National Family Health Survey (NFHS)-6

The recently released National Family Health Survey (NFHS)-6 (2023-24) by the Ministry of Health and Family Welfare (MoHFW) highlights significant progress in child nutrition, maternal healthcare, and immunisation coverage in India. At the same time, it draws attention to persistent challenges such as child undernutrition, poor infant feeding practices, inadequate dietary diversity, maternal workload, and gaps in local-level implementation of nutrition programmes.

About the National Family Health Survey (NFHS)

The National Family Health Survey (NFHS) is India's most comprehensive survey on population, health, and nutrition indicators. It was launched in 1992-93 with the objective of creating a reliable database for evidence-based policymaking in health and family welfare.

Since then, India has completed NFHS-2 (1998-99), NFHS-3 (2005-06), NFHS-4 (2015-16), NFHS-5 (2019-21), and NFHS-6 (2023-24).

The survey is conducted by the Ministry of Health and Family Welfare (MoHFW), with the International Institute for Population Sciences (IIPS), Mumbai, serving as the nodal agency.

NFHS collects data on maternal and child health, fertility, family planning, nutrition, immunisation, infant mortality, women's empowerment, sanitation, drinking water, and household living conditions.

Positive Trends Highlighted in NFHS-6

Improvement in Child Nutrition

The survey reveals a significant decline in stunting, which is a major indicator of chronic malnutrition. The proportion of children under five years who are stunted has fallen from 35.5% to 29.3%, indicating gradual improvement in nutritional outcomes.

This decline reflects the impact of initiatives such as POSHAN Abhiyaan, better healthcare services, and improved awareness regarding child nutrition.

Better Maternal and Child Healthcare

India has achieved notable success in institutional healthcare delivery.

More than 90% of births now take place in health facilities, while nearly 58% of deliveries occur in public health institutions. Furthermore, about 91% of deliveries are assisted by skilled healthcare professionals, contributing to reduced maternal and infant mortality.

These improvements reflect the success of schemes such as Janani Suraksha Yojana (JSY) and Pradhan Mantri Matru Vandana Yojana (PMMVY).

Expansion of Immunisation Coverage

NFHS-6 reports that nearly 87% of children aged 12–23 months are fully immunised.

This achievement strengthens India's efforts toward universal immunisation under Mission Indradhanush, protecting children against preventable diseases and improving overall child health outcomes.

Major Challenges Highlighted by NFHS-6

Persistent Child Undernutrition

Despite improvements, child malnutrition remains a serious concern.

Nearly 29.3% of children below five years remain stunted, indicating long-term nutritional deprivation.

Similarly, wasting, which reflects acute malnutrition, has shown only marginal improvement. High levels of wasting continue to indicate inadequate nutrition and repeated infections among children.

The pace of improvement is insufficient to achieve the targets of the Sustainable Development Goals (SDGs) and the National Nutrition Mission.

Poor Infant and Young Child Feeding Practices (IYCF)

The survey highlights serious deficiencies in feeding practices during early childhood.

Only about half of newborns are breastfed within one hour of birth, despite the well-established health benefits of early breastfeeding.

Among children aged 6–8 months, only around 60% receive complementary foods on time.

Even more concerning is that merely 15% of children aged 6–23 months receive an adequate and balanced diet, indicating widespread nutritional inadequacy during a critical stage of growth and development.

Poor Dietary Diversity

NFHS-6 reveals that the diets of many Indian children and families lack nutritional diversity.

Consumption of pulses, fruits, vegetables, nuts, milk products, and animal-source foods remains inadequate in many households.

At the same time, there is a growing consumption of processed foods and sugar-sweetened beverages, which provide calories but lack essential nutrients.

The survey also points out that healthy diets remain economically unaffordable for many families, particularly among poorer households.

Maternal Time Poverty

A major concern identified by NFHS-6 is the increasing burden on women.

Many women simultaneously perform agricultural work, livestock management, domestic responsibilities, childcare, and unpaid labour, leaving limited time for childcare and nutritional care.

This phenomenon, often referred to as "maternal time poverty," directly affects child feeding practices and child development outcomes.

Weak Focus on the First 1,000 Days

The period from pregnancy until a child's second birthday—commonly known as the first 1,000 days—is crucial for physical growth, brain development, and long-term health.

NFHS-6 highlights several concerns in this regard:

• Insufficient data collection specifically focused on children aged 0–2 years.

• Growth faltering often begins before it is detected.

• Nutrition programmes continue to focus more on treatment rather than prevention.

As a result, many nutritional deficiencies are identified only after significant damage has already occurred.

Regional and Institutional Gaps

The survey also identifies several structural challenges, including:

• Significant regional and socioeconomic disparities in nutrition outcomes.

• Limited use of nutrition data for planning and intervention.

• Inadequate training and capacity of frontline workers such as ASHAs, Anganwadi Workers (AWWs), and Auxiliary Nurse Midwives (ANMs).

• Weak coordination among departments responsible for health, nutrition, sanitation, and water supply.

• Insufficient childcare facilities for working mothers.

Government Initiatives to Improve Nutrition

POSHAN Abhiyaan (National Nutrition Mission)

Launched in 2018, POSHAN Abhiyaan aims to reduce stunting, wasting, underweight prevalence, and anaemia among children, pregnant women, and lactating mothers.

The programme promotes:

• Real-time growth monitoring.

• Community participation through Jan Andolan.

• Behavioural change communication.

• Convergence among multiple departments.

Mission Saksham Anganwadi and POSHAN 2.0

This integrated programme combines:

• Supplementary Nutrition Programme (SNP)

• POSHAN Abhiyaan

• Anganwadi Services

The scheme targets children below six years, pregnant women, lactating mothers, and adolescent girls, while also focusing on upgrading Anganwadi infrastructure and promoting Early Childhood Care and Education (ECCE).

Other Important Schemes

Several complementary schemes support child and maternal nutrition, including:

• PM POSHAN Scheme (Mid-Day Meal Programme)

• Anaemia Mukt Bharat (AMB)

• Mission Indradhanush

• Pradhan Mantri Matru Vandana Yojana (PMMVY)

• Janani Suraksha Yojana (JSY)

• National Crèche Scheme (Palna)

Way Forward

NFHS-6 recommends a comprehensive strategy to improve child nutrition and maternal health.

Nutrition-specific interventions should focus on promoting breastfeeding within one hour of birth, ensuring timely complementary feeding after six months, improving dietary diversity through locally available foods, and expanding nutrition counselling services.

Institutionally, there is a need to recruit district-level nutritionists and data analysts, strengthen the quality of anthropometric measurements, and use digital tools for growth monitoring.

At the governance level, child nutrition should become a regular agenda item in Gram Sabhas and Panchayats, while coordination among Health, ICDS, Jal Jeevan Mission, Swachh Bharat Mission-Gramin, and Rural Development Departments must be strengthened.

Gender-sensitive measures should reduce women's unpaid care burden by promoting shared caregiving responsibilities, expanding community crèches, and improving childcare support systems.

Food system reforms should ensure affordable access to pulses, millets, fruits, vegetables, and protein-rich foods, while regulating the marketing and consumption of ultra-processed foods.

Conclusion

The findings of NFHS-6 indicate that India has made significant progress in reducing stunting, expanding institutional deliveries, and improving immunisation coverage. However, challenges such as persistent undernutrition, poor feeding practices, inadequate dietary diversity, maternal time poverty, and weak local implementation mechanisms continue to hinder progress.