national family health survey

National Family Health Survey-6 (NFHS-6), 2023-24 has been released by the government. The NFHS assesses India’s Progress in health, nutrition, and Human Development. Read here to learn more.

The release of the National Family Health Survey-6 (NFHS-6), 2023-24 by the Union Ministry of Health and Family Welfare marks an important milestone in India’s journey towards improved health and social development.

Conducted periodically, NFHS serves as the country’s most comprehensive source of data on population, health, nutrition, fertility, family welfare, and women’s empowerment.

NFHS-6 reveals substantial progress in maternal and child health, institutional deliveries, immunization, family planning, financial inclusion, and digital empowerment.

Particularly noteworthy is the rise in institutional deliveries to 90.6%, indicating India’s steady movement towards universal safe childbirth coverage. At the same time, the survey highlights emerging challenges such as rising obesity, increasing non-communicable diseases (NCDs), high Caesarean-section rates, and persistent child undernutrition.

Thus, NFHS-6 presents a mixed picture of significant achievements alongside emerging public health concerns.

What is the National Family Health Survey (NFHS)?

The National Family Health Survey is a large-scale, nationally representative survey conducted across India to generate reliable data on:

Population characteristics
Fertility and family planning
Maternal and child health
Nutrition
Mortality
Women’s empowerment
Healthcare utilization

The survey supports evidence-based policymaking and programme implementation.

Evolution of NFHS

Survey Round	Year
NFHS-1	1992-93
NFHS-2	1998-99
NFHS-3	2005-06
NFHS-4	2015-16
NFHS-5	2019-21
NFHS-6	2023-24

Nodal Agency: The survey is coordinated by the International Institute for Population Sciences, under the guidance of the Ministry of Health and Family Welfare.

Features of National Family Health Survey-6

Expanded Coverage

Surveyed 6.79 lakh households
Covered 715 districts
Excluded Manipur due to prevailing circumstances

Technology-Driven Survey

Full adoption of Computer-Assisted Personal Interviewing (CAPI)
Real-time validation of data
Reduced reporting errors

New Focus Areas

NFHS-6 introduced data collection on:

Direct Benefit Transfers (DBT)
Self Help Groups (SHGs)
Digital literacy
Digital financial transactions

Enhanced Health Assessment

Expanded Clinical, Anthropometric and Biochemical (CAB) testing, including HIV testing.

Key Findings of NFHS-6

Maternal Health and Safe Motherhood

Rise in Institutional Deliveries: One of the most significant achievements is the increase in institutional deliveries.

Indicator	NFHS-5	NFHS-6
Institutional Deliveries	88.6%	90.6%
Skilled Birth Attendance	89.4%	91.3%
Postnatal Care within 2 Days	79.1%	85.3%

Institutional deliveries have reduced:

Maternal mortality
Neonatal mortality
Birth complications

This indicates improved access to healthcare facilities and skilled personnel.

Improvement in Antenatal Care (ANC)

Antenatal Registration

Increased to 95.9%

First Trimester Registration

Improved from 70% to 76.2%

Early registration allows the timely identification of:

High-risk pregnancies
Nutritional deficiencies
Medical complications

Better Nutritional Supplementation

Iron and Folic Acid (IFA) Consumption

Indicator	NFHS-5	NFHS-6
IFA for 100+ Days	44.1%	54.9%
IFA for 180+ Days	26.0%	37.8%

This reflects strengthened maternal nutrition interventions.

Government Schemes Driving Maternal Health Gains

Major contributors include:

Janani Suraksha Yojana
Janani Shishu Suraksha Karyakram
Pradhan Mantri Surakshit Matritva Abhiyan
Surakshit Matritva Aashwasan
Pradhan Mantri Matru Vandana Yojana

Child Health and Nutrition

Reduction in Child Malnutrition

Stunting: Stunting declined significantly.

Indicator	NFHS-5	NFHS-6
Stunting	35.5%	29.3%

Stunting reflects chronic undernutrition.

Severe Wasting

Indicator	NFHS-5	NFHS-6
Severe Wasting	7.7%	5.2%

This indicates improvement in acute nutritional status.

Underweight Children

Indicator	NFHS-5	NFHS-6
Underweight	32.1%	31.8%

Improvement remains relatively slow, indicating persistent nutritional challenges.

Infant and Young Child Feeding Practices

Complementary Feeding

Children aged 6-8 months receiving complementary food along with breastfeeding increased from 45.9% to 59.5%

Exclusive Breastfeeding

NFHS-6 reports 95.6% of infants under six months are exclusively breastfed.

Early Initiation of Breastfeeding

Improved from 41.8% to 50.1%
Early breastfeeding improves immunity and neonatal survival.

Policy Drivers of Nutritional Gains

Major initiatives include:

Childhood Immunisation

Full Immunisation Coverage

Indicator	NFHS-5	NFHS-6
Fully Immunised Children	83.8%	87.1%

Vaccine-Specific Improvements

Rotavirus Vaccine: Coverage increased dramatically from 36.4% to 85.4%

Second Dose of Measles Vaccine: Coverage increased from 58.6% to 71.8%

Key Drivers:

Universal Immunisation Programme
U-WIN
Improved cold-chain infrastructure

Better Child Health Outcomes

Acute Respiratory Infections (ARI)

Declined from 2.8% to 1.9%

Severe Diarrhoea

Reduced to 0.5%
This indicates improved preventive healthcare and immunisation coverage.

Demographic Transition and Population Stabilisation

Total Fertility Rate (TFR)

India’s TFR remains: 2.0
This is below the replacement level fertility rate of 2.1.

Implications:

However, some states may face ageing-related challenges in the future.

Contraceptive Prevalence Rate (CPR)

Improved from 66.7% to 69.1%
This reflects better access to family planning services.

Women’s Empowerment and Social Transformation

Digital Inclusion

Internet Usage

Women who have ever used the internet increased from 33.3% to 64.3%

Mobile Phone Ownership

Increased from 53.9% to 63.6%

This indicates rapid digital empowerment.

Financial Inclusion

Women operating their own bank accounts increased from 78.6% to 89.0%

This reflects the success of:

Financial inclusion programmes
Direct Benefit Transfers
Digital banking expansion

Menstrual Hygiene

Use of hygienic menstrual protection methods among women aged 15-24 years increased from 77.6% to 79.2%

Supported by:

Menstrual Hygiene Scheme
Rashtriya Kishor Swasthya Karyakram
Pradhan Mantri Bhartiya Janaushadhi Pariyojana

Health Insurance Coverage

Households covered by health insurance rose significantly:

41.0% to 60.2%
A major contributor is Ayushman Bharat Pradhan Mantri Jan Arogya Yojana

Emerging Concerns Highlighted by NFHS-6

Rising Caesarean Section Deliveries

C-section deliveries increased from 21.5% to 27.2%
This exceeds the WHO-recommended threshold of 10-15%.

Public-Private Divide

Facility Type	C-Section Rate
Public Hospitals	16.9%
Private Hospitals	54.1%

Concerns

Commercialisation of childbirth
Unnecessary medical interventions
Increased healthcare costs

Persistent Child Undernutrition

Despite improvements, nearly one-third of children remain stunted.

This suggests continuing challenges in:

Dietary diversity
Maternal nutrition
Household food security

The Growing Obesity Epidemic

Women

Obesity increased from 24% to 30.7%
Urban women: 42.8%

Men

Obesity increased from 22.9% to 27.3%
This reflects changing lifestyles and dietary habits.

Rise of Non-Communicable Diseases

Increasing prevalence of:

Diabetes
Hypertension
Cardiovascular diseases

signals India’s epidemiological transition from communicable to lifestyle diseases.

Gaps in Continuity of Antenatal Care

Although registration is high More than one-third of women do not complete four ANC visits.
This weakens maternal healthcare outcomes.

Omission of Anaemia Biomarkers

A major concern is the removal of blood-based anaemia testing from the National Family Health Survey-6.

Implications:

Reduced ability to track anaemia trends
Difficulty in evaluating:
- Anaemia control programmes
- Iron supplementation efforts
- Nutrition interventions

Significance of NFHS-6 for Governance

Evidence-Based Policymaking

The survey provides district-level data for:

Health planning
Resource allocation
Programme evaluation

Monitoring Sustainable Development Goals (SDGs)

National Family Health Survey indicators directly contribute to monitoring:

Strengthening Cooperative Federalism

States can use National Family Health Survey data to:

Identify regional disparities
Design targeted interventions
Improve service delivery

Way Forward

Regulate Excessive C-Sections

Mandatory audits of private hospitals
Strengthening midwifery-led care
Promoting normal deliveries

Combat Obesity and NCDs

Front-of-Pack Labelling (FOPL)
Taxation of ultra-processed foods
Health education campaigns
Promotion of physical activity

Improve Child Nutrition

Dietary diversification
Fortified foods
Strengthening Anganwadi services
Better maternal nutrition

Strengthen Primary Healthcare

Enhance Health and Wellness Centres under Ayushman Bharat for screening and management of Diabetes, Hypertension, and Obesity

Utilise Digital Health Platforms

AI-based micro-planning
U-WIN-driven immunisation tracking
Digital health records
Predictive analytics

Conclusion

National Family Health Survey-6 presents a largely encouraging picture of India’s progress in maternal and child health, nutrition, immunisation, family planning, financial inclusion, and women’s empowerment.

The remarkable rise in institutional deliveries, improvements in immunisation coverage, reduction in stunting, and expansion of health insurance indicate the positive impact of sustained public health investments and welfare programmes.

However, the survey also reveals a new generation of public health challenges, rising obesity, growing non-communicable diseases, excessive Caesarean deliveries, and persistent child undernutrition.

Going forward, India must complement its success in expanding healthcare access with a stronger focus on preventive healthcare, nutrition security, behavioural change, and lifestyle modification to achieve the vision of a healthy and developed nation.

UPSC Mains Practice Questions

Q. National Family Health Survey-6 reflects India’s transition from concerns of access to concerns of quality and continuity of healthcare. Discuss.

Q. Despite improvements in maternal and child health indicators, India continues to face a dual burden of malnutrition and non-communicable diseases. Critically analyse.

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National Family Health Survey