National Family Health Survey (NFHS): Evolution, Findings, Challenges

The recent National Family Health Survey (NFHS-5) has unveiled critical health trends in India, highlighting issues like rising anaemia among women and children, growing prevalence of non-communicable diseases (NCDs), and stark regional healthcare disparities. With the Total Fertility Rate (TFR) now at 2.0, India nears population stabilization, though states like Bihar still face challenges. Gender disparities persist in family planning, with women predominantly using sterilization, while male participation remains low. These findings are pivotal for shaping future health policies and addressing India’s evolving healthcare needs.

Introduction to the National Family Health Survey (NFHS)

The National Family Health Survey (NFHS) serves as the foundation for public health planning and monitoring in India. Conducted by the International Institute for Population Sciences (IIPS), under the Ministry of Health and Family Welfare (MoHFW), NFHS provides insights into the country’s health trends, covering topics such as fertility, child mortality, family planning, and lifestyle diseases. Over time, the survey has expanded in scope, addressing broader issues like gender-based violence, menstrual hygiene, and nutrition.

Historical Overview of NFHS

The NFHS has evolved in both scope and depth since its inception:

• NFHS-1 (1992-93): Focused on fertility, family planning, and maternal-child health.
• NFHS-2 (1998-99): Introduced indicators like reproductive health and domestic violence.
• NFHS-3 (2005-06): Added data on HIV/AIDS, sexual health, and child nutrition.
• NFHS-4 (2015-16): Expanded coverage to district-level data and introduced measurements for non-communicable diseases.
• NFHS-5 (2019-21): Further broadened its scope, with data on menstrual hygiene, child immunization, and the prevalence of lifestyle diseases.

The survey is funded by a mix of international and domestic agencies, including USAID, UNICEF, and the Bill and Melinda Gates Foundation, along with significant contributions from the Indian government.

NFHS-5: Major Findings

The NFHS-5, conducted between 2019 and 2021, brought new insights into India’s health status and exposed key challenges. Some of its most important findings include:

Total Fertility Rate (TFR):
India has achieved a Total Fertility Rate (TFR) of 2.0, nearing the replacement level of 2.1. This indicates progress in family planning efforts, though some states, like Bihar and Uttar Pradesh, continue to report higher fertility rates.

Gender Ratio:
For the first time in NFHS history, India reported more women than men, with a sex ratio of 1,020 women for every 1,000 men. However, the sex ratio at birth still reflects a preference for male children.

Child Nutrition:
Child malnutrition remains a significant challenge, with 35.5% of children under five being stunted and 32.1% underweight. These figures highlight persistent malnutrition, particularly in rural areas, despite improvements in healthcare access.

C-Section Births:
C-section deliveries have risen significantly, accounting for 21.5% of all births, up from 17.2% in NFHS-4. This trend is particularly noticeable in private hospitals, raising concerns about the overuse of this procedure.

Women’s Empowerment:
NFHS-5 showed positive developments in women’s financial empowerment, with 79% of women having access to their own bank accounts, compared to 53% in NFHS-4. This reflects growing autonomy and control over financial resources.

Anaemia:
A worrying trend from NFHS-5 is the increase in anaemia among women and children. Over 57% of women aged 15-49 are anaemic, marking a rise from previous rounds of the survey. Anaemia continues to pose a severe public health challenge.

Challenges Faced by NFHS

While the NFHS provides invaluable data, it faces several challenges that impact its accuracy and timeliness.

Data Collection Delays:
The COVID-19 pandemic caused significant delays in data collection during NFHS-5, particularly in Phase II states. These delays have impacted the timeliness of the results and raised concerns about the reliability of data gathered during such an unprecedented time.

Quality and Accuracy of Data:
There are concerns about the accuracy of self-reported health data, particularly regarding non-communicable diseases like hypertension and diabetes. Often, individuals may misreport conditions due to a lack of awareness or misunderstanding of medical terms, impacting the reliability of the data.

Regional Disparities:
NFHS consistently highlights stark regional disparities. States like Kerala and Tamil Nadu perform well on most health indicators, while states in the northern regions, such as Uttar Pradesh and Bihar, lag behind. These discrepancies emphasize the unequal access to healthcare services and outcomes between regions.

Overreliance on Women for Family Planning:
The NFHS data shows a continued reliance on women for family planning, with female sterilization being the most commonly used contraceptive method. The low rates of male sterilization indicate that women bear a disproportionate share of the responsibility for family planning.

Rising Burden of Non-Communicable Diseases (NCDs):
NFHS-5 collected data on lifestyle diseases like hypertension and diabetes for the first time, revealing a growing burden of non-communicable diseases. This trend poses a significant challenge for India’s healthcare system, which has traditionally focused on communicable diseases.

Way Forward: Addressing the Challenges

To enhance the effectiveness of future NFHS rounds, several steps need to be taken:

Leveraging Technology:
The NFHS can benefit from integrating digital tools for data collection, such as mobile applications and cloud-based platforms. This would streamline the collection process, reduce delays, and improve the accuracy of data. Real-time data validation systems could further enhance data reliability.

Targeted Regional Interventions:
The disparities between regions require region-specific interventions. States like Bihar and Uttar Pradesh, which consistently report poor health outcomes, need targeted programs to improve healthcare access, address malnutrition, and promote family planning.

Promoting Male Participation in Family Planning:
There is a pressing need to increase male participation in family planning efforts. Awareness campaigns should encourage men to take a more active role in contraceptive decisions, and incentives should be provided for male sterilization to reduce the burden on women.

Tackling Anaemia:
The high prevalence of anaemia needs urgent attention. Expanding nutrition programs and fortifying food with iron and essential nutrients can help combat iron deficiency, particularly among women and children.

Addressing Non-Communicable Diseases (NCDs):
Given the rising burden of lifestyle diseases, India’s healthcare system must shift toward preventive care. Routine screenings, public health campaigns, and greater access to treatment for conditions like hypertension and diabetes are essential to addressing the NCD challenge.

Conclusion

The National Family Health Survey remains a cornerstone of India’s health and family welfare monitoring system. While the NFHS-5 findings highlight improvements in areas like fertility control, women’s empowerment, and child immunization, several challenges persist. The survey’s data reveals ongoing regional disparities, rising anaemia rates, and a growing burden of non-communicable diseases. Addressing these challenges requires a multi-faceted approach, including leveraging technology, promoting male involvement in health decisions, and implementing region-specific interventions. By doing so, the NFHS can continue to provide valuable insights that guide India’s public health policies and programs toward a healthier future.

Practice Question

Discuss the key challenges highlighted by NFHS-5 and suggest measures to address them, with special focus on regional disparities, rising non-communicable diseases, and family planning. (250 words)