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National Family Health Survey 5, Strengths & Weakness of India in healthcare

National Family Health Survey 5, Strengths & Weakness of India in healthcare


  • GS 2 || Governance & Social Justice || Human Development || Health

Why in news?

The National Family Health Survey is a survey carried out on a massive scale across the country.


  • The National Family Health Survey is a large-scale survey conducted across the country to collect data on a variety of characteristics that may eventually aid the Ministry of Health and Family Welfare (MOHFW) in formulating policies and programmes to assist in the upliftment of India’s vulnerable populations.
  • In 1992-92, the National Family Health Survey was undertaken for the first time.
  • Following then, four more rounds were held, the most recent of which was NFHS 5, which began in 2018-19 but is currently stopped due to the COVID-19-related shutdown in various states.

About National Family Health Survey:

  • The National Family Health Survey (NFHS) is a multi-round, large-scale survey that is undertaken in a representative sample of Indian households.
  • The important findings from the second part of the most recent NFHS (NFHS-5, 2019-21) have been announced, and the verdict is mixed, with plenty of good news and plenty of bad news.
  • These findings are particularly important and should be given due consideration, as they are not a hastily compiled state-of-health index, but rather a complete, comprehensive, multi-dimensional report card on India’s demographic and health trajectory.

Key Findings of the Survey:

  • NFHS 4 & 5, a Comparison: The NFHS-5 report card has a lot of positive aspects.
    • Improvements have been seen in a variety of areas, including educational attainment, institutional deliveries, immunizations, infant mortality, and so on.
    • Regardless of the speed, progress must be commended, especially considering the deplorable state of India’s health system, which has become tragically apparent since the COVID-19 outbreak.
  • Decline in TFR, a Major Positive: The Total Fertility Rate (TFR) has been decreasing over time, and it is now slightly below the replacement rate of 2.1 (at 2.0).
    • This is true in all Indian states, indicating that the overall population has stabilised.
  • Difference in Sex Ratio at Birth and at Adulthood:Between 2019 and 21 in India, there were 1,020 adult women per 1,000 men for the first time.
    • The facts, however, do not change the fact that India’s sex ratio at birth (SRB) is still more skewed towards boys than the natural SRB (which is 952 girls per 1000 boys).
    • The biggest states with low SRB include Uttar Pradesh, Haryana, Punjab, Rajasthan, Bihar, Delhi, Jharkhand, Andhra Pradesh, Tamil Nadu, Odisha, and Maharashtra.
  • Poor Performance in Dealing with Anaemia:In all Indian states, the prevalence of anaemia has increased in children under the age of five (from 58.6% to 67%), women (53.1 to 57%), and men (22.7 to 25%). (20 percent -40 percent incidence is considered moderate).
  • All states are classified as “severe” with the exception of Kerala (39.4%).
  • Performance of Malnutrition Indicators:Stunting (low height-for-age), wasting (low weight-for-height), and underweight (low weight-for-age) are the three malnutrition markers that have improved generally.
    • However, this overall improvement creates an anomaly because numerous States in Phase 1 of the NFHS-5 indicated a worsening in one or more of these indicators, whereas none of the States showed a worsening in Phase 2.
    • It’s probable that the covid-19 influenced the Phase 2 survey, resulting in undercounting of instances.
    • Furthermore, the proportion of overweight children, women, and men has risen, indicating malnutrition, which has major health effects in the form of noncommunicable diseases (NCDs).

Issues Associated:

  • Micronutrient Deficiencies: In addition to anthropometric measures, micronutrient deficiencies, or a lack of vitamins and minerals important for body processes such as generating enzymes, hormones, and other substances needed for growth and development, are also measured.
    • Micronutrients are not covered by the NFHS.
  • A ‘One-Size-Fits-All’ Approach to Dietary Intake Monitoring: Diets in India are extremely diverse. Many traditional diets reflect both local climate conditions and a diverse range of vital nutrient sources, such as proteins, lipids, and carbohydrates.
    • Dietary policing, which imposes an unnatural uniformity and prevents huge sections of Indians who are not historically vegetarian from eating animal protein, is likely to limit micronutrient diversity and lead to poor health outcomes.
  • Covid-19 Blame Game: Because the data for the Phase-2 of NFHS-5 was obtained in significant part under the exceedingly unusual conditions of the COVID-19 pandemic, it has been suggested that the poor health outcomes are due to Covid-19.
    • The decline in public health indices, on the other hand, cannot be wholly attributable to the pandemic.
    • The Pandemic may have given fuel to the fire of deteriorating public health, but it did not start it.
  • Unethical Delivery Practices Affecting Women’s Health: The survey focuses on markers of women’s empowerment, autonomy, and mobility, as well as reproductive health.
    • Cesarean births have increased considerably, according to data; in private health facilities, 47.5 percent of births are by C-section (14.3 percent in public health facilities).
    • These data are highly anomalous, and they call into question the unethical actions of private health practitioners that place monetary gain above the health of women.
  • Limited Male Engagement in Family Planning: In states such as Andhra Pradesh (98 percent), Telangana (93 percent), Kerala (88 percent), Karnataka (84 percent), Bihar (78 percent), and Maharashtra, female sterilisation continues to dominate as the modern technique of contraception (77 percent).
    • Male participation in family planning is restricted, as seen by the low use of condoms and male sterilisation across the United States.

Way Forward:

  • Policy Interventions to Address Health Concerns: The survey reveals significant health disparities. The research suggests that governments at both the national and state levels should be concerned about health.
    • An action plan to address India’s health needs is essential, and it must be inclusive, firm in its commitment, and well-funded.
  • Lessons to be taken from NFHS:The findings of the NFHS serve as a reminder of the critical need to close disparities in girls’ education and address women’s and children’s poor nutritional status.
    • The pandemic’s impact should be emphasised, as well as the disruption it brought to services such as balanced nourishment for children.
    • Such events highlight the importance of constructing resilient and fortified systems capable of delivering even under the most adverse conditions.
  • Collaboration in the Health Sector: To make basic and advanced health services accessible, affordable, and acceptable to all, current times require integrated and coordinated efforts from all health institutions, academia, and other partners directly or indirectly associated with health care services.
  • Government Must Develop a Targeted Social and Behaviour-Change Communication Strategy: To ensure that men also take responsibility for family planning, the government must adopt a targeted social and behavior-change communication strategy.


Only the decennial population census gives more comprehensive data than the NFHS. It should be seen as a critical turning point in India’s policymaking. The bigger picture for states and the centre is to see it as a matrix to work with in order to improve development metrics.

Mains oriented question:

“Only the decennial population census gives more comprehensive data than the National Family Health Survey (NFHS).” It should be seen as a watershed moment in India’s policymaking.” Comment. (200 words)