The document discusses Demographic Health Surveys (DHS) conducted in India called the National Family Health Survey (NFHS). It notes that DHS are nationally representative household surveys that collect data on population, health, and nutrition trends in developing countries. In India, NFHS surveys collect data from hundreds of thousands of households, women, and men through standardized questionnaires on topics like marriage, fertility, family planning, and health. The data are used widely by policymakers and researchers to inform health policies and programs in India.

1. Demographic Health Surveys/ National Family Health Survey in India
Dr T R Dilip,
International Institute for Population Sciences
MBD Course C1: Introduction to Demography and History of
Population
29th August 2022

2. Demographic health surveys (DHS) program
• DHS initially designed to expand on demographic, fertility and family
planning data collected in the World Fertility Surveys and
Contraceptive Prevalence Surveys
• DHS program aims to advance global understanding of health and
population trends in developing countries
• established by the United States Agency for International
Development (USAID) in 1984
• Over 350 surveys conducted in over 90 countries
• Implemented in overlapping 5 year phases (now DLHS-8 2018-2023)

3. Main objectives of the DHS
• to improve the collection, analysis, and dissemination of population,
health, and nutrition data
• to facilitate use of these data for planning, policy-making and program
management
• to generate data that are comparable across countries

4. DHS Questionnaires
• DHS surveys are designed to collect data on marriage, fertility, mortality,
family planning, reproductive health, child health, nutrition, and HIV/AIDS
• women of reproductive age (15–49) are the focus of the survey
• DHS surveys utilize a minimum of two questionnaires—a Household
Questionnaire and a Woman’s Questionnaire
• Men’s questionnaire is optional
• Biomarker Questionnaire, introduced as part of DHS-7 (2013-18)
previously part of household questionnaire

5. DHS Woman’s model questionnaires
1) Background characteristics (age, education, religion, etc.)
2) Reproduction
3) Contraception
4) Pregnancy and postnatal care
5) Child immunization
6) Child health and nutrition
7) Marriage and sexual activity
8) Fertility preferences
9) Husband’s background and woman’s work
10) HIV/AIDS
11) Other health issues

6. DHS Woman’s questionnaires (Optional module)
• Accident and Injury
• Adult and Maternal mortality
• Disability
• Domestic Violence
• Female Genital Cutting
• Fistula
• Male Child Circumcision
• Newborn Care
• Non-communicable Diseases
• Out-of-pocket Health Expenditures

7. DHS Household questionnaire (DHS-7)
• Respondent for the Household Questionnaire is any knowledgeable
person age 15 or older living in the household
• List all the usual members and visitors in the selected households
including age, sex, education, and relationship to the head of the
household
• Information is collected about the source of water, type of sanitation
facilities, materials used to construct the house, ownership of various
consumer goods, and use of iodized salt.
• Household Questionnaire is used to identify women eligible for individual
interview and children under five who are to be weighed, measured, and
tested for anemia

8. DHS Man’s model questionnaires (DHS-7)
Man’s questionnaire is for men of reproductive age (typically 15 to 49, 54, or 59)
• background characteristics
• reproduction and fertility preferences,
• contraception,
• employment and gender roles,
• HIV/AIDS, and
• other health issues

9. DHS program has contributed to
• Improved tools, methods, partnerships, and technical guidance to collect
quality population, health, and nutrition data.
• Increased in-country individual and institutional capacity for identification
of data needs and for survey design, management, and data collection to
meet those needs.
• Improved availability of DHS Program survey data and information.
• Advanced availability and synthesis of DHS Program survey data.
• Improved facilitation of DHS Program data use among stakeholders
worldwide.

10. DHS key strengths
• Nationally representative household surveys with large samples
• Open access data
• DHS uses standard methods for all of its surveys
Sampling methods
Questionnaires
Training of interviewers (at least 3 weeks)
Data processing
Tabulation
• Data comparable over time and across countries
• Emphasis on quality, continuity, and consistency

11. Main limitation
• DHS is a cross-sectional survey.
• DHS collects information at a single point in time and takes a
“snapshot” or picture of what is occurring at that time.
• They cannot explain why something happens, and they do not link
cause and effect the way some other kinds of research do (for
example a prospective (or cohort) study that follows participants for a
long time to see patterns in risk behavior and disease.

12. DHS in India
• Popularly known as “National Family Health Survey (NFHS)”
• Under stewardship and funding from the Ministry of Health and
Family Welfare (MoHFW), Government of India
• IIPS has been the nodal agency for all the rounds of NFHS
• Technical assistance from ICF, USA through the USAID funded DHS
program
• Received donor funding received in earlier rounds but getting
transformed into a MOHFW, Government of India funded exercise

13. National Family Health Survey (FHS)- in India
Households
covered Women sample men sample
States/ districts
covered
NFHS-I (1992-93) 88,562
89,777 ever married
women 13-49 years - 24 states
NFHS-II (1998-99) 91,196
89,199 ever married
women aged 15-49
years - 26 states
NFHS-III (2005-06) 1,09,041
124,385 women 15-
49 years
74,369 men 15-54
years all 29 states
NFHS-IV (2015-16) 6,01,506
723,875 women 15-
49 years
112122 men 15-49
years
all states and UTs
and 640 districts
NFHS-V (2019-21) 6,36,699
724,115 women 15-
49 years
101,829 men 15-49
years
all states and UTs
and 707 districts

14. National Family Health Survey 2019-21 (NFHS-5)
Coverage
• provides informationon population, health, and nutrition for India,
each state/union territory (UT), and for 707 districts as on March 31st
2017.
• gathered information from 636,699 households, 724,115 women, and
101,839 men
• Data collection as earlier in two phases
• Phase I: 17 June 2019 to 30 January 2020 covering 17 states and 5 Uts
• Phase-II from 2 January 2020 to 30 April 2021 covering 11 states and 3 Uts
• 17 Field Agencies engaged for data collection

15. NFHS (2019-21): Objectives
“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.”

16. NFHS: Uses
Policy uses
• to assist policymakers and programme managers in setting benchmarks and
examining progress over time in India’s health sector
• providing evidence on the effectiveness of ongoing programmes
• to identify the need for new programmes in specific health areas
Others
• Input for global and national level evidence base for health policies and interventions
• Promote accountability for governmental intervention
• Widely used by community of academics, activists, journalist to serve their needs

17. NFHS India stakeholders (users/implementers/funders)
• National
• NITI Ayog
• Ministry of Health and Family Welfare
• Ministry of Women and Child Development
• Ministry of Education
• Ministry of Statistics and Programme
implementation
• Other Central ministries
• State government departments
• IIPS
• Other survey committees
• National research community
• National political parties
• Individuals
• Researchers
• Policy makers
• NGOs/Activist
• Journalists
• Global/ Regional
• UN agencies
• USAID
• Funders (till NFHS-4)
• Health Community (Policy & Research)
• Other Research Community

18. NFHS-V: Questionnaires
• Household Questionnaire
• Woman’s Questionnaire
• Man’s Questionnaire
• Biomarker Schedule
Canvassed in 18 local languages using Computer
Assisted Personal Interviewing (CAPI)

19. NFHS-5 Household questionnaire (96 questions)
• age, sex, marital status, relationship to the head of the household, and
education, Caste, religion, BPL status
• ownership of an Aadhaar card, tobacco use, alcohol consumption,
disabilities
• Birth registration (0-4 years) & School attendance 5-14 years
• Ownership of assets & amenities
• water, sanitation, and hygiene; water treatment; type of toilet facilities
• Prevalence of TB, use of heath facilities, iodized salt for cooking, mosquito
nets
• number of deaths in the household in the two years preceding the survey

20. NFHS-5 Woman’s questionnaire (1140 questions+ calendar data)

21. Woman’s questionnaire

22. NFHS-5: Man’s questionnaire (847 questions)
• man’s characteristics,
• media exposure,
• marriage,
• employment,
• presence at antenatal care visits,
• number of children,
• contraceptive knowledge and use,
• fertility preferences,
• nutrition,
• Sexual behaviour,
• attitudes toward gender roles,
• HIV/AIDS, health issues,
• attitudes towards gender roles,
• tobacco and alcohol use,
• knowledge of tuberculosis,
• current morbidity (diabetes, asthma, goitre and other thyroid diseases, heart disease, cancer), and
• household decision making.

23. Data limitations
• As a cross sectional survey main focus on quantitative data to answer How
many? how often? When? & Where. Seldom answers' How? and Why?
• increasing number of stakeholders in planning of NFHS, with each
stakeholder adding questions in line with their organizational agenda
• Length of the questionnaire
• Interviewee fatigue
• Tendency to skip sections by the interviewers to reduce work load
• Inclusion of sensitive questions (sexual behaviour, domestic violence etc..)
where it is difficulty to check validity of responses received
• Quality issues due to the increasing presence and role of consultancy
organizations in gathering the field-level information (monitoring to be
strengthened)

24. Resources
DHS/NFHS data sets organized systematically and disseminated at
https://dhsprogram.com/data/available-datasets.cfm
Croft, Trevor N., Aileen M. J. Marshall, Courtney K. Allen, et al. 2018. Guide to DHS Statistics.
Rockville, Maryland, USA: ICF. https://dhsprogram.com/Data/Guide-to-DHS-Statistics/index.cfm
International Institute for Population Sciences (IIPS) and ICF. 2021. National Family Health Survey
(NFHS-5), 2019-21: India. Mumbai: IIPS. http://rchiips.org/nfhs/NFHS-5Reports/NFHS-
5_INDIA_REPORT.pdf
Understanding and Using the Demographic and Health Surveys – DHS Curriculum Facilitator’s Guide:
Module 1, July/August 2011. Calverton, Maryland, USA: ICF Macro
Understanding and Using the Demographic and Health Surveys – DHS Curriculum Facilitator’s Guide:
Instructor’s Guide, March 2014. Rockville, Maryland, USA: ICF International
https://dhsprogram.com/pubs/pdf/DHSC8/Module_8_dhsc8.pdf