 will provide data for around 34 SDG indicators at various levels.

Key findings of the report-

Key results from NFHS-5 National Report- Progress from NFHS-4 (2015-16) to NFHS-5 (2019-21):

Total Fertility Rates (TFR):

• The TFR, an average number of children per women, has further declined from 2.2 to 2.0 at the national level between NFHS-4 & 5. 
• There are only five States in India, which are above replacement level of fertility of 2.1. They are Bihar (2.98), Meghalaya (2.91), Uttar Pradesh (2.35), Jharkhand (2.26) Manipur (2.17).
• India has made significant progress in population control measures in recent times. 

Contraceptive Prevalence Rate (CPR):

• Overall CPR has increased substantially from 54% to 67% in the country. 
• Use of modern methods of contraceptives has also increased in almost all States/UTs. 
• The unmet need for spacing, which remained a major issue in India in the past has come down to less than 10 percent.

Antenatal care (ANC) visit:

• The proportion of pregnant women who had an ANC visit in the first trimester increased from 59 to 70 percent between NFHS-4 and NFHS-5. 
• In most of the States, with the maximum increase of 25 percentage points in Nagaland, followed by Madhya Pradesh and Haryana was noticed. 
• In contrast, Goa, Sikkim, Punjab and Chhattisgarh showed marginal decrease in first trimester ANC visits. 

Institutional Births:

• Institutional Births have increased substantially from 79 percent to 89 percent in India. 
• Even in rural areas around 87 percent births are delivered in Institutions and the same is 94 percent in urban areas. 
• Institutional births increased by a maximum of 27 percentage points in Arunachal Pradesh, followed by over 10 percentage points in Assam, Bihar, Meghalaya, Chhattisgarh, Nagaland, Manipur, Uttar Pradesh, and West Bengal. 

Vaccination/Immunization:

• In NFHS-5, more than three-fourths (77%) children age 12-23 months were fully immunized, compared with 62 percent in NFHS-4. 
• Full vaccination coverage among children ranges from 57 percent in Nagaland to 95 percent in DNH & DD. 
• Odisha (91%), Tamil Nadu (89%), and West Bengal (88%) also have shown relatively higher immunization coverage.

Level of stunting:

• The level of stunting among children under 5 years has marginally declined from 38 to 36 percent for India since the last four years. 
• Stunting is higher among children in rural areas (37%) than urban areas (30%) in 2019-21. 
• Variation in stunting ranges from the lowest in Puducherry (20%) and highest in Meghalaya (47%). 

Overweight or obesity:

• The prevalence of overweight or obesity has increased in most States/UTs in NFHS-5. 
• At national level, it increases from 21 percent to 24 percent among women and 19 percent to 23 percent among men. 
• More than a third of women in Kerala, A&N Islands, Andhra Pradesh, Goa, Sikkim, Manipur, Delhi, Tamil Nadu, Puducherry, Punjab, Chandigarh and Lakshadweep (34-46 %) are overweight or obese.

SDG indicators:

• NFHS-5 shows an overall improvement in SDG indicators in all States/UTs. 
• The extent to which married women usually participate in three household decisions (about health care for herself; making major household purchases; visit to her family or relatives) indicates that their participation in decision making is high, ranging from 80 percent in Ladakh to 99 percent in Nagaland and Mizoram. 
• Rural (77%) and urban (81%) difference is found to be marginal. 
• The prevalence of women having a bank or savings account that they use has increased from 53 to 79 percent in the last 4 years.

Clean cooking fuel & sanitation:

• Between NFHS-4 and NFHS-5, the use of clean cooking fuel (44% to 59%) and improved sanitation facilities (49% to 70%), including a hand-washing facility with soap and water (60% to 78%) have improved considerably. 
• There has been a substantial increase in the proportion of households using improved sanitation facilities, which could be attributed to the Swatch Bharat Mission programme.

New dimensions in NFHS-6 (2023-24) – Learning from NFHS-5-

  Due to the ongoing COVID-19 pandemic, a number of new challenges related to the health system have emerged in the country. In this context, NFHS-6, which is scheduled to be conducted during 2023-24, propose to cover various new domain areas, which include:

• COVID-19 hospitalization and distress financing, COVID-19 vaccinations, Director Benefit Transfers (DBT) under various welfare schemes initiated by GoI, Migration, Digital literacy, Utilization of health services— counselling on family planning after abortion and incentives under new methods of family planning, quality of family planning programme, menstrual hygiene, marital choice, visit by community health workers for health awareness and needs, supplementary nutrition from the Anganwadi/ ICDS center while breastfeeding, blood transfusion (month and year), financial inclusion among women, knowledge of anaemia, Hepatitis B &C, Syphilis etc. 
• Unlike in previous rounds, NFHS-6 will adopt Urban Frame Survey (UFS, 2012-17) of National Statistical Office (NSO), Ministry of Statistics and Programme Implementation (MOSPI) as a sampling frame for urban area. 
• This strategy will minimize the non-sampling errors to large extent as the boundary identification problems using 2011 census frame will be resolved. 
• While for rural areas, updated list of villages from NSO will be used as a frame, which would be matched with the PCA from the Census to get auxiliary information.

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