A Close Reading of the NFHS-5

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November 27, 2021

Why in news?

The findings of Phase-II of the 2019-21 National Family Health Survey (NFHS-5) was released by the Union Ministry of Health and Family Welfare.

What is the survey about?

  • The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
  • This year, over 6 lakh households across the country were surveyed for this exercise.
  • The NFHS provides estimates on key indicators related to population, family planning, child and maternal health, nutrition, adult health, and domestic violence, among others.
  • The Ministry of Health and Family Welfare, Government of India, has designated International Institute for Population Sciences (IIPS) as the nodal agency for the NFHS.
  • NFHS was funded by the United States Agency for International Development (USAID) with supplementary support from UNICEF.
  • The First National Family Health Survey (NFHS-1) was conducted in 1992-93.

What are the key findings of the report?

  • Population - The Total Fertility Rates (TFR) has declined from 2.2 to 2.0 at the national level, even below the replacement rate of 2.1.
  • This means that the total population has stabilised and therefore politicians need to devote their energies to urgent health matters, instead of pointing out the population explosion.

TFR is the average number of children born to a woman during her lifetime whereas Replacement Fertility Rate is the level of fertility at which a population exactly replaces itself from one generation to the next.

  • Sex ratio - Nationally, there are 1,020 adult women per 1,000 men portraying that women outnumber men in India for the first time but this raises question on whether this signals the beginning of the end of a tenacious problem of deep-rooted son preference.
  • Nationally, the SRB has improved from 919 in 2015-16 to 929 in 2019-21, but it is still short of the natural SRB.
  • The adult sex ratio is shaped by many factors other than sex selective abortions and in household surveys, the adult sex ratio might also be affected by sampling errors.
  • Therefore, there is a need to recognise that the move to a small family size combined with persistent son preference is likely to impede the improvements in SRB.
  • Anaemia - The incidence of anaemia has increased from 58.6 to 67% in under-5 children, from 53.1 to 57% in women and from 22.7 to 25% in men.
  • Anaemia which is characterised as a serious public health concern by WHO has to be focussed as it is as worsening as the COVID-19 effect.
  • Malnutrition - The three indicators of malnutrition - stunting, wasting and underweight showed an overall improvement.

Child Nutrition indicators

All-India level data

Stunting (low height-for-age)

Declined from 38% to 36%

Wasting (low weight-for-height)

Declined from 21% to 19%

Underweight (low weight-for-age)

Declined from 36% to 32%

  • There is also increase in the proportion of overweight children, women and men with serious health consequences in the form of non-communicable diseases.
  • Breastfeeding - Exclusive breastfeeding to children under age 6 months has shown an improvement in all-India level from 55 percent in 2015-16 to 64% in 2019-21
  • IMR – Infant Mortality Rate has declined marginally across states which can be attributed to the increased institutional births.

IMR is the number of infants who die before reaching the age of one year, per 1,000 live births.

  • Gender related indicators - Indicators on use of hygienic methods of protection during menstrual period among women between 15-24 years of age, and spousal violence among married women were included

nfhs 5

What are the notes of caution about the survey?

  • The NHFS does not have data on micronutrients that are essential for body functions such as producing enzymes, hormones and other substances needed for growth and development.
  • Some analyses have suggested that the rate of progress has slowed down based on comparisons between NHFS-4 and NHFS-5.
  • The data for the second phase of NFHS-5 have been, to a large extent, collected during the unusual conditions of the COVID-19 pandemic but the deterioration in public health indicators cannot be attributed entirely to the pandemic.
  • The data that increase in caesarian births in private health facilities (47.5% births are by C-section) call into question unethical practices of private health providers who prioritise monetary gain over women’s health and control over their bodies.
  • The survey highlights deep inequalities in health outcomes and an action plan to improve India’s health needs to be inclusive, firm in its commitment and backed by solid resources.



  1. https://www.thehindu.com/opinion/lead/a-close-reading-of-the-nfhs-5-the-health-of-india/article37711746.ece
  2. https://prsindia.org/policy/vital-stats/national-family-health-survey-5


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