National Family Health Survey (NFHS-5) – Phase-I (Important Data Sets and Some Key Questions)

The first phase of the 5th round of the National Family Health Survey (NFHS-5) was conducted in 2019-20 and its findings were released in December 2020.

States/UT Covered Under Phase-I

In the first phase of the fifth round, the findings for 17 states and 5 union territories been presented.

Andhra Pradesh, Assam, Bihar, Goa, Gujarat, Himachal Pradesh, Karnataka, Kerala, Maharashtra, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, Telangana, Tripura, West Bengal, Andaman Nicobar Island, Dadra and Nagar Haveli and Daman and Diu, Jammu & Kashmir, Ladakh and Lakshadweep

The fieldwork in the remaining 14 (Phase-II) States/UTs is currently under progress.

Importance of the Report

The NFHS provides estimates on key indicators related to population, family planning, child and maternal health, nutrition, adult health, and domestic violence, among others.

All the rounds of NFHS have been conducted by the International Institute for Population Sciences (IIPS), Mumbai, as the national nodal agency.

These important indicators on population, health and family welfare, nutrition and others will help track progress of Sustainable Development Goals (SDGs) in the country. Many indicators of NFHS-5 are similar to those of NFHS-4, carried out in 2015-16 to make possible comparisons over time.

However, NFHS-5 that includes new focal areas such as expanded domains of child immunization, 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, will give requisite input for strengthening existing programmes and evolving new strategies for policy intervention.

The key results from the State/UT factsheets are as follows:

• The Total Fertility Rates (TFR) has further declined since NFHS-4 in almost all the Phase-1 States and UTs. The replacement level of fertility (2.1) has been achieved in 19 out of the 22 States/UTs and only 3 states viz. Manipur (2.2), Meghalaya (2.9) and Bihar (3.0) have TFR above replacement levels now.
• Overall Contraceptive Prevalence Rate (CPR) has increased substantially in most States/UTs and it is the highest in HP and WB (74%). Use of modern methods of contraception has also increased in almost all States/UTs.
• Unmet needs of family planning have witnessed a declining trend in most of the Phase-1 States/UTs. The unmet need for spacing which remained a major issue in India in the past has come down to less than 10 per cent in all the States except Meghalaya and Mizoram.
• Full immunization drive among children aged 12-23 months has recorded substantial improvement across States/UTs/districts. More than two-third of children are fully immunized in all the States and UTs except Nagaland, Meghalaya and Assam.  In almost three-fourths of districts, 70% or more children aged 12-23 months are fully immunized against childhood diseases.

On comparing NFHS-4 and NFHS-5 data, the increase in full immunization coverage is observed to be expeditious in many states and UTs; in 11 out of the 22 states/UTs, the increase was to the tune of over 10 percentage point and in another 4 states/UTs between 5 to 9 percentage point over the short span of 4 years. This can be attributed to the flagship initiative of Mission Indradhanush launched by the government since 2015.

• Institutional births have increased substantially with over four-fifth of the women delivering in institutions in 19 States and UTs.  Institutional delivery is over 90 per cent in 14 out of the total 22 Sates and UTs.
• Along with an increase in institutional births, there has also been a substantial increase in C-section deliveries in many States/UTs especially in private health facilities.
• Sex ratio at birth has remained unchanged or increased in most States/UTs. Majority of the states are in normal sex ratio of 952 or above. SRB is below 900 in Telangana, Himachal Pradesh, Goa, DNH & DD.
• Child nutrition indicators show a mixed pattern across states. While the situation improved in many States/UTs, there has been minor deterioration in others.
• Anaemia among women and children continues to be a cause of concern. More than half of the children and women are anemic in 13 of the 22 States/UTs. It has also been observed that anemia among pregnant women has increased in half of the States/UTs compared to NFHS-4, in spite of substantial increase in the consumption.
• For both women and men, there is a lot of variation in the high or very high random blood glucose levels across States/UTs. Men are more likely to have slightly higher blood glucose levels in the range of high or very high compared to women. The percentage of men with high or very high blood glucose is highest in Kerala (27%) followed by Goa (24%). Prevalence of elevated blood pressure (hypertension) among men is somewhat higher than in women.
• The percentage of households with improved sanitation facility and clean fuel for cooking has increased in almost all the 22 States/UTs over the last four years (from  2015-16  to  2019-20). The Government of India has made concerted efforts to provide toilet facilities to maximum households through Swachh Bharat Mission, and improved household environment through Pradhan Mantri Ujjwala Yojana in the country. For instance, the use of cooking fuel has increased more than 10 percentage point in all the States and UTs during the last 4 years with over 25 percentage point increase in states of Karnataka and Telangana.
• Women’s empowerment indicators portray considerable improvement across all the States/UTs included in Phase 1. Considerable progress has been recorded between NFHS-4 and NFHS-5 in regard to women operating bank accounts.  For instance, in the case of Bihar the increase was to the tune of 51 percentage point from 26 per cent to 77 per cent. More than 60 per cent of women in every state and UTs in the first phase have operational bank accounts.

It may also be stated that recurrent floods in Kerala during the time of survey as well as the previous year may have affected the utilization of maternal care services and hence, it may have some unusual/unexpected trend in some of maternal care indicators for some of the districts.

• All states (except Mizoram) have seen an increase in the use of family planning methods. Goa (42%-point) and Bihar (32%-point) have seen the highest increase in the use of family planning methods.
• Consequently, most states have seen a decrease in the total fertility rate (TFR). Bihar’s TFR has declined from 3.4 (in NFHS-4) to 3. All other medium and large states in the survey (i.e., population above 1 crore) have a TFR below the replacement level rate of 2.1.
• The most notable decline in Sex Ratio at Birth was in Goa (from 966 to 838), and Kerala (from 1,047 to 951).  Only Tripura has a sex ratio at birth above 1,000 (i.e., more females born than males).
• In Kerala, nearly 100% of the births were institutional births.  Only 46% of the births in Nagaland were institutional births.
• Assam has seen one of the largest drops in IMR, from 48 deaths (per 1,000 live births) to 32 deaths.  IMR remains high in Bihar (47 deaths per 1,000 live births).
•  In Bihar and Gujarat, 40% or more of the children under the age of five years are underweight.
• The proportion of women and men, between the age of 15-49 years, who are overweight or obese have increased across nearly all states (except Gujarat and Maharashtra).  Overweight or obesity is measured through the Body Mass Index of persons.
• In Andhra Pradesh, Goa, Karnataka, Telangana, Kerala and Himachal Pradesh, nearly one-third of men and women (between 15-49 years of age) are overweight or obese.
• 99% households in Kerala have an improved sanitation facility, while only 49% households have it in Bihar. 
• The proportion of women who have a mobile phone has increased across all states. However, only about 50% women own and use a mobile phone in Andhra Pradesh, Bihar, Gujarat, and West Bengal.
• Across all states, the proportion of men who have used the internet was higher than women. In Andhra Pradesh, Bihar, and Tripura, less than 25% women have used internet.
• Across all 17 states, close to 80% women now have a savings or bank account, except in Gujarat (70%) and Nagaland (64%).
• However, the proportion of women who own a house or land (including joint ownership) has declined in 9 of the 17 states. Tripura, Maharashtra and Assam have seen a large decline in women owning house/ land.
• The proportion of married women (between 18-49 years of age) who have ever faced spousal violence has increased in 5 states. In Karnataka, it has doubled, from 21% to 44%. More than a third of the married women face spousal violence in Karnataka (44%), Bihar (40%), Manipur (40%), and Telangana (37%).

The Key Questions without answers:-

1. Why the Spousal Violence almost doubled in Karnataka ?
2. Why the Women owning house/land declined in Maharashtra and Assam ?
3. Why one fourth women in Gujurat do not have a bank account ?
4. Why only one fourth of women population in Andhra Pradesh uses Internet?
5. Why more than half of the Bihar does not have access to sanitation facility ?
6. Why the sex ratio at birth in Kerala declined and fallen below 1000?
7. Why the nearly one fourth Kerala population have high blood sugar ?
8. Why anemia among pregnant women has increased in all the surveyed states ?