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Editorials/Opinions Analysis for UPSC 07 January 2022



To bring out reliable data on emerging health and family welfare issues, National Family Health Survey 5 is the recent round of the survey carried on by MoH&FW on all states and Union territories. At first glance, NFHS-5 appears to be a mixed bag — much to cheer about, but concern areas remain. 

However, it also highlights the need for periodic review addressing gaps such as institutional delivery and adolescent anemia 


GS-II: Social Justice and Governance (Issues related to Health, Government Policies and Interventions) 


  1. About National Family Health Survey
  2. How often is the NFHS conducted? 
  3. Comparison between NFHS-5 and NFHS-4 
  4. Areas of concern 
  5. Measures taken by the government: 
  6. Way forward

About National Family Health Survey:

  • It is a large-scale, multi-round survey conducted in a representative sample of households throughout India and provides information on population, health, and nutrition for each state/union territory (UT). 
  • The International Institute for Population Sciences (IIPS) Mumbai, is the nodal agency for providing coordination and technical guidance for the survey. 
  • The survey provides state and national information for India on: 
    • Fertility 
    • Infant and child mortality 
    • The practice of family planning 
    • Maternal and child health 
    • Reproductive health 
    • Nutrition 
    • Anemia 
    • Utilization and quality of health and family planning services 
  • It provides essential data on health and family welfare needed by the Ministry of Health and Family Welfare and other agencies. 
  • It provides information on important emerging health and family welfare issues. 
How often is the NFHS conducted? 

The below information gives details on the round and the year it was conducted. 

  1. First Round of NFHS conducted in 1992-93 
  2. Second Round of NFHS conducted in 1998-99 
  3. Third Round of NFHS conducted in 2005-06 
  4. Fourth Round of NFHS conducted in 2015-16 
  5. Fifth Round of NFHS conducted in 2018-19 

Comparison between NFHS-5 and NFHS-4 

  • NFHS-5 includes some new topics, such as preschool education, disability, access to a toilet facility, death registration, bathing practices during menstruation, and methods and reasons for abortion.  
  • For the first time since the NFHS 1992-93 survey, the sex ratio is slightly higher among the adult population.  
  • It is also for the first time in 15 years that the sex ratio at birth has reached 929 (it was 919 for 1,000 males in 2015-16). 
  • The total fertility rate has also dropped from 2.2 per cent to a replacement rate of 2 per cent. 
  • It appears that states which were already experiencing a decline in fertility rates have continued to do so, without much change in the trends in the higher fertility states.  
  • There has been an appreciable improvement in general literacy levels and in the percentage of women and men who have completed 10 years or more of schooling, which has reached 41 per cent and 50.2 per cent respectively.  
  • There has also been a consistent drop in neonatal, infant and child mortality rates — a decrease of around 1 per cent per year for neonatal and infant mortality and a 1.6 per cent decrease per year for under five mortality rate. 
  • Between NFHS 4 and NFHS 5, the percentage of children below five years who are moderately underweight has reduced from 35.8 per cent to 32.1 per cent.
  • Moderately stunted children have fallen from 38.4 per cent to 35.5 per cent, Moderately wasted from 21 per cent to 19.3 per cent.
  • Severely wasted have increased slightly from 7.5 per cent to 7.7 per cent. 

Areas of concern 

  • India has become a country with more anemic people since NFHS-4 (2015-16), with anemia rates rising significantly across age groups, ranging from children below six years, adolescent girls and boys, pregnant women, and women between 15 to 49 years.  
  • Adverse effects of anemia affect all age groups —  
    • Lower physical and cognitive growth and alertness among children and adolescents.
    • Lesser capacity to learn and play, directly impacting their future potential as productive citizens.  
    • Lower capacity to work and quick fatigue for adolescents and adults, translates into lower work output and lesser earnings.  
    • Anemia among adolescent girls (59.1 per cent) advances to maternal anaemia and is a major cause of maternal and infant mortality and general morbidity and ill health in a community. 

Measures taken by the government: 

National Health Mission (NHM): 

  • National Health Mission (NHM) was launched by the government of India in 2013 subsuming the National Rural Health Mission and the National Urban Health Mission.
  • The main programmatic components include Health System Strengthening in rural and urban areas for – Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A), and Communicable and Non-Communicable Diseases.  
  • The NHM envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people’s needs. 

Anemia Mukt Bharat  

  • It has been launched in the year 2018 as part of Intensified National Iron Plus Initiative (NIPI) Program for accelerating the annual rate of decline of anemia from one to three percentage points. 
  • The target groups for AMB are Children 6-59 months, 5-9 years, Adolescent Girls & Boys of 10-19 years, Women of Reproductive Age (15-49 years), Pregnant Women and Lactating Mothers.  

Integrated Child Development Services (ICDS) 

  • Integrated Child Development Services (ICDS) is a government programme in India which provides food, preschool education, primary healthcare, immunization, health check-up and referral services to children under 6 years of age and their mothers. 
  • The scheme was launched in 1975, discontinued in 1978 by the government of Morarji Desai, and then relaunched by the Tenth Five Year Plan. 
  • In addition to fighting malnutrition and ill health, the programme is also intended to combat gender inequality by providing girls the same resources as boys. 
 Way forward:
  • The foundational nutritional deficit which ought to be considered an indicator of great concern, is generally ignored by policy makers and experts.
  • Unless this is addressed, rapid improvement in nutritional indicators cannot happen. 
  • Convergence among multiple stakeholders is critical to bring about the desired change. 
  • Together, we must challenge discriminatory social norms that drive gender-based violence and harmful practices, and empower women to exercise agency and autonomy in all spheres of life. 
December 2023