Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Key Demographic Transitions captured by 5th round of NFHS


From UPSC perspective, the following things are important :

Prelims level: National Family Health Survey

Mains level: Read the attached story

The Union health ministry released the summary findings of the fifth round of the National Family and Health Survey (NFHS-5), conducted in two phases between 2019 and 2021.

About NFHS

  • The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
  • The previous four rounds of the NFHS were conducted in 1992-93, 1998-99, 2005-06 and 2015-16.
  • 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, anaemia, utilization and quality of health and family planning services etc.

Objectives of the survey

Each successive round of the NFHS has had two specific goals:

  • 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.

Key highlights of the NFHS-5

[1] Women outnumbering men

  • NFHS-5 data shows that there were 1,020 women for 1000 men in the country in 2019-2021.
  • This is the highest sex ratio for any NFHS survey as well as since the first modern synchronous census conducted in 1881.
  • To be sure, in the 2005-06 NFHS, the sex ratio was 1,000 or women and men were equal in number.

[2] Fertility has decreased

  • The Total Fertility Rate (TFR) has also come down below the threshold at which the population is expected to replace itself from one generation to next.
  • TFR was 2 in 2019-2021, just below the replacement fertility rate of 2.1. To be sure, in rural areas, the TFR is still 2.1.
  • In urban areas, TFR had gone below the replacement fertility rate in the 2015-16 NFHS itself.

[3] Population is ageing

  • A decline in TFR, which implies that lower number of children are being born, also entails that India’s population would become older.
  • Sure enough, the survey shows that the share of under-15 population in the country has therefore further declined from 28.6% in 2015-16 to 26.5% in 2019-21.

[4] Children’s nutrition has improved

  • The share of stunted (low height for age), wasted (low weight for height), and underweight (low weight for age) children have all come down since the last NFHS conducted in 2015-16.
  • However, the share of severely wasted children has not, nor has the share of overweight (high weight for height) or anaemic children.
  • The share of overweight children has increased from 2.1% to 3.4%.

[5] Nutrition problem for adults

  • For children and their mothers, there are at least government schemes such as Integrated Child Development Services (ICDS) that seek to address the nutritional needs at the time of childbirth and infancy.
  • However, there is a need to address the nutritional needs of adults too.
  • The survey has shown that though India might have achieved food security, 60% of Indians cannot afford nutritious diets.
  • While the share of women and men with below-normal Body Mass Index (BMI) has decreased, the share of overweight and obese (those with above-normal BMI) and the share of anaemic has increased.

[6] Basic sanitation challenges

  • Availability of basic amenities such as improved sanitation facilities clean fuel for cooking, or menstrual hygiene products can improve health outcomes.
  • There has been an improvement on indicators for all three since the last NFHS. However, the degree of improvement might be less than claimed by the government.
  • For example, only 70% population had access to an improved sanitation facility.
  • While not exactly an indicator of open defecation, it means that the remaining 30% of the population has a flush or pour-flush toilet not connected to a sewer, septic tank or pit latrine.

[7] Use of clean fuel

  • The share of households that use clean cooking fuel is also just 59%.

[8] Financial inclusion

  • The share of women having a bank account that they themselves use has increased from 53% to 79%.
  • Households’ coverage by health insurance or financing scheme also has increased 1.4 times to 41%, a clear indication of the impact of the government’s health insurance scheme.


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