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


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, since 1992. 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.

Like NFHS-4, which was conducted in 2015-16, NFHS-5 presents district-level estimates for indicators such as population, fertility, family planning, infant and child mortality, maternal and child health, domestic violence. It introduces new areas of focus such as disabilities, preschool education, access to toilet facilities, death registration, and methods and reasons for abortion.

The fieldwork for this nation-wide report was conducted in two phases. The first phase – covering 17 states and 5 union territories – stretched from June 17, 2019, to January 30, 2020. The second phase – covering 11 states and 3 union territories – was conducted between January 2, 2020, and April 30, 2021. In total, the surveys covered 636,699 households, 724,115 women (aged 15-49 years), and 101,839 men (aged 15-54 years).

This document is divided into 15 chapters: Introduction (Chapter 1); Household population and housing characteristics (Chapter 2); Characteristics of respondents (Chapter 3); Fertility and fertility preferences (Chapter 4), Family planning (Chapter 5), Other proximate determinants of fertility (Chapter 6); Infant and child mortality (Chapter 7); Maternal health (Chapter 8); Child health (Chapter 9); Nutrition and anaemia (Chapter 10); Morbidity and health care (Chapter 11); Other adult health issues (Chapter 12); HIV/AIDS-related knowledge, attitudes and behaviour (Chapter 13); Women’s empowerment (Chapter 14) and Domestic violence (Chapter 15).


  1. Of the total number of people surveyed, 72 per cent of the women and 84 per cent of the men were literate. The report also notes that 41 per cent of the women surveyed and 50 per cent of the men survey had completed 10 or more years of schooling.

  2. About 19 per cent of the total surveyed households did not have access to any sanitation facilities. Only 69 per cent of households of people belonging to Scheduled Tribes had access to sanitation facilities, reporting the lowest among any group surveyed. Use of an ‘improved sanitation facility’ (toilets not shared with other households) was reported by 69 per cent of all surveyed households. The number was higher in urban areas (80.7 per cent) than rural areas (63.6 per cent).

  3. Roughly 96 per cent of households surveyed (99 per cent urban and 95 per cent rural) had access to an ‘improved source’ of drinking water – including piped water, public taps, standpipes, tube wells, rainwater.

  4. About 90 per cent of all women residing in urban areas had access to hygienic menstrual products – sanitary napkins, menstrual cups, tampons – compared to 73 per cent of all women in rural areas. The report adds that 90 per cent of women with 12 or more years of schooling used hygienic menstrual products compared to 44 per cent of women who had not been to school.

  5. Only 58.6 per cent of the households used ‘clean fuel’ for cooking, such as electricity, liquefied petroleum gas, natural gas, or biogas. The numbers were higher in urban areas (90 per cent) than in rural areas (43 per cent).

  6. Of all the people surveyed, 25.2 per cent of women and 76.2 per cent of men were employed. A majority of women were employed as agricultural workers (46 per cent) and production workers (21 per cent). Similarly, most men also worked as agricultural or production workers (32 per cent each).

  7. The total fertility rate in the country was two children per woman. The report notes that 21.2 years was the median age at which women had their first pregnancy.

  8. The use of modern contraceptives – like sterilisation, injectables, intrauterine devices, contraceptive pills and condoms – amongst married women increased from 48 per cent in 2015-16 to 56 per cent in 2019-21. Female sterilisation was the most common method, used by 38 per cent of married women surveyed, while male sterilisation was reported by 0.3 per cent of the women.

  9. The report notes that 53 per cent of all abortions were performed in private health facilities and 20 per cent were done in the public health sector. Around 27 per cent were performed at home by the women themselves. Almost half of the women surveyed who reported getting an abortion listed unplanned pregnancy as the reason.

  10. All basic vaccinations (vaccines for tuberculosis, diphtheria, pertussis, tetanus, polio and measles) were administered to 76.5 per cent of children aged 12-23 months, an increase from 62 per cent noted in 2015-16. Around 3.6 per cent of children aged 12-23 months had received no vaccinations at all.

  11. The report found that 36 per cent of children under the age of five years were stunted (too short for their age) and 19 per cent were wasted (weighed less for their height). Roughly 67 per cent of children aged 6-59 months had anaemia, a considerable rise since the 2015-16 estimates of 59 per cent.

  12. The incidence of anaemia among men and women between ages 15 and 49 years has increased since 2015-16, the report noted. Approximately 57 per cent of women between this age bracket had anaemia in 2019-21 compared to the 53 per cent in 2015-16.

  13. The under-five mortality rate – probability of death between birth and the fifth birthday –declined from 50 deaths per 1,000 live births in 2015-16 to 42 deaths per 1,000 in 2019-21. During the same period, the infant mortality rate declined from 41 deaths per 1,000 live births to 35 deaths per 1,000 live births.

  14. Approximately three-fifths of the women surveyed reported facing problems in obtaining medical care. These problems included lack of money, distance from health facilities, lack of female healthcare workers and lack of medicines. Women were more likely to approach accredited social health activists (ASHAs), auxiliary nurse midwives and anganwadi workers than any other healthcare workers, the report states.

  15. The survey found that 22 per cent of women and 31 per cent of men aged 15-49 years had a “comprehensive knowledge” of HIV/AIDS. Around 51 per cent of women and 46 per cent of men knew that it is possible for HIV/AIDS to be transmitted from mother to child and that the risk could be reduced if the mother took certain drugs.

  16. The report states that 29 per cent of women aged 18-49 years had experienced physical violence. Around 39 per cent of women who had no schooling reported experiencing physical violence compared to 17 per cent of women who had finished 12 or more years of school education.

    Focus and Factoids by Neelima Mundayur.

    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: K.S. James, S.K. Singh, Hemkhotang Lhungdim, Chander Shekar, Laxmi Kant Dwivedi, Sarang Pedgaonkar, Fred Arnold


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


Mar, 2022