National Family and Health Survey 5


  • Recently, the Union Health Ministry released the summary findings of the fifth round of the National Family and Health Survey 5 (NFHS 5), conducted in two phases between 2019 and 2021.

National Family and Health Survey 5
Credit: TH

Key Highlights of the National Family and Health Survey 5 (NFHS 5)

Sex ratio is skewed in favour of women

  • India now has 1,020 women for every 1000 men, is not getting any younger, and no longer faces the threat of a population explosion.
  • According to NFHS-3, conducted in 2005-06, the ratio was equal, 1000: 1000; it went down to 991:1000 in 2015-16 in NFHS-4. This is the first time, in any NFHS or Census, that the sex ratio is skewed in favour of women.

Gender parity

  • The gender ratio at birth for children born in the last five years is still 929, which suggests that son-preference, in its various macabre forms, still persists, but the sex ratio is a significant milestone achieved on the back of policies aimed to curb sex selection practices that were once rampant and female infanticide, and on the fact that women in India tend to live longer than men.

Fertility Rate has decreased

  • The Total Fertility Rate (TFR) has also come down below the threshold at which the population is expected to replace itself from one generation to next.
  • Total Fertility Rate (TFR) was 2 in 2019-2021, just below the replacement fertility rate of 2.1. To be sure, in rural areas, the TFR is still 2.1.
  • In urban areas, TFR had gone below the replacement fertility rate in the 2015-16 NFHS itself.
  • An overall survey of the major differences between the NFHS-5 and NFHS-4 suggests that the use of contraceptives has improved from 53.5% to 66.7% in the latest NFHS-5 and institutional births increased from 78.9% to 88.6%.

Ageing Population

  • A decline in TFR, which implies that lower number of children are being born, also entails that India’s population would become older.
  • Sure enough, the survey shows that the share of under-15 population in the country has therefore further declined from 28.6% in 2015-16 to 26.5% in 2019-21.
  • India is still a young country — a median age of 24 years in 2011 according to the Census figures — but it is ageing, and that comes with the associated policy challenges.

Nutrition Level 

  • The share of stunted (low height for age), wasted (low weight for height), and underweight (low weight for age) children have all come down since the last NFHS conducted in 2015-16.
  • However, the share of severely wasted children has not, nor has the share of overweight (high weight for height) or anaemic children.
  • The share of overweight children has increased from 2.1% to 3.4%.
  • For children and their mothers, there are at least government schemes such as Integrated Child Development Services (ICDS) that seek to address the nutritional needs at the time of childbirth and infancy.
  • However, there is a need to address the nutritional needs of adults too.
  • The survey has shown that though India might have achieved food security, 60% of Indians cannot afford nutritious diets.
  • While the share of women and men with below-normal Body Mass Index (BMI) has decreased, the share of overweight and obese (those with above-normal BMI) and the share of anaemic has increased.
  • India’s battle with anaemia also appears to have faltered. The proportion of anaemic children (5-59 months) increased from 58% to 67%. Women aged 15-49 who were anaemic increased from 53% to 57% and men of the same age increased from 29% to 31% between both editions of the NFHS.
  • Overall, the NFHS-5 shows a reduction in stunting, which is an indicator of chronic undernutrition,
    • From 38.4% to 35.5%, which is only about 3 percentage points in five years, about 0.6 percentage point a year.
    • Between NFHS-3 and NFHS-4 we saw a improvement from 48% to 38.4%, roughly 1 percentage point a year. So there is definitely a slowdown in improvement and this is much below the goals set under Poshan Abhiyaan

Sanitation Challenges

  • Availability of basic amenities such as improved sanitation facilities clean fuel for cooking, or menstrual hygiene products can improve health outcomes.
  • There has been an improvement on indicators for all three since the last NFHS. However, the degree of improvement might be less than claimed by the government.
  • For example, only 70% population had access to an improved sanitation facility.
  • While not exactly an indicator of open defecation, it means that the remaining 30% of the population has a flush or pour-flush toilet not connected to a sewer, septic tank or pit latrine.

Use of clean fuel

  • The share of households that use clean cooking fuel is also just 59%.

Financial inclusion

  • The share of women having a bank account that they themselves use has increased from 53% to 79%.
    • The all-India figure for phone use among women went up from 45.9% in 2015-16 to 54% in 2019-21
  • Households’ coverage by health insurance or financing scheme also has increased 1.4 times to 41%, a clear indication of the impact of the government’s health insurance scheme.

Back to basics

  • NFHS is a sample survey, and whether these numbers apply to the larger population can only be said with certainty when the next national census is conducted, although it is very likely that they will in the case of many states and Union territories.
  • NFHS-5 was conducted in two phases between 2019 and 2021, and covered 650,000 households from 707 districts of the country. The States and UTs that were surveyed in Phase-II are Arunachal Pradesh, Chandigarh, Chhattisgarh, Haryana, Jharkhand, Madhya Pradesh, NCT of Delhi, Odisha, Puducherry, Punjab, Rajasthan, Tamil Nadu, Uttar Pradesh and Uttarakhand.
    • The findings of NFHS-5 from 22 States & UTs covered in Phase-I were released in December, 2020.
  • NFHS-5 includes some new focal areas, such as death registration, pre-school education, expanded domains of child immunisation, components of micro-nutrients to children, menstrual hygiene, frequency of alcohol and tobacco use, additional components of non-communicable diseases (NCDs), expanded age ranges for measuring hypertension and diabetes among all aged 15 years and above, which will give requisite input for strengthening existing programmes and evolving new strategies for policy intervention.

Source: HT

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