National Family Health Survey (NFHS-1 to NFHS-5)

The National Family Health Survey is a massive survey that takes place all over the country and the main goal of this survey is to collect key information about families in India that will help the Ministry of India design policies that will benefit the country’s most backward people groups. The National Family Health Survey began in 1992 and is the first round of the survey. Four additional surveys have been conducted to date, the most recent being the National Family Health Survey-5 (NFHS 5) which began in 2018-2019 but is not finished yet due to the COVID -19 lockdown situations in the country.

National Family Health Survey Rounds

To date, five rounds of the survey have been conducted, and the start and end years of the surveys are listed below.

Survey	Rounds
National Family Health Survey -1	1992-1993
National Family Health Survey -2	1998-1999
National Family Health Survey -3	2005-2006
National Family Health Survey -4	2015-2016
National Family Health Survey -5	2018-2019

Now we will discuss each of the National Family Health Surveys in detail:

Overview of National Family Health Survey 1

The first large health survey in India is the National Family Health Survey 1, which was conducted from 1992-1993. Except for Sikkim, Kashmir, and a few union territories, all states completed NFHS-1. It almost covered 99% of India’s total population. The main success of this survey was that it provided separate estimates for rural and urban areas. The ministry choose Mumbai’s International Institute for Population Sciences (IIPS) to provide technical guidance and coordination for NFHS-1.

Objectives of NFHS 1:

• The primary goal of the NFHS 1 was to collect detailed information about family planning, family planning strategies, knowledge about family planning, family planning devices, family sizes, and fertility rates.
• Collecting data on socioeconomic and demographic indicators of both the child’s and mother’s health.
• Obtaining information on nutrition, vaccinations, and fertility rates in the country.
• To obtain information about the weight of the children
• Another major goal is to collect data on breastfeeding, food supplements, and the level of health care provided to women before and after delivery.

Essentially, health surveys are conducted in the manner of questionnaires, allowing authorities to collect all relevant information without leaving anything out. The questionnaire used for NFHS-1 is the same in all states in India, but to learn about some specialties in a few states, other information was gathered, such as child marriages in Rajasthan and AIDS awareness in the society.

Overview of National Family Health Survey 2

The National Family Health Survey 2, India’s second health survey, was conducted from 1998-1999. It almost completely covered India’s total population. The NFHS 2 has gone through two stages. The stages were completed between November 1998 and March 1999. Almost 90,000 women aged 15 to 49 from 26 states were shortlisted for the NFHS-2. The NFHS-2 primarily provided information on state-level health data. It also provided detailed information on the changes that must be made in social and economic factors to achieve the desired results in terms of India’s health situation, as well as schemes related to them.

NFHS-2 provided separate estimates for rural and urban areas, as well as three metropolitan cities: Mumbai, Kolkata, and Chennai. It also provided estimates for Mumbai’s slum areas. The United States of America and USAID- United States Agency for International Development provided financial support for the NFHS-2. UNICEF also provided financial support for the nutrition survey. The International Institute of Population Studies (IIPS) was chosen by the ministry to provide technical guidance and coordination for NFHS-2.

As previously stated, the health surveys will be carried out in the form of questionnaires, allowing authorities to collect all relevant information without leaving anything out. The NFHS-2 uniform pattern of questions, sample design, and field procedure was followed for the purpose of easily comparing with old data and obtaining error-free results.

Objectives of NFHS 2:

• The primary goal of the NFHS-2 is to collect data on birth rates, detailed family planning information, infant mortality rates, child mortality rates, and the availability of health facilities for children and mothers. 
• To collect data on educational systems, women’s living standards, and domestic violence.
• Obtain information on the weights of the children and the women who have been shortlisted.
• Collect data on the nutritional status of both women and children.
• Another major goal of NFHS-2 is to collect blood samples from women and children under the age of three to identify anemia in the country. 
• Two additional blood tests were performed in Mumbai and Delhi to determine the amount of lead in the blood. 
•  The final goal was to determine the amount of iodized salt used in cooking.

Overview of National Family Health Survey 3

National Family Health 3 is the third survey in the series, and it was conducted from 2005-2006. It is like NFHS 1 and 2 in that it is designed to collect important information about children, women, nutrition, mortality rate, reproductive health, and so on. NFHS-3 was also designed to provide information about family education, sexual behaviors, tuberculosis, and malaria. Women aged 15-49 and all men aged 15-54 were interviewed in the NFHS-3. Another important topic covered in NFHS-3 is the testing of adults for HIV. The NFHS-3 provided an estimate of the prevalence of HIV in the population, as well as separate reports for a few states. The National Family Health Survey-3 was conducted in all 29 states, involving more than 99%  of the population. Individual reports for slum and non-slum areas in the country were also provided by the National Family Health Survey-3. The ministry choose the International Institute for Population Sciences (IIPS) in Mumbai to provide technical guidance and coordination for NFHS-3.

The National Family Health Survey 3 was funded by the United States Agency for International Development (USAID), DFID, the Bill and Melinda Gates Foundation, UNICEF, UNFPA, and the Ministry of Health and Family Welfare. Macro International, USA, provided technical support for the entire NFHS-3. Furthermore, NACO and the National AIDS Research Institute (NARI) provided technical support for the NFHS-3’s HIV components.

As previously stated, the health surveys were carried out in the form of questionnaires, allowing authorities to collect all relevant information without leaving anything out. The questionnaire for the NFHS-3 was uniform, available in 18 different languages, and used biomarker measurements so that the comparison with the old data can be made error-free.

Objectives of NFHS 3:

• The NFHS-3 had two major goals in each round and they are to provide clear information about health and family welfare issues and to provide important data on health and family welfare.
• The results of the two goals will assist the Ministry of India in developing policies that will benefit the country’s most disadvantaged people groups.
• Learn about parental mortality, male involvement in family discussions, and sexual behaviors.
• To learn more about injections, viral diseases, tuberculosis, and malaria.
• Another major goal is to collect data on the prevalence of HIV at the national level by collecting blood samples from men and women aged 15 to 54 and 15 to 49.

Overview of National Family Health Survey 4

The fourth survey in the series, National Family Health 4, was conducted in 2015-2016. It is like NFHS 1–3 in that it is intended to collect vital information about children, women, nutrition, mortality rates, reproductive health, and so on. In addition, NFHS-4 covers several new topics, such as the use of mosquito nets, malaria sprays, insurance, abortion rates, and women’s ownership of assets. The National Family Health Survey – 4 interviewed women aged 15-49 and men aged 15-54. Women aged 15-49, men aged 15-54, and young children were interviewed to learn about their nutritional status. A unique feature of the National Family Health Survey-4 is the collection of data on adults’ glucose levels, blood pressure, and HIV status. The National Family Health Survey – 4 is the first survey to collect data on glucose and blood pressure levels across the country. The National Family Health Survey – 4 covered all 29 Indian states and 7 Union Territories. The main difference between National Family Health Survey – 4 is that it is intended to provide key indicators on the whole. 

The NFHS-4 questionnaire was uniform in design, available in 18 different languages, and used biomarker measurements to ensure error-free comparison with previous data. The questionnaire’s contents were determined in early 2013 after extensive research.

Objectives of NFHS 4:

• The main goal of the National Family Health Survey-4 is to provide a detailed report on health and family welfare, as well as new emerging issues.
• The clinical component of NFHS-4 was created to provide accurate information about malnutrition, hypertension, HIV, and glucose levels.
• Obtaining information on household population and housing characteristics such as hand washing, sanitation, schooling, and birth registrations.
• To collect information about respondents’ characteristics such as employment, occupation, and education.
• Obtain fertility information such as birth intervals, age of first birth, ideal family size, knowledge of family planning, and desire for another child.
• Other fertility-related information includes first sexual encounter, age of marriage, recent sexual activity, and pregnancy outcomes
• To obtain information about Maternal Health, such as Pregnancy Registration, Additional Care Coverage, Prenatal Ultrasound Testing, and Delivery Services.
• To collect data on nutrition in children, such as nutritional status, feeding practices, and food consumption in men and women.
• To learn more about morbidities and health care issues such as tuberculosis, tobacco use, health insurance coverage, and health-care problems.
• Women’s health is also one of the major objectives in the National Family Health Survey 4.

Overview of National Family Health Survey 5

The recent round of the survey is the National Family Health Survey 5 conducted by MoHFW in 2018-2019 and it’s not finished yet due to the COVID lockdown situations in the country. The main aim is to obtain reliable information about emerging health and family issues. National Family Health Survey 5 is receiving technical assistance from ICF International and financial assistance from United States Agency for International Development. The NFHS 5 has successfully captured the data during 2019-2020 and almost seven lakh households are being used to cover the data. MoHFW declared the International Institute for Population Sciences (IIPS), Mumbai, as the main agency for all the rounds of NFHS.

Objectives of NFHS 5:

• The main goal of the National Family Health Survey-4 is to provide a detailed report on health and family welfare and also about the new ongoing and emerging issues in the country.
• To collect information about respondents’ characteristics such as employment, occupation, and education.
• Obtain fertility information such as birth intervals, age of first birth, ideal family size, knowledge of family planning, and desire for another child.
• Gather information about Maternal Health, such as Pregnancy Registration, Additional Care Coverage, Prenatal Ultrasound Testing
• Obtain information on nutrition in children, such as nutritional status, feeding practices, and food consumption in men and women.
• Obtain additional health issues such as random blood glucose levels, cancer screening tests, and random glucose measurements.
• To collect HIV/AIDS information such as HIV/AIDS knowledge, multiple sexual partners, and comprehensive HIV knowledge in both men and women.
• Gather information about women’s empowerment issues such as employment and earnings, control over women’s earnings, and women’s freedom of movement, among others.
• Collecting information about domestic violence, such as physical violence experience, age of first sexual violence experience, violence by wife on husband, types of violence, and so on.

National Family Health Survey 5 Key Findings:

The results are compared to the National Family Health Survey 4 data from 2015-2016.

• The infant mortality rate per thousand live births has decreased by 35.2 percent.
• The rate of neonatal mortality has decreased by 24.9 percent per thousand live births.
• In married women, the use of condoms, capsules, and IUDs has increased from 47 percent to 56.6 percent.
• Marriages among 20-24-year-old girls fell from 26.8 percent to 23.3 percent.
• Household health insurance coverage increased from 28.7 percent to 41 percent.
• In five states, spousal violence has increased: Sikkim, Maharashtra, Himachal Pradesh, Assam, and Karnataka.
• Malnutrition has plummeted, and stunting has increased in 11 of 18 states.
• Overweight children have increased in 20 states.

Conclusion:

When we look at the national level, we can see that the infant mortality rate (IMR) and neonatal mortality rate (NMR) have both decreased significantly. Malnutrition, obesity, and insurance coverage, on the other hand, have all increased significantly. Breastfeeding rates among children under the age of six months have increased from 55% to 64%. The primary goal of the survey is to collect critical information about Indian families that will assist the Ministry of India in developing policies that will benefit the country’s most vulnerable people groups. If the Ministry conducts more of these surveys and continues to implement the schemes for the people, India will undoubtedly serve as a model for many other countries.