National Family Health Survey

National Family Health Survey (NFHS) is India’s flagship, multi‑round household survey that systematically captures a wide spectrum of health, nutrition, and family‑planning indicators across the nation’s states and union territories. Conducted under the aegis of the Ministry of Health and Family Welfare and technically managed by the International Institute for Population Sciences (IIPS), the NFHS provides the most granular, nationally representative data on maternal and child health, reproductive behaviour, and disease prevalence, forming the empirical backbone for policy formulation, programme evaluation, and progress tracking toward the Sustainable Development Goals. ## Origins and Historical Development The first NFHS was launched in 1992‑93 as a concrete response to the National Population Policy of 1992, which called for a “comprehensive assessment of health and family‑welfare status” to guide demographic planning. Initiated by the Ministry of Health and Family Welfare with IIPS as the executing agency, the survey was funded in part by the United Nations Population Fund (UNFPA) and the United States Agency for International Development (USAID). Subsequent rounds—NFHS‑2 (1995‑96), NFHS‑3 (1998‑99), NFHS‑4 (2005‑06), and NFHS‑5 (2019‑21)—have been spaced roughly every five to ten years, each expanding scope and sample size to reflect India’s evolving demographic profile. Early rounds surveyed roughly 89,000 households each, providing a baseline for key indicators such as total fertility rate (TFR) and infant mortality rate (IMR). By NFHS‑4, the sample grew to 601,509 households, and NFHS‑5 further increased coverage to 636,699 households, enabling state‑level estimates for all 28 states and 8 union territories. The longitudinal continuity of the NFHS series has made it possible to trace demographic transitions over three decades, from a high‑fertility, high‑mortality regime to a more nuanced health landscape. ## Survey Design and Methodology Each NFHS round employs a stratified, multistage sampling framework that first selects Primary Sampling Units (PSUs) based on the 2011 Census of India, then randomly chooses households within each PSU. The design ensures a minimum of 30 households per PSU and a target of 30 PSUs per district, yielding a design effect that typically ranges between 1.5 and 2.0. Data collection is carried out by trained field investigators using computer‑assisted personal interviewing (CAPI) devices, which reduce transcription errors and allow real‑time consistency checks. The questionnaire suite comprises a household schedule, a women’s schedule (for all women aged 15–49), a men’s schedule (for men aged 15–54), and a biomarker module. The biomarker component, introduced in NFHS‑4, captures hemoglobin concentration, anthropometric measurements, and, where feasible, blood glucose and urine analysis. This integration of clinical data with self‑reported information distinguishes NFHS from many other demographic surveys and enables precise estimates of anemia prevalence (66 % among women in NFHS‑1, 57 % in NFHS‑5) and child stunting (48 % to 35 % over the same period). ## Major Findings and Trends Across the five rounds, the NFHS has documented a steady decline in fertility: the TFR fell from 3.4 births per woman in NFHS‑1 to 2.0 in NFHS‑5, approaching the replacement level of 2.1. Infant mortality dropped dramatically from 73 deaths per 1,000 live births to 28, while the maternal mortality ratio (MMR) decreased from 212 to 113 per 100,000 live births, reflecting the impact of expanded obstetric care. Nutritional indicators show mixed progress; while under‑five stunting fell from 48 % to 35 %, anemia among adolescent girls (15‑19) remains above 55 %, signalling persistent micronutrient gaps. Contraceptive prevalence rose from 40 % in NFHS‑2 to 53 % in NFHS‑5, driven largely by increased uptake of modern methods such as sterilisation (female: 36 % in NFHS‑5) and intra‑uterine devices. Immunisation coverage for children aged 12‑23 months improved from 44 % for full immunisation in NFHS‑2 to 62 % in NFHS‑5, yet regional disparities persist, with the northeastern states lagging behind the southern states. These granular insights have been pivotal in identifying “high‑focus” districts where health interventions are most needed. ## Policy Impact and Current Status Data from the NFHS directly inform the National Health Mission (NHM) and its sub‑programmes, including the Janani Suraksha Yojana (JSY) for institutional deliveries and the Pradhan Mantri Matru Vandana Yojana (PMMVY) for maternal nutrition. The Ministry of Health and Family Welfare uses NFHS indicators as the primary benchmarks for the Sustainable Development Goal 3 targets, publishing annual progress reports that