National Family Health Survey NFHS – 5

What is the National Family Health Survey (NFHS)?

• The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
• Five rounds of the survey have been conducted since the first survey in 1992-93.
• The survey provides state and national information for India on fertility, infant and child mortality, the practice of family planning, maternal and child health, reproductive health, nutrition, etc.
• The Ministry of Health has designated the International Institute for Population Sciences (IIPS) Mumbai, as the nodal agency, responsible for providing coordination and technical guidance for the survey.
• IIPS has collaborated with the following international agencies for the successful conduct of the survey.

1. ORC, Macro, Maryland, USA
2. East-West Centre, Honolulu, Hawaii, USA

Note: in NFHS 4 and NFHS 5, along with USAID and ICF; DFID, the Bill and Melinda Gates Foundation, UNICEF, UNFPA, and the MacArthur Foundation, as well as the Indian Government also supported the surveys in a major way.

Which Agencies Provided the Funding for NFHS?

• Many international agencies and the Central Government Ministry have provided the necessary funds to carry out the survey.
• United States Agency for International Development (USAID)
• United Nations Children’s Fund (UNICEF)
• Bill and Melinda Gates Foundation
• United Nations Population Fund (UNFPA)
• MOHFW, Government of India
• Also, the data that is published by the Ministry is also used by the WHO, World Bank & UNICEF.

National Family Health Survey (NFHS-5)?

• National Family Health Survey 5 is the recent round of the survey carried on by MoH&FW to bring out reliable data on emerging health and family welfare issues.

• The coordinating and implementing agencies that are helping the ministry to bring out this NFHS round are:

1. International Institute for Population Sciences, Mumbai
2. A group of survey organizations and Population Research Centers

• ICF International is providing technical assistance for the NFHS 5 while the United States Agency for International Development is providing financial assistance.
• Seven lakh households are being covered to collect the data.
• 67 indicators are being used to cover the NFHS 5 data. The list of important indicators is mentioned below:

1. Population and household profile (PT POINTER)
2. Marriage and fertility
3. Family planning
4. Contraception
5. Maternal and child health
6. Delivery care
7. Vaccinations
8. Treatment of childhood diseases
9. Nutrition and feeding practices
10. Anemia
11. Diabetes
12. Hypertension and
13. Cancer examination

Note: The data for NFHS was expected to be released by July 2020 but due to the current pandemic situation, it has been delayed.

• The States and UTs which were surveyed in Phase-II are Arunachal Pradesh, Chandigarh, Chhattisgarh, Haryana, Jharkhand, Madhya Pradesh, NCT of Delhi, Odisha, Puducherry, Punjab, Rajasthan, Tamil Nadu, Uttar Pradesh, and Uttarakhand.
• The findings of NFHS-5 in respect of 22 States & UTs covered in Phase-I were released in December 2020.

National Family Health Survey-5 Phase I covered 22 States and UTs. It was released in December 2020.

For Findings of National Family Health Survey-5 Phase I: Click here.

NFHS-5 Phase II

• The States and UTs which were surveyed in Phase-II are Arunachal Pradesh, Chandigarh, Chhattisgarh, Haryana, Jharkhand, Madhya Pradesh, NCT of Delhi, Odisha, Puducherry, Punjab, Rajasthan, Tamil Nadu, Uttar Pradesh and Uttarakhand.
• The findings of NFHS-5 in respect of 22 States & UTs covered in Phase-I were released in December 2020.
• The main objective of successive rounds of the NFHS is to provide reliable and comparable data relating to health and family welfare and other emerging issues.
• The National Family Health Survey-5 survey work has been conducted in around 6.1 lakh sample households from 707 districts (as of March 2017) of the country; covering 724,115 women and 101,839 men to provide disaggregated estimates up to district level.
• All the results of NFHS-5 are available in the public domain on the Ministry website (www.mohfw.gov.in ).
• The all-India and State/UT level factsheet released includes information on 131 key indicators.
• It provides information on important indicators which are helpful in tracking the progress of Sustainable Development Goals (SDGs) in the country. NFHS-4 (2015-16) estimates were used as baseline values for a large number of SDG indicators.
• Many indicators of the National Family Health Survey-5 are similar to NFHS-4carried out in 2015-16 to make possible comparisons over time.
• However, NFHS-5 includes some new focal areas, 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 ranges for measuring hypertension and diabetes among all aged 15 years and above, which will give requisite input for strengthening existing programs and evolving new strategies for policy intervention.

Findings of NFHS - Phase II and Total

• The Sex Ratio of India is now 1020 at the national level.
• The Total Fertility Rates (TFR), an average number of children per woman has further declined from 2.2 to 2.0 at the national level and all 14States/UT’s ranging from 1.4 in Chandigarh to 2.4 in Uttar Pradesh. All Phase-II States have achieved replacement levels of fertility (2.1) except Madhya Pradesh, Rajasthan, Jharkhand, and Uttar Pradesh.
• Overall Contraceptive Prevalence Rate (CPR) has increased substantially from 54% to 67% at the all-India level and in almost all Phase-II States/UTs with an exception of Punjab. The use of modern methods of contraceptives has also increased in almost all States/UTs.
• Unmet needs of family Planning have witnessed a significant decline from13 percent to 9 percent at the all-India level and in most of the Phase-II 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 in all the States except Jharkhand (12%), Arunachal Pradesh (13%), and Uttar Pradesh(13%).
• Full immunization drive among children aged 12-23 months have recorded a substantial improvement from 62 % to 76% at the all-India levels. 11out of 14 States/UTs have more than three-fourth of children aged 12-23 months with full immunization and it is highest (90%) for Odisha.
• On comparing NFHS-4 and NFHS-5 data, the increase in full immunization coverage is observed to be expeditious in many states and UTs; More than50 percent of Phase-II States/ UTs are sharing over 10 percentage points during the short span of 4 years. This can be attributed to the flagship initiative of Mission Indradhanush launched by the government in 2015.
• There is an increase from 51 % to 58% of women receiving the recommended four or more ANC visits by health providers at the all-India levels.
• Also, all the Phase-II States/UTs have shown improvement except Punjab between 2015-16 to2019-20.
• Institutional births have increased substantially from 79 percent to 89 percent at all-India Level. Institutional delivery is 100 percent in Puducherry and Tamil Nadu and more than 90 percent in 7 States/UTs out of 12 PhaseII States/UTs.
• 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.
• Child Nutrition indicators show a slight improvement at an all-India level as Stunting, Wasting and Underweight have declined.

1. Stunting has declined from 38 percent to 36 percent,
2. wasting from 21 percent to 19 percent, and
3. underweight from 36 percent to 32 percent at the all-India level.
4. In all phase-II States/UTs situation has improved in respect of child nutrition but the change is not significant as drastic changes in respect of these indicators are unlikely in a short span period.

• Anaemia among children and women continues to be a cause of concern. More than half of the children and women (including pregnant women) areanemic in all the phase-II States/UTs and all-India level compared to NFHS4, in spite of the substantial increase in the composition of iron-folic acid (IFA)tablets by pregnant women for 180 days or more.
• Exclusive breastfeeding to children under age 6 months has shown an improvement in the all-India level from 55 percent in 2015-16 to 64 percent in 2019-21. All the phase-II States/UTs are also showing considerable progress.
• Women's empowerment indicators portray considerable improvement at all Indian level and across all the phase-II States/UTs. Significant progress has been recorded between NFHS-4 and NFHS-5 in regard to women operating bank accounts from 53 percent to 79 percent at the all-India levels. For instance, in the case of Madhya Pradesh, the increase was to the tune of 37 percentage points from 37 percent to 75 percent. More than 70 percent of women in every state and UTs in the second phase have operational bank accounts.

Download the whole Factsheet of National Family Health Survey-5 in comparison with NFHS-4