Several data points from the fifth National Family Health Survey (NFHS) have been omitted from the NFHS-6 factsheet released on May 29, despite questions corresponding to these having been asked during the survey conducted between 2023 and 2024.
The omitted data points include several population-level statistics, indicators related to women’s and children’s health, family planning, and data on central government schemes such as the Swachch Bharat Abhiyan (sanitation) and the Ujjwala Yojana (cooking fuel).
Sources in the Union Ministry of Health and Family Welfare explained that several data points in the NFHS were being reported by other surveys, and the omissions were an attempt at “data harmonisation”.
The NFHS is a large-scale household survey conducted across India to track vital data on health, family welfare, and nutrition. Indicators help policymakers evaluate and design effective public health programmes. The first such survey took place in 1992-93. It is conducted by the International Institute of Population Sciences (IIPS), under the supervision of the Ministry of Health and Family Welfare.
The NFHS-5 (2019-21) factsheet had 131 key indicators or data points at the national level, while the NFHS-6 factsheet has 101.
Omissions include indicators of the population sex ratio, the sex ratio at birth, mortality rates, and the percentages of births and deaths recorded in the civil registration system. The latest factsheet also lacks indicators on access to sanitation facilities, such as toilets, and to clean cooking fuels. Several indicators for women’s health were also removed, such as adolescent fertility rate, type of contraceptives being used, whether health workers had counselled women on family planning, and whether they were informed about the side effects of their chosen contraceptive method.
The factsheet also removed an indicator of women’s access to healthcare services — the out-of-pocket expenditure for each delivery.
Data on the reach of several health programmes were also removed, including data on children with diarrhoea who received ORS or zinc, HIV awareness and service delivery, and the waist-to-hip ratio, an indicator of abdominal obesity linked to increased risk of diseases such as diabetes and hypertension.
The data points on screening for the three most common types of cancers — cervical, breast, and oral — were also removed. More than 1.5 lakh Ayushman Arogya Mandirs or primary health centres have been upgraded since 2018 to provide screening and care for non-communicable diseases, including the three cancers. However, the uptake of cancer screening services has been poor. NFHS-5 data showed that only 0.9% of people were screened for breast and oral cancers, and 1.9% for cervical cancer.
When contacted, a Health Ministry source reasoned: “There were several parameters in the NFHS that were being reported by other surveys independently. So, these were removed from the NFHS factsheets in an attempt at data harmonisation between reports produced by the government.”
Sources said several of these data points would be provided in other surveys. “Data on cooking fuel is provided in the report on the Ujjwala scheme, and data on sanitation services in the report on Swachch Bharat. When it comes to metrics such as infant mortality, maternal mortality, registration of births and deaths — these are already provided in the Sample Registration Survey. In fact, the total fertility rate (the number of children women have in their lifetime), which is present in this data, is also present in the SRS report,” a Health Ministry source said.
The source said data on cancer screening would also be provided by other surveys. The Indian Council of Medical Research usually provides data on cancer prevalence.
The Health Ministry had already announced that indicators about the prevalence and extent of anaemia, which were part of NFHS-5, would not be included in NFHS-6. This was dropped after experts said the current way of measuring it for the survey, using a drop of blood from a finger prick, could overestimate prevalence. A better way, the experts said, was to use venous blood samples. According to sources, data on anaemia using such a method would be reported by the “Diet and Biomarker” survey conducted by the National Institute of Nutrition. NFHS-5 data showed there was an increase in anaemia levels despite the government’s ‘Anaemia Mukt Bharat’ programme that provided iron-folic acid tablets to girls and women to address iron-deficiency anaemia.
In its introductory pages, the NFHS-6 states that its “contents are more or less similar to NFHS-5 to allow comparisons over time”. The note further reads, “However, NFHS-6 includes some new topics, such as Direct Bank Transfer and Self-Help Group coverage, digital literacy and financial transactions, etc. The scope of clinical, anthropometric, and biochemical testing (CAB) has also been expanded to include HIV testing.”
