Why this report released and with which objectives?

The main objectives of this report are

• To provide essential data on health and family welfare needed by the Ministry of Health and Family Welfare and other agencies for policy and programme purposes
• To provide information on important emerging health and family welfare issues

These surveys primarily serve to provide essential data on health and family welfare for policy-making and planning and throw light on important emerging health and family welfare issues. Besides providing information to the home agencies, the NFHS surveys update the DHS (Demographic and Health Surveys) funded by the USAID. This organization’s analyses are in turn used by the WHO, UNICEF, World Bank, etc.

It also 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, anaemia, utilization and quality of health and family planning services.

It provides an indicator for tracking 30 Sustainable Development Goals (SDGs) that the country aims to achieve by 2030.

When it was established?

NFHS was established in 1956 under the joint sponsorship of Sir Dorabji Tata Trust, the Government of India and the United Nations (UN), IIPS has established itself as the premier institute for training and research in population studies for developing countries in the Asia and Pacific region. It started by Government of India in 1992-93 as the first large-scale, multi-round household survey conducted at a national level. The First National Family Health Survey (NFHS-1) was conducted in 1992-93. The survey collected extensive information on population, health, and nutrition, with an emphasis on women and young children. NFHS was the first survey to collect information on fertility, infant and child mortality, the practice of family planning, maternal and child health, reproductive health, nutrition, anaemia, utilization and quality of health and family planning services.

      The Second National Family Health Survey (NFHS-2) was conducted in 1998-99 in all 26 states of India with added features on the quality of health and family planning services, domestic violence, reproductive health, anaemia, the nutrition of women, and the status of women.

      The Third National Family Health Survey (NFHS-3) was carried out in 2005-2006. Eighteen Research Organizations including five Population Research Centres surveyed in 29 states of India.  

       The Fourth National Family Health Survey (NFHS-4) was carried out in 2014-2015. NFHS-4 funding was provided by the Government of India, the United States Agency for International Development (USAID), the Department for International Development (DFID), the Bill and Melinda Gates Foundation, UNICEF, the United Nations Population Fund (UNFPA), and the MacArthur Foundation. NFHS-4 is the first of the NFHS series that collects data in each of India’s 29 States and all 7 Union Territories. Also, NFHS-4, for the first time, will provide estimates of most indicators at the district level for all 640 districts of the country included in the 2011 Census.

And this was the 5th round of NFHS.

Where downfall of fertility rate recorded most?

The total fertility rate is defined as the average number of children that would be born to a woman by the time she ends childbearing. Below-replacement fertility is defined as a combination of fertility and mortality levels that leads to a negative population growth rate, hence a declining population size. TFR is considered one of the most useful indicators of fertility.

The total fertility rate (TFR) across most Indian states declined in the past half-a-decade, more so among urban women, according to the latest National Family Health Survey (NFHS).

Urban women recorded a lower fertility rate than women residing in rural areas across almost all states across time, but this gap has been shrinking, according to the first phase of NFHS-5, 2019-20. 

Sikkim recorded the lowest TFR, with one woman bearing 1.1 children on average; Bihar recorded the highest TFR of three children per woman. In 19 of the 22 surveyed states, TFRs were found to be ‘below-replacement’ — a woman bore less than two children on average through her reproductive life.

According to the health ministry factsheet, Andaman and Nicobar Islands, Goa, Ladakh, Jammu and Kashmir and Lakshadweep reported a TFR of fewer than 1.5 children per woman. Kerala was the only state that experienced an increase in TFR to 1.8 from 1.6 in 2015-16 (NFHS-4).

The fertility rate of women in rural areas sharply dropped in Jammu and Kashmir, Maharashtra, Assam, Nagaland, Manipur, Mizoram and Bihar, while the fertility rate of women in urban areas went below-replacement fertility across all 21 states except Bihar, where it has remained unchanged at 2.4 since 2015-16.

Bihar’s TFR decreased significantly (by 0.4) in last five years, while information for Uttar Pradesh was not collected in the first phase of the latest round of the survey. Bihar’s TFR was 4 while that of Uttar Pradesh was 3.8 in 2005-06 (NFHS-3).

 

 

Who are in zone of major concern?

Anaemia among women remains a major cause of concern. In all the states, anaemia is much higher among women compared to men. Female sterilisation continues to dominate as the modern method of contraception in states like Andhra Pradesh (98 per cent), Telangana (93 per cent), Kerala (88 per cent), Karnataka (84 per cent), Bihar (78 per cent) and Maharashtra (77 per cent).

Male engagement in family planning continues to be limited and disappointing as seen by the low uptake of condoms and male sterilisation across states.

Despite the efforts being made, it is alarming to see the increase in child marriages in a number of states, reveals the data.

There has been an increase in child marriages in Tripura (40.1 per cent from 33.1 per cent in 2015-16), Manipur (16.3 per cent from 13.7 per cent in 2015-16) and Assam (31.8 per cent from 30.8 per cent in 2015-16), while states like West Bengal (41.6 per cent) and Bihar (40.8 per cent) still have high prevalence of child marriages. States such as Manipur, Andhra Pradesh, Himachal Pradesh and Nagaland have also shown increase in teenage pregnancies. Along with increase in child marriages, Tripura has also shown an increase in teenage pregnancies, from 18.8 per cent in 2015-16 to 21.9 per cent in 2019-20.

How NFHS-5 different from other NFHS report?

This report different from others because of the following reasons

• The fifth edition of the National Family Health Survey (NFHS) claiming “considerable improvement” in the supply of vaccine for childhood immunisation from the fourth round in 2015-16.
• The NFHS-5 captured data during 2014-19 and its content is similar to NFHS-4 (2015-16) to allow comparisons over time and also marks a shift from it.
• 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.
• However, in 2019, for the first time, the NFHS-5 sought details on the percentage of women and men who have ever used the Internet.

Key findings of NFHS-5 are

• The NFHS-5 was conducted in around 6.1 lakh sample households to provide disaggregated data up to district levels. It is still going on in some states
• Total Fertility Rate (TFR) has declined since NFHS-4 in almost every Phase-1 State and UT. The replacement level of fertility was 2.1 in 19 out of the 22 States/UTs. Only 3 states exceeded the mark, namely Manipur at 2.2, Meghalaya at 2.9, and Bihar at 3.0.
• Overall Contraceptive Prevalence Rate, CPR saw a substantial increment in most States/UTs and it has been the highest in Himachal Pradesh and West Bengal at 74%.
• Unmet needs of family planning's trend declined in most of the Phase-1 States/UTs.
• Full immunization drive among children between ages 12-23 months, recorded a substantial improvement. In 75% of the districts surveyed, 70% of children between 12-23 months are fully immunized against childhood diseases.
• 11 out of the 22 states and UTs saw an increment of over 10 per cent in immunisation and in another 4 states/UT, the range was between 5 to 9 per cent over a short span of 4 years. This can be attributed to the flagship initiative of Mission Indradhanush launched by the government since 2015.
• An increase in the per cent of women receiving the recommended four or more ANC visits by health providers in many States/UTs has also been observed.
• Institutional births have increased in a good amount with more than four-fifths of the women delivering in institutions in 19 States and UTs.
• Keeping in view of the prevailing COVID-19 situation, a lot of planning and preparations have been carried out in terms of the necessary revisions in the survey protocols and protective measures to resume fieldwork in Phase II States/UTs.