National Family Health Survey (NFHS)

The National Family Health Survey, or NFHS, is India's biggest household survey on health, population and family welfare. It asks lakhs of households and women and men about fertility, child health, nutrition, family planning, marriage, domestic violence and access to services. The survey is carried out by the Ministry of Health and Family Welfare (MoHFW), with the International Institute for Population Sciences (IIPS), Mumbai as the nodal agency. Most of India's well-known numbers on child marriage, stunting and anaemia come from the NFHS.

Why does it exist?

India runs many health and welfare schemes, but the government needs to know if they work. Hospital records only show people who reach a hospital. The NFHS visits homes directly, so it captures people who never come to the system. It gives reliable figures at national, state and, since NFHS-4, district level. These numbers help the government decide where to spend money and which districts need urgent attention.

Where did it come from?

The NFHS began in the early 1990s:

• NFHS-1: 1992-93
• NFHS-2: 1998-99
• NFHS-3: 2005-06
• NFHS-4: 2015-16 (first to give estimates for all 640 districts of the 2011 Census)
• NFHS-5: 2019-21 (about 6.37 lakh households; 707 districts)
• NFHS-6: 2023-24 (about 6.79 lakh households; fact sheets released in 2026)

The early rounds got funding from USAID and technical help from international partners under the global Demographic and Health Surveys (DHS) Program. NFHS-6 was the first round run fully by IIPS without USAID involvement.

How does it work?

1. Sampling: A sample of villages and urban blocks is chosen so that it represents every district and state.
2. Household visits: Trained field teams visit each selected home and use standard questionnaires for the household, women, and men.
3. Health checks (biomarkers): Teams measure height, weight, blood pressure, blood sugar and haemoglobin (for anaemia) on the spot.
4. Fact sheets and reports: IIPS publishes national, state and district fact sheets, followed by detailed reports.

Key indicators it measures

• Fertility: Total Fertility Rate (TFR), the average number of children a woman would have in her life
• Marriage: share of women aged 20-24 married before 18, and men aged 25-29 married before 21
• Child health: stunting, wasting, underweight, full immunisation
• Women's health: anaemia, institutional deliveries, antenatal care
• Family planning, domestic violence, women's bank accounts and mobile phone use

Headline NFHS-6 (2023-24) findings

• TFR stayed at 2.0, below the replacement level of 2.1. Bihar had the highest TFR (2.7) and Andaman and Nicobar Islands the lowest (0.9).
• Women aged 20-24 married before 18: 20.1% (23.3% in NFHS-5); men aged 25-29 married before 21: 15.9%.
• Stunting in children under 5 fell from 35.5% to 29.3%.
• Institutional deliveries rose to 90.6%, and full immunisation (12-23 months) to 87.1%.
• The number of key indicators in the fact sheets fell from 131 (NFHS-5) to 101.

Commonly confused concepts

• NFHS vs Census: The Census counts every single person, once in about ten years, under the Registrar General of India (Ministry of Home Affairs). The NFHS is a sample survey that goes deeper on health and family topics.
• NFHS vs Sample Registration System (SRS): SRS, run by the Registrar General, gives yearly estimates of birth rate, death rate, infant mortality and maternal mortality. NFHS gives detailed health and behaviour data every few years. Their figures can differ (for example, NFHS-6 TFR is 2.0 while SRS shows 1.9).
• NFHS vs HMIS: The Health Management Information System (HMIS) uses records from health facilities. NFHS uses household interviews.
• NFHS vs HCES: The Household Consumption Expenditure Survey (by MoSPI) measures what households spend, not their health.

Issues, criticism and the way forward

• Long gaps: Years can pass between rounds, so policy may use old data.
• Dropped indicators: Critics point out that NFHS-6 published fewer indicators than NFHS-5. The ministry calls this "data harmonisation" with other surveys.
• Self-reported answers: Some questions, like age at marriage or violence, depend on what respondents say; sensitive issues may be under-reported.
• Way forward: Publish full unit-level data quickly, keep indicators comparable across rounds, and link NFHS with yearly sources like SRS and HMIS.

Concepts to Know

• Nodal agency: The main organisation in charge of running and coordinating a project.
• Sample survey: A survey of a carefully chosen part of the population, which is then used to estimate the whole.
• Replacement level fertility (2.1): The average number of children per woman needed for a population to replace itself, without migration.
• Stunting: When a child is too short for their age, a sign of long-term undernutrition.
• Biomarker: A body measurement, like blood haemoglobin or blood sugar, used to check health.