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.
Nodalagency – 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.
