What is National Family Health Survey (NFHS)?

The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted based on the representative samples collected from households throughout India.

The NFHS survey provides state and national information for India on various health parameters such as fertility, infant and child mortality, the practice of family planning, maternal and child health, reproductive health, nutrition, anaemia, utilization and quality of health and family planning services.

Who releases the National Family Health Survey?

NFHS is released by the Ministry of Health and Family Welfare (MOHFW).

But the MOHFW designated the International Institute for Population Sciences (IIPS), Mumbai, as the nodal agency. The IIPS is responsible for providing coordination and technical guidance for the survey.

Technical assistance for the NFHS was provided mainly by ORC Macro (USA) but various other organizations assist with specific issues.

Who will fund for National Family Health Survey (NFHS)?

The Survey of this size cannot be carried out with government funds alone. Many international agencies provide funds to carry out the NFHS. They are,

• United States Agency for International Development (USAID)
• The Bill and Melinda Gates Foundation
• Department for International Development (DFID)
• United Nations Children’s Fund (UNICEF)
• United Nations Population Fund (UNFPA)
• MOHFW, Government of India

What is the Goal of National Family Health Survey (NFHS)?

Every National Family Health Survey (NFHS) has two specific goals to fulfill. They are

1. to provide essential data needed by the Ministry of Health and Family Welfare and other agencies for informed decision making and policy and programme intervention purposes.
2. to provide insight regarding important emerging health and family welfare issues

Apart from these two specific objectives, NFHS also helps to monitor the progress of various Sustainable Development Goals (SDGs) especially SDG-3 (Good Health and Well-Being).

How many National Family Health Surveys (NFHS) conducted so far?

There are 5 rounds of National Family Health Surveys (NFHS) conducted so far in India. They are,

1. First Round of NFHS conducted in 1992-93 (NFHS-1)
2. Second Round of NFHS conducted in 1998-99 (NFHS-2)
3. Third Round of NFHS conducted in 2005-06 (NFHS-3)
4. Fourth Round of NFHS conducted in 2015-16 (NFHS-4)
5. Fifth Round of NFHS conducted in 2019-20 (NFHS-5)

The NFHS-1, NFHS-2, NFHS-3 didn’t cover UTs except for Delhi because the objective of the survey then was to provide State-level estimates. (Source)

Since NFHS-4, the survey introduced district-level estimates for many important indicators and also included other UTs to provide holistic information.

5^th round of National Family Health Survey (NFHS-5): (Source)

The MOHFW recently released Phase – I of NFHS-5 comprising data for 22 states/UTs. The Survey was earlier expected to release in July but due to the Covid-19 pandemic the release of the survey got delayed and it is finally released on 12^th December 2020.

The fieldwork in the remaining 14 (Phase-II) States/UTs is currently in progress and expected to be available in May 2021.

The national-level indicators including most of the SDG health indicators are expected to be available by June/July 2021.

Important points regarding NFHS-5:

• The state factsheet released includes information on 131 key indicators.
• The district-level factsheet includes information on 104 key indicators.
• NFHS-5 uses the majority of NFHS-4 key indicators so that it would be comparable with NFHS-4 without any loss of information.

What is new in the 5^th round of NFHS (NFHS-5)?

The NFHS-5 also included district-level estimates which were introduced during the NFHS-4. Apart from that NFHS-5 also included some new topics such as

• Preschool education,
• Disability,
• Access to a toilet facility,
• Death registration,
• Bathing practices during menstruation (menstrual hygiene),
• Methods and reasons for abortion.
• components of micro-nutrients to children,
• frequency of alcohol and tobacco use,
• additional components of non-communicable diseases (NCDs),
• expanded age ranges for measuring hypertension and diabetes among all aged 15 years and above etc.

What are the key findings of NFHS-5? (Source: The Hindu)

• Malnutrition: Of the 22 States and UTs, there is an increase in the prevalence of severe acute malnutrition in 16 States/UTs (compared to NFHS-4 conducted in 2015-16).
  • The percentage of children under five who are underweight has also increased in 16 out of the 22 States/UTs.
  • There is also an increase in the prevalence of other indicators such as adult malnutrition measured by those having a Body Mass Index of less than 18.5kg/m2 in many States/ UTs.
• Anaemia: Anaemia levels among children as well as adult women have increased in most of the States with a decline in anaemia among children being seen only in four States/UTs.
• Obesity: Most States/UTs also see an increase in overweight/obesity prevalence among children and adults, once again drawing attention to the inadequacy of diets in India both in terms of quality and quantity.
• Stunting: The data report an increase in childhood stunting in 13 of the 22 States/UTs compared to the data of NFHS-4.
  • There was a 10-pp (Percentage Point) decline in stunting among children under five between 2005-06 (NFHS-3) and 2015-16 (NFHS-4), from 48% to 38%, averaging 1 pp a year. This was considered to be a very slow pace of improvement.
• Starvation: Volunteers of the Right to Food campaign have listed over 100 starvation deaths based on media and/or verified fact-finding reports since 2015.
• Food insecurity: Field surveys such as ‘Hunger Watch’ are already showing massive levels of food insecurity and decline in food consumption, especially among the poor and vulnerable households.
  • In the Hunger Watch survey carried out in 11 States, two-thirds of the respondents reported that the nutritional quality and quantity of their diets worsened in September-October compared to before the lockdown.
• Jump in Vaccination: The survey has found considerable improvement in vaccination coverage among children aged 12-23 months across all States/UTs.
• Urban-Rural gender gaps in Internet use: There is an urban-rural gap as well as gender divide with respect to the use of the Internet. On average, less than 3 out of 10 women in rural India and 4 out of 10 women in urban India ever used the Internet.
• Increase in bank accounts operated by women: The number of bank accounts that women not only hold but also operate themselves has increased dramatically over the past five years.