National Family Health Survey 2020 – Discussion – RSTV IAS UPSC

  • IASbaba
  • February 19, 2021
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National Family Health Survey 2020


TOPIC: General Studies 2

  • Government policies related to Health

In News: The Ministry of Health and Family Welfare has released the first set of findings from the fifth and the latest round of the National Family Health Survey, conducted in 2019-20. 

  • The survey, providing detailed information on population, health, and nutrition for states and Union Territories, was conducted after a gap of about three years. 
  • The first sets of findings were released for 22 states and Union territories, which together are home to almost half of the country’s population. It includes big states like Maharashtra, Bihar and West Bengal, but does not include the country’s most populous state, Uttar Pradesh. 

Objective: To provide reliable and comparable datasets on health, family welfare and other emerging issues.  

  • Four rounds of NFHS (1992–93, 1998–99, 2005–06 and 2015–16) have been successfully completed in India.  
  • The state factsheet released include information on 131 key indicators.
  • These important indicators on population, health and family welfare, nutrition and others will help track progress of Sustainable Development Goals (SDGs) in the country.

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.

Due to the launch of Mission Indradhanush, India has achieved the following –

  • There is increase in the per cent of women receiving the recommended four or more ANC visits by health providers in many States/UTs. This percentage has increased in 13 States/UTs between 2015-16 to 2019-20.
  • 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. Almost 91% of districts recorded over 70% institutional deliveries of births in the 5 years preceding the survey.
  • 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. Drastic changes in respect of stunting and wasting are unlikely in a short period.
  • Anaemia among women and children continues to be a cause of concern. More than half of the children and women are anaemic in 13 of the 22 States/UTs. It has also been observed that aanaemia among pregnant women has increased in half of the States/UTs compared to NFHS-4, in spite of substantial increase in the consumption of IFA tablets by pregnant women for 180 days or more.
  • 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.

The darker side

With a debilitating death toll and an economic recession, India has had among the worst effects of the COVID-19 pandemic. There is anecdotal evidence that the pandemic and lockdown measures have led to new complications related to food consumption and food security for impoverished Indians. But an express indication of the possible scale of the crisis can be gleaned from the data from the newly released National Family Health Survey 2019-20 which was conducted before the pandemic and its impact. 

  • The partially released early data from NFHS-5 for 22 States/Union Territories — data for U.P., M.P. Tamil Nadu, Rajasthan, Punjab, Jharkhand and Odisha are not yet out — shows a disappointing record on metrics such as child nutrition and adult anthropometric measurements, suggesting the exacerbation now of an already fraught situation. 
  • NFHS-5 shows that four key metrics for the nutritional status of children declined in 2019-20 compared to levels in 2015-16 (NFHS-4) in many of the surveyed States. 
  • Gujarat, Maharashtra and West Bengal recorded an increase in the percentage of anaemic and wasted (low weight for height) children compared to even the 2005-06 survey. 
  • In the key indicator of childhood stunting, there has been an increase in 13 of the 22 States/UTs in comparison to NFHS-4, with a noticeable improvement only in Bihar and Assam. Even here, the reduction in stunting numbers is lower than the government’s targets. Bihar has shown a promising decline of 5.4 % points in stunting, but still retains the highest percentage of stunted children (42.9%) among big States.


The persistence of poor anthropometric measures related to hunger and nutrition suggests that existing programmes to address them, such as POSHAN Abhiyaan, will need a push and focus to meet targets such as the 2%-point decrease in childhood stunting every year. More importantly, the complications arising out of the pandemic should make the Centre and States refocus on welfare delivery as a concerted strategy to eradicate hunger and extreme poverty. This is an imperative that would not just meet the UN’s Sustainable Development Goal targets but will also ensure the well-being of citizens in a country that showed significant promise in combining economic growth and general welfare in the last couple of decades before encountering major reversals lately.

Connecting the Dots:

  1. Early data from NFHS-5 show decline in key anthropometric and nutrition indicators. Critically examine.

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