The document provides information on the National Family Health Survey (NFHS-3) conducted in India in 2005-2006. Some key points: - NFHS-3 was conducted to provide estimates on family welfare, maternal and child health, and nutrition indicators. It also covered new topics like HIV prevalence. - Over 124,000 women and 74,000 men were interviewed across India. In Haryana, over 2,700 women and 1,000 men were interviewed. - The survey found that literacy rates, access to healthcare, and use of family planning methods had increased since the previous surveys, though gaps remained between urban and rural areas. - Maternal and child health indicators like anten

1. NATIONAL FAMILY HEALTH
SURVEY (NFHS) -3
Dr. Raghavendra Huchchannavar
Junior Resident, Deptt. of Community
Medicine,
PGIMS, Rohtak

2. contents
• INTRODUCTION
• AIMS OF NFHS 3
• SAMPLE DESIGN AND SAMPLE SIZE
• DATA COLLECTION
• COMPONENTS
• RECENT ADVANCES
• REFERENCES

3. INTRODUCTION
• 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.
• NFHS - 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 education, perinatal mortality,
high-risk sexual behaviour, tuberculosis & also on lifestyle
of people.

4. INTRODUCTION
• NFHS-3 interviewed all women age 15-49 years and all men
age 15-54 years(earlier ever-married women age 15-49 were
eligible)
• NFHS-3 is the first nationwide community-based survey in
India to provide an estimate of HIV prevalence in the general
population
• Also provides estimates for the slum and non-slum
populations of 8 cities

5. INTRODUCTION
• Conducted by: the Ministry of Health and Family Welfare
(MOHFW)
• Nodal agency for the project: The International Institute for
Population Sciences (IIPS), Mumbai
• Funding: United States Agency for International Development
(USAID), the United Kingdom Department for International
Development (DFID), the Bill and Melinda Gates Foundation,
UNICEF, UNFPA, and MoHFW
• Technical assistance: Macro International, USA at all stages of the
project , NACO and the National AIDS Research Institute (NARI),
Pune for the HIV component of NFHS-3
• Haryana : Centre for Research in Rural and Industrial Development
(CRRID), Chandigarh

6. aims
• Provide estimates of important family welfare and health
indicators by background characteristics at the national and
state levels
• Measure trends in family welfare and health indicators over
time at the national and state levels
• HIV prevalence estimates at the national and state level for
each of the six states identified by the National AIDS Control
Organization (NACO) as having high HIV prevalence
• Estimates of population and health indicators for slum areas
and for non-slum areas in eight cities.

7. SAMPLE DESIGN

8. Sample selection in rural areas
Sampling frame – 2001
census list of villages
Stratification
On basis of
geographic areas
Village size
Female literacy
Villages selected
Probability proportional to
population of village.
In each selected
PSU, 30 households
selected from household
List using systematic
random sampling
Selected sample PSU,
mapping &
Household listing done
served frame for selecting
Households

9. Sample Selection In Urban Areas
Sampling Frame – 2001
Census List Of Wards
Stratification
On Basis Of
Geographic Areas
Village Size
Female Literacy
Wards Selected
Probability Proportional
To Population Of
Wards.
In Each Selected
CEB, Household
Listing Done.
Systematic Random
Sampling Used To
Select 30 Household
1 Census Enumeration
Block (CEB),
Consisting Of Approx
100-200 Households,
Selected From Each
Selected Ward Using
The PPS Sampling
Method

10. Sample size
• In NFHS-3, the initial target sample size was 1,500 completed
interviews with ever-married women in states with a
population of less than 5 million (Arunachal Pradesh, Manipur,
Meghalaya, Mizoram, Nagaland, Sikkim, Tripura.)
• 3,000 in states with a 2001 population between 5 and 30
million (Assam, Chhattisgarh, Delhi, Goa, Haryana,
Himachal Pradesh, Jammu &Kashmir, Jharkhand, Punjab,
Uttaranchal)
• 4,000 in states with a 2001 population of more than 30 million
(Andhra Pradesh, Bihar, Gujarat, Karnataka, Kerala, Madhya
Pradesh, Maharashtra, Orissa, Rajasthan, Tamil Nadu, West
Bengal)
• 10,000 in Uttar Pradesh.

11. Sample size
• Adjustments to the initial sample size in specific states: Based
on the general assumption that a robust estimation of most
population and health indicators requires a minimum sample
of 1,000 ever-married women, the target sample size for the
eight cities was fixed at a minimum of 2,000 interviews with
ever-married women (equally distributed between slum and
non-slum areas of each city).
• Cities selected - Delhi, Chennai (TN), Hyderabad (AP), Indore
(MP), Kolkata (WB), Meerut (UP), Mumbai and Nagpur
(Maharashtra).

12. Sample size
• The sample size of HIV tests is 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% and 15%
relative standard error, the estimated sample size is 6400 tests
each for men and women in high HIV prevalence states.
• At the national level, the assumed level of HIV prevalence of
less than one percent (or 0.92%) and less than 5% standard
error gave an estimate of 125,000 HIV tests needed at the
national level.

13. Sample size
• The target sample size, which was fixed in terms of ever-
married women, was transformed into the number of
households to be covered.

14. DATA COLLECTION
• Fieldwork for NFHS-3 was conducted in 2 phases from Nov
2005 to Aug 2006, (Haryana: April-June 2006)
• 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
• Biomarkers Measured
– Height and weight
– Haemoglobin
– Blood samples for HIV testing

15. DATA COLLECTION
INDIA HARYANA
Number
Interviewed
Response
Rate (%)
Number
Interviewed
Response
Rate (%)
Households 109,041 98 2,302 99
Women
(age 15-49)
124,385 95 2,790 96
Men
(age 15-54)
74,369 87 1,083 85

16. COMPONENTS
1. Household and individual characteristics
2. Fertility and family planning
3. Maternal health
4. Child health
5. Nutritional status
6. HIV knowledge, behaviour and prevalence
7. Morbidity and Lifestyle
8. Women’s empowerment
9. Domestic violence

17. Household characteristics
Parameter Percentage
1. Literate population
2. Mean household size
3. Live in a pucca house
4. Own agricultural land
5. Have a television
6. Have access to toilet facility
67.6
4.8
41.4
45.6
44.2
44.5

18. Household and individual characteristics
Electricity
Piped water
93
51
56
12
68
25
Urban Rural Total
HARYANA: Electricity 92% (U-98%, R-89%),
Piped water 40 (U-60%, R-30%)
% of households with electricity connection and piped water supply (India)

19. 11
8
4
64
10 4 17
8
3
59
7
7
25
3
2
49
11
12
LPG Kerosene
Coal Wood
Dung cakes Other
NFHS-1 NFHS-2
NFHS-3
Household and individual characteristics
Type of fuel used in household (India)
HARYANA:
Wood 34.3%
LPG 29.6%
Dung cakes 24.4%

20. 88 83
52
88
81
51
6-10 years 11-14 Years 15-17 years
Urban
Male Female
84 79
47
79
66
28
6-10 years 11-14 years 15-17 years
Rural
Male Female
In urban areas, gender disparity in school enrollment is
negligible; but in rural India, gender disparity in school
enrollment persists and increases sharply with age
Household and individual characteristics
School Attendance by Residence (India)
HR:
Urban:
B 53%
G 62%
Rural:
B 52%
G 34%

21. Literacy status by states
94 93
84
80 77 75 73 72 70 70 69 69 69
65 64 63 60 60 59
55 54 53 52 50
45 45 44
37 3736
93 96 90 94 90
83
92
83
88
73
84 83
77
86 83
76
83
75 74
78 78 79
74 72 74 76 74
69 70
74
0
10
20
30
40
50
60
70
80
90
100
MZ
KE
GO
HP
DL
NG
MN
SK
MH
MG
TN
PJ
TR
UT
GJ
AS
HR
KA
WB
INDIA
JK
AR
OR
AP
CH
UP
MP
JH
BH
RJ
Women Men

22. Total Fertility Rates for States
INDIA
 Replacement or
below replacement
(10 states 35%
population)
 TFR 2.1 – 2.4
(6 states 20%
population)
 TFR 2.5 – 3.6
(9 states 19%
population)
 TFR 3.7 – 4.0
(4 states 25%
population)

23. Trends in tfr by Residence
Urban
Rural
Total
2.7
3.67
3.39
2.27
3.07
2.85
2.06
2.98
2.68
NFHS-1 NFHS-2 NFHS-3
HARYANA:
NFHS-1: 4.0
NFHS-2: 2.9
NFHS-3: 2.7
Trends in TFR by Residence (India)

24. 7-17
months
11%
18-23
months
16%
24-35
months
34%
36-47
months
19%
48-59
months
9%
60+
months
10%
61% of
Births
(2nd order & above)
occur less than
36 months
after the
preceding birth
Length of Birth Intervals
HARYANA:
< 36 months – 66%

25. Knowledge of Modern Methods
49
8
11
85
69
74
79
97
45
17
20
83
51
93
87
95
Injectables
Female condom
Emergency contraception
Pill
IUD
Condom/Nirodh
Male sterilization
Female sterilization
Men Women
Percent of women and men 15-49 aware of family planning methods

26. Current use of contraceptive Methods among currently married
women
27
4
1
2
2
34
2
3
2
3
37
1
3
2
5
NFHS-1 NFHS-2 NFHS-3
Trends in Use of Contraception
• Practice of female sterilization is
increasing
• Practice of male sterilization is
decreasing
• Condom use is increasing

27. 7
21
42
56
61
56
46
8
26
49
63
67 65
57
13
33
56
70
73
69
63
0
10
20
30
40
50
60
70
80
15-19 20-24 25-29 30-34 35-39 40-44 45-49
NFHS-1 NFHS-2 NFHS-3
Trends in Contraceptive Use by Age
Age
Percentage of married women using any method
Family Planning use shows increase
in every age over the three NFHS
period.
HARYANA: Any method – 63%

28. Unmet Need by Type and State
5
7 7 8 8 8 8 9 9 9 10 10 10 11 11 11
12 13 13
15 15 15
17 17
19
21
23 23
26
35
3 2 3 3 4 4 3 4
6 5 6 5
4 4 4 5 5
6
7
6
7 7
6
12
8 9
11 11
10
23
Total For spacing
NATIONALAVERAGE:
13% unmet need
In Nagaland (30%) and Meghalaya (24%)
unmet need is more than met need.

29. 65
83
59
66
86
60
77
91
72
Total Urban Rural
NFHS-1 NFHS-2 NFHS-3
* For last births in the past 3 years
Percent
Maternal health
HARYANA: 88%
Women* Who Received atleast 1 ANC visit

30. Maternal health
Among women who received ANC:
• Less than two-thirds had weight, blood, or urine taken, or
blood pressure measured
• Three-fourths had their abdomen examined
• 76% of women received two or more tetanus toxoid injections
• 36% were told about pregnancy complications

31. 41
34
26
NFHS-3NFHS-2NFHS-1
Institutional Delivery
49
42
35
NFHS-3NFHS-2NFHS-1
Delivery assisted by
health personnel
*For live births in the
past 5 years
Percent
Maternal health
Trends in Delivery Care (India)*
HARYANA:
Institutional delivery 39%
Delivery assisted by health personnel 54%

32. Maternal health
Trends in Delivery
• 9% of live births in the past 5 years were delivered by C-
section
• 16% of first births are delivered by a C-section
• C-sections increase sharply with women’s education and
wealth
• C-sections are almost twice as common for deliveries in the
private sector than in the public sector: 28 vs. 15 percent

33. Men's Participation in Maternal Health Care
65
43
50
17 17 1718
40
33
Urban Rural Total
Present during ANC
Not present during any ANC
No ANC
Percent of men age 15-49 with a child under 3 years
Present
during
ANC
HR: 48%
Urban:64%
Rural:41%

34. Percent among men age 15-49 with a child under 3 years

35. Main Reasons for Not Having ANC
40
20
15
9
0 10 20 30 40 50
Man did not think it was necessary/did not
allow
Costs too much
Family did not think it was necessary/did
not allow
Child’s mother did not want check-up
Percent of men with a child under 3 years and the child’s mother did not get ANC

36. Child health

37. 73717069
666565
6261
57
54525048
454543424242403838363434
3030
1515
0
10
20
30
40
50
60
70
80
UP
CH
MP
JH
AS
OR
RJ
BH
AR
IN
AP
TR
GJ
WB
MG
JK
KA
PJ
UT
HR
DL
MH
NA
HP
MZ
SK
TN
MN
GO
KE
Per 1,000 live births
Infant Mortality Rates by State
Child health

38. 0
10
20
30
40
50
60
70
80
Neonatal
Mortality Postneonatal
Mortality Infant
Mortality Under-five
Mortality
37
21
58
79
41
15
56
70
Female Male
Per 1,000
Child health
Childhood Mortality Rates by Sex Per 1,000 live births

39. 72
56
50
77
80
62
47
64
37
30
50
86
0 10 20 30 40 50 60 70 80 90 100
40-49
30-39
20-29
< 20
MOTHER'S AGE AT BIRTH
7 or more
4-6
2-3
1
BIRTH ORDER
4 years or more
3 years
2 years
< 2 years
PREVIOUS BIRTH INTERVAL Per 1,000 live births
Infant Mortality Rates by Demographic Characteristics (India)
Child health

40. Child health
• 39% of children under age 5 with diarrhoea in the two weeks
before the survey received some kind of oral rehydration
therapy
• 26% were treated with a solution prepared from oral
rehydration salt (ORS) packets
• More than one-quarter did not receive any kind of treatment
• 16% received antibiotics, which are not normally
recommended for treating childhood diarrhoea

41. Trends in Immunizations by Vaccine
30
62
54
42
52
14
72
63
51
55
5
78 78
59 55
0
20
40
60
80
100
None BCG Polio3 Measles DPT3
Percentage of children age 12-23 months
NFHS-1 NFHS-2
Trends in Immunizations by Vaccine (India)
Haryana:
BCG 85%
OPV3 83 %
Measles 76 %
DPT3 74 %

42. Nutritional status

43. Children’s Nutritional Status
by State
2020
22 23
25 25 25 26 26
30
33 33
36 37 37 38 38 39 40 40 40 41 42 43
45
47
49
56 57
60
0
10
20
30
40
50
60
70
SK
M…
M…
KE
PJ
GA
NA
JK
DL
TN
AP
AR
AS
HP
M…
KA
UT
W…
HR
TR
RJ
OR
UP
IN
GJ
CH
M…
BH
JH
MP
Children under age 5 years who are underweight (%)

44. 36
14
2
51
0
11
6
1
18
40
16
2
57
0
14 12
2
28
39
16
2
56
0
13 10
1
24
Urban Rural Total
NFHS-3, 2005-06
The anaemia prevalence levels are more than two times higher among
women than men with almost half of them with moderate to severe
anaemia.
The prevalence of anaemia is marginally higher in rural than urban
areas but anaemia is a common problem in both urban and rural areas.
More than 50 percent of women are anaemic
Women
Men
Anaemia Prevalence among Women and Men by Residence (India)
Nutritional status

45. 26
31
2
59
Mild Moderate Severe Any anaemia
The prevalence of
anaemia among
pregnant women is
higher than among
non-pregnant
women.
The prevalence of
moderate anaemia
is greater among
pregnant women
women
Compared with non-
pregnant women:
• The prevalence of
anaemia among
pregnant women is
higher.
•The prevalence of
moderate anaemia
is higher among
pregnant women.
Anaemia prevalence among
Pregnant Women % (India)
Nutritional status

46. MILD MODERATE SEVERE ANY
NFHS 2 30.9 14.5 1.6 47
NFHS 3 36.9 17.9 1.9 56.6
Trends in anaemia prevalence (%) among women (in
Haryana)
Nutritional status

47. Prevalence of Undernutrition and Overweight/Obesity among Adults by
Residence
25
41
36
24
7
13
27
38
34
16
6
9
Urban Rural Total Urban Rural Total
Women Men
Undernutrition
(% abnormally thin)
% Overweight/
obese
Undernutrition is more
prevalent in rural areas.
Overweight and
obesity are more than
three times higher in
urban than in rural
areas.
Undernutrition and
overweight/ obesity are
both higher for women
than men

48. HIV knowledge, behaviour and prevalence

49. HIV/AIDS Awareness
61
36
17
47
84
70
33
63
Who have heard of AIDS
Who know that HIV/AIDS can be prevented
by using condoms
Who have a comprehensive knowledge
about HIV/AIDS
Who know that HIV/AIDS can be
transmitted from a mother to her baby
Women Men
Percent

50. HIV/AIDS Awareness by State
34
38 39
45 46
50 53 54
59 61 63 64 66 67 69 69 70
74 74 76 78
82 83 83 86
90
95 95 95
99
61
76 75 78
72 74
82 79 79
84
64
87
78
90
76
92
87
92 91 94
89
93 92 93 94
98 98 96 99 99
0
20
40
60
80
100
120
JH RJ BHUPCHMPGJWBAS INMGHROR JK ARUTKA PJ TR AP SKMHNAHPGODL TNMZKEMN
Women Men
Percentage of women and men age 15-49

51. HIV knowledge, behaviour and prevalence
• Among never married men age 15-49 who reported sexual
intercourse in the past 12 months, 18 percent have had more
than one partner and 94 percent have had higher-risk sex
• 27% of never married women and 40% of never married men
who had higher risk sex in the past 12 months used a condom
the last time they had sex.
• 37% of never married young men and 18% of never married
young women used a condom the last time they had sex.
• Urban residents, those with 12 or more complete years of
education, and with regular exposure to media are more likely
to use a condom during their most recent act of sex.

52. State Total (%) Women (%) Men (%)
Manipur
Andhra Pradesh
Karnataka
Maharashtra
Tamil Nadu
Uttar Pradesh
Non-high prevalence
states
1.13
0.97
0.69
0.62
0.34
0.07
0.12
0.76
0.76
0.54
0.48
0.40
0.05
0.08
1.59
1.22
0.86
0.78
0.27
0.10
0.16
India 0.28 0.22 0.36
HIV Prevalence by State

53. Morbidity and Lifestyle

54. Morbidity and Lifestyle
0
200
400
600
800
1000
1200
ARMNBH JH AS TR NA SK WBMG GJ MZ TN UP AP IN OR RJ MPUT HRMHCH KE DL PJ HP GO KA JK
Per 100,000 persons
TB prevalence by state

55. Morbidity and Lifestyle
• Tobacco use is 11 percent among women, and nearly 1 in 10
pregnant and breastfeeding women also use tobacco
• 36% of men chew paan masala, gutkha, or other tobacco
• 33% of men smoke cigarettes or bidis
• Among men and women who smoke, more than 9 in 10
smoked at least one cigarette/bidi in the last 24 hours
• Among men who smoke, 61% smoked more than 5
cigarettes/bidis in the past 24 hours

56. 83
76
72 70 70 69 69 69 69 68 67
64 63 62 62 60 60
57
53 53
48 46 45 44 43
40 40 40
34
28
74
57
36 38
50
32
60
40
27
39
29
36
31
19
33
26
42
33
40
36
18
40
28
36
33
27
34
31
21
14
0
10
20
30
40
50
60
70
80
90
MZTR ASMNWBCHMGMPORNABHUPAR JH SK GJ RJ IN JK UTMHHRKAKEAPDLHPTN PJGO
Any tobacco Cigarettes/bidis
NFHS-3, 2005-06
More than two-thirds of men
in 11 states use tobacco
Tobacco use by state among men
Morbidity and Lifestyle

57. Morbidity and Lifestyle
61
48
40
32 31
28 27
25
23
19
16 16
12 12 11 11
8 8 8
5 5 5 5 4 3 3 3 2 1 1
0
10
20
30
40
50
60
70
MZ TRMNMGORNA AR CH AS SK WBMP JH UPMH IN RJ BH GJ KA AP JK UTGOTN DL HR KE PJ HP
(Percentage)
Tobacco use by state among women

58. Morbidity and Lifestyle
61
52
49
47 47
45 45
43 42 42 41 40 40 39 39 39 38
35 34 33 32 31 30
28 28
25 24
19
16
13
0
10
20
30
40
50
60
70
AR CHMGAPMNKE SK PJ TN MZ TR OR GONA JH UT AS BHWBDL IN MP HP HR KA UPMH RJ GJ JK
(Percentage)
Alcohol use by state

59. No. of Women per lakh No. of Men per lakh
Diabetes Asthma Goitre
and other
thyroid
disorders
Diabetes Asthma Goitre
and other
thyroid
disorders
India 881 1696 949 1051 1627 383
Haryana 1169 1552 388 608 1266 739
Highest Kerala
(2549)
Tripura
(5924)
Kerala
(5744)
Kerala
(3078)
Tripura
(5086)
Kerala
(1888)
Lowest Rajastha
n
(282)
Himachal
Pradesh
(384)
J & K
(237)
J & K
(278)
Jharkhan
d
(407)
J & K (0)
Gujarat
(72)
Morbidity and Lifestyle
Morbidity due to diabetes, asthma and thyroid disorders

60. Women’s empowerment

61. Gender Disparity in Literacy
Age
Sex
Literacy rate
(%)
Gender
Disparity
15-19 Male
Female
89
74
17%
20-24 Male
Female
84
64
23%

62. Percentage of women age 15-49 who are allowed to go alone to:
51
48
38
33
4
Market
Health facility
Places outside the village/community
All three places
None of the three places
The majority of women have little freedom of movement.
Only one-third go to all three destinations: the market, health facility
and outside the village or community.

63. Percentage who agree that a husband is justified in hitting or beating his
wife if she:
54
29
35
30
14
20
25
41
51
23
29
26
8
13
24
37
At least one reason
Goes out without telling him
Neglects the house or children
Argues with him
Refuses to have sex
Doesn’t cook properly
He suspects she is unfaithful
Shows disrespect for in-laws
Men
Women

64. Domestic violence

65. Domestic violence
87% of spousal
violence initiated
within 5 years of
marriage
0
7
13
32
35 37
0%
20%
40%
60%
80%
100%
Marriage <1 year Within 2
years
Within 5
years
Within 10
years
More than
10 years
Not experienced violence Experienced violence
87% of spousal violence
initiated within 5 years of
marriage
Percent
Spousal violence by year of marriage (India)

66. Spousal Violence by State
6
13
15 15 16 16 16 17
20
22
25
27 28 28
30 31
35
37 37 38 39 40 40
42 42
44 44
46 46
59
0
10
20
30
40
50
60
70 Percent of ever-married women

67. Domestic violence
• Only one in four abused women have ever sought help
• Women are much less likely to seek help for sexual violence,
than for physical violence
• When women seek help, they do so mainly from family
members, not from institutions:
– Police: 2 percent
– Social service organizations: 1 percent
– Religious leaders: 1 percent
• Help seeking varies very little by background characteristics,
including education and wealth

68. Recent advances
• Government of India has decided to discontinue National
Family Health Survey the fourth round of which was to be
conducted in 2012-13.
• The Ministry of Health and Family Welfare is instead planning
to roll out an integrated National Health Survey (NHS) that
will replace three existing ones - NFHS, the district-level
health survey (DLHS) and the Annual Health Survey (AHS)
conducted across nine priority states by the office of the
census commissioner.
• While NFHS was largely funded by external agencies such as
United States Agency for International Development and
agencies of the United Nations, the proposed NHS will be
funded fully by the health ministry, although it has not been
decided yet which agency is going to conduct it.

69. Recent advances
• The proposed NHS will start only in 2014 and the data is
likely to be available by 2015
• Drawback: NFHS was largely externally designed and funded
is seen as a more credible source of information compared
with data from government sources such as those provided by
the Integrated Child Development Services (ICDS)

70. references
• International Institute for Population Sciences (IIPS) and Macro
International. 2007. National Family Health Survey (NFHS-3),
2005–06: India: Volume I. Mumbai: IIPS.
• International Institute for Population Sciences (IIPS) and Macro
International. 2007. National Family Health Survey (NFHS-3),
2005–06: India: Volume II. Mumbai: IIPS.
• National Family Health Survey (NFHS-3), India, 2005-06:
Haryana. Mumbai: IIPS.
• Hindustan Times: Live Hindustan. Government-to-discontinue-
National-Family-Health-Survey.html. Apr 11, 2012
• www.nfhsindia.org
• www.mohfw.nic.in