Why in News?
Recently, NFHS introduced many changes in the dimensions of the survey.
What is NFHS?
- NFHS – It is India’s most comprehensive and regularly conducted household survey that provides reliable, comparable and large scale data on population, health and nutrition indicators.
- Conducted by – The Ministry of Health and Family Welfare.
- Launched in – 1992.
- Nodal agency – The International Institute for Population Sciences as the nodal agency.
- Significance –NFHS has become a critical evidence base for policy formulation, programme evaluation and monitoring of national and global development goals across states and districts in India.
- Tool for governance – Since its inception, NFHS has evolved beyond a simple health survey into a multidimensional tool for governance.
- Core objectives
- Policy Planning – It provides essential, high-quality data to the Ministry of Health and Family Welfare (MoHFW) and other government agencies for crafting targeted policies and programs.
- Trend Tracking – It monitors the effectiveness of ongoing public health initiatives and identifies emerging issues in health and welfare
- The Expanding Role of NFHS in Public Policy – Each successive round has generally expanded its scope by retaining previous indicators while incorporating new themes.
- NFHS-4 (2015–16) – It introduced district-level estimates and digital data collection through tablets.
- NFHS-5 (2019–21) – It further expanded coverage by including indicators related to disability, sanitation, preschool education, menstrual hygiene, death registration, and non-communicable diseases.
- NFHS-6 – It marks a departure from the trend of continuous expansion.
- Coverage – Nearly 6.8 lakh households across all States and Union Territories except Manipur.
- While introducing several new indicators, it also removes many long-standing ones, reducing the total number of indicators from 131 in NFHS-5 to 101 in NFHS-6.
What are the key gains recorded in NFHS-6?
- Improvement in Maternal Healthcare – One of the most encouraging findings of NFHS-6 is the improvement in maternal healthcare services.
- The proportion of mothers receiving at least four antenatal care check-ups has increased significantly compared to NFHS-5.
- This reflects improved healthcare outreach, greater awareness among pregnant women, and better implementation of maternal health programmes such as the Janani Suraksha Yojana and Pradhan Mantri Surakshit Matritva Abhiyan.
- Institutional deliveries have also increased further, indicating greater trust in healthcare facilities and improved accessibility of maternal health services.
- Progress in Child Nutrition – The survey records a decline in child stunting among children under five years of age.
- This suggests gradual improvement in nutritional outcomes and reflects the impact of programmes such as Poshan Abhiyaan, Integrated Child Development Services (ICDS), and targeted nutrition interventions.
- The reduction in stunting observed in NFHS-6 is larger than the decline recorded between NFHS-4 and NFHS-5, indicating accelerated progress in tackling chronic undernutrition.
- Decline in Spousal Violence – NFHS-6 reports a reduction in the proportion of women experiencing spousal violence, from 29.3% in NFHS-5 to 22.3%.
- This improvement may be linked to rising awareness of women's rights, greater access to education, stronger legal protections, and expanding economic opportunities for women.
- Although domestic violence remains a serious concern, the decline represents an important social development.
- Digital Inclusion and Women's Empowerment – A major new finding is the sharp increase in women's internet usage.
- The growth of digital connectivity, affordable smartphones, and government-led digital inclusion initiatives has significantly enhanced women's access to information and services.
- In some States, such as Andhra Pradesh, women’s internet use has more than tripled.
- This development is particularly important because digital access contributes to education, financial inclusion, healthcare awareness, and economic participation.
What are the new dimensions introduced in NFHS-6?
- Direct Benefit Transfers (DBTs) – The survey includes questions regarding the receipt of direct benefit transfers.
- This enables policymakers to assess the reach and effectiveness of welfare delivery systems that increasingly rely on digital platforms.
- Financial Inclusion and Digital Literacy – For the first time, NFHS examines digital literacy and financial transactions. These indicators align with initiatives such as Digital India and the expansion of digital payment systems.
- Self-Help Group Participation – The survey also collects information on membership in self-help groups (SHGs), recognising their growing role in women's empowerment, livelihood generation, and community development.
- Expanded Disease Surveillance – NFHS-6 includes testing for Hepatitis-B and Hepatitis-C among men and women.
- Additionally, blood samples from children are being collected to assess Hepatitis-B prevalence.
- Another significant addition is the reintroduction of biological HIV testing, which had been discontinued in NFHS-5.
- This strengthens disease surveillance and public health planning.
What are the major indicators that have been dropped?
- Anaemia – NFHS-5 reported alarming increases in anaemia among children, women, and pregnant women.
- These findings raised concerns regarding the effectiveness of programmes such as Anaemia Mukt Bharat.
- The reason for removing anaemia relates to methodological concerns.
- NFHS previously measured haemoglobin using finger-prick blood samples and portable analysers.
- Several researchers argued that this method overestimated anaemia prevalence compared to venous blood testing.
- The government has now shifted anaemia assessment to the Diet and Biomarkers Survey conducted by the National Institute of Nutrition, which uses venous blood samples and is considered more accurate.
- However, the absence of anaemia data from NFHS creates a temporary information gap.
- Mortality Indicators – Three critical mortality indicators have been removed:
- Neonatal Mortality Rate (NMR)
- Infant Mortality Rate (IMR)
- Under-Five Mortality Rate (U5MR)
- These indicators are now expected to be monitored through the Sample Registration System (SRS).
- However, unlike NFHS, the SRS does not provide district-level estimates or detailed socio-economic disaggregation.
- Sex Ratio Indicators – NFHS-6 no longer reports:
- Overall sex ratio
- Sex ratio at birth
- The removal is significant because these indicators serve as important measures of gender equity and help monitor sex-selective practices.
- Their absence reduces the availability of a key tool for assessing progress towards gender justice.
- Sanitation and Clean Cooking Fuel – Indicators relating to sanitation access and clean cooking fuel usage have also been dropped.
- These measures were directly linked to flagship programmes such as:
- Swachh Bharat Mission
- Pradhan Mantri Ujjwala Yojana
- Without NFHS data, independent large-scale assessment of these programmes becomes more difficult.
- Cancer Screening Indicators – Indicators related to screening for cervical, breast, and oral cancers, introduced only in NFHS-5, have been removed after a single survey cycle.
- Given the growing burden of non-communicable diseases in India, discontinuing these indicators may limit the understanding of preventive healthcare coverage.
What lies ahead?
- NFHS-6 presents a complex picture of India's development trajectory.
- The survey highlights encouraging progress in maternal healthcare, child nutrition, institutional deliveries, women's digital empowerment, and reduction in domestic violence.
- It also broadens the scope of public health monitoring through new indicators related to digital inclusion, financial access, hepatitis testing, and HIV surveillance.
- However, the removal of several critical indicators—including anaemia, mortality, sanitation, sex ratio at birth, clean cooking fuel use, and cancer screening—raises concerns regarding data continuity and policy accountability.
- While alternative surveys may capture some of these measures, none offer the same comprehensive national and district-level perspective as NFHS.
- Going forward, India must balance the need for methodological improvements and evolving policy priorities with the equally important objective of maintaining long-term, comparable datasets.
- A robust and comprehensive NFHS remains essential for evidence-based governance, effective welfare delivery, and the achievement of sustainable development goals.
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Reference
The Hindu| NFHS - 6
