What is lost and gained in NFHS-6

India’s latest National Family Health Survey (NFHS-6) records gains in child nutrition, maternal care, institutional births and women’s internet use.  

About NFHS

• The National Family Health Survey (NFHS) is a large-scale, multi-round household survey conducted by the Ministry of Health and Family Welfare. The International Institute for Population Sciences (IIPS), Mumbai acts as the nodal agency for the survey.
• NFHS provides reliable data on important population, health and nutrition indicators, and is widely used for policy-making, programme evaluation and development planning.

Evolution of NFHS

• NFHS-4 (2015–16): Introduced district-level estimates and tablet-based digital interviews. It covered 114 indicators.
• NFHS-5 (2019–21): Expanded the survey to 131 key indicators and included new themes such as preschool education, disability and menstrual hygiene practices.
• NFHS-6 (2023–24): Covered nearly 6.8 lakh households across all states and Union Territories, except Manipur.

Key Change in NFHS-6

Historically, NFHS followed an additive approach, where earlier questions were retained and new indicators were added over time. However, NFHS-6 marks a shift, as it has reduced some earlier components instead of only adding new ones.

What NFHS-6 Gained	What NFHS-6 Lost
NFHS-6 added new areas such as Direct Benefit Transfers (DBT), Self-Help Group membership, digital literacy, financial transactions, Hepatitis-B and Hepatitis-C testing, dried blood spot collection for children aged 4–5, and the return of biological HIV testing. It also showed improvement in key indicators such as antenatal check-ups, institutional births, women’s internet use, reduction in stunting and decline in spousal violence.	NFHS-6 reduced the number of indicators from 131 in NFHS-5 to 101, with several important indicators dropped. These include anaemia, neonatal mortality, infant mortality, under-five mortality, sex ratio, sex ratio at birth, sanitation access, clean cooking fuel use and cancer-screening indicators.
Some major state-level gains include a sharp rise in health insurance coverage in West Bengal and a significant increase in women’s internet use in Andhra Pradesh. These additions make NFHS-6 more relevant to digital inclusion, welfare delivery and new health diagnostics.	The removal of these indicators weakens district-level and socio-economic tracking of key public health, gender and welfare outcomes. It also reduces direct monitoring of major government schemes such as Anaemia Mukt Bharat, Swachh Bharat Mission and PM Ujjwala Yojana.

Implications of NFHS-6 Changes

• Removal of key indicators creates data gaps in infant mortality, sanitation, sex ratio at birth, cancer screening and HIV knowledge.
• It weakens district-level and socio-economic tracking of health and welfare outcomes.
• Dropping indicators linked to schemes like Swachh Bharat, Ujjwala and Anaemia Mukt Bharat limits independent programme evaluation.
• It reduces comparability across NFHS rounds and affects long-term policy analysis.
• NFHS-6 shows a shift from an additive survey model to a more selective approach.

Significance of NFHS-6 Changes

• Use of venous blood testing for anaemia can improve data accuracy.
• The return of biological HIV testing fills an earlier data gap.
• New indicators on DBT, SHG membership, digital literacy and financial transactions reflect changing welfare delivery.
• Inclusion of Hepatitis-B and Hepatitis-C testing expands health diagnostics.
• However, lack of clear explanation for dropped indicators raises concerns over transparency and continuity.