DHS - India

Abstract

The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted in a representative sample of households throughout India. Four rounds of the survey have been conducted in 1992-93, 1998-99, 2005-06, and 2015-16. The fifth round of the survey (2019-2020) is currently in the field. All of the surveys are part of the Demographic and Health Surveys (DHS) Program. The surveys provide information on population, health, and nutrition at the national and state level. Since 2015-16, the surveys have also provided information at the district level. Some of the major topics included in NFHS-4 (2015-16) are fertility, infant and child mortality, family planning, maternal and reproductive health, child vaccinations, prevalence and treatment of childhood diseases, nutrition, women’s empowerment, domestic violence, marriage, sexual activity, employment, anemia, anthropometry, HIV/AIDS knowledge and testing, tobacco and alcohol use, biomarker tests (anthropometry, anemia, HIV, blood pressure, and blood glucose), and water, sanitation, and hygiene. The primary objective of the NFHS surveys is to provide essential data on health and family welfare, as well as emerging issues in these areas. The information collected through the NFHS surveys is intended to assist policymakers and program managers in setting benchmarks and examining progress over time in India’s health sector. The Ministry of Health and Family Welfare (MOHFW), Government of India, designated the International Institute for Population Sciences (IIPS), Mumbai, as the agency responsible for providing coordination and technical guidance for all of the surveys. IIPS has collaborated with a large number of field agencies for survey implementation. The Demographic and Health Surveys Program has provided technical assistance for all of the surveys.

Documentation

You can access the data through the DHS website. Data files are available in the following five formats:

• Hierarchical CSPro file
• Flat files: ASCII data with syntax, Stata, SPSS, SAS

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All datasets are distributed in archived ZIP files that include the data file and its associated documentation. The DHS Program is authorized to distribute, at no cost, unrestricted survey data files for legitimate academic research. Registration is required to access the data.

Additional information about the surveys is available on the India page on the DHS Program website. This page provides a list of surveys and reports, plus Country Quickstats for India, and it is the gateway to accessing more information about the India surveys and datasets.

Methodology

2015-16 National Family Health Survey (NFHS-4): Fieldwork for NFHS-4 was conducted in two phases, from January 2015 to December 2016. The fieldwork was conducted by 14 field agencies, including three Population Research Centers. Laboratory testing for HIV was done by seven laboratories throughout India. NFHS-4 collected information from a nationally representative sample of 601,509 households, 699,686 women age 15-49, and 112,122 men age 15-54. The survey covered all 29 states, 7 Union Territories, and 640 districts in India.

Funding for the survey was provided by the Ministry of Health and Family Welfare, Government of India; the United States Agency for International Development (USAID); UKAID/DFID; the Bill & Melinda Gates Foundation; UNICEF; the United Nations Population Fund (UNFPA); and the MacArthur Foundation. Technical Assistance for NFHS-4 was provided by Macro International, Maryland, USA.

2005-06 National Family Health Survey (NFHS-3): Fieldwork for NFHS-3 was conducted in two phases, from November 2005 to August 2006. The fieldwork was conducted by 18 field agencies, including six Population Research Centers. Laboratory testing for HIV was done by the SRL Ranbaxy laboratory in Mumbai. NFHS-3 collected information from a nationally representative sample of 109,041 households, 124,385 women age 15-49, and 74,369 men age 15-54. The survey covered all 29 states. Only the Union Territories were not included.

Funding for the survey was provided by the United States Agency for International Development (USAID); United Kingdom Department for International Development (DFID); the Bill & Melinda Gates Foundation; UNICEF; the United Nations Population Fund (UNFPA); and the Government of India. Technical assistance for NFHS-3 was provided by Macro International, Maryland, USA.

1998-99 National Family Health Survey (NFHS-2): Fieldwork for NFHS-2 was conducted in two phases, from November 1998 to December 1999. The fieldwork was conducted by 13 field agencies, including five Population Research Centers. NFHS-2 collected information from a nationally representative sample of 91,196 households and 89,188 ever-married women age 15-49. Male interviews were not included in the survey. The survey cover

Contains data from the DHS data portal. There is also a dataset containing India - National Demographic and Health Data on HDX.

The DHS Program Application Programming Interface (API) provides software developers access to aggregated indicator data from The Demographic and Health Surveys (DHS) Program. The API can be used to create various applications to help analyze, visualize, explore and disseminate data on population, health, HIV, and nutrition from more than 90 countries.

This survey was conducted in India by the International Institute for Population Sciences (IIPS). 89,777 ever married women between the ages of 19 - 49 were interviewed from April 1992 - September 1993. Major topics covered:Abortion; Anthropometry; Causes of Death; HIV Knowledge; Maternal Mortality; Micronutrients; Service Availability; Tuberculosis Questions; Vitamin A Questions

Data access requires registration with USAID. USAID now makes this data available directly on their website, which can be accessed here: https://dhsprogram.com/methodology/survey/survey-display-50.cfm - along with additional years of data here: https://dhsprogram.com/data/available-datasets.cfm

We advise you use this location to access the data as they have updated formats, etc. This material remains in the archive for preservation and historical purposes.

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Abstract

The National Family Health Survey 2019-21 (NFHS-5), the fifth in the NFHS series, provides information on population, health, and nutrition for India, each state/union territory (UT), and for 707 districts.

The primary objective of the 2019-21 round of National Family Health Surveys is to provide essential data on health and family welfare, as well as data on emerging issues in these areas, such as levels of fertility, infant and child mortality, maternal and child health, and other health and family welfare indicators by background characteristics at the national and state levels. Similar to NFHS-4, NFHS-5 also provides information on several emerging issues including perinatal mortality, high-risk sexual behaviour, safe injections, tuberculosis, noncommunicable diseases, and the use of emergency contraception.

The information collected through NFHS-5 is intended to assist policymakers and programme managers in setting benchmarks and examining progress over time in India’s health sector. Besides providing evidence on the effectiveness of ongoing programmes, NFHS-5 data will help to identify the need for new programmes in specific health areas.

The clinical, anthropometric, and biochemical (CAB) component of NFHS-5 is designed to provide vital estimates of the prevalence of malnutrition, anaemia, hypertension, high blood glucose levels, and waist and hip circumference, Vitamin D3, HbA1c, and malaria parasites through a series of biomarker tests and measurements.

Geographic coverage

National coverage

Analysis unit

• Household
• Individual
• Children age 0-5
• Woman age 15-49
• Man age 15 to 54

Universe

The survey covered all de jure household members (usual residents), all women aged 15-49, all men age 15-54, and all children aged 0-5 resident in the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

A uniform sample design, which is representative at the national, state/union territory, and district level, was adopted in each round of the survey. Each district is stratified into urban and rural areas. Each rural stratum is sub-stratified into smaller substrata which are created considering the village population and the percentage of the population belonging to scheduled castes and scheduled tribes (SC/ST). Within each explicit rural sampling stratum, a sample of villages was selected as Primary Sampling Units (PSUs); before the PSU selection, PSUs were sorted according to the literacy rate of women age 6+ years. Within each urban sampling stratum, a sample of Census Enumeration Blocks (CEBs) was selected as PSUs. Before the PSU selection, PSUs were sorted according to the percentage of SC/ST population. In the second stage of selection, a fixed number of 22 households per cluster was selected with an equal probability systematic selection from a newly created list of households in the selected PSUs. The list of households was created as a result of the mapping and household listing operation conducted in each selected PSU before the household selection in the second stage. In all, 30,456 Primary Sampling Units (PSUs) were selected across the country in NFHS-5 drawn from 707 districts as on March 31st 2017, of which fieldwork was completed in 30,198 PSUs.

For further details on sample design, see Section 1.2 of the final report.

Mode of data collection

Computer Assisted Personal Interview [capi]

Research instrument

Four survey schedules/questionnaires: Household, Woman, Man, and Biomarker were canvassed in 18 local languages using Computer Assisted Personal Interviewing (CAPI).

Cleaning operations

Electronic data collected in the 2019-21 National Family Health Survey were received on a daily basis via the SyncCloud system at the International Institute for Population Sciences, where the data were stored on a password-protected computer. Secondary editing of the data, which required resolution of computer-identified inconsistencies and coding of open-ended questions, was conducted in the field by the Field Agencies and at the Field Agencies central office, and IIPS checked the secondary edits before the dataset was finalized.

Field-check tables were produced by IIPS and the Field Agencies on a regular basis to identify certain types of errors that might have occurred in eliciting information and recording question responses. Information from the field-check tables on the performance of each fieldwork team and individual investigator was promptly shared with the Field Agencies during the fieldwork so that the performance of the teams could be improved, if required.

Response rate

A total of 664,972 households were selected for the sample, of which 653,144 were occupied. Among the occupied households, 636,699 were successfully interviewed, for a response rate of 98 percent.

In the interviewed households, 747,176 eligible women age 15-49 were identified for individual women’s interviews. Interviews were completed with 724,115 women, for a response rate of 97 percent. In all, there were 111,179 eligible men age 15-54 in households selected for the state module. Interviews were completed with 101,839 men, for a response rate of 92 percent.

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Public health insurance coverage in India before and after PM-JAY: repeated cross-sectional analysis of nationally representative survey dataThe National Family Health Survey (NFHS), India data is publicly available data set and can be accessed on request. It can be downloaded upon registration from the Demographic and Health Survey (DHS) website upon registration at The DHS Program - Request Access To Datasets. We have used data from the fourth and fifth round of NFHS, which can be accessed after registration from the link given here for NFHS 4 and NFHS 5 https://dhsprogram.com/data/dataset/India_Standard-DHS_2015.cfm?flag=0 and here https://dhsprogram.com/data/dataset/India_Standard-DHS_2020.cfm?flag=0 respectively. These datasets (HR file) have been used to obtain this combined dataset of a paper entitled "Public health insurance coverage in India before and after PM-JAY: repeated cross-sectional analysis of nationally representative survey data" submitted to BMJ Global Health August 2023.

Abstract

The National Family Health Surveys (NFHS) programme, initiated in the early 1990s, has emerged as a nationally important source of data on population, health, and nutrition for India and its states. The 2005-06 National Family Health Survey (NFHS-3), the third in the series of these national surveys, was preceded by NFHS-1 in 1992-93 and NFHS-2 in 1998-99. Like NFHS-1 and NFHS-2, NFHS-3 was designed to provide estimates of important indicators on family welfare, maternal and child health, and nutrition. In addition, NFHS-3 provides information on several new and emerging issues, including family life education, safe injections, perinatal mortality, adolescent reproductive health, high-risk sexual behaviour, tuberculosis, and malaria. Further, unlike the earlier surveys in which only ever-married women age 15-49 were eligible for individual interviews, NFHS-3 interviewed all women age 15-49 and all men age 15-54. Information on nutritional status, including the prevalence of anaemia, is provided in NFHS3 for women age 15-49, men age 15-54, and young children.

A special feature of NFHS-3 is the inclusion of testing of the adult population for HIV. NFHS-3 is the first nationwide community-based survey in India to provide an estimate of HIV prevalence in the general population. Specifically, NFHS-3 provides estimates of HIV prevalence among women age 15-49 and men age 15-54 for all of India, and separately for Uttar Pradesh and for Andhra Pradesh, Karnataka, Maharashtra, Manipur, and Tamil Nadu, five out of the six states classified by the National AIDS Control Organization (NACO) as high HIV prevalence states. No estimate of HIV prevalence is being provided for Nagaland, the sixth high HIV prevalence state, due to strong local opposition to the collection of blood samples.

NFHS-3 covered all 29 states in India, which comprise more than 99 percent of India's population. NFHS-3 is designed to provide estimates of key indicators for India as a whole and, with the exception of HIV prevalence, for all 29 states by urban-rural residence. Additionally, NFHS-3 provides estimates for the slum and non-slum populations of eight cities, namely Chennai, Delhi, Hyderabad, Indore, Kolkata, Meerut, Mumbai, and Nagpur. NFHS-3 was conducted under the stewardship of the Ministry of Health and Family Welfare (MOHFW), Government of India, and is the result of the collaborative efforts of a large number of organizations. The International Institute for Population Sciences (IIPS), Mumbai, was designated by MOHFW as the nodal agency for the project. Funding for NFHS-3 was provided by the United States Agency for International Development (USAID), DFID, the Bill and Melinda Gates Foundation, UNICEF, UNFPA, and MOHFW. Macro International, USA, provided technical assistance at all stages of the NFHS-3 project. NACO and the National AIDS Research Institute (NARI) provided technical assistance for the HIV component of NFHS-3. Eighteen Research Organizations, including six Population Research Centres, shouldered the responsibility of conducting the survey in the different states of India and producing electronic data files.

The survey used a uniform sample design, questionnaires (translated into 18 Indian languages), field procedures, and procedures for biomarker measurements throughout the country to facilitate comparability across the states and to ensure the highest possible data quality. The contents of the questionnaires were decided through an extensive collaborative process in early 2005. Based on provisional data, two national-level fact sheets and 29 state fact sheets that provide estimates of more than 50 key indicators of population, health, family welfare, and nutrition have already been released. The basic objective of releasing fact sheets within a very short period after the completion of data collection was to provide immediate feedback to planners and programme managers on key process indicators.

Geographic coverage

• National (29 states )
• Regional (for HIV Prevalence : Andhra Pradesh, Karnataka, Maharashtra, Manipur, and Tamil Nadu)
• Local (population and health indicators for slum and non-slum populations for eight cities, namely Chennai, Delhi, Hyderabad, Indore, Kolkata, Meerut, Mumbai, and Nagpur)

Analysis unit

• Household
• Women age 15-49
• Men age 15-59

Universe

The population covered by the 2005 DHS is defined as the universe of all ever-married women age 15-49, NFHS-3 included never married women age 15-49 and both ever-married and never married men age 15-54 as eligible respondents.

Kind of data

Sample survey data

Sampling procedure

SAMPLE SIZE

Since a large number of the key indicators to be estimated from NFHS-3 refer to ever-married women in the reproductive ages of 15-49, the target sample size for each state in NFHS-3 was estimated in terms of the number of ever-married women in the reproductive ages to be interviewed.

The initial target sample size was 4,000 completed interviews with ever-married women in states with a 2001 population of more than 30 million, 3,000 completed interviews with ever-married women in states with a 2001 population between 5 and 30 million, and 1,500 completed interviews with ever-married women in states with a population of less than 5 million. In addition, because of sample-size adjustments required to meet the need for HIV prevalence estimates for the high HIV prevalence states and Uttar Pradesh and for slum and non-slum estimates in eight selected cities, the sample size in some states was higher than that fixed by the above criteria. The target sample was increased for Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland, Tamil Nadu, and Uttar Pradesh to permit the calculation of reliable HIV prevalence estimates for each of these states. The sample size in Andhra Pradesh, Delhi, Maharashtra, Tamil Nadu, Madhya Pradesh, and West Bengal was increased to allow separate estimates for slum and non-slum populations in the cities of Chennai, Delhi, Hyderabad, Indore, Kolkata, Mumbai, Meerut, and Nagpur.

The target sample size for HIV tests was estimated on the basis of the assumed HIV prevalence rate, the design effect of the sample, and the acceptable level of precision. With an assumed level of HIV prevalence of 1.25 percent and a 15 percent relative standard error, the estimated sample size was 6,400 HIV tests each for men and women in each of the high HIV prevalence states. At the national level, the assumed level of HIV prevalence of less than 1 percent (0.92 percent) and less than a 5 percent relative standard error yielded a target of 125,000 HIV tests at the national level.

Blood was collected for HIV testing from all consenting ever-married and never married women age 15-49 and men age 15-54 in all sample households in Andhra Pradesh, Karnataka, Maharashtra, Manipur, Tamil Nadu, and Uttar Pradesh. All women age 15-49 and men age 15-54 in the sample households were eligible for interviewing in all of these states plus Nagaland. In the remaining 22 states, all ever-married and never married women age 15-49 in sample households were eligible to be interviewed. In those 22 states, men age 15-54 were eligible to be interviewed in only a subsample of households. HIV tests for women and men were carried out in only a subsample of the households that were selected for men's interviews in those 22 states. The reason for this sample design is that the required number of HIV tests is determined by the need to calculate HIV prevalence at the national level and for some states, whereas the number of individual interviews is determined by the need to provide state level estimates for attitudinal and behavioural indicators in every state. For statistical reasons, it is not possible to estimate HIV prevalence in every state from NFHS-3 as the number of tests required for estimating HIV prevalence reliably in low HIV prevalence states would have been very large.

SAMPLE DESIGN

The urban and rural samples within each state were drawn separately and, to the extent possible, unless oversampling was required to permit separate estimates for urban slum and non-slum areas, the sample within each state was allocated proportionally to the size of the state's urban and rural populations. A uniform sample design was adopted in all states. In each state, the rural sample was selected in two stages, with the selection of Primary Sampling Units (PSUs), which are villages, with probability proportional to population size (PPS) at the first stage, followed by the random selection of households within each PSU in the second stage. In urban areas, a three-stage procedure was followed. In the first stage, wards were selected with PPS sampling. In the next stage, one census enumeration block (CEB) was randomly selected from each sample ward. In the final stage, households were randomly selected within each selected CEB.

SAMPLE SELECTION IN RURAL AREAS

In rural areas, the 2001 Census list of villages served as the sampling frame. The list was stratified by a number of variables. The first level of stratification was geographic, with districts being subdivided into contiguous regions. Within each of these regions, villages were further stratified using selected variables from the following list: village size, percentage of males working in the nonagricultural sector, percentage of the population belonging to scheduled castes or scheduled tribes, and female literacy. In addition to these variables, an external estimate of HIV prevalence, i.e., 'High', 'Medium' or 'Low', as estimated for all the districts in high HIV prevalence states, was used for stratification in high HIV prevalence states. Female literacy was used for implicit stratification (i.e., villages were

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Analysis unit

Woman, Birth, Child, Man, Member

Universe

Women age 15-49, Births, Children age 0-4, Men age 15-54, All persons

Kind of data

Demographic and Household Survey [hh/dhs]

Sampling procedure

MICRODATA SOURCE: International Institute for Population Sciences (IIPS) and ICF.

SAMPLE UNIT: Woman SAMPLE SIZE: 699686

SAMPLE UNIT: Birth SAMPLE SIZE: 1315617

SAMPLE UNIT: Child SAMPLE SIZE: 259627

SAMPLE UNIT: Man SAMPLE SIZE: 112122

SAMPLE UNIT: Member SAMPLE SIZE: 2869043

Mode of data collection

Face-to-face [f2f]

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IntroductionPreconception nutrition, the nutritional status of women before pregnancy, is crucial for maternal and child health. Interventions focusing on preconception nutrition can help break the intergenerational cycle of malnutrition by improving the health and nutritional status of women before pregnancy. This study investigated the recent trends and patterns in the nutritional status of nulliparous adolescents and young women across six countries in South Asia: Bangladesh, India, Maldives, Nepal, Pakistan, and Sri Lanka.MethodsThis study utilized the cross-sectional data from the Demographic and Health Survey (DHS) conducted between 2010 and 2022 for six South Asian countries. A total sample of 20,024 nulliparous married women aged 15–24 years was analyzed to estimate the pooled prevalence for various anthropometric outcomes. Annual changes in the prevalence of the outcome indicators were presented for each country. Predictors of thinness and overweight were analyzed using logistic regression models.ResultsBased on the latest rounds of DHS for respective countries, the pooled weighted prevalence of thinness was 24.4%, overweight was 24.8%, and short height was 11.3%. The prevalence of underweight ranged from 14.6% in Pakistan (DHS 2018) to 25.9% in India (DHS 2021). The least reduction in the prevalence of underweight was observed in India at 2.8% and Nepal at 0.7%. Based on the latest surveys, the mean BMI among women aged 15–24 years was the highest in Maldives (24.1, 95% CI: 23.4, 24.8) and Pakistan (22.9, 95% CI: 22.2, 23.5) and the lowest in India (20.9, 95% CI: 20.9, 21.0) and Nepal (20.8, 95% CI: 20.4, 21.2). The pooled prevalence of thinness and short height was high in rural areas (26.2 and 11.8%), among less educated (28.1 and 14.5%), and bottom 40% wealth quintile groups (29.8 and 15.8%). Compared to young women (20–24 years), adolescent girls were 39% more likely to be underweight (OR: 1.39; 95% CI: 1.25, 1.54).ConclusionThe findings highlight the need to broaden the scope of policies and programs designed for pregnant and lactating women so that nulliparous married women can be screened frequently for their anthropometric progress. Given the uneven distribution of the burden, it is recommended to implement comprehensive nutrition packages to reach all population subgroups across the regions.

Average marginal effects of BMI on self-reported diabetes status: Probit and IV-Probit model estimates for married couples sub-sample.

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Average marginal effects of BMI on ordinal blood glucose levels amongst overweight or obese individuals (BMI ≥ 25 kg/m2): Ordered Probit model estimates based on full sample data.

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Descriptive statistics by overweight or obesity status.