National Family Health Survey-6

Why in News?

India made significant progress in maternal and child health, with improvements in vaccination and hospital births, and a drop in stunting and severe wasting among young children, according to the National Family Health Survey-6.

What is National Family Health Survey (NFHS)?

• NFHS  is a large-scale, multi-round household survey conducted across India.
• It provides vital, nation- and state-level data on population, health, and nutrition.
• Managed by - The Ministry of Health and Family Welfare (MoHFW).
• Conducted by - Mumbai's International Institute for Population Sciences (IIPS).
• Survey Rounds - Since its inception, 5 major rounds of the NFHS have been completed, with a 6^th rolling out - NFHS-6 (2023-2024).

What are the Key Data’s tracked by NHFS?

• The NFHS gathers information on a wide range of public health and demographic indicators:
• Demographics - Fertility rates, family planning methods, and mortality rates (infant, child, and maternal).
• Maternal & Child Health - Antenatal care, delivery care, vaccinations, and breastfeeding practices.
• Nutrition & Health Status - Anemia, stunting, wasting, and Body Mass Index (BMI) for children and adults.
• Emerging Issues - Domestic violence, knowledge of HIV/AIDS, and access to sanitation.

What are the Key Highlights of NFHS-6?

• The survey shows significant progress in basic health, universal immunization, and financial protection while flagging a critical shift toward lifestyle diseases and a dual burden of nutrition.

Total Fertility Rate (TFR) is the average number of children a woman would have in her lifetime if she survives through her childbearing years and experiences current age-specific fertility rates.

Stunting refers to impaired physical and cognitive growth in children, defined as having a height significantly lower than the standard for their age.

Wasting refers to the process where a person is too thin for their height, resulting from recent, severe weight loss or an inability to gain weight.

• Maternal health progress - India’s total fertility rate held steady at 2.0 in 2023-24, just under the replacement threshold of 2.1%, while the contraceptive prevalence rate rose from 66.7% to 69.1%.
• The survey highlights progress in maternal health services across the country, with 95.9% of pregnant women receiving antenatal care, including
  • 76.2% in the first trimester, an increase from 70% in the previous survey period.
• Mothers receiving at least 4 antenatal care visits also increased from 58.5% to 65.2%.
• Maternal nutrition indicators also showed improvement, with mothers consuming iron folic acid supplements for 100 days or more during pregnancy rising from 44.1% to 54.9%.
• Those consuming supplements for 180 days or more rose from 26% to 37.8%.
• Increasing Use of Hygiene - It found that the use of hygienic methods of menstrual protection among women age 15-24 years has increased from 77.6% to 79.2%.
• Rise in Health insurance coverage - Health insurance or financing scheme coverage expanded significantly from 41% to 60.2% at the household level.
• Doubling in Internet Usage - The percentage of women who have used the internet nearly doubled from 33.3% to 64.3%.
• Women having a mobile phone that they use themselves rose from 53.9% to 63.6%.
• Increase in Bank Account Usage - Women having a bank or savings account that they use themselves rose from 78.6% to 89%.

What are the Architectural & Methodological Changes in NFHS-6?

• NFHS-6 expanded its canvas to adapt to India's evolving socio-economic and digital needs:
• Expanded Footprint - Surveyed approximately 6.79 lakh households across 715 districts (covering all States/UTs except Manipur due to security situations).
• Technological Shift - Fully utilized Computer-Assisted Personal Interviewing (CAPI), facilitating real-time data checks and higher data integrity.
• New topics added - Direct Bank Transfer (DBT) and Self-Help Group (SHG) coverage, digital literacy and financial transactions, etc.
• The scope of clinical, anthropometric, and biochemical testing (CAB) has also been expanded to include HIV testing.
• New Modular Additions - Integrated metrics on
  • Direct Benefit Transfer (DBT) coverage,
  • Self-Help Group (SHG) footprints,
  • Advanced digital literacy, and
  • Expanded biochemical testing (including HIV testing).

What are the key challenges posed by the survey?

• The survey flagged the increase in non-communicable diseases, lifestyle-related risks, and the dual burden of undernutrition and increasing obesity among adults as persistent health challenges.
• The C-Section Surge - National Trend - C-section deliveries rose from 21.5% to 27.2%, far exceeding the WHO’s optimal threshold of 10–15%.
• Sectoral Disparity - Private hospitals recorded 54.1% C-sections compared to just 16.9% in public health facilities, highlighting a commercialized trend in private maternal care.
• Spatial Divide - Urban areas clocked a 40% C-section rate, driven heavily by urban corporate healthcare centers.
• Rising Adult Obesity - 5-Year Surge (2019–2024) - Overweight/obese individuals in the 15–49 age group increased by 6.7 percentage points for women and 4.4 percentage points for men.
• Gender Indicator - Women’s obesity rate jumped significantly from 24% to 30.7%.
• Urban-Rural Divide - Obesity remains heavily concentrated in cities. Urban areas reported 42.8% of women as overweight or obese, nearly double the rural rate of 25.5%.
• Thus, India is shifting from infectious-disease burdens to lifestyle-centric, chronic NCD risks (such as diabetes and hypertension).
• Rising Non-Communicable Diseases (NCDs) - The obesity footprint is moving alongside elevated blood sugar and hypertension metrics.
• This threatens to create a massive out-of-pocket health expenditure crisis for families, as public infrastructure remains primarily geared toward acute and communicable disease treatments. 
• Persistent Under-5 Vulnerability - Despite structural drops in stunting and severe wasting, roughly 1 in every 3 Indian children still suffers from chronic undernutrition, showing a slow rate of nutritional transition.
• The Omission of Anaemia Biomarkers - One of the biggest debate points in NFHS-6 was the official removal of blood-drawn anaemia testing.
• Critics argue that removing this biomarker undercuts longitudinal tracking of the Anaemia Mukt Bharat strategy, making it difficult to assess iron-deficiency trends on the ground.

What is the way forward?

Maternal Health & Private Sector

• Mandatory Auditing - Enforce strict audits for private hospitals exceeding WHO’s 10–15% C-section threshold.
• Decouple Incentives - Implement flat-rate delivery packages to eliminate profit-driven surgeries.
• Scale Midwifery - Expand the Nurse Practitioner Midwife cadre to promote natural childbirth.

Obesity & NCDs

• Fiscal Deterrents - Impose higher GST on ultra-processed foods to curb urban obesity.
• Mandatory FOPL - Fast-track FSSAI’s Front-of-Pack labeling warnings.
• Strengthen HWCs - Equip ASHAs with digital tools for early diabetes and hypertension surveillance.

Child Nutrition

• Targeted Feeding - Use POSHAN 2.0 to distribute regional, millet-based infant fortifiers.
• Leverage U-WIN - Digitally track and micro-target areas with high child wasting.

Data Deficits

• Restore Anemia Testing - Re-integrate objective blood-drawn testing into national baselines.
• Regional Appraisals - Conduct specialized surveys for left-out, conflict-hit pockets.

References

1. NFHS | NFHS-6
2. The Hindu | NFHS-6
3. The Indian Express | NFHS-6