Dev 360 | India’s Child Health: What’s Measured, What’s Missing | Patralekha Chatterjee

Child health data is not just about children: it is a country’s report card on justice, equity and governance. If children thrive, the nation thrives; if they falter, the cracks in the system are laid bare.

As Unicef’s former executive director James Grant once said: “The health of children is the surest indicator of the health of a society.” That is why the release of the latest National Family Health Survey, India’s flagship study of population, health and nutrition launched in 1992-93, matters.

The National Family Health Survey-6 (NFHS-6) fact sheets, released on May 29, 2026, bring good news. The most significant gains have come in child health. Stunting among children under five has declined, as has severe wasting, institutional deliveries now exceed 90%, and full immunisation coverage for children aged 12-23 months has risen to over 87%. Additionally, India’s Total Fertility Rate (TFR) has stabilised at 2.0, falling below the replacement level of 2.1. These are unequivocal achievements: the result of decades of sustained effort and investment. This is the national picture, with huge state-level variations, yet the needle has visibly moved.

However, the survey is not all feel-good: it also showed a worrying decline in exclusive breastfeeding among children under six months, from 63.7% in NFHS-5 to 55.8% in NFHS-6. Breast milk is safe, clean and contains antibodies which help protect against many common childhood illnesses, as the World Health Organisation stresses.

The Sample Registration System (SRS) statistical report 2024, also released recently, and another source of information on child health, reveals that the national Infant Mortality Rate (IMR) stands at 24 per 1,000 live births (down from 30 in 2019), with rural IMR at 27 and urban at 17. Despite this decline, one in every 42 infants at the national level, one in every 37 infants in rural areas and one in every 59 infants in urban areas, still die within one year of life, the Bulletin notes.

State-level variations are glaring -- Kerala’s IMR is 8, the lowest among all major Indian states; the corresponding figure for Uttar Pradesh is 35.

What the official data now in the public domain don’t tell -- or no longer tell comprehensively -- is equally significant.

The latest NFHS fact sheets in the public domain dropped the entire infant, neonatal, and under-5 mortality section, along with sex ratio at birth. Anaemia indicators (once covering children, women, men, and adolescents) are gone from NFHS and shifted to the new Diet and Biomarkers Survey: DABS-I.

As Dipa Sinha, development economist focusing on social policy, nutrition, public health and gender, puts it: “Many items included in NFHS-5 do not appear in the NFHS 6-fact sheets that have just been released. One example -- infant mortality. Infant mortality is included in the Sample Registration System (SRS) Statistical Report 2024, which also came out recently. But NFHS and SRS are two different surveys, managed by different government agencies, and can’t be compared. The SRS (managed by the Office of the Registrar General & Census Commissioner, India) has a smaller sample size and it does not offer granular district-level statistics. The NFHS-6, the first completely government-managed NFHS round without external technical assistance from the DHS (Demographic and Health Surveys), a USAID-supported global health data initiative, was overseen by the ministry of health and family welfare.”

“We can say more only when the full NFHS-6 data are released, which will hopefully be done. The detailed report and the unit-level data should be made accessible to the public like in previous rounds. With the currently-available data in factsheets, it is difficult to say precisely who are the most vulnerable children, what are the risk factors and what are emerging risks. We need this information not just for researchers but also for policy makers,” she adds.

In February 2025, the US government (under the second Trump administration) terminated most USAID funding and programmes as part of a broad foreign aid review and restructuring. This led to the abrupt shutdown of the DHS programme’s core operations, primarily funded by USAID for over 40 years. Clearly, global funding impacts the survey landscape.

At present, we have a fragmented data landscape. SRS gives reliable national and state-level (with rural-urban splits for bigger states) mortality trends but lacks district-level estimates and the rich disaggregation by wealth, caste, education, or maternal factors that NFHS once provided. DABS-I, which promises more accurate venous blood sampling for anaemia, completed fieldwork but has not released results as of early June 2026.

We are therefore still relying on NFHS-5’s high (and contested) figures on anaemia: 67% of children 6-59 months, 57% of women 15-49 and other indicators. Hopefully, more detailed information from the latest NFHS will be released. But if that does not happen soon, we will face a critical granularity gap through omission of district level data in many areas. Take Maharashtra. According to NFHS 5 (2019-2021), the prevalence of diarrhoea among children below five in the two weeks preceding the survey was 3.5 per cent in Mumbai. The corresponding figure for Nandurbar, a backward and tribal dominated district, was 9.8 per cent.

This is the kind of information which the recent official surveys do not provide and this is what makes it impossible to pinpoint vulnerable blocks or tribal pockets where infant deaths remain disproportionately high. Compounding this, NFHS 6 also dropped key structural determinants of child health, such as household access to clean cooking fuel and improved sanitation.

Analysts, researchers and state planners must now stitch together pieces from different surveys with varying methodologies, reference periods, and geographic coverage. The direct linkages that made earlier NFHS rounds so useful are harder to trace. Intra-state inequalities become blurrier.

Survival and nutrition gains are being reported in India. But to be in effective future-forward mode, one must have access to the granular picture of what is going wrong, what is driving vulnerability, and where. Without it, policymakers risk flying partially blind on targeting the hardest-to-reach children and women. The Government of India is measuring success by outputs and infrastructure delivery; public health researchers are trying to measure human well-being and causal networks.

The solution does not lie in romanticising any one survey but in demanding better integration: timely release of full NFHS-6 detailed reports, early DABS-I results with clear methodological notes, continued strengthening of SRS/CRS, and inclusion of harder indicators on violence, intra-household realities, and social determinants.

Until then, the true state of child health -- and broader human development -- in India is knowable, but only through some extra effort, triangulation, and a willingness to read between the data gaps.