National Family Health Survey (NFHS-5) 2019-21: Bihar


Since 1992, the International Institute for Population Sciences, Mumbai, has conducted the National Family Health Survey (NFHS) for the Ministry of Health and Family Welfare, Government of India. The NFHS report for 2019-21 is the fifth in this series. It provides information on population, health and nutrition in 28 states, eight union territories, and 707 districts of India.

NFHS-5 presents district-level data on indicators such as population, fertility, family planning, infant and child mortality, maternal and child health, domestic violence and disability. This report on Bihar – published in May 2021 – presents information covering 38 districts. Development and Research Services Pvt. Ltd., New Delhi, conducted the fieldwork for the report between July 9, 2019, to February 2, 2020, covering 35,834 households, 42,483 women (aged 15-49 years) and 4,897 men (aged 15-54 years).

This 202-page document is divided into 14 sections: Introduction (Section 1); Household Characteristics (Section 2); Education (Section 3); Fertility (Section 4); Family Planning (Section 5); Infant and Child Mortality (Section 6); Maternal Health (Section 7); Child Health (Section 8); Breastfeeding, Nutrition, and Anaemia (Section 9); Adult Health and Health Care (Section 10); HIV/AIDS (Section 11); Sexual Behaviour (Section 12); Women’s Empowerment (Section 13); and Domestic Violence (Section 14).


  1. About 84 per cent of the households in Bihar were situated in rural areas, the report states. As low as 34 per cent of all households surveyed in Bihar lived in a pucca house and 54 per cent live in a semi-pucca house.

  2. Almost 39 per cent of the households in Bihar did not have access to sanitation facilities, that is, the members of these dwellings defecated in open spaces.

  3. Urban households in the state had greater access to piped water (18 per cent) compared to rural households (eight per cent).

  4. Among children aged 6-17 years, 85 per cent attended school. In the 6-14 years age group, rate of school attendance was 89 per cent, which dropped to 69 per cent among children aged 15-17 years.

  5. Around 55 per cent of women (aged 15-49 years) and 76 per cent of men (aged 15-49 years) were literate, that is, they had either passed Class 9 or passed a simple test for literacy conducted as part of the NFHS-5 survey.

  6. The Total Fertility Rate (TFR) in Bihar was three children per woman – 0.4 points lower than the 3.4 children per women noted in NFHS-4. In urban areas, the fertility rate was 2.4 children per woman, while in rural areas it was 3.1 children per woman.

  7. More married women used contraception in urban areas (62 per cent) than in rural areas (55 per cent). Among currently married women, 95 per cent were aware of birth control pills and only 19 per cent were aware of female condoms. Half of the men within the age group of 15-49 years believed it was “women’s business” to use contraception.

  8. In Bihar, the infant mortality rate was 47 deaths (before one year of age) for every 1,000 live births, almost the same as that in NFHS-4 (48 deaths per 1,000 live births). The infant mortality rate was 64 per 1,000 live births for teenage mothers (below 20 years of age) as compared to 42 per 1,000 live births for mothers aged 20-29 years and 49 per 1,000 live births for mothers aged 30-39 years.

  9. Among women who had given birth in the five years prior to the survey, around 39 per cent had received antenatal care from a doctor and 29 per cent had received care from an auxiliary nurse midwife, a lady health visitor, a nurse or a midwife. Roughly 18 per cent of women who had given birth during the same period reported receiving no antenatal care.

  10. Almost three-fourths, that is, 71 per cent of children aged 12-23 months had received vaccines against the six major childhood diseases: tuberculosis, diphtheria, pertussis, tetanus, polio, and measles. About 97 per cent of the children had received partial vaccinations and only three per cent had not received any vaccine dose at all.

  11. As many as 43 per cent of the children under the age of five were stunted (too short for their age) and 23 per cent were wasted (too thin for their height), including nine per cent who were ‘severely’ wasted.

  12. About 42 per cent of women and 36 per cent of men were either obese or too thin. Obesity among women had increased from 12 to 16 per cent from the time of NFHS-4 to NFHS-5. However, more men were thin than they were obese, a pattern maintained in both NFHS-4 and NFHS-5. Undernutrition was common among younger age groups (15-19 years) in rural areas and among women from Scheduled Tribes. Obesity was more common in older adults in urban areas and among well-educated men.

  13. In the state, 92 per cent of men and almost 76 per cent of women (aged 15-49 years) had heard of HIV/AIDS but only 10.3 per cent of women and 25 per cent men had ‘comprehensive knowledge’ of it.

  14. In Bihar, only 15 per cent of the households had any health insurance that covered at least one member of the family. Health insurance coverage was slightly more prevalent in rural areas (15 per cent) than in urban areas (12 per cent).

  15. As high as 40 per cent of the surveyed women (aged 18-49 years) reported experiencing either physical or sexual violence, and seven per cent women reported having experienced both physical and sexual violence. Of those who had experienced such violence, only three per cent sought help from a medical professional and two per cent went to the police for aid.

    Focus and Factoids by Debadrita Saha.

    PARI Library's health archive project is part of an initiative supported by the Azim Premji University to develop a free-access repository of health-related reports relevant to rural India.


International Institute for Population Sciences (IIPS), Mumbai

Contributors: S.K. Singh, Laxmi Kant Dwivedi, Chander Shekhar, Brajesh


Ministry of Health and Family Welfare, Government of India, New Delhi


May, 2021