National Family Health Survey-5

About

The National Family Health Survey-5 (NFHS-5) is the fifth round of India’s large-scale survey on population, health, nutrition and family welfare. It provides national, State/UT and district-level information on important indicators such as fertility, maternal and child health, nutrition, anaemia, family planning and healthcare utilisation.

NFHS-5 also expanded its scope to include issues such as disability, preschool education, sanitation, death registration, menstrual practices and certain non-communicable diseases, making it an important database for evidence-based policymaking and monitoring SDG-related indicators.

Who Conducted NFHS-5?

• The Ministry of Health and Family Welfare (MoHFW) is the nodal ministry responsible for NFHS.
• The International Institute for Population Sciences (IIPS), Mumbai, was designated as the nodal agency for conducting the survey.
• The fieldwork was carried out by 17 field agencies.
• Data were collected using Computer-Assisted Personal Interviewing (CAPI) in 19 languages.
• The survey covered 6,36,699 households, 7,24,115 women and 1,01,839 men.

Survey Period

The survey was conducted in two phases during 2019–21. The second phase was delayed because of the COVID-19 pandemic, and fieldwork was finally completed in April 2021.

Goals of NFHS-5

• The main objective of NFHS-5 was to provide reliable and comparable data on population, health and family welfare for policymaking.
• It aimed to assess changes in fertility, mortality, family planning, maternal and child health and nutrition.
• It also sought to provide evidence on emerging health and social issues.
• The survey provides data that can be used by the Central and State Governments to evaluate existing programmes and identify areas requiring policy intervention.
• Its findings also support India’s monitoring of health-related Sustainable Development Goals (SDGs).

Funding

NFHS-5 was primarily funded by the Government of India through the Ministry of Health and Family Welfare.

• The USAID-supported Demographic and Health Surveys (DHS) Programme and ICF, USA, provided technical assistance and additional funding.
• ICMR and the National AIDS Research Institute (NARI), Pune, provided assistance for certain clinical, anthropometric and biochemical tests.

Background of NFHS

The NFHS programme was started in 1992–93 to create a reliable national database on population, health and family welfare. All five rounds have been conducted under the stewardship of the Ministry of Health and Family Welfare, with IIPS serving as the nodal agency.

Evolution of NFHS

Important Evolution

A major change from NFHS-4 onwards was the greater emphasis on district-level estimates, allowing governments to identify geographical pockets of poor health outcomes and design more targeted interventions.

Key Findings of NFHS-5

Fertility

·       India’s Total Fertility Rate (TFR) declined from 2.2 in NFHS-4 to 2.0 in NFHS-5, taking the national fertility rate below the replacement level of 2.1.

·       This indicates that India is moving towards a new demographic phase in which population ageing, changing dependency ratios and management of the demographic dividend will become increasingly important.

Family Planning

·       The overall contraceptive prevalence rate increased from 54% to 67% between NFHS-4 and NFHS-5. At the same time, the unmet need for family planning declined from 13% to 9%.

·       This indicates greater access to and adoption of family-planning methods.

Maternal Healthcare

·       The proportion of pregnant women receiving an antenatal check-up during the first trimester increased from 59% to 70% between NFHS-4 and NFHS-5.

·       This improvement indicates greater utilisation of antenatal healthcare, although timely and quality maternal care remains important for further reducing maternal mortality.

Child Immunisation

·       The proportion of children aged 12–23 months receiving full basic vaccination increased from 62% in NFHS-4 to 76.4% in NFHS-5.

·       The improvement reflects progress in routine immunisation and programmes such as Universal Immunisation Programme and Mission Indradhanush.

Child Nutrition

NFHS-5 recorded a decline in several indicators of child undernutrition:

• Stunting declined from 38.4% to 35.5%.
• Wasting declined from 21.0% to 19.3%.
• Underweight prevalence declined from 35.8% to 32.1%.

However, the continued prevalence of undernutrition shows that nutrition remains a major public-health challenge.

Anaemia

·       Despite progress in several health indicators, anaemia remains a major concern.

·       According to NFHS-5, around 57% of women aged 15–49 years and 67% of children aged 6–59 months were anaemic.

·       This highlights the need for stronger interventions in maternal nutrition, child nutrition, micronutrient supplementation and dietary diversity.

Institutional Deliveries

·       The proportion of births taking place in health institutions increased substantially between NFHS-4 and NFHS-5, reflecting greater utilisation of institutional maternal healthcare.

·       This progress is supported by programmes such as Janani Suraksha Yojana (JSY), Janani Shishu Suraksha Karyakram (JSSK) and SUMAN.

Health Insurance Coverage

·       The proportion of households with at least one member covered by a health insurance or financing scheme increased from 28.7% to 41.4% between NFHS-4 and NFHS-5.

·       This indicates an improvement in financial protection, although substantial gaps remain in healthcare affordability and coverage.

Household Living Conditions: NFHS-5 recorded significant improvements in access to basic household amenities.

• The proportion of households having electricity increased to 96.8%.
• Access to an improved drinking-water source increased to 96.9%.
• Households using an improved sanitation facility increased to 70.2%.
• The use of clean cooking fuel increased to 58.6%.

NFHS-4 to NFHS-5

The official Government assessment describes NFHS-5 as showing significant progress across several population, health and family-welfare indicators, while also highlighting continuing challenges.

FAQs

1. What is NFHS-5?
Ans: NFHS-5 is India’s fifth nationwide survey providing data on population, health, nutrition and family welfare for 2019–21.

2. Who conducted NFHS-5?
Ans: It was conducted by IIPS, Mumbai, under the Ministry of Health and Family Welfare.

3. What was India’s TFR according to NFHS-5?
Ans: India’s TFR declined from 2.2 to 2.0, falling below the replacement level of 2.1.

4. What happened to full immunisation under NFHS-5?
Ans: Full basic immunisation among children aged 12–23 months increased from 62% to 76.4%.

5. What is the major concern highlighted by NFHS-5?
Ans: Despite overall improvement, anaemia and child malnutrition remain major public-health concerns.

6. What is the significance of NFHS-5 for policymaking?
Ans: It provides national, State/UT and district-level evidence for designing, monitoring and evaluating health and welfare policies.