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


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 Kerala – published in March 2021 – presents information covering 14 districts. The Society for Promotion of Youth and Masses, New Delhi, conducted the fieldwork for the report between July 20 to December 2, 2019, covering 12,330 households, 10,969 women (aged 15-49 years) and 1,473 men (aged 15-54 years).

This 198-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 53 per cent of the households surveyed in Kerala were in rural areas. As high as 83 per cent of all households surveyed lived in a pucca house and almost all households (99.5 per cent) had access to electricity.

  2. Around 98.5 per cent of households in the state had access to ‘improved’ sanitation facilities and only 0.3 per cent used open spaces or fields for defecation. Of the total households surveyed, 72.1 per cent used clean fuel – electricity, liquefied petroleum gas, natural gas or biogas – for cooking. 

  3. Among children aged 2-4 years, a higher percentage of girls (56 per cent) attended preschool compared to boys (51 per cent). School attendance in Kerala was almost universal (99.8 per cent) in the 11-14 years age group but dropped to 94.3 per cent among children aged 15-17 years. 

  4. The median age for women (aged 25-49 years) at their first marriage was 21.5 years. The report notes that six per cent of women between the ages of 20-24 years were married before the legal minimum age of 18, a decrease from the eight per cent recorded in NFHS-4.

  5. The total fertility rate in Kerala was 1.8 children per woman, an increase from the NFHS-4 number of 1.6 children per woman.

  6. The contraceptive prevalence rate (CPR) among married women increased from 53 per cent in NFHS-4 to almost 61 per cent. The use of modern contraceptive methods like sterilization, intrauterine devices, injectables and condoms also increased slightly from 50.3 per cent in NFHS-4 to 52.8 per cent.

  7. The infant mortality rate in Kerala fell from 5.6 deaths (before the age of one year) per 1,000 live births during NFHS-4 to 4.4 deaths per 1,000 live births. The under-five mortality rate – probability of death between birth and the fifth birthday – also declined from 7.1 deaths per 1,000 live births to 5.2 deaths per 1,000 live births.

  8. Of the last pregnancies among women (aged 15-49 years) in the five years prior to the survey, 92.3 per cent resulted in live birth and 2.7 per cent pregnancies ended with an abortion.

  9. Between NFHS-4 and NFHS-5, basic vaccination coverage – for tuberculosis, diphtheria, pertussis, tetanus, polio and measles – decreased from 82.1 per cent to 77.8 per cent. The report states that 98 per cent of children were at least partially vaccinated and only about two per cent had received no vaccinations at all.

  10. Of the children under the age of five years, 23 per cent were stunted (too short for their age) and 16 per cent were wasted (too thin for their height). Prevalence of anaemia among children rose from 36 per cent in NFHS-4 to 39 per cent.

  11. As per self-reports (responses chosen from a questionnaire without researcher interference) by men and women between 15-49 years of age, 4,081 women per 100,000 women and 3,987 men per 100,000 men had diabetes. The report adds that 4,792 women per 100,000 women and 833 men per 100,000 men had asthma.

  12. In Kerala, only 35 per cent women and 45 per cent men had ‘comprehensive knowledge’ about HIV/AIDS. Comprehensive knowledge includes knowing that regular use of a condom and having only one uninfected sexual partner can reduce chances of getting HIV/AIDS. It also refers to the rejection of common misconceptions about the transmission and prevention of the disease.

  13. Women’s use of a hygienic means of menstrual protection – sanitary napkins, tampons and menstrual cups – increased from 90 per cent during NFHS-4 to 93 per cent. Sanitary napkins were the majorly used method of menstrual protection. Use of a hygienic method, the report notes, is lowest among Scheduled Tribes (86.1 per cent) and Scheduled Castes (88.1 per cent).

  14. In the 12 months preceding the survey, 26 per cent of women had been employed compared to almost 75 per cent of men. Roughly 78.5 per cent of women surveyed had a bank or savings account they themselves used. Further, 25 per cent women (aged 15-49 years) owned a house either alone or jointly.

  15. Of all women (aged 18-49 years) surveyed in Kerala, 10 per cent reported experiencing physical or sexual violence and one per cent reported having experienced both. Among women who had experienced physical violence, 57 per cent did not tell anyone about it or seek help.

    Focus and Factoids by Akshita Hazarika.

    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, Laxmi Kant Dwivedi and Y. Vaidehi


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


Mar, 2021