National Family Health Surveys Research Paper

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India’s National Family Health Surveys (NFHS) are designed to provide key information about population and health conditions and the needs of the country’s women, men, and children. Information is collected from nationally representative samples of households throughout the country. The surveys, which are part of the global Demographic and Health Surveys program, collect information on such topics as reproductive health, child health, immunizations, family planning, HIV/AIDS, nutritional status, women’s status, population growth, and household living conditions.

Since the early 1990s, India has conducted two National Family Health Surveys and a third is being implemented in 2005–2006. The surveys are conducted under the stewardship of India’s Ministry of Health and Family Welfare (MOHFW). The International Institute for Population Sciences in Mumbai (formerly Bombay) has been the coordinating agency for all three surveys. The first two surveys were funded by the United States Agency for International Development (USAID), with additional funding from the government of India, and with some supplementary funds from the United Nations Children’s Fund (UNICEF) for the second survey. Macro International, USA, and the East-West Center, USA, provided technical assistance to the first two surveys. The third survey is funded by USAID, the U.K. Department for International Development, the Bill and Melinda Gates Foundation, UNICEF, the United Nations Population Fund, and the government of India. Macro International is again providing technical assistance to the third survey.

The NFHS surveys collect individual, household, and community-level information by conducting face-toface interviews and by measuring key biomarkers. The interviews and measurements are conducted using welldeveloped and tested survey instruments and rigorously trained survey personnel. Survey questionnaires have been translated into more than twenty languages, and interviews are conducted in the predominant local language of the respondents. Participation in the surveys is completely voluntary. Informed consent is obtained from all survey respondents before questions are asked and before blood specimens are collected. Stringent quality control measures are employed in all aspects of survey planning and implementation, including sample design, the development and field-testing of survey instruments, the training of survey personnel, and the supervision of data collection and data processing.

The first National Family Health Survey (NFHS-1) was conducted in 1992–1993 in about 90,000 households and covered all states of India except Sikkim. The first survey was aimed at strengthening the research capabilities of India’s network of eighteen population research centers (located mainly in universities and semiautonomous research institutions throughout the country), which is supported by the MOHFW. India had resisted conducting a World Fertility Survey or a Demographic and Health Survey for many years, but became interested in the NFHS when it was suggested that this would be the ideal mechanism through which to upgrade the survey capabilities of its population research centers. The first survey proved to be a major landmark in the development of a comprehensive demographic and health database for India.

The second National Family Health Survey (NFHS-2), conducted in 1998–1999 in about 90,000 households in all Indian states, expanded this database by providing time-trend information and including additional information on postpartum care, the quality of health and family-planning services, reproductive health problems, and domestic violence. The second survey also tested hemoglobin levels in the blood of women and young children and tested household salt to see if the salt was iodized.

The third National Family Health Survey (NFHS-3), which is being implemented in 2005–2006, builds on the strengths and successes of NFHS-1 and NFHS-2 by maintaining continuity in core content and coverage, while adding new dimensions. In response to new and emerging health and demographic data needs, NFHS-3 has an extended size and scope. In addition to ever-married women age fifteen to forty-nine, NFHS-3 is collecting data for the first time from never married women age fifteen to forty-nine, and both married and unmarried men age fifteen to fifty-four throughout India. NFHS-3 is additionally collecting blood samples from adult women and men for HIV testing. NFHS-3 aims to interview about 240,000 women and men and to take blood specimens for about 280,000 anemia tests and 135,000 HIV tests.

The findings from the NFHS surveys have been used extensively for evidence-based decision-making. The information gathered in the surveys has been instrumental in bringing about a number of major policy and program changes in India, and the survey data are being used to monitor the progress of various population and health programs.

NFHS data have been used extensively in the development and implementation of India’s Five-Year Plans. For example, the Tenth Plan (2002–2007) has set national and state goals of increasing exclusive breastfeeding, achieving timely complementary feeding of children, and reducing severe undernutrition based primarily on the findings of NFHS-2. The survey findings of serious health conditions among scheduled castes, scheduled tribes, and other disadvantaged groups formed the basis for revising and refocusing India’s National Health Policy in 2002 to better address the health needs of the poorest segments of society. The survey findings on unmet need for contraception were instrumental in facilitating a complete overhaul of the country’s family welfare program.

The NFHS data have also been used extensively for policy and program purposes at the state level. For example, based on the NFHS findings of serious nutritional deficiencies among very young children, the government of Gujarat developed an action plan to refocus its nutrition programs on children under three years of age. NFHS data were also instrumental in galvanizing the Tamil Nadu state government to mount a more aggressive campaign to deal with the spread of HIV/AIDS.

The NFHS surveys have also greatly increased India’s capacity to undertake and analyze first-rate demographic and health surveys. The surveys are considered the “gold standard” in survey-taking and a source of the most reliable information on major population and health indicators in India. Data gathered in the surveys have resulted in hundreds of research and policy publications in professional and scientific journals and have been the subject of numerous Ph.D. dissertations around the world. In addition, the results of the surveys have received extensive media coverage. In response to NFHS-2 alone, there were some three hundred newspaper articles, TV broadcasts, radio shows, and Internet articles based solely on the survey findings.

Important limitations of these surveys should also be recognized, however. First, the survey samples are not large enough to collect reliable information on certain important but relatively rare health conditions or events, such as maternal mortality. Second, the surveys do not provide the much needed district-level population and health indicators, again due to inadequate sample sizes. Third, the data collected on several health indicators in the surveys are self-reported, making them not as reliable as clinical data. And finally, the cross-sectional designs of the surveys limit their usefulness for causal analysis and understanding reasons for change.

In spite of these inherent limitations, there is overwhelming evidence that the NFHS surveys have provided valuable information on key population and health issues, and have been instrumental in building India’s research capacity.

Bibliography:

  1. International Institute for Population Sciences (IIPS). National Family Health Survey (MCH and Family Planning), India 1992–93. Bombay: IIPS.
  2. International Institute for Population Sciences (IIPS) and ORC Macro. National Family Health Survey (NFHS-2), 1998-99: India. Mumbai, India: IIPS.

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