Missing Numbers, Missing Accountability: Why NFHS-6 Has Triggered Questions About India's Health Data

India's largest health survey has arrived with a striking omission: some of the country's most sensitive public health indicators have vanished.

The sixth round of the National Family Health Survey (NFHS-6), released last week, drops 43 indicators that were part of previous surveys. Among them are measures that tracked anaemia, child mortality, sex ratio at birth, sanitation, clean cooking fuel access, cancer screening and HIV awareness.

For public health experts, the concern is not merely about missing statistics. It is about what happens when some of the nation's most uncomfortable realities are no longer measured.

Five years ago, NFHS-5 sparked a nationwide debate when it revealed a worsening anaemia crisis. Nearly 67% of Indian children under five were anaemic, up from 58.6% in the previous survey. Among women aged 15-49, the prevalence stood at 57%, while more than half of pregnant women were anaemic.

Those figures cast serious doubt on the effectiveness of the government's flagship Anaemia Mukt Bharat programme, launched in 2018 with the promise of dramatically reducing anaemia nationwide.

Today, all seven anaemia indicators have disappeared from the NFHS-6 factsheet.

No figures for children. No figures for adolescent girls. No figures for pregnant women. No figures for women of reproductive age.

The programme remains measurable. The outcome does not.

The survey continues to track whether pregnant women consumed iron-folic acid supplements. What it no longer tracks is whether those interventions actually reduced anaemia.

For many researchers, that distinction is critical. Measuring inputs without measuring outcomes makes it far harder to determine whether public programmes are delivering results.

A Survey That Shapes National Policy

Conducted by the International Institute for Population Sciences (IIPS) under the Union Health Ministry, the NFHS is regarded as India's most comprehensive health and demographic database. Governments use it to design policies, researchers use it to identify trends, and international organisations rely on its findings to assess India's development indicators.

Unlike many other government surveys, NFHS provides district-level insights, allowing policymakers to identify regional disparities and target interventions accordingly.

Its influence extends far beyond academic circles. The survey has traditionally served as a report card on the effectiveness of government programmes ranging from nutrition and maternal health to sanitation and family planning.

That is why the latest omissions have attracted scrutiny.

More Than Anaemia

The changes go well beyond nutrition data.

NFHS-6 no longer includes the sex ratio at birth - an indicator that has long reflected India's struggle against gender discrimination and sex-selective practices.

Also absent are indicators measuring household access to improved sanitation and clean cooking fuel.

Both indicators were closely linked to two of the Modi government's most visible welfare programmes: Swachh Bharat Mission and Pradhan Mantri Ujjwala Yojana.

NFHS-5 had reported that over 40% of Indian households still lacked access to clean cooking fuel despite years of Ujjwala implementation. Similarly, sanitation data suggested that the country remained short of its goal of becoming fully open-defecation free.

Those measurements are no longer part of the NFHS-6 key indicators.

Child Mortality Measures Removed

Among the most surprising omissions are three core indicators of child survival:

• Neonatal mortality rate
• Infant mortality rate
• Under-five mortality rate

While mortality statistics remain available through other government databases, NFHS historically offered something unique: the ability to analyse deaths across income groups, educational categories, regions and social backgrounds.

Without that lens, researchers say it becomes harder to understand inequalities in health outcomes.

Cancer Screening and HIV Awareness Disappear

NFHS-5 had introduced national indicators tracking whether individuals had ever been screened for cervical, breast and oral cancers.

The move was seen as recognition that India faces a growing burden of non-communicable diseases alongside infectious diseases.

Those screening indicators have now been removed.

Similarly, four measures of HIV/AIDS awareness - including knowledge about prevention and condom use - have disappeared from the survey.

Public health experts argue that awareness remains a cornerstone of HIV prevention, making the loss of these indicators particularly significant.

The Shadow of the NFHS-5 Controversy

The disappearance of anaemia indicators comes against the backdrop of a prolonged dispute over NFHS-5 findings.

After the survey reported a sharp increase in child anaemia - from 58.6% to 67% - the Union Health Ministry questioned the methodology used to estimate haemoglobin levels, arguing that capillary blood sampling may have inflated the figures.

The then IIPS Director, Professor K.S. James, defended the survey's methodology and findings.

In 2023, while NFHS-6 fieldwork was underway, James was suspended over alleged recruitment irregularities. He later resigned. The suspension generated criticism from sections of the academic community, which viewed it as an attempt to pressure researchers over findings that embarrassed the government.

The government never publicly detailed the allegations that led to the suspension.

New Indicators, New Priorities

NFHS-6 has not simply removed indicators; it has also introduced 13 new ones.

These include:

• Population aged 60 and above
• Households with bank accounts
• Female ownership of land or housing
• Antenatal care coverage
• Birth-dose hepatitis-B vaccination
• Breastfeeding indicators
• Unmet need for limiting births

The additions reflect emerging policy priorities such as financial inclusion, ageing and maternal health.

However, health researchers caution that new indicators cannot substitute for the loss of long-established measures tracking nutrition, mortality and disease burden.

A Growing Burden of Lifestyle Diseases

Even with the reduced indicator set, NFHS-6 reveals troubling health trends.

Obesity has risen sharply among both men and women.

Nearly 31% of women aged 15 years and above - an estimated 21.6 crore people - are now classified as obese. Among men, the figure stands at 27.3%, representing around 20.4 crore individuals.

Diabetes and hypertension have also increased significantly.

Around 8.15 crore men and 6.42 crore women now have very high blood sugar levels. Meanwhile, approximately 12 crore men and 10.5 crore women suffer from mild to moderately elevated blood pressure.

Public health specialists describe these trends as evidence of India's growing burden of non-communicable diseases, which now account for the majority of deaths in the country.

The Double Burden

Yet India's health challenge remains paradoxical.

While obesity is rising, undernutrition has not disappeared.

NFHS-6 shows that roughly one in five Indian men and women remain underweight. The decline in undernutrition observed between NFHS-4 and NFHS-5 has reversed.

Experts describe this as "epidemiological polarisation"- a situation where obesity and undernutrition coexist within the same population.

The result is a country confronting two nutrition crises simultaneously.

The Larger Question

Data alone does not solve public health problems.

But without data, measuring progress becomes impossible.

How do policymakers know whether anaemia is falling?

How do they determine whether nutrition programmes are working?

How do they assess whether cancer screening is expanding, or whether awareness campaigns are reaching vulnerable communities?

For decades, NFHS answered those questions.

The debate surrounding NFHS-6 is not simply about missing numbers. It is about whether a nation can effectively confront its health challenges when some of its most critical indicators are no longer visible.

Because public health problems do not disappear when the data disappears.

Only the ability to hold systems accountable does.

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