Home / Opinion / Columns /  The nine lives of India’s National Family Health Survey

The widespread attention garnered by the latest findings of the National Family Health Survey (NFHS) shows that it has established itself as a credible database today. This marks a remarkable turnaround for a survey that received a hostile reception when it first began life in the early 1990s.

When the US Agency for International Development (USAID) first started its Demographic and Health Survey (DHS) programme in the 1980s to study fertility behaviour in the developing world, India viewed it with scepticism. The fall of the Berlin Wall in 1989 changed India-US relations, paving the way for the country’s first DHS survey in 1992-93. But the decision courted controversy. India’s statistical establishment questioned the need for a new demographic survey, given India’s long-standing record in producing such statistics on its own. It expressed fears that the well-funded survey would drive up survey costs for all organizations in a ratchet effect. The most potent criticism came from Left activists, who characterized it as an “imperialist" tool to control the Third World’s population. The claim was not entirely disconnected from reality. The infamous Kissinger report of 1974 had been declassified by then, and it exposed why the US was keen to fund fertility research: the fear that an ‘explosion’ in Third World numbers would create masses of discontented youth, who would fall prey to communism and undermine US commercial interests globally.

Neither India’s statistical establishment nor the Left had much influence over policy even then, and the survey went ahead despite their objections. But doubts remained. The health ministry demanded a sample reverification by an independent team, which USAID refused to fund. Finally, the ministry used its own funds for the exercise and decided to publish the results only after that second survey. Still, academics remained wary of using the survey’s data.

The academic opinion shifted to some extent when two renowned demographers, Pravin Visaria and S. Irudaya Rajan, hailed the NFHS as a landmark survey in an Economic and Political Weekly article published in 1999. They explained how it filled important data gaps in the country and argued that few surveys in India had shown such a concern for verification and quality control.

The second round conducted in 1998-99 got greater attention than the first, but it was the third round of 2005-06 that finally brought the NFHS into prominence. The results of the third round were released in 2007, when India was in the middle of an unprecedented growth boom. The stasis in child malnutrition rates reported by it seemed to suggest that the boom had left many behind. It was a section of the Left and those in the right-to-food movement who played an important role in drawing the country’s attention to those startling findings.

The attention on India’s nutritional failings embarrassed the government, and voices within the administration argued that the survey be discontinued. But saner voices prevailed and the NFHS fourth round received a go-ahead, with the additional mandate of generating district-level estimates. The resulting expansion in sample size, however, created doubts over the outcome’s comparability with previous rounds. The NFHS’s technical advisory group wasn’t able to fully convince the National Statistical Commission (NSC) on this, but in the interest of time, a truce was called. The fourth round finally took place after a gap of 10 years. The latest round was interrupted by the pandemic, but was thankfully not derailed.

The chequered history of the NFHS holds four important lessons. First, it underlines the importance of transparency. Right from its inception, anonymized sample data was available to everyone for free. The National Sample Survey (NSS) unit-level data was opened up only after the NFHS appeared on the scene, and till recently, it was not available for free. The openness of NFHS made it an outlier in the Indian data ecosystem in its early years, and helped establish its credibility.

The second important lesson relates to the politics of data. How and when a certain dataset is to be generated is often determined by societal or global elites. But how that will be eventually used is often beyond their control, especially if such datasets follow open-access policies. Nutrition was not the primary focus area of the original DHS programme, but it was the nutritional component of the NFHS that grabbed attention in India.

This brings us to the third important lesson. A big reason why nutrition received most attention was our lack of regular and credible nationally representative data on nutrition till then. Data on fertility and mortality trends were still available from other sources. To be sure, state governments did compile monthly data on nutritional outcomes through the Integrated Child Development Services (ICDS), but no one believed those numbers. It was widely acknowledged, even by ICDS officials, that the ‘real time’ data generated through the programme was biased and varied greatly in quality and coverage across regions. As the NFHS gained acceptability, more and more states began relying on it for nutritional planning. The big lesson here is that in many situations, there is no alternative to an independent well-designed survey.

Finally, the NFHS survived and thrived in this country despite its tribulations because of public ownership. Growing demand for credible data in the world’s largest democracy ensured its survival. If we are not to be led astray by statistics, we must continue to track our data ecosystem closely.

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