The findings of the sixth National Family Health Survey, conducted in 2023-24, point to a reality that is, at once, encouraging and cautionary. There are signs of progress in some aspects. Institutional deliveries in India stand at 90.6%. India’s total fertility rate — the average number of children a woman would have during her reproductive years — has not changed from the last NFHS and remains at 2 — below the 2.1 marker that is considered replacement level fertility below which a country experiences population decline. The share of underweight children, too, has fallen: it was 53.4% in NFHS-1, which was conducted in 1992-93, and now stands at 31.8%. Stunting is down by 17% and severe wasting by 32%. Immunisation coverage has also risen to over 87%. Alas, that is where the good news ends and the red flags begin. The NFHS-6 has sounded the alarm over the health burden caused by obesity and malnutrition. Obesity has increased from 22.9%, as highlighted in NFHS-5, to 27.3% among men, and from 24% to 30.7% among women. The trajectory is consistent with international assessments. The steep challenge of rising lifestyle diseases has been flagged by a recent study in Nature last month which showed that obesity is plateauing in developed nations but is accelerating in developing countries. Close to one-fifth of men and women in India have high blood sugar and are suffering from hypertension. At the other end of the spectrum, only 15.3% of children aged 6-23 months receive an adequate diet. Another extremely concerning trend is the decline in breastfeeding — only 55.8% of children aged under six months are breastfed. Global estimates indicate that improved breastfeeding practices can prevent about 820,000 child deaths every year.

There is a methodological issue that deserves attention. The NFHS-6 has some key indicators missing — sex ratio at birth, prevalence of anaemia, and access to clean cooking fuel are among these. This is a significant omission. The NFHS is among the world’s largest household surveys, providing granular data that shape public policy and welfare interventions. Missing indicators may limit the ability of policymakers to identify emerging challenges and assess the effectiveness of existing welfare programmes. Addressing these grey areas will require moving beyond a narrow focus on healthcare delivery. Public health policy must place greater emphasis on preventive care, nutrition education, healthier food environments and robust data-gathering at the earliest.