NATIONAL FAMILY HEALTH SURVEY-6 (2023-24)

Why in News?

• The Ministry of Health and Family Welfare (MoHFW) released the findings of National Family Health Survey-6 (NFHS-6) for the period 2023–24.
• The survey reveals major improvements in maternal health, child nutrition, immunization coverage, women's empowerment and healthcare access.
• However, it also highlights emerging concerns such as rising obesity, non-communicable diseases (NCDs), excessive Caesarean deliveries, and the removal of several important indicators from the survey framework.

MAJOR FINDINGS

1. Significant Improvement in Maternal Healthcare

• Maternal healthcare indicators have shown steady improvement, indicating better access to healthcare services and stronger implementation of government programmes.

Institutional Deliveries

• The proportion of births occurring in healthcare facilities increased from 88.6% in NFHS-5 to 90.6% in NFHS-6.
• This indicates that India is moving closer to achieving universal safe childbirth.

Skilled Birth Attendance

• Births attended by trained health personnel increased from 89.4% to 91.3%, reducing risks associated with childbirth complications.

Antenatal Care (ANC)

• The survey reports that 95.9% of pregnant women registered for antenatal care, while registration during the crucial first trimester increased from 70% to 76.2%.
• The proportion of women receiving at least four ANC visits also improved significantly, reflecting better continuity of maternal care.

Postnatal Care

• Postnatal care for newborns within two days of delivery increased from 79.1% to 85.3%, ensuring timely identification of complications among mothers and infants.

Improved Iron-Folic Acid Consumption

• Consumption of Iron Folic Acid (IFA) tablets for more than 100 days during pregnancy increased from 44.1% to 54.9%, while consumption for over 180 days increased from 26% to 37.8%.

GOVERNMENT PROGRAMS BEHIND THE PROGRESS The improvement in maternal health indicators is linked to the implementation of:

• Janani Suraksha Yojana (JSY)
• Janani Shishu Suraksha Karyakram (JSSK)
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)
• SUMAN (Surakshit Matritva Aashwasan)
• Pradhan Mantri Matru Vandana Yojana (PMMVY 2.0)

2. Child Nutrition Indicators Show Improvement

• The survey records a decline in major forms of child malnutrition, suggesting positive outcomes from nutrition-focused interventions.

Reduction in Stunting

• The proportion of children under five suffering from stunting (low height-for-age) declined significantly from 35.5% to 29.3%.

Reduction in Severe Wasting

• Severe wasting (low weight-for-height) reduced from 7.7% to 5.2%, indicating improvement in acute nutritional status.Underweight Children
• The proportion of underweight children declined marginally from 32.1% to 31.8%.

Better Complementary Feeding Practices

• The percentage of children aged 6–8 months receiving complementary food along with breastmilk increased from 45.9% to 59.5%.

GOVERNMENT PROGRAMS BEHIND THE PROGRESS These improvements are attributed to:

• POSHAN Abhiyaan

• POSHAN 2.0

• Saksham Anganwadi

• Integrated Child Development Services (ICDS)

3. Expansion of Immunization Coverage

• NFHS-6 records significant progress in childhood immunization.
• Full vaccination coverage among children aged 12–23 months increased from 83.8% to 87.1%, while 95.6% of vaccinations were administered through public healthcare facilities.

Vaccine-Specific Improvements

• Rotavirus vaccination coverage increased from 36.4% to 85.4%.

• Second dose of Measles vaccine coverage increased from 58.6% to 71.8%.

GOVERNMENT PROGRAMS BEHIND THE PROGRESS The gains are linked to:

• Universal Immunization Programme (UIP)
• U-WIN Digital Platform
• Strengthening of cold-chain infrastructure

As a result, the prevalence of Acute Respiratory Infections (ARI) and severe diarrhoea among children also declined. 4. Population Stabilisation Continues

• India's Total Fertility Rate (TFR) remains stable at 2.0, which is below the replacement-level fertility rate of 2.1.
• This indicates that India has largely entered a phase of population stabilisation.
• The Contraceptive Prevalence Rate (CPR) increased from 66.7% to 69.1%, suggesting improved access to family planning services.

5. Women's Empowerment Indicators Improve

• One of the most striking findings of NFHS-6 is the rapid improvement in indicators related to women's empowerment.

Digital Inclusion

• The proportion of women who have ever used the internet nearly doubled from 33.3% to 64.3%.

• Similarly, women owning and using a personal mobile phone increased from 53.9% to 63.6%.

Financial Inclusion

• Women operating their own bank or savings accounts increased from 78.6% to 89%, reflecting greater financial autonomy.

Menstrual Hygiene

• Use of hygienic menstrual products among young women increased from 77.6% to 79.2%.

Reduced Spousal Violence

• Women reporting spousal violence declined from 29.3% to 22.3%, indicating gradual improvement in gender-related outcomes.

6. Health Insurance Coverage Expands Rapidly

• The share of households covered by health insurance increased from 41% to 60.2%.
• A major contributor to this growth has been Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY), which aims to reduce out-of-pocket healthcare expenditure.

MAJOR CONCERNS HIGHLIGHTED BY NFHS 6

Rising Caesarean Section Deliveries

• The proportion of births delivered through Caesarean Section (C-Section) increased sharply from 21.5% to 27.2%, significantly exceeding the World Health Organization's recommended range of 10–15%.
• Private hospitals reported an exceptionally high C-section rate of 54.1%, compared to 16.9% in public hospitals, raising concerns regarding commercialization of maternal healthcare.

Dual Burden of Malnutrition

• Despite improvements, India continues to face a dual challenge.
• While nearly one-third of children remain stunted, obesity levels among adults have increased sharply.
• Among women, obesity increased from 24% to 30.7%, while among men it increased from 22.9% to 27.3%.
• This indicates that India simultaneously faces problems of undernutrition and overnutrition.

Rising Non-Communicable Diseases (NCDs) Increasing obesity is accompanied by rising prevalence of:

• Diabetes
• Hypertension
• Other lifestyle-related diseases

This reflects India's ongoing epidemiological transition from infectious diseases to chronic diseases. Controversy: Removal of Important Indicators

• One of the most debated aspects of NFHS-6 is the reduction in the number of indicators.
• The preliminary NFHS-6 fact sheet contains only 101 indicators, compared to 131 indicators in NFHS-5.
• Overall, 43 indicators were removed, while only 13 new indicators were added.

Important Indicators Removed The following indicators have been excluded: Health Indicators

• Anaemia
• Neonatal Mortality Rate (NMR)
• Infant Mortality Rate (IMR)
• Under-Five Mortality Rate (U5MR)

Gender Indicators

• Sex Ratio at Birth
• Overall Sex Ratio

Social Development Indicators

• Sanitation Coverage
• Clean Cooking Fuel Usage

Public Health Indicators

• Cancer Screening
• Several HIV Awareness Indicators

WHY WAS ANAEMIA REMOVED?

• The removal of anaemia data generated significant debate.
• NFHS traditionally measured haemoglobin using a finger-prick blood sample, which several researchers argued tended to overestimate anaemia prevalence.
• Consequently, anaemia measurement has been shifted to the Diet and Biomarkers Survey in India (DBSI) conducted by the Indian Council of Medical Research and National Institute of Nutrition.
• Unlike NFHS, this survey uses venous blood samples, which are considered more accurate.
• However, the absence of anaemia data from NFHS weakens direct monitoring of the Anaemia Mukt Bharat Mission.

NEW AREAS ADDED IN NFHS 6 NFHS-6 introduces several new themes reflecting India's digital transformation. These include:

• Direct Benefit Transfers (DBTs)
• Self-Help Groups (SHGs)
• Digital Literacy
• Digital Financial Transactions
• Hepatitis-B Testing
• Hepatitis-C Testing
• Reintroduction of HIV Testing