Lok Sabha Question No. 97 (STARRED), answered on 2021-12-03
Subject: National Family Health Survey
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Bidyut Baran Mahato, Gajanan Chandrakant Kirtikar

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA STARRED QUESTION NO.97 TO BE ANSWERED ON THE 3 RD  DECEMBER, 2021 NATIONAL FAMILY HEALTH SURVEY

## *97. SHRI BIDYUT BARAN MAHATO: SHRI GAJANAN KIRTIKAR:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a)  the  main  objective  of  conducting  National  Family  Health  Survey  (NFHS)  along with  the  number  of  NFHS  conducted in the country  and the major  findings therein, State/UT-wise particularly in Maharashtra, Madhya Pradesh, Jharkhand, Tamil Nadu and Tripura;
- (b) the percentage of children found malnourished, anemic and not provided lifesaving vaccine against diarrhoea and other diseases as per the NFHS 3 and 4, survey-wise and State/UT-wise,  particularly  in  Maharashtra,  Madhya  Pradesh,  Jharkhand  and  Tamil Nadu;
- (c)  whether  any  improvement has been noticed subsequent to the surveys, if so, the details thereof;
- (d) whether a number of States/UTs were not covered by some of these surveys, if so, the details thereof along with the reasons therefor;
- (e)  whether  the  Government  has  restructured  the  format  of  NFHS,  if  so,  the  details thereof; and
- (f) the steps taken by Government to ensure compilation of true and objective data for making its future policies and programmes?

## ANSWER

THE MINISTER OF HEALTH AND FAMILY WELFARE (DR. MANSUKH MANDAVIYA)

- (a) to (f) A Statement is laid on the Table of the House.

## STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION NO. 97* FOR 3 RD  DECEMBER, 2021

(a) to (f) The National Family Health Survey (NFHS) in India was initiated in the early 1990s and has emerged as a nationally important source of data on population, health and nutrition for India and its States. So far, five rounds of the National Family Health Survey have been conducted.

The broad objectives of the NFHS are to provide high quality data on population and health indicators as well as data on emerging issues in health and family welfare; and to provide essential  information  that  would  assist  policymakers  and  programme managers in setting benchmarks and examining progress over time in India's health sector.  Besides  this,  this  survey  provides  evidence  on  the  effectiveness  of  ongoing programmes implemented by Government of India.

The  performance  of  India  and  States/UTs  on  major  health  indicators  as  per  the latest  round  of  NFHS.  The  State/UT  wise  major  findings  is  placed  at  Annexure-I. However,  some  of  the  major  findings  in  respect  to  Maharashtra,  Madhya  Pradesh, Jharkhand, Tamil Nadu and Tripura are:

-  Birth  registration  of  children  is  higher  than  90%  in  all  the  States  except Jharkhand where it is 73.5%.
-  The Total Fertility Rate of all the States have reached the replacement level of fertility (TFR 2.1) except for Jharkhand where it is 2.3 children per woman.
-  Under-five Mortality Rate is more than 40 in Madhya Pradesh, Jharkhand and Tripura.
-  In all the States except Jharkhand (61.7%), about or more than two-third of the currently married women age 15-49 years use any method of contraception to either delay or limit their pregnancy.
-  The unmet need for family planning is below 10 percent in all the States except Jharkhand (11.5%).
-  In all the States except Jharkhand (38.6%), more than half of the mothers had at least 4 ANC visits for their most recent birth in the last 5 years. In Tamil Nadu, 89.9% mothers had at least 4 ANCs for their most recent birth in the last 5 years.
-  Institutional  births  are  more  than  90%  in  all  the  States  except  for  Jharkhand (75.8%) and Tripura (89.2%).
-  Full vaccination of children is  more than 70% in all the States except Tripura (69.5%).
-  Except for Tamil Nadu (55.1%) and Tripura (62.1%), exclusive breastfeeding of infants under age 6 months is more than 70% in all other States.
-  Use of menstrual hygienic products among women age 15-24 is almost universal in  Tamil  Nadu  (98.3%).  However,  in  Madhya  Pradesh  only  60.5%  young women use hygienic methods of protection during their menstrual period.

The  State/UT-wise  and  national  estimates  on  prevalence  of  malnourishment, anemia and full vaccination of children as per NFHS-3 and NFHS-4 are given in the Annexure-II  and  Annexure-III.  Information  on  vaccines  against  diarrhea  are  not available in NFHS-3 and NFHS-4 publication.

Significant improvements over key health and family welfare indicators have been observed in subsequent rounds of NFHS. The performance of a few indicators across different rounds of NFHS is given at Annexure-IV.

The details of States/UTs not covered by some of these surveys are as follows:

- (i) NFHS-1 (1992-93):
-  Srinagar region of Jammu and Kashmir was not covered due to law and order situation at the time of fieldwork.
-  Sikkim was not covered in NFHS-1 due to non-availability of information on basic parameters for sample selection.

(ii) NFHS-1,  2,  3 :  The  Union  Territories  except  the  NCT  of  Delhi  were  not covered in the first three rounds of NFHS as the objective of the survey at that time was to provide State level estimates. Further, the size of population in the UTs were very small and consisted less than one percent of the total population of India.

However,  since  NFHS-4,  all  the  States/UTs  and  Districts  are  being  covered  as  the scope  of  the  survey  was  widened  from  National  level  estimates  to  District  level estimates.

The five rounds of National Family Health Survey conducted so far have more or less on a similar structure to maintain the comparability of estimates across various rounds. However, additions, deletions and modifications to the questionnaire are made in  subsequent  rounds  taking  into  consideration  the  emerging  issues  in  health  and family welfare domain of the country; and requirement of quality data for tracking the ongoing programmes and formulating new policies. The major revisions made in the format of NFHS since its inception are placed at Annexure - V.

MoHFW has always been striving at strengthening quality of data in NFHS by introducing  several  innovative  measures  in  collection,  processing  and  interpretation. The following are the major steps taken by NFHS in subsequent rounds:

-  Comprehensive  training  and  Multilayer  monitoring  and  supervision  of  field work.
-  Minimizing  instrumental  errors, human  errors  and  transcription errors in collection of biomarkers.
-  Developing nested design using a modular approach adopted from NFHS-4.
-  Introduction of Computer-Assisted Personal Interviews (CAPI).
-  Real  time  access  to  data  using  field  check  tables,  for  immediate  feedback through online interactions since NFHS-4.
-  Developing error messages in the data collected from a Primary Sampling Unit (PSU) by supervisor from NFHS-5.
-  Application  of  Artificial  Intelligence  (AI)  and  Machine  Learning  (ML)  for generating Query Reports on selected indicators before completing any PSU to enhance data quality.
-  Developing COVID-19 specific SOPs in the second phase of NFHS-5.
-  Backchecks  in  randomly  selected  Households  (HHs)  in  10%  PSUs  in  each district and revisits in all HHs in case of deviance in over 10% surveyed HHs in post COVID scenario.

Annexure-I Performance of States/UTs in selected key health indicators, NFHS-5 (2019-21)

| States/UTs               |   Children under age 5 years whose birth was registered with the civil authority (%) |   Total fertility rate (children per woman) | Under-five mortality rate (U5MR)   |   Current use of family planning methods- Any method (%) |   Total unmet need for family planning(%) |   Mothers who had at least 4 antenatal care visits (%) |   Institutional births (%) | Children age 12-23 months fully vaccinated based on information from either vaccination card or mother's recall(%)   | Children under age 6 months exclusively breastfed (%) Women age 15-24 years who use hygienic methods of protection during their   |   menstrual period(%) |
|--------------------------|--------------------------------------------------------------------------------------|---------------------------------------------|------------------------------------|----------------------------------------------------------|-------------------------------------------|--------------------------------------------------------|----------------------------|----------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------|-----------------------|
| India                    |                                                                                 89.1 |                                         2   | 41.9                               |                                                     66.7 |                                       9.4 |                                                   58.1 |                       88.6 | 76.4                                                                                                                 | 63.7                                                                                                                              |                  77.3 |
| Andaman &Nicobar Islands |                                                                                 97.4 |                                         1.3 | (24.5)                             |                                                     65.8 |                                      13.5 |                                                   83.4 |                       99   | 77.8                                                                                                                 | (73.3)                                                                                                                            |                  98.9 |
| Andhra Pradesh           |                                                                                 92.2 |                                         1.7 | 35.2                               |                                                     71.1 |                                       4.7 |                                                   67.5 |                       96.5 | 73.0                                                                                                                 | 68.0                                                                                                                              |                  85.1 |
| Arunachal Pradesh        |                                                                                 87.7 |                                         1.8 | 18.8                               |                                                     59.1 |                                      12.5 |                                                   36.5 |                       79.2 | 64.9                                                                                                                 | 63.4                                                                                                                              |                  91.8 |
| Assam                    |                                                                                 96.3 |                                         1.9 | 39.1                               |                                                     60.8 |                                      11   |                                                   50.7 |                       84.1 | 66.4                                                                                                                 | 63.6                                                                                                                              |                  66.3 |
| Bihar                    |                                                                                 75.6 |                                         3   | 56.4                               |                                                     55.8 |                                      13.6 |                                                   25.2 |                       76.2 | 71.0                                                                                                                 | 58.9                                                                                                                              |                  58.8 |
| Chandigarh               |                                                                                 97.6 |                                         1.4 | *                                  |                                                     77.4 |                                       6.9 |                                                   78.7 |                       96.9 | (80.9)                                                                                                               | #                                                                                                                                 |                  93.4 |
| Chhattisgarh             |                                                                                 96.6 |                                         1.8 | 50.4                               |                                                     67.8 |                                       8.3 |                                                   60.1 |                       85.7 | 79.7                                                                                                                 | 80.4                                                                                                                              |                  68.8 |
| DNH&DD                   |                                                                                 98.1 |                                         1.8 | 37.0                               |                                                     68   |                                      11.9 |                                                   86.2 |                       96.5 | 94.9                                                                                                                 | 79.4                                                                                                                              |                  93.6 |
| Goa                      |                                                                                100   |                                         1.3 | (10.6)                             |                                                     67.9 |                                       8.4 |                                                   93   |                       99.7 | 81.9                                                                                                                 | (61.4)                                                                                                                            |                  96.8 |
| Gujarat                  |                                                                                 97.5 |                                         1.9 | 37.6                               |                                                     65.3 |                                      10.3 |                                                   76.9 |                       94.3 | 76.3                                                                                                                 | 65.0                                                                                                                              |                  65.8 |
| Haryana                  |                                                                                 95.1 |                                         1.9 | 38.7                               |                                                     73.1 |                                       7.6 |                                                   60.4 |                       94.9 | 76.9                                                                                                                 | 69.5                                                                                                                              |                  93.2 |
| Himachal Pradesh         |                                                                                 97.9 |                                         1.7 | 28.9                               |                                                     74.2 |                                       7.9 |                                                   70.3 |                       88.2 | 89.3                                                                                                                 | 69.9                                                                                                                              |                  91.5 |
| Jammu &Kashmir           |                                                                                 95.3 |                                         1.4 | 18.5                               |                                                     59.8 |                                       7.8 |                                                   80.9 |                       92.4 | 86.2                                                                                                                 | 62.0                                                                                                                              |                  73.4 |
| Jharkhand                |                                                                                 73.5 |                                         2.3 | 45.4                               |                                                     61.7 |                                      11.5 |                                                   38.6 |                       75.8 | 73.9                                                                                                                 | 76.1                                                                                                                              |                  74.9 |
| Karnataka                |                                                                                 97.5 |                                         1.7 | 29.5                               |                                                     68.7 |                                       6.5 |                                                   70.9 |                       97   | 84.1                                                                                                                 | 61.0                                                                                                                              |                  84.2 |
| Kerala                   |                                                                                 99   |                                         1.8 | 5.2                                |                                                     60.7 |                                      12.5 |                                                   78.6 |                       99.8 | 77.8                                                                                                                 | 55.5                                                                                                                              |                  93   |
| Ladakh                   |                                                                                 98.6 |                                         1.3 | 29.5                               |                                                     51.3 |                                       7.9 |                                                   78.4 |                       95.1 | 88.2                                                                                                                 | 70.9                                                                                                                              |                  78.2 |
| Lakshadweep              |                                                                                100   |                                         1.4 | (0.0)                              |                                                     52.6 |                                      12.3 |                                                   88.3 |                       99.6 | (86.1)                                                                                                               | (67.0)                                                                                                                            |                  98.3 |
| Madhya Pradesh           |                                                                                 94.1 |                                         2   | 49.2                               |                                                     71.7 |                                       7.7 |                                                   57.5 |                       90.7 | 77.1                                                                                                                 | 74.0                                                                                                                              |                  60.5 |
| Maharashtra              |                                                                                 96.3 |                                         1.7 | 28.0                               |                                                     66.2 |                                       9.6 |                                                   70.3 |                       94.7 | 73.5                                                                                                                 | 71.0                                                                                                                              |                  84.8 |
| Manipur                  |                                                                                 87.4 |                                         2.2 | 30.0                               |                                                     61.3 |                                      12.2 |                                                   79.4 |                       79.9 | 68.8                                                                                                                 | 70.7                                                                                                                              |                  82.9 |
| Meghalaya                |                                                                                 82.1 |                                         2.9 | 40.0                               |                                                     27.4 |                                      26.9 |                                                   52.2 |                       58.1 | 63.8                                                                                                                 | 42.7                                                                                                                              |                  64.9 |
| Mizoram                  |                                                                                 99.4 |                                         1.9 | 24.0                               |                                                     31.2 |                                      18.9 |                                                   58   |                       85.8 | 72.5                                                                                                                 | 67.9                                                                                                                              |                  89.8 |
| Nagaland                 |                                                                                 73.2 |                                         1.7 | 33.0                               |                                                     57.4 |                                       9.1 |                                                   20.7 |                       45.7 | 57.9                                                                                                                 | 43.2                                                                                                                              |                  80.2 |
| NCT of Delhi             |                                                                                 94.4 |                                         1.6 | 30.6                               |                                                     76.4 |                                       6.1 |                                                   77.2 |                       91.8 | 76.0                                                                                                                 | 64.3                                                                                                                              |                  96.9 |
| Odisha                   |                                                                                 90.8 |                                         1.8 | 41.1                               |                                                     74.1 |                                       7.2 |                                                   78.1 |                       92.2 | 90.5                                                                                                                 | 72.9                                                                                                                              |                  81.5 |
| Puducherry               |                                                                                 99.3 |                                         1.5 | 3.9                                |                                                     66   |                                      10.5 |                                                   86.9 |                       99.6 | 82.0                                                                                                                 | 64.8                                                                                                                              |                  99.1 |
| Punjab                   |                                                                                 97.7 |                                         1.6 | 32.7                               |                                                     66.6 |                                       9.9 |                                                   59.3 |                       94.3 | 76.2                                                                                                                 | 55.5                                                                                                                              |                  93.2 |
| Rajasthan                |                                                                                 91.4 |                                         2   | 37.6                               |                                                     72.3 |                                       7.6 |                                                   55.3 |                       94.9 | 80.4                                                                                                                 | 70.4                                                                                                                              |                  84.1 |
| Sikkim                   |                                                                                 96.5 |                                         1.1 | 11.2                               |                                                     69.1 |                                      11.9 |                                                   58.4 |                       94.7 | 80.6                                                                                                                 | 28.3                                                                                                                              |                  86.3 |
| Tamil Nadu               |                                                                                 98.3 |                                         1.8 | 22.3                               |                                                     68.6 |                                       7.5 |                                                   89.9 |                       99.6 | 89.2                                                                                                                 | 55.1                                                                                                                              |                  98.3 |
| Telangana                |                                                                                 90   |                                         1.8 | 29.4                               |                                                     68.1 |                                       6.4 |                                                   70.4 |                       97   | 79.1                                                                                                                 | 68.2                                                                                                                              |                  92.1 |
| Tripura                  |                                                                                 93.8 |                                         1.7 | 43.3                               |                                                     71.2 |                                       8.2 |                                                   52.7 |                       89.2 | 69.5                                                                                                                 | 62.1                                                                                                                              |                  68.8 |
| Uttar Pradesh            |                                                                                 79.5 |                                         2.4 | 59.8                               |                                                     62.4 |                                      12.9 |                                                   42.4 |                       83.4 | 69.6                                                                                                                 | 59.7                                                                                                                              |                  72.6 |
| Uttarakhand              |                                                                                 91.9 |                                         1.9 | 45.6                               |                                                     70.8 |                                       8.8 |                                                   61.8 |                       83.2 | 80.8                                                                                                                 | 52.5                                                                                                                              |                  91.2 |
| West Bengal              |                                                                                 98.2 |                                         1.6 | 25.4                               |                                                     74.4 |                                       7   |                                                   75.8 |                       91.7 | 87.8                                                                                                                 | 53.3                                                                                                                              |                  83   |

Source: NFHS-5 National/State/UT factsheets (http://rchiips.org/nfhs/factsheet\_NFHS-5.shtml)

*Rate not shown; based on fewer than 250 unweighted person-years of exposure to the risk of death.

#Percentage not shown; based on fewer than 25 unweighted cases.

Figures in () are based on 25-49 unweighted cases

Percentage  of  children  under  age  five  years  classified  as  malnourished  according  to  three anthropometric  indices  of  nutritional  status,  according  to  State/Union  Territory,  NFHS-3 (2005-06) & NFHS-4 (2015-16)

| State/Union Territory   | Children under 5 years who are stunted (height- for-age)* (%)   | Children under 5 years who are stunted (height- for-age)* (%)   | Children under 5 years who are wasted (weight- for-height)* (%)   | Children under 5 years who are wasted (weight- for-height)* (%)   | Children under 5 years who are underweight (weight for age)* (%)   | Children under 5 years who are underweight (weight for age)* (%)   |
|-------------------------|-----------------------------------------------------------------|-----------------------------------------------------------------|-------------------------------------------------------------------|-------------------------------------------------------------------|--------------------------------------------------------------------|--------------------------------------------------------------------|
| State/Union Territory   | NFHS-3                                                          | NFHS-4                                                          | NFHS-3                                                            | NFHS-4                                                            | NFHS-3                                                             | NFHS-4                                                             |
| India                   | 48                                                              | 38.4                                                            | 19.8                                                              | 21                                                                | 42.5                                                               | 35.7                                                               |
| Andhra Pradesh #        | 42.7                                                            | 31.4                                                            | 12.2                                                              | 17.2                                                              | 32.5                                                               | 31.9                                                               |
| A &NIslands             | -                                                               | 23.3                                                            | -                                                                 | 18.9                                                              | -                                                                  | 21.5                                                               |
| Arunachal Pradesh       | 43.3                                                            | 29.3                                                            | 15.3                                                              | 17.3                                                              | 32.5                                                               | 19.5                                                               |
| Assam                   | 46.5                                                            | 36.4                                                            | 13.7                                                              | 17                                                                | 36.4                                                               | 29.8                                                               |
| Bihar                   | 55.6                                                            | 48.3                                                            | 27.1                                                              | 20.8                                                              | 55.9                                                               | 43.9                                                               |
| Chandigarh              | -                                                               | 28.7                                                            | -                                                                 | 10.9                                                              | -                                                                  | 24.5                                                               |
| Chhattisgarh            | 52.9                                                            | 37.6                                                            | 19.5                                                              | 23.1                                                              | 47.1                                                               | 37.7                                                               |
| Dadra &Nagar Haveli     | -                                                               | 41.7                                                            | -                                                                 | 27.6                                                              | -                                                                  | 38.8                                                               |
| Daman &Diu              | -                                                               | 23.4                                                            | -                                                                 | 24.1                                                              | -                                                                  | 26.7                                                               |
| Delhi                   | 42.2                                                            | 31.9                                                            | 15.4                                                              | 15.9                                                              | 26.1                                                               | 27                                                                 |
| Goa                     | 25.6                                                            | 20.1                                                            | 14.1                                                              | 21.9                                                              | 25                                                                 | 23.8                                                               |
| Gujarat                 | 51.7                                                            | 38.5                                                            | 18.7                                                              | 26.4                                                              | 44.6                                                               | 39.3                                                               |
| Haryana                 | 45.7                                                            | 34                                                              | 19.1                                                              | 21.2                                                              | 39.6                                                               | 29.4                                                               |
| Himachal Pradesh        | 38.6                                                            | 26.3                                                            | 19.3                                                              | 13.7                                                              | 36.5                                                               | 21.2                                                               |
| Jammu &Kashmir          | 35                                                              | 27.4                                                            | 14.8                                                              | 12.1                                                              | 25.6                                                               | 16.6                                                               |
| Jharkhand               | 49.8                                                            | 45.3                                                            | 32.3                                                              | 29                                                                | 56.5                                                               | 47.8                                                               |
| Karnataka               | 43.7                                                            | 36.2                                                            | 17.6                                                              | 26.1                                                              | 37.6                                                               | 35.2                                                               |
| Kerala                  | 24.5                                                            | 19.7                                                            | 15.9                                                              | 15.7                                                              | 22.9                                                               | 16.1                                                               |
| Lakshadweep             | -                                                               | 26.8                                                            | -                                                                 | 13.7                                                              | -                                                                  | 23.6                                                               |
| Madhya Pradesh          | 50                                                              | 42                                                              | 35                                                                | 25.8                                                              | 60                                                                 | 42.8                                                               |
| Maharashtra             | 46.3                                                            | 34.4                                                            | 16.5                                                              | 25.6                                                              | 37                                                                 | 36                                                                 |
| Manipur                 | 35.6                                                            | 28.9                                                            | 9                                                                 | 6.8                                                               | 22.1                                                               | 13.8                                                               |
| Meghalaya               | 55.1                                                            | 43.8                                                            | 30.7                                                              | 15.3                                                              | 48.8                                                               | 28.9                                                               |
| Mizoram                 | 39.8                                                            | 28.1                                                            | 9                                                                 | 6.1                                                               | 19.9                                                               | 12                                                                 |
| Nagaland                | 38.8                                                            | 28.6                                                            | 13.3                                                              | 11.2                                                              | 25.2                                                               | 16.7                                                               |
| Odisha                  | 45                                                              | 34.1                                                            | 19.5                                                              | 20.4                                                              | 40.7                                                               | 34.4                                                               |
| Puducherry              |                                                                 | 23.7                                                            | -                                                                 | 23.6                                                              | -                                                                  | 22                                                                 |
| Punjab                  | 36.7                                                            | 25.7                                                            | 9.2                                                               | 15.6                                                              | 24.9                                                               | 21.6                                                               |
| Rajasthan               | 43.7                                                            | 39.1                                                            | 20.4                                                              | 23                                                                | 39.9                                                               | 36.7                                                               |
| Sikkim                  | 38.3                                                            | 29.6                                                            | 9.7                                                               | 14.2                                                              | 19.7                                                               | 14.2                                                               |
| Tamil Nadu              | 30.9                                                            | 27.1                                                            | 22.2                                                              | 19.7                                                              | 29.8                                                               | 23.8                                                               |
| Telangana               | -                                                               | 28                                                              | -                                                                 | 18                                                                | -                                                                  | 28.3                                                               |
| Tripura                 | 35.7                                                            | 24.3                                                            | 24.6                                                              | 16.8                                                              | 39.6                                                               | 24.1                                                               |
| Uttar Pradesh           | 56.8                                                            | 46.2                                                            | 14.8                                                              | 17.9                                                              | 42.4                                                               | 39.5                                                               |
| Uttarakhand             | 44.4                                                            | 33.5                                                            | 18.8                                                              | 19.5                                                              | 38                                                                 | 26.6                                                               |
| West Bengal             | 44.6                                                            | 32.5                                                            | 16.9                                                              | 20.3                                                              | 38.7                                                               | 31.5                                                               |

Source: NFHS Reports/Factsheets (http://rchiips.org/nfhs/index.shtml)

* Below - 2 SD from the International Reference Population median.

# NFHS-3 figures for Andhra Pradesh denotes estimates for the undivided State of Andhra Pradesh.

Percentage  of  Children  age  6-59  months  classified  as  having  anaemia,  and  percentage  of children age 12-23 months fully immunized based on information from either vaccination card or mother's recall according to State/Union Territory, NFHS-3 (2005-06) & NFHS-4 (2015-16)

| State/Union Territory   | Children age 6-59 months who are anaemic (<11.0 g/dl) (%)   | Children age 6-59 months who are anaemic (<11.0 g/dl) (%)   | Children age 12-23 months fully immunized based on information from either vaccination card or mother's recall (%)   | Children age 12-23 months fully immunized based on information from either vaccination card or mother's recall (%)   |
|-------------------------|-------------------------------------------------------------|-------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------|
|                         | NFHS-3                                                      | NFHS-4                                                      | NFHS-3                                                                                                               | NFHS-4                                                                                                               |
| India*                  | 69.5                                                        | 58.5                                                        | 43.5                                                                                                                 | 62.0                                                                                                                 |
| Andhra Pradesh #        | 70.8                                                        | 58.6                                                        | 46.0                                                                                                                 | 65.2                                                                                                                 |
| A &NIslands             | -                                                           | 49                                                          | -                                                                                                                    | 73.2                                                                                                                 |
| Arunachal Pradesh       | 56.9                                                        | 54.2                                                        | 28.4                                                                                                                 | 38.2                                                                                                                 |
| Assam                   | 69.6                                                        | 35.7                                                        | 31.4                                                                                                                 | 47.1                                                                                                                 |
| Bihar                   | 78                                                          | 63.5                                                        | 32.8                                                                                                                 | 61.7                                                                                                                 |
| Chandigarh              | -                                                           | 73.1                                                        | -                                                                                                                    | (79.5)                                                                                                               |
| Chhattisgarh            | 71.2                                                        | 41.6                                                        | 48.7                                                                                                                 | 76.4                                                                                                                 |
| Dadra &Nagar Haveli     | -                                                           | 84.6                                                        | -                                                                                                                    | 43.2                                                                                                                 |
| Daman &Diu              | -                                                           | 73.8                                                        | -                                                                                                                    | 66.3                                                                                                                 |
| Delhi                   | 57                                                          | 59.7                                                        | 63.2                                                                                                                 | 68.8                                                                                                                 |
| Goa                     | 38.2                                                        | 48.3                                                        | 78.6                                                                                                                 | 88.4                                                                                                                 |
| Gujarat                 | 69.7                                                        | 62.6                                                        | 45.2                                                                                                                 | 50.4                                                                                                                 |
| Haryana                 | 72.3                                                        | 71.7                                                        | 65.3                                                                                                                 | 62.2                                                                                                                 |
| Himachal Pradesh        | 54.7                                                        | 53.7                                                        | 74.2                                                                                                                 | 69.5                                                                                                                 |
| Jammu &Kashmir #        | 58.6                                                        | 54.5                                                        | 66.7                                                                                                                 | 75.1                                                                                                                 |
| Jharkhand               | 70.3                                                        | 69.9                                                        | 34.2                                                                                                                 | 61.9                                                                                                                 |
| Karnataka               | 70.4                                                        | 60.9                                                        | 55.0                                                                                                                 | 62.6                                                                                                                 |
| Kerala                  | 44.5                                                        | 35.7                                                        | 75.3                                                                                                                 | 82.1                                                                                                                 |
| Lakshadweep             | -                                                           | 53.6                                                        | -                                                                                                                    | 89.0                                                                                                                 |
| Madhya Pradesh          | 74.1                                                        | 68.9                                                        | 40.3                                                                                                                 | 53.6                                                                                                                 |
| Maharashtra             | 63.4                                                        | 53.8                                                        | 58.8                                                                                                                 | 56.2                                                                                                                 |
| Manipur                 | 41.1                                                        | 23.9                                                        | 46.8                                                                                                                 | 65.8                                                                                                                 |
| Meghalaya               | 64.4                                                        | 48                                                          | 32.9                                                                                                                 | 61.4                                                                                                                 |
| Mizoram                 | 44.2                                                        | 19.3                                                        | 46.5                                                                                                                 | 50.7                                                                                                                 |
| Nagaland                | -                                                           | 26.4                                                        | 21.0                                                                                                                 | 35.4                                                                                                                 |
| Odisha                  | 65                                                          | 44.6                                                        | 51.8                                                                                                                 | 78.6                                                                                                                 |
| Puducherry              | -                                                           | 44.9                                                        | -                                                                                                                    | 91.2                                                                                                                 |
| Punjab                  | 66.4                                                        | 56.6                                                        | 60.1                                                                                                                 | 89.0                                                                                                                 |
| Rajasthan               | 69.7                                                        | 60.3                                                        | 26.5                                                                                                                 | 54.8                                                                                                                 |
| Sikkim                  | 59.2                                                        | 55.1                                                        | 69.6                                                                                                                 | 83.0                                                                                                                 |
| Tamil Nadu              | 64.2                                                        | 50.7                                                        | 80.9                                                                                                                 | 69.7                                                                                                                 |
| Telangana               | -                                                           | 60.7                                                        | -                                                                                                                    | 67.5                                                                                                                 |
| Tripura                 | 62.9                                                        | 48.3                                                        | 49.7                                                                                                                 | 54.5                                                                                                                 |
| Uttar Pradesh           | 73.9                                                        | 63.2                                                        | 23.0                                                                                                                 | 51.1                                                                                                                 |
| Uttarakhand             | 61.4                                                        | 59.8                                                        | 60.0                                                                                                                 | 57.6                                                                                                                 |
| West Bengal             | 61                                                          | 54.2                                                        | 64.3                                                                                                                 | 84.4                                                                                                                 |

Source: NFHS Reports/Factsheets (http://rchiips.org/nfhs/index.shtml)

* In NFHS-3, the national estimates for anaemia exclude the State of Nagaland.

# NFHS-3 figures for Andhra Pradesh denotes estimates for the undivided State of Andhra Pradesh.

Figures in () are based on 25-49 unweighted cases.

## Performance of key indicators across different rounds of NFHS

| Sl. No.   | Indicator                                                                                                                    | NFHS-3 (2005-06)   | NFHS-4 (2015-16)   | NFHS-5 (2019- 21)   |
|-----------|------------------------------------------------------------------------------------------------------------------------------|--------------------|--------------------|---------------------|
|           | Population and Household Profile                                                                                             |                    |                    |                     |
| 1         | Children under age 5 years whose birth was registered with the civil authority (%)                                           | 41.1               | 79.7               | 89.1                |
| 2         | Population living in households with electricity (%)                                                                         | 67.9               | 88                 | 96.8                |
| 3         | Population living in households with an improved drinking- water source (%)                                                  | 87.9               | 94.4               | 95.9                |
| 4         | Population living in households that use an improved sanitation facility (%)                                                 | 29                 | 48.5               | 70.2                |
| 5         | Households using clean fuel for cooking (%)                                                                                  | 25.6               | 43.8               | 58.6                |
| 6         | Households with any usual member covered under a health insurance/financing scheme (%)                                       | NA                 | 28.7               | 41                  |
|           | Marriage and Fertility                                                                                                       |                    |                    |                     |
| 7         | Women age 20-24 years married before age 18 years (%)                                                                        | 47.4               | 26.8               | 23.3                |
| 8         | Women age 15-19 years who were already mothers or pregnant at the time of the survey (%)                                     | 16                 | 7.9                | 6.8                 |
| 9         | Total fertility rate (children per woman)                                                                                    | 2.7                | 2.2                | 2.0                 |
|           | Family Planning                                                                                                              |                    |                    |                     |
| 10        | Current Use of Family Planning Methods- Any method (%)                                                                       | 56.3               | 53.5               | 66.7                |
| 11        | Current Use of Family Planning Methods- Any modern method (%)                                                                | 48.5               | 47.8               | 56.5                |
| 12        | Total unmet need for Family Planning (%)                                                                                     | 12.8               | 12.9               | 9.4                 |
|           | Maternity and Delivery Care                                                                                                  |                    |                    |                     |
| 13        | Mothers who had an antenatal check-up in the first trimester (%)                                                             | 44                 | 58.6               | 70                  |
| 14        | Mothers who had at least 4 antenatal care visits (%)                                                                         | 37                 | 51.2               | 58.1                |
| 15        | Mothers who received postnatal care from a doctor/nurse/LHV/ANM/midwife/other health personnel within 2 days of delivery (%) | 36.8               | 62.4               | 78                  |
| 16        | Institutional births (%)                                                                                                     | 40.8               | 78.9               | 88.6                |
|           | Child Vaccination and Child Feeding Practices                                                                                |                    |                    |                     |
| 17        | Children age 12-23 months fully vaccinated based on information from either vaccination card or mother's recall (%)          | 43.5               | 62                 | 76.4                |
| 18        | Children under age 3 years breastfed within one hour of birth (%)                                                            | 23.4               | 41.6               | 41.8                |
| 19        | Children under age 6 months exclusively breastfed (%)                                                                        | 46.3               | 54.9               | 63.7                |
|           | Nutritional Status of Children                                                                                               |                    |                    |                     |
| 20        | Children under 5 years who are stunted (height-for-age) (%)                                                                  | 48                 | 38.4               | 35.5                |
| 21        | Children under 5 years who are wasted (weight-for-height) (%)                                                                | 19.8               | 21                 | 19.3                |
| 22        | Children under 5 years who are underweight (weight-for- age) (%)                                                             | 42.5               | 35.8               | 32.1                |
|           | Women's Empowerment                                                                                                          |                    |                    |                     |
| 23        | Women having a bank or savings account that they themselves use (%)                                                          | 15                 | 53                 | 78.6                |
| 24        | Women age 15-24 years who use hygienic methods of protection during their menstrual period (%)                               | NA                 | 57.6               | 77.3                |

Source: NFHS Reports and Factsheets (http://rchiips.org/nfhs/index.shtml)

## The major revisions made in the format of NFHS since its inception .

1. Respondents: The first round of NFHS (1992-93) collected information from ever-married women age 13-49 years, the age range was modified to 15-49 years in NFHS-2 (1998-99). The third round onwards interviewed never-married women age 15-49 and ever-married and never-married men age 15-54 years.
2. Coverage: In the first three rounds of NFHS, excluding the NCT of Delhi none of the other Union Territories were covered in the surveys. However, since NFHS-4 (2015-16), the coverage of the survey has expanded to all the States and UTs of the country and estimates are being provided for them.
3. The first three rounds of NFHS provided estimates at the National and State level. However, the design of the NFHS has changed since the fourth round to provide estimates of key indicators up to district levels. This has led to tremendous increase in the sample size of the survey from 88562 households  in  NFHS-1,  91196  HHs  in  NFHS-2,  109041  HHs  in  NFHS-3  to  601509  HHs  in NFHS-4 and 636699 HHs in NFHS-5.
4. Biomarkers: The NFHS-1 collected information on height/length and weight only.  The second round  added  biomarkers  like  haemoglobin  testing  and  salt  iodisation.  In  NFHS-3  community based HIV testing was done for the first time in India. Blood pressure and random blood sugar measurements  were  included  in  NFHS  for  the  first  time  in  NFHS-4.  The  recently  concluded NFHS-5 included all the tests and measurements of the previous round mentioned above except HIV testing and conducted new tests and measurements like waist and hip circumference, HbA1C, Malaria Parasites and anti-malarial drug resistance and Vitamin D-3.
5. The  third  and  fourth  rounds  of  NFHS  additionally  provided  estimates  of  population  and  health indicators for slum and non-slum populations for eight cities, namely Chennai, Delhi, Hyderabad, Indore, Kolkata, Meerut, Mumbai, and Nagpur.
6. Since NFHS-4, Computer-assisted Personal Interviewing (CAPI) method has been incorporated in NFHS to synchronise the data collected from the field to the central office which minimizes the data  processing  and  data  cleaning  duration  to  a  great  extent.  The  CAPI  method  also  minimizes errors and interviewing duration at the field level.
7. Change  in  age-range  for  certain  indicators:  Prior  to  NFHS-5,  information  on  prevalence  of Diabetes and Hypertension for adults was being collected from women age 15-49 and men age 1554. However, in NFHS-5 this information was collected from adults 15 and above to comply with the indicator of Sustainable Development Goals (SDG). Similarly, information on violence against women in NFHS-5 has been collected from women age 18-49 only instead of 15-49 to comply with Protection of Children from Sexual Offences (POCSO) regulations.