National Family Health Survey

About National Family Health Survey (NFHS)

The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted in a representative sample of households throughout India. All National Family Health Surveys have been conducted under the stewardship of the Ministry of Health and Family Welfare, Government of India, with the International Institute for Population Sciences, Mumbai, serving as the nodal agency. ICF International (formerly Macro International), Maryland, USA, provided technical assistance for all four surveys conducted as on date.

National Family Health Survey findings

Fifth National Family Health Survey (NFHS-5)

The National Family Health Survey 2019-21 (NFHS-5), the fifth in the NFHS series, provides information on population, health, and nutrition for India and each state/union territory (UT). Like NFHS-4, NFHS-5 also provides district-level estimates for many important indicators. The contents of NFHS-5 are similar to NFHS-4 to allow comparisons over time. However, NFHS-5 includes some new topics, such as preschool education, disability, access to a toilet facility, death registration, bathing practices during menstruation, and methods and reasons for abortion. The scope of clinical, anthropometric, and biochemical testing (CAB) has also been expanded to include measurement of waist and hip circumferences, and the age range for the measurement of blood pressure and blood glucose has been expanded. However, HIV testing has been dropped.

Salient findings are as follows

The key results from the State/UT factsheets are as follows:

• The Total Fertility Rates (TFR) has further declined since NFHS-4 in almost all the Phase-1 States and UTs. The replacement level of fertility (2.1) has been achieved in 19 out of the 22 States/UTs and only 3 states viz. Manipur (2.2), Meghalaya (2.9) and Bihar (3.0) have TFR above replacement levels now.
• Overall Contraceptive Prevalence Rate (CPR) has increased substantially in most States/UTs and it is the highest in HP and WB (74%). Use of modern methods of contraception has also increased in almost all States/UTs.
• Unmet needs of family planning have witnessed a declining trend in most of the Phase-1 States/UTs. The unmet need for spacing which remained a major issue in India in the past has come down to less than 10 per cent in all the States except Meghalaya and Mizoram.
• Full immunization drive among children aged 12-23 months has recorded substantial improvement across States/UTs/districts. More than two-third of children are fully immunized in all the States and UTs except Nagaland, Meghalaya and Assam.  In almost three-fourths of districts, 70% or more children aged 12-23 months are fully immunized against childhood diseases.
• There is increase in the per cent of women receiving the recommended four or more ANC visits by health providers in many States/UTs. This percentage has increased in 13 States/UTs between 2015-16 to 2019-20.
• Institutional births have increased substantially with over four-fifth of the women delivering in institutions in 19 States and UTs.  Institutional delivery is over 90 per cent in 14 out of the total 22 Sates and UTs. Almost 91% of districts recorded over 70% institutional deliveries of births in the 5 years preceding the survey.
• Along with an increase in institutional births, there has also been a substantial increase in C-section deliveries in many States/UTs especially in private health facilities.
• Sex ratio at birth has remained unchanged or increased in most States/UTs. Majority of the states are in normal sex ratio of 952 or above. SRB is below 900 in Telangana, Himachal Pradesh, Goa, DNH & DD.
• Child nutrition indicators show a mixed pattern across states. While the situation improved in many States/UTs, there has been minor deterioration in others. Drastic changes in respect of stunting and wasting are unlikely in a short period.
• Anaemia among women and children continues to be a cause of concern. More than half of the children and women are anaemic in 13 of the 22 States/UTs. It has also been observed that aanaemia among pregnant women has increased in half of the States/UTs compared to NFHS-4, in spite of substantial increase in the consumption of IFA tablets by pregnant women for 180 days or more.
• For both women and men, there is a lot of variation in the high or very high random blood glucose levels across States/UTs. Men are more likely to have slightly higher blood glucose levels in the range of high or very high compared to women. The percentage of men with high or very high blood glucose is highest in Kerala (27%) followed by Goa (24%). Prevalence of elevated blood pressure (hypertension) among men is somewhat higher than in women.
• The percentage of households with improved sanitation facility and clean fuel for cooking has increased in almost all the 22 States/UTs over the last four years (from  2015-16  to  2019-20). The Government of India has made concerted efforts to provide toilet facilities to maximum households through Swachh Bharat Mission, and improved household environment through Pradhan Mantri Ujjwala Yojana in the country. For instance, the use of cooking fuel has increased more than 10 percentage point in all the States and UTs during the last 4 years with over 25 percentage point increase in states of Karnataka and Telangana.
• Women’s empowerment indicators portray considerable improvement across all the States/UTs included in Phase 1. Considerable progress has been recorded between NFHS-4 and NFHS-5 in regard to women operating bank accounts.  For instance, in the case of Bihar the increase was to the tune of 51 percentage point from 26 per cent to 77 per cent. More than 60 per cent of women in every state and UTs in the first phase have operational bank accounts.

For the reports, click here.

Fourth National Family Health Survey (NFHS-4)

The Fourth National Family Health Survey (NFHS-4) was carried out in 2014-2015. NFHS-4 funding was provided by the Government of India, the United States Agency for International Development (USAID), the Department for International Development (DFID), the Bill and Melinda Gates Foundation, UNICEF, the United Nations Population Fund (UNFPA), and the MacArthur Foundation. Technical assistance for the HIV component of the survey was provided by the National AIDS Control Organization and the National AIDS Research Institute.

NFHS-4 is the first of the NFHS series that collects data in each of India’s 29 States and all 7 Union Territories. Also, NFHS-4, for the first time, will provide estimates of most indicators at the district level for all 640 districts of the country included in the 2011 Census. In NFHS-4, women aged 15-49 years and men aged 15-54 years are interviewed.

Salient findings of NFHS-4

The results from the first phase of the National Family Health Survey (NFHS-4), 2015-16 has been made available. Findings for the 13 States of Andhra Pradesh, Bihar, Goa, Haryana, Karnataka, Madhya Pradesh, Meghalaya, Sikkim, Tamil Nadu, Telangana, Tripura, Uttarakhand, West Bengal and two Union Territories of Andaman and Nicobar Islands and Puducherry have been released. Data collection for the second phase States and Union Territories is currently ongoing.
The salient findings are as follows

• Fewer children are dying in infancy and early childhood - All 15 States/Union Territories have rates below 51 deaths per 1,000 live births, although there is considerable variation among the States/Union Territories. Infant mortality rates range from a low of 10 in Andaman and Nicobar Islands to a high of 51 deaths per 1000 live births in Madhya Pradesh.
• Better care for women during pregnancy and childbirth contributes to reduction of maternal deaths and improved child survival- Almost all mothers have received antenatal care for their most recent pregnancy and increasing numbers of women are receiving the recommended four or more visits by the service providers. More and more women now give birth in health care facilities and rates have more than doubled in some States in the last decade. More than nine in ten recent births took place in health care facilities in Andaman and Nicobar Islands, Andhra Pradesh, Goa, Karnataka, Puducherry, Sikkim, Tamil Nadu, and Telangana, providing safer environments for mothers and new-borns.
• Overall, women in the First Phase States/Union Territories are having fewer children - The total fertility rates, or the average number of children per woman, range from 1.2 in Sikkim to 3.4 in Bihar. All First Phase States/Union Territories except Bihar, Madhya Pradesh and Meghalaya have either achieved or maintained replacement level of fertility– a major achievement in the past decade.
• Full immunization coverage among children age 12-23 months varies widely in the First Phase States/Union Territories - At least 6 out of 10 children have received full immunization in 12 of the 15 States / Union Territories. In Goa, West Bengal, Sikkim, and Puducherry more than four-fifths of the children have been fully immunised. Since the last round of National Family Health Survey, the coverage of full immunization among children has increased substantially in the States of Bihar, Madhya Pradesh, Goa, Sikkim, West Bengal and Meghalaya.
• Married women are less likely to be using modern family planning in eight of the First Phase States/Union Territories - There has been an increase in the use of modern family planning methods only in the States of Meghalaya, Haryana, and West Bengal. The decline is highest in Goa followed by Karnataka and Tamil Nadu. Despite the decline, about half or more married women are using modern family planning in eight of the 15 States/Union Territories.
• Fewer children under five years of age are now found to be stunted, showing intake of improved nutrition - In nine States/Union Territories, less than one-third of children are found too short for their age. While this reveals a distinct improvement since the previous survey, it is found that in Bihar, Madhya Pradesh and Meghalaya more than 40% of children are stunted. Wasting is still very high by international standards in all of the States/Union Territories. Anaemia has also declined, but still remains widespread. More than half of children are anaemic in ten of the 15 States/Union Territories. Similarly, more than half of women are anaemic in eleven States/Union Territories. Over-nutrition continues to be a health issue for adults. At least 3 in 10 women are overweight or obese in Andaman and Nicobar Islands, Andhra Pradesh, Goa, Puducherry, and Tamil Nadu.
• Over two-thirds of households in every State/Union Territory have access to an improved source of drinking water, and more than 90% of households have access to an improved source of drinking water in nine of the 15 States/Union Territories - More than 50% of households have access to improved sanitation facilities in all First Phase States/Union Territories except Bihar and Madhya Pradesh. Use of clean cooking fuel, which reduces the risk of respiratory illness and pollution, varies widely among the First Phase States/Union Territories, ranging from only about 18% of households in Bihar to more than 70% of households in Tamil Nadu and more than 80% of households in Puducherry and Goa.
• Lack of HIV awareness in Indian adults - Nearly 82 % women and nearly 70 % men in the 13 States lacked comprehensive knowledge of HIV/AIDS and safe sex practices. A comparison with NFHS 3 revealed that while 45% men had ‘heard of’ HIV in 2005 (across the 13 States for which partial data has been released), only 30% currently are aware of the disease. For women, the figure fell from 24% in 2005 to 18% in 2016. The most drastic fall in awareness is in Andhra Pradesh.
• Tobacco use among men has fallen from 50 per cent in 2005-06 to 47 per cent in 2015. Similarly, alcohol consumption among men has fallen from 38 per cent to 34 per cent. Over the last decade, consumption of alcohol among men has fallen in Madhya Pradesh, Bihar, Uttarakhand, Haryana, West Bengal and Meghalaya.

For the reports, click here.

First National Family Health Survey (NFHS-1)

The First National Family Health Survey (NFHS-1) was conducted in 1992-93. The survey collected extensive information on population, health, and nutrition, with an emphasis on women and young children. Eighteen Population Research Centres (PRCs), located in universities and institutes of national repute, assisted IIPS in all stages of conducting NFHS-1. All the state-level and national-level reports for the survey have already been published (48 reports in all). For the reports, click here.

Second National Family Health Survey (NFHS-2)

The Second National Family Health Survey (NFHS-2) was conducted in 1998-99 in all 26 states of India with added features on the quality of health and family planning services, domestic violence, reproductive health, anemia, the nutrition of women, and the status of women. The results of the survey have been published. For the reports, click here.

Third National Family Health Survey (NFHS-3)

The Third National Family Health Survey (NFHS-3) was carried out in 2005-2006. Eighteen Research Organizations including five Population Research Centres carried out the survey in 29 states of India. The funding for NFHS-3 is provided by USAID, DFID, the Bill and Melinda Gates Foundation, UNICEF, UNFPA, and MOHFW, GOI. ORC Macro, USA, is providing technical assistance for NFHS-3, and the National AIDS Control Organization (NACO) and the National AIDS Research Institute (NARI) are providing technical assistance for the HIV component.

For the reports, click here.

Source : National Family Health Survey website

Related resources

1. Manual on health statistics in India