NFHS-6: India's Health and Nutrition Report Card

Why in News?

The National Family Health Survey-6 (NFHS-6), based on data collected during 2023–24, has been released. The survey presents India's latest health and nutrition indicators, showing significant improvements in healthcare access and immunisation, while highlighting continued challenges in child nutrition, feeding practices, and diet quality.

About National Family Health Survey (NFHS)

The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted across India to assess the country's health, nutrition, fertility, mortality, family planning, and maternal and child health indicators.

The survey is conducted under the Ministry of Health and Family Welfare (MoHFW), while the International Institute for Population Sciences (IIPS), Mumbai, serves as the nodal agency for its implementation with technical assistance from national and international organizations.

The findings of NFHS provide crucial inputs for designing, monitoring, and evaluating public health programmes and policies.

Major Findings of NFHS-6

Improvements in Child Nutrition

The survey indicates that stunting among children below five years has declined by about 3 percentage points compared to NFHS-5, reflecting gradual improvement in long-term nutritional status.

However, wasting, which indicates acute malnutrition, has shown only a marginal improvement, while severe wasting has declined slightly.

The reduction in stunting is encouraging because it reflects improvements in maternal health, sanitation, drinking water, healthcare services, and dietary intake, all of which influence child growth over a long period.

Significant Progress in Healthcare Access

NFHS-6 records substantial improvements in the accessibility of healthcare services across the country.

Nearly 90% of all births now take place in health institutions, with about 58% occurring in public healthcare facilities.

Almost 91% of deliveries are attended by trained healthcare professionals, ensuring safer childbirth.

The survey also reveals that 95% of pregnant women received at least one antenatal care (ANC) visit, indicating wider coverage of maternal healthcare services.

Similarly, about 87% of children aged 12–23 months are now fully immunised, largely due to the dedicated efforts of Accredited Social Health Activists (ASHAs), Anganwadi Workers (AWWs), and Auxiliary Nurse Midwives (ANMs). Private healthcare institutions account for only a small proportion of immunisation services.

These improvements demonstrate the positive impact of government initiatives aimed at strengthening primary healthcare, maternal health, immunisation, and public health infrastructure.

Persistent Challenges in Child Feeding Practices

Despite major improvements in healthcare services, feeding practices remain one of the weakest components of child nutrition in India.

Only about half of all newborns are breastfed within the first hour of birth, despite the high rate of institutional deliveries.

Among children aged 6–8 months, only 60% receive complementary foods such as solid or semi-solid food at the appropriate age.

More concerning is the finding that only 15% of children between 6 and 23 months receive an adequate diet, indicating widespread nutritional deficiencies during the most critical stage of growth.

This gap between better healthcare access and poor feeding practices represents one of the most important findings of NFHS-6.

Importance of the First 1,000 Days

The period from the beginning of pregnancy until a child's second birthday, commonly referred to as the First 1,000 Days, is regarded as the most critical stage for physical growth, brain development, and cognitive ability.

Scientific evidence shows that the majority of brain development occurs during the first five years, while stunting generally develops before the age of two years.

Although this period is extremely important, NFHS-6 does not provide separate data for children aged 0–2 years, limiting the ability to formulate targeted nutrition interventions.

Role of Annaprasana in Child Nutrition

The traditional Indian ceremony of Annaprasana, during which a child is introduced to solid food for the first time, generally takes place between six and twelve months of age.

Delayed introduction of complementary food after this period can contribute significantly to growth faltering, stunting, and malnutrition.

Therefore, nutrition awareness programmes should integrate traditional cultural practices such as Annaprasana to encourage timely complementary feeding.

The Growing Processed Food Challenge

NFHS-6 and household expenditure surveys reveal a gradual shift in food consumption patterns.

Many households are spending less on cereals while increasing expenditure on processed foods, packaged beverages, dairy products, and convenience foods.

Although this creates an impression of greater dietary diversity, it often results in diets that are high in calories but poor in essential nutrients.

According to the ICMR–National Institute of Nutrition (ICMR-NIN) dietary guidelines, a balanced diet should include millets, pulses, fruits, vegetables, nuts, milk, and animal-source foods. However, such nutritious diets remain unaffordable for many low-income households.

As a result, families increasingly depend on cheap processed foods, leading to what experts describe as the Nutrition Transition Trap, where traditional healthy diets are replaced by energy-dense but nutrient-poor foods.

Maternal Time Poverty: An Overlooked Challenge

Another major factor contributing to poor child nutrition is maternal time poverty.

Although NFHS-6 reports that around 30% of women participate in paid employment, this figure does not capture the large amount of unpaid work performed by women, particularly in rural areas.

Many women spend considerable time in agriculture, livestock rearing, domestic work, and household responsibilities, leaving them with limited time for breastfeeding and childcare.

In the absence of crèche facilities, working mothers often leave young children with elderly family members or older siblings, particularly girls, reducing opportunities for proper feeding and care.

Recommendations for Improving Child Nutrition

Strengthening Frontline Health Workers

The skills of Anganwadi Workers (AWWs) in collecting and analysing child growth data should be improved so that nutritional problems can be identified at an early stage.

District-level nutrition experts and data analysts should support ASHAs, ANMs, and AWWs in interpreting growth data and planning timely interventions.

Use of Digital Technology

Digital platforms should complement face-to-face counselling by providing practical guidance on breastfeeding, complementary feeding, and locally available nutritious foods for mothers and frontline workers.

Behaviour Change Communication

Nutrition awareness campaigns should be based on local cultural traditions, including Annaprasana, to promote timely introduction of complementary foods.

Joint training programmes involving ASHAs, AWWs, and ANMs should strengthen counselling skills and improve family awareness regarding infant feeding.

Multi-sectoral Convergence

Child nutrition should become a regular agenda in Gram Sabha and Panchayat meetings.

Local governments should prioritise investments in Anganwadi Centres, safe drinking water, sanitation, and nutrition services.

The focus of POSHAN Abhiyaan should shift from treating severe malnutrition alone to preventing growth faltering through early identification and intervention.

Expansion of Crèche Facilities

Crèches should be recognised as essential social infrastructure because they enable mothers to participate in economic activities while ensuring proper childcare, nutrition, and early learning.

Successful community-based crèche models developed by several non-governmental organisations (NGOs) should be expanded nationwide.

Greater Involvement of Fathers

Encouraging fathers to actively participate in childcare, feeding, and household responsibilities can significantly improve child nutrition and reduce the burden on mothers.

Conclusion

The findings of NFHS-6 present a picture of two contrasting realities. On one hand, India has made remarkable progress in institutional deliveries, maternal healthcare, immunisation, and healthcare accessibility. On the other hand, poor feeding practices, inadequate complementary nutrition, unhealthy dietary patterns, and maternal time poverty continue to undermine child nutrition.