NFHS Bulletin

The NFHS Bulletin is a series of four-page policy briefs summarizing secondary analysis of data from the 1992-93 National Family Health Survey (NFHS) in India. The series is copublished by the International Institute for Population Sciences (IIPS) in Mumbai and the East-West Center.

The NFHS collected information from nearly 90,000 Indian women on a range of demographic and health topics. Conducted under the auspices of the Indian Ministry of Health and Family Welfare, the survey provides national and state-level estimates of fertility, infant and child mortality, family planning practice, maternal and child health, and the utilization of services available to mothers and children. IIPS conducted the survey in cooperation with consulting organizations and 18 population research centers throughout India. The East-West Center and a U.S.-based consulting firm, Macro International, provided technical assistance, and the United States Agency for International Development (USAID) provided financial support.

Single copies of the NFHS Bulletin on are available free by airmail and may be reproduced for educational use. Airmail postage charges for additional copies are $0.50 each within the United States and its territories and $1.00 each elsewhere. Send an e-mail message to Population and Health Studies at the East-West Center.

You are also welcome to download most issues of the NFHS Bulletin as fully formated Adobe Acrobat .pdf files including all text and graphics. Just click on any of the titles that are underlined. (You can download the Acrobat Reader free from the Internet.)

No. 17, Factors Affecting Sex-Selective Abortion in India by Robert D. Retherford and T. K. Roy. January 2003.

Birth histories collected during NFHS-1 and NFHS-2 show an unusually large proportion of male births in some population groups, which suggests that female fetuses are being aborted. Male births are particularly overrepresented in certain western and northern states, in families that already have daughters but no sons, and among women with a high level of education and media exposure. Analysis of women's ideal sex ratio (the ratio of ideal number of sons to ideal number of daughters) indicates that son preference is declining in almost all states and socioeconomic groups. Nevertheless, ideal sex ratios are still much higher than the biological norm, implying that considerable potential exists for further increases in levels of sex-selective abortion.

No. 16, Are the WHO/UNICEF Guidelines on Breastfeeding Appropriate for India? by Ravilla Anandaiah and Minja Kim Choe. September 2000.

An analysis of NFHS-1 results supports the hypothesis that breastfeeding reduces mortality in the first few months of live. The beneficial effects extend to older infants when breastfeeding is combined with supplemental foods. A surprising finding is that breastfeeding with supplements is nearly always more beneficial than exclusive breastfeeding, even for children at very young ages (less than four months) when exclusive breastfeeding is typically recommended.

Results from NFHS-1 indicate that more than half of all Indian children under age four are malnourished. Children whose mothers have little or no education and children with three or more older siblings tend to have a lower nutritional status than do other children. Surprisingly, malnutrition rates are just as high for boys as for girls.

Women living in households that use biomass cooking fuels, defined in the NFHS as wood and dung, have a much higher prevalence of both partial and complete blindness than women living in households that use cleaner fuels. Among women age 30 and older, 17% of partial blindness and 20% of complete blindness can be attributed to cooking smoke from biomass fuels. The government and nongovernmental organizations (NGOs) in India need to strengthen programs that promote improved cookstoves and increase efforts to educate the public about the adverse health effects of cooking smoke.

Adults in households that cook with biomass fuels, defined in the NFHS as wood and dung, suffer a significantly higher risk of tuberculosis than adults in households that cook with cleaner fuels. An estimated 51% of the active tuberculosis cases reported in the NFHS can be attributed to exposure to cooking smoke from biomass fuels. The government and nongovernmental organizations (NGOs) in India need to strengthen programs that promote improved cookstoves and increase efforts to educate the public about the adverse health effects of cooking smoke.

NFHS data on infant and child mortality indicate that seven groups of children in India are particularly vulnerable to mortality risks. These are: children born less than 24 months after a previous birth, children in families where an older sibling has died, children born to mothers less than 20 years old, children of illiterate mothers, children in very poor households, children in households whose head belongs to a scheduled caste or tribe, and children in households without access to a flush or pit toilet. Intervention programs to improve child survival should focus on these high-risk groups.

An analysis of NFHS data shows poor knowledge and use of oral rehydration therapy (ORT) among Indian women despite the government’s efforts to publicize this treatment for childhood diarrhea. Many children are treated with unnecessary—sometimes harmful—antibiotics or other drugs. Women who are regularly exposed to radio, television, or cinema are considerably more likely to know about and use ORT than are women who are not exposed to these media.

NFHS results show that mother’s tetanus immunization during pregnancy is associated not only with reduced neonatal mortality, which is expected, but also with substantially reduced early-childhood mortality, which is surprising, even after controlling for the effects of 13 potentially confounding demographic and socioeconomic variables. Probably this occurs because tetanus immunization is correlated with general health-seeking behavior.

The Indian family welfare program has been dominated for decades by a reliance on female sterilization. NFHS results, however, show that Indian women tend to undergo sterilization only after giving birth to many children. This implies that further reliance on sterilization is not likely to reduce total fertility much below the current level of 3.4 children per women. To be successful, efforts to continue India's fertility decline need to include a strong emphasis on temporary contraceptive methods.

Indian children under age three living in households that use wood or animal dung as their primary cooking fuel have an almost one-third higher risk of acute respiratory infection (ARI) than do children living in households that use cleaner fuels.

Recent exposure to family planning messages on radio or television has a significant positive effect on current and intended future use of contraception, even after controlling for the effects of general media exposure.

Since the late 1970s, fertility in India has fallen faster than indicated by the Sample Registration System (SRS) but more slowly than indicated by the NFHS. Current fertility is probably somewhat higher than indicated by either source.

An examination of wanted and unwanted fertility levels shows broad variation in the current stage of fertility transition in eight of India’s states.

Without gender preference, national-level fertility in India would decrease by about 8 percent.

Tamil Nadu and Andhra Pradesh are family planning success stories, whereas Uttar Pradesh has by far the highest fertility of any state in India. A comparison of NFHS findings from these three states provides some useful lessons for Uttar Pradesh and other high-fertility states.

In 13 Indian states where HIV is though to be especially prevalent, only one in six ever-married women has ever heard of AIDS. Even fewer have a good understanding of the disease and how it is transmitted.

In Uttar Pradesh, only 20 percent of currently married women age 13-49 are using any form of family planning. Among women who are not using contraception, 13 percent have an unmet need for limiting births, and 17 percent have an unmet need for spacing their next birth.