The findings of household surveys provide valuable information on the state of the nation and the well-being of its population. India is fortunate to have a long and successful series of surveys. The system of statistical data collection in India, depending on a close engagement between leading statisticians, economists, demographers and the government, has been globally respected for the quality of data collected and the truthfulness of what is presented. Surveys such as the NSS, NFHS, and PLFS, among others, offer findings that are a marker of how well we are doing, areas in which our global commitment to meet Sustainable Development Goals by 2030 is on track, and where we are lagging.
Recently, there have been commentaries in reputed media and academic journals that have suggested that methodological and design flaws have underestimated the progress that India has made on the socio-economic front. For example, Dr Shamika Ravi, member of the Prime Minister’s Economic Advisory Council, argued that India’s surveys have a rural bias and are based on “unsound data collection frameworks” that “systematically underestimate India’s progress and development” (see “The sample is wrong”, The Indian Express, July 7). Others, including India’s leading statistician, Pronab Sen, have refuted these claims (see “No, India’s statisticians aren’t stupid”, The Indian Express, July 11).
Likewise, scientists from the National Institute of Rural Development and Panchayati Raj, Hyderabad, have cast doubts on NFHS’ gender data, suggesting that the National Family Health Survey does not “accurately represent the condition and position of women in India” and will not determine whether women are gaining from the activities designed to realise the 2030 agenda, particularly “those activities that directly target gender equality” because it relies too heavily on men’s responses (“How to make India’s National Family Health Survey More Gender Sensitive”, Joseph and Madhuri, Lancet, 2022). This too was refuted in commentaries in the same journal by international and Indian researchers (Arnold and Kishor; Jejeebhoy, Lancet, 2023).
A third example is the government of India’s scepticism about the Global Hunger Index (GHI) 2022 that ranked India 107 among 121 countries; questions were raised about the construction of the index, which was labelled “biased and disconnected from ground reality” without providing reasons (Hindustan Times, October 16, 2022).
Controversy over NFHS findings
The suspension of the Director of the International Institute for Population Sciences (IIPS), the institution responsible for conducting India’s prestigious National Family Health Surveys, reflects yet another reaction to adverse survey findings. Although “administrative irregularities” have been cited officially, there has been wide speculation that this suspension is related to unwelcome NFHS findings that run counter to public pronouncements made by India’s leadership, and IIPS’ (and its Director’s) stand in support of the integrity of these findings (The Wire, 29 July, 31 July; Manorama, 30 July, The Telegraph Online, 30 July; The Hindu, 31 July).
The National Family Health Surveys (NFHS) have been conducted, over five rounds (the sixth is ongoing) since the early 1990s, and have been globally admired for the quality of their data and findings, and insights for policy. They provide valuable and reliable information on multiple aspects of individual well-being—poverty and living conditions, health and mortality, fertility and family planning, education, labour force participation, nutrition, gender relations, and more.
They allow researchers and policymakers to track social change over time and place, providing good news about where progress has been made and which government programmes may have had a positive impact, as well as not so good news about where we are stagnating, which programmes are lagging and need modification and/or increased financial investment. A look at the progress made over the past three surveys, conducted about 15 years and four years, respectively, before the most recent one, provides information on change over time, and documents what has worked well and what has failed to do so, as the chart below shows.
The findings demonstrate that the situation, by and large, has improved substantially. Access to safe drinking water is today near-universal (96 per cent). Over the last 15 years, moreover, access to toilets and clean cooking fuel has more than doubled, and even within the short span of four years increased by over 20 and 15 percentage points, respectively. Even so, findings suggest that access to these amenities is far from universal.
Malnutrition a concern
Today, four in five adolescents aged 14-15 are in secondary school and two in three of those aged 16-17 are in higher secondary school, again reflecting systematic improvements over the century. With the increase in schooling, child marriage has plummeted; marriage below age 15 fell from 18 to 5 per cent, and marriage below age 18 more than halved over the 15-year period between NFHS-3 and NFHS-5.
The total fertility rate is now 2.0, and the unmet need for contraception, a marker of how well the family planning programme has been meeting the needs of women and men, has declined to 9 per cent, with much of the decline occurring in the last four years. Progress on pregnancy-related care is evident from the finding that almost nine in 10 women undergo delivery in an institution or with a skilled birth attendant, with a huge spurt occurring in the decade from 2005-06 to 2015-16. Infant and neonatal mortality have plummeted; the neonatal mortality rate had reached 18 per 1000 births in 2019-21, suggesting that India is well on its way to meeting the SDG target of 12/1000 births by 2030.
What has stagnated and remains disappointingly high are indicators of childhood malnutrition. While the percentage of children under six who are underweight has fallen, one-third of children remain underweight and one in 10 is severely underweight.
Stunting fell modestly between NFHS-3 and NFHS-4 and remained virtually unchanged thereafter—so that today 36 per cent are stunted and 15 per cent severely so. Wasting levels show not even a modest decline, so that over the course of this century, one in five children are reported as wasting, and one in 12 as severely so. And finally, two-thirds of children are anaemic, with 2 per cent severely so in 2019-21, reflecting levels unchanged since the beginning of the century.
Last mile coverage
Just a smattering of the vast findings of successive NFHS surveys presented here suggests optimism about India’s progress on many fronts, but there is some way to go, and the last and most difficult mile is yet to be covered. There is, for instance, discouraging news on the child malnutrition front.
Also Read | NFHS-5 findings: The good, the bad & the ugly
Again, while much progress has been made, statements announcing that India is free of open defecation may be premature. These negative findings must be taken in the same light as the host of positive outcomes discussed above, and should serve as a wake-up call for increased investment in programmes and the implementation of restructured and evidence-based programmes that respond to social realities and obstacles.
These are the messages of NFHS. The director of IIPS cannot be held responsible for unflattering findings. This reaction of the Ministry of Health and Family Welfare—shooting the messenger—is unlikely to improve the health and well-being of households and children in India. What it will do, however, is hurt the credibility of future NFHS surveys, such that any genuine improvement will be met, nationally and internationally, with scepticism and suspicions of manipulation.
Shireen J. Jejeebhoy is a demographer and social scientist and is currently a Distinguished Visiting Faculty at the International Institute for Population Sciences. She is also the director of Aksha Centre for Equity and Wellbeing, a small research non-profit.