National Family Health Survey 5 (NFHS-5)

The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.

The Ministry of Health and Family Welfare (MoHFW) has designated the International Institute for Population Sciences(IIPS) Mumbai, as the nodal agency for providing coordination and technical guidance for the survey.

The funding for different rounds of NFHS has been provided by USAID, the Bill and Melinda Gates Foundation, UNICEF, UNFPA, and MoHFW (Government of India).

The NFHS-1 was conducted in 1992-93 and NFHS-4 in 2014-2015.

The NFHS-5 has captured the data during 2019-20 and has been conducted in around 6.1 lakh households.

NFHS-5 includes some new topics, such as preschool education, disability, access to a toilet facility, death registration, bathing practices during menstruation, and methods and reasons for abortion.

In 2019, for the first time, the NFHS-5 sought details on the percentage of women and men who have ever used the Internet.

Sex Ratio

NFHS-5 data shows that there were 1,020 women for 1000 men in the country in 2019-2021.

This is the highest sex ratio for any NFHS survey as well as since the first modern synchronous census conducted in 1881.

Sex Ratio at Birth

India still has a sex ratio at birth (SRB) more skewed towards boys than the natural SRB, which is 952 girls per 1000 boys.

Only Tripura has a sex ratio at birth above 1,000 (i.e., more females born than males).

Total Fertility Rate (TFR)

TFR was 2 in 2019-2021, just below the replacement fertility rate of 2.1.

In rural areas, the TFR is still 2.1.

In urban areas, TFR had gone below the replacement fertility rate in the 2015-16 NFHS itself.

A decline in TFR, which implies that a lower number of children are being born, also entails that India's population would become older.

There are only five states in India which are above replacement level of fertility of 2.1.

These states are: Bihar (2.98), Meghalaya (2.91), Uttar Pradesh (2.35), Jharkhand (2.26) and Manipur (2.17)

Bihar (2.98) have the highest fertility rates in the country, while Sikkim (1.1) have the lowest.

Children's Nutrition

All-India level as Stunting has declined from 38% to 36%, wasting from 21% to 19% and underweight from 36% to 32% at all India level.

The share of overweight children has increased from 2.1% to 3.4%.

Infant Mortality Rate (IMR)

Infant Mortality Rate (IMR) is defined as the "number of deaths of children under the age of 1 year per 1000 live" births for a given year.

The country's average IMR stands at 32 per 1,000 live births which includes an average 36 deaths for rural and 23 for urban areas.

Bihar registered the highest IMR (47) while Kerala reported the lowest death rates.


The incidence of anaemia in under-5 children (from 58.6 to 67%), women (53.1 to 57%) and men (22.7 to 25%) has worsened in all States of India.

Barring Kerala (at 39.4%), all States are in the "severe" category.


Full immunization drive among children aged 12-23 months has recorded substantial improvement from 62% to 76% at all-India level.

11 out of 14 States/UTs have more than three-fourth of children aged 12-23 months with fully immunization and it is highest (90%) for Odisha.

Institutional Births

Institutional births have increased substantially from 79% to 89% at all-India Level.

Institutional delivery is 100% in Puducherry and Tamil Nadu and more than 90% in 7 States/UTs out of 12 Phase II States/UTs.

Family Planning

Overall Contraceptive Prevalence Rate (CPR) has increased substantially from 54% to 67% at all-India level and in almost all Phase-II States/UTswith an exception of Punjab.

Women Empowerment

Women's empowerment indicators portray considerable improvement at all India level and across all the phase-II States/UTs.

Underage Marriages

According to NFHS-5, 23.3% women surveyed got married before attaining the legal age of 18 years, down from 26.8% reported in NFHS-4.

Highest Rate of Underage Marriages are found in West Bengal, while lowest in J&K.


Access to electricity, improved source of drinking water and sanitation facility has increased.

The proportion of households using clean fuel for cooking has also increased across nearly all states.

The proportion of women who have a savings or bank account has increased across all the 17 states.

Proportion of women who own a house or land (including joint ownership) has declined in 9 of the 17 states.

In 2019, for the first time, the NFHS-5 sought details on the percentage of women and men who have ever used the Internet.

More women using mobile phones across all states, however, many of them do not have access to internet.

The five states reporting the lowest percentage of women, whoever used the Internet in urban India were Andhra Pradesh (33.9%), Bihar (38.4%), Tripura (36.6%), Telangana (43.9%) and Gujarat (48.9%).