National Family Health Survey (NFHS)

The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted in a representative sample of households throughout India. The NFHS is a collaborative project of the International Institute for Population Sciences(IIPS), Mumbai, India; ORC Macro, Calverton, Maryland, USA and the East-West Center, Honolulu, Hawaii, USA.

• The Ministry of Health and Family Welfare (MOHFW), Government of India, designated IIPS as the nodal agency, responsible for providing coordination and technical guidance for the NFHS. NFHS was funded by the United States Agency for International Development (USAID) with supplementary support from United Nations Children’s Fund (UNICEF).
• IIPS collaborated with a number of Field Organizations (FO) for survey implementation.
• Each FO was responsible for conducting survey activities in one or more states covered by the NFHS. Technical assistance for the NFHS was provided by ORC Macro and the East-West Center.

Objectives of National Family Health Survey :

• The main objective of successive rounds of the NFHS is to provide reliable and comparable datasets on health, family welfare and other emerging issues.  
• Four rounds of NFHS (1992–93, 1998–99, 2005–06 and 2015–16) have been successfully completed in India. 
• All the rounds of NFHS have been conducted by the International Institute for Population Sciences (IIPS), Mumbai, as the national nodal agency. 
• Earlier the Health Ministry itself used to conduct District Level Health Survey (DLHS) and Annual Health Survey (AHS).
• MoHFW has decided to conduct integrated NFHS with a periodicity of three years in lieu of different surveys from 2015-16 onwards to meet the evolving requirements for frequent, timely and appropriate data at the National, State and District levels.  
• The NFHS-5 is being conducted in around 6.1 lakh sample households to provide disaggregated data up to district levels. 
• And this data so generated when completed would be comparable with NFHS-4 without any loss of information.

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Significance:

• The First National Family Health Survey (NFHS-1) was conducted in 1992-93. The survey collected extensive information on population, health, and nutrition, with an emphasis on women and young children. 
• Eighteen Population Research Centres (PRCs), located in universities and institutes of national repute, assisted IIPS in all stages of conducting NFHS-1. All the state-level and national-level reports for the survey have already been published (48 reports in all).

  The Second National Family Health Survey (NFHS-2) was conducted in 1998-99 in all 26 states of India with added features on the quality of health and family planning services, domestic violence, reproductive health, anemia, the nutrition of women, and the status of women. The results of the survey are currently being published.

• The Third National Family Health Survey (NFHS-3) was carried out in 2005-2006. Eighteen Research Organizations including five Population Research Centres carried out the survey in 29 states of India. 
• The funding for NFHS-3 is provided by USAID, DFID, the Bill and Melinda Gates Foundation, UNICEF, UNFPA, and MOHFW, GOI. ORC Macro, USA, is providing technical assistance for NFHS-3, and the National AIDS Control Organization (NACO) and the National AIDS Research Institute (NARI) are providing technical assistance for the HIV component.

NFHS-5:

• India’s population is stabilising, as the total fertility rate (TFR) has decreased across majority of the states. 
• 17 states analysed in the fifth round of National Family Health Survey (NFHS), except for Bihar, Manipur and Meghalaya, all other states have a TFR of 2.1 or less, which implies that most states have attained replacement level fertility, an analysis by the Population Foundation of India (PFI) .
• The first set of findings from the fifth NFHS, conducted in 2019-20, was released by the Ministry of Health and Family Welfare on Saturday, December 12, four years after the last survey (NFHS-4, 2015-16).
• NFHS 5 merits urgent attention, as this is the most comprehensive and robust data at scale on health and family welfare and emerging issues in this area, stated PFI.
• All 17 states have witnessed an increase in the use of modern contraceptives of family planning. The proportion of women with unmet need for family planning, who want to stop or delay child-bearing but are not using any method of contraception, has declined in all states, except Meghalaya and Andhra Pradesh.
• Except for Manipur, all states have reported an increase in users getting information on side effects of current contraceptive methods.

Concern areas:

• Anaemia among women remains a major cause of concern. In all the states, anaemia is much higher among women compared to men. 
• Female sterilisation continues to dominate as the modern method of contraception in states like Andhra Pradesh (98 per cent), Telangana (93 per cent), Kerala (88 per cent), Karnataka (84 per cent), Bihar (78 per cent) and Maharashtra (77 per cent).
• Male engagement in family planning continues to be limited and disappointing as seen by the low uptake of condoms and male sterilisation across states.
• Despite the efforts being made, it is alarming to see the increase in child marriages in a number of states, reveals the data.
• There has been an increase in child marriages in Tripura (40.1 per cent from 33.1 per cent in 2015-16), Manipur (16.3 per cent from 13.7 per cent in 2015-16) and Assam (31.8 per cent from 30.8 per cent in 2015-16), while states like West Bengal (41.6 per cent) and Bihar (40.8 per cent) still have high prevalence of child marriages. 
• States such as Manipur, Andhra Pradesh, Himachal Pradesh and Nagaland have also shown increase in teenage pregnancies. 
• Along with increase in child marriages, Tripura has also shown an increase in teenage pregnancies, from 18.8 per cent in 2015-16 to 21.9 per cent in 2019-20.
• While spousal violence has generally declined in most of the states and UTs, it has witnessed an increase in five states, namely Sikkim, Maharashtra, Himachal Pradesh, Assam and Karnataka. 
• Karnataka witnessed the largest increase in spousal violence, from 20.6 per cent in NFHS 4 to 44.4 per cent in NFHS-5.
• Sexual violence has increased in five states (Assam, Karnataka, Maharashtra, Meghalaya and West Bengal), as per the data.

Government Innitiatives:

• POSHAN Abhiyaan: It is considerable improvement in vaccination coverage among children age 12-23 months across all states and UTs.
• Mission Indradhanush 
• ICDS

Way Forward

Health concerns must receive higher priority in terms of resources allocated towards public health,  frontline health workers, who bear the burden of health issues on the ground, must be compensated fairly.

Needs a deep reflection and identify the poor performing pockets and the community-based care of children with Severe Acute Malnutrition (SAM). The Community Based Care for Acute Malnutrition has to be mainstreamed as routine part of the government system