NFHS-6 Leaves Out Anaemia, Cancer and HIV-Related Indicators

Summary:
The release of the NFHS-6 factsheet has sparked discussion among public health experts due to the removal of several long-standing indicators, including those related to anaemia, cancer screening, and HIV awareness. While the survey introduces new measures covering areas such as ageing, financial inclusion, immunisation, and women’s asset ownership, critics argue that the omission of key health outcome indicators could make it more difficult to assess the effectiveness of public health programmes and track long-term trends. The debate has also been shaped by questions surrounding the exclusion of anaemia data, leadership changes at the International Institute for Population Sciences (IIPS), and the broader role of NFHS as one of India’s most important sources of health and demographic information. 

NFHS-6 Factsheet Sparks Debate Over Omission of Key Health Indicators

In 2018, the Narendra Modi-led government launched the Anaemia Mukt Bharat initiative with the goal of reducing anaemia across the country. However, findings from NFHS-5 painted a concerning picture. Anaemia prevalence among children under five rose to nearly 67 per cent from 58.6 per cent in NFHS-4. The condition affected 57 per cent of women aged 15–49 and 52.2 per cent of pregnant women, raising questions about the effectiveness of the programme.

The recently released NFHS-6 factsheet, published on May 29, does not include anaemia-related data. According to the document, 43 indicators have been removed and 13 new ones added compared to the previous survey round, with all seven anaemia indicators among those omitted.

Sources suggest that the sharp increase in reported childhood anaemia rates had been challenged by the Union Health Ministry, which argued that the use of capillary blood sampling may have led to inflated estimates. Prof. K.S. James, then Director of the International Institute for Population Sciences (IIPS), the organisation responsible for conducting the survey, defended the methodology and findings. It is important to note that only the factsheet has been released so far, while the full NFHS-6 report is yet to be published.

Leadership Controversy During NFHS-6

While NFHS-6 fieldwork was underway in July 2023, Prof. James was suspended over allegations related to recruitment irregularities. Critics questioned both the timing and the nature of the allegations. Media reports citing sources within IIPS claimed that the ministry had earlier asked him to step down after he reportedly refused to distance himself from NFHS-5 findings that had generated concern within the government.

Prof. James declined to resign at that stage and was subsequently suspended. He later resigned in August, citing personal reasons. In October, the government revoked his suspension and accepted his resignation on the same day. The allegations behind the suspension were never publicly detailed. Prof. James currently serves as a Senior Visiting Scholar at the Newcomb Institute of Tulane University, while NFHS-6 was completed and released under a new leadership team.

The Indian Academic Freedom Network had criticised the suspension, arguing that independent research and data collection are essential for evidence-based policymaking and public accountability.

Why the NFHS Matters

The NFHS is conducted every five years and serves as one of India’s most comprehensive sources of information on health, nutrition, family welfare, and living conditions. Policymakers, researchers, and public health experts rely heavily on its findings to assess programme performance and identify emerging challenges.

NFHS-6 includes 101 indicators, compared with 131 in NFHS-5, making the removal of several long-standing measures a subject of discussion among researchers and health experts.

Anaemia Indicators Removed

One of the most debated changes is the exclusion of anaemia prevalence data. While the survey continues to record whether pregnant women consumed iron-folic acid supplements for 100 or 180 days, it no longer measures the actual prevalence of anaemia among children, pregnant women, adolescents, and adults.

Critics argue that tracking programme implementation without measuring health outcomes makes it more difficult to evaluate whether interventions are producing the intended results. Anaemia remains a significant public health concern because of its links to impaired cognitive development in children and increased health risks during pregnancy.

Cancer Screening Data No Longer Included

The factsheet also excludes indicators related to cervical, breast, and oral cancer screening that were introduced in NFHS-5. These measures had helped establish a national baseline for monitoring preventive healthcare and early detection efforts.

Health experts have long emphasised the importance of screening in improving cancer outcomes. Without these indicators, it becomes more difficult to assess changes in screening coverage over time using NFHS data.

HIV Awareness Indicators Omitted

Indicators measuring awareness and knowledge of HIV/AIDS have also been removed. Previous survey rounds assessed understanding of transmission, prevention, and risk reduction strategies among men and women.

Public health specialists consider awareness a critical component of HIV prevention efforts, and the absence of these measures may limit the ability to track progress in public education and outreach programmes.

Other Indicators Dropped

The list of removed indicators extends beyond health conditions. Measures related to child mortality disparities, sanitation, clean cooking fuel, literacy, birth and death registration, family planning counselling, informed choice, and treatment practices for childhood illnesses are also absent from the released factsheet.

Many of these indicators had helped researchers analyse inequalities across income groups, regions, education levels, and social categories.

New Areas Added in NFHS-6

At the same time, NFHS-6 introduces new indicators covering ageing, financial inclusion, immunisation, breastfeeding practices, women’s asset ownership, bank account ownership, and antenatal care utilisation.

While these additions provide insights into emerging policy priorities, some experts argue that new indicators cannot fully replace the value of long-term measures that tracked major public health challenges. The broader debate centres on whether important indicators should be removed while new ones are introduced.