NFHS-5 Findings on Bihar: Progress in Fertility Transition Amid Persistent Gender and Human Development Challenges
The National Family Health Survey-5 (NFHS-5) highlights Bihar's mixed development trajectory. While the state has witnessed a significant decline in Total Fertility Rate (TFR) and improvement in contraceptive use, it continues to lag behind the national average on several critical indicators such as child marriage, malnutrition, infant mortality, diarrhoeal diseases, anaemia among women, and gender inequality. The findings underline that demographic transition alone cannot ensure human development without simultaneous investments in education, women's empowerment, healthcare, nutrition and social awareness.
Several reports based on NFHS-5 (2019-21) have highlighted Bihar's demographic and health profile, showing:
These findings continue to guide policy formulation for India's population stabilization and human development goals.
Bihar has historically recorded India's highest fertility levels. NFHS-5 shows that although fertility has declined considerably over the past two decades, Bihar still records the highest Total Fertility Rate (TFR) among major states. The decline indicates increasing acceptance of family planning, improved awareness and better access to contraceptive services. However, fertility remains well above the replacement level, implying continued population momentum.The survey also shows that Bihar's fertility decline has been faster than in the previous decade, but the state still remains ahead of Uttar Pradesh and Jharkhand in terms of fertility.
| Survey | Bihar | India |
|---|---|---|
| NFHS-3 (2005-06) | 4.0 | — |
| NFHS-4 (2015-16) | 3.4 | 2.2 |
| NFHS-5 (2019-21) | 3.0 | 2.0 |
Key Observation
| Rank | State | TFR |
|---|---|---|
| 1 | Bihar | 3.0 |
| 2 | Uttar Pradesh | 2.4 |
| 3 | Jharkhand | 2.3 |
| Rank | State/UT | TFR |
|---|---|---|
| 1 | Sikkim | 1.1 |
| 2 | Andaman & Nicobar Islands | Below 1.5 |
| 3 | Goa | Below 1.5 |
Across India, urban women continue to have fewer children than rural women. Bihar follows the same trend. However, unlike most states, Bihar's urban fertility remained unchanged at 2.4, indicating slower demographic transition in urban areas compared to other states.The narrowing rural-urban gap suggests improved access to family planning services in rural regions.
NFHS-5 indicates an improvement in Bihar's overall sex ratio.
| Indicator | NFHS-4 | NFHS-5 |
|---|---|---|
| Females per 1000 males | 1062 | 1090 |
Nationally, sex ratio improved from 991 to 1020 females per 1000 males.Despite this improvement, Bihar continues to experience deep-rooted gender discrimination reflected in:
Experts argue that declining fertility combined with persistent son preference may intensify sex-selective behaviour.
One of Bihar's most significant improvements is the rapid increase in contraceptive prevalence.
| Indicator | NFHS-4 | NFHS-5 |
|---|---|---|
| Contraceptive Use | 24% | 56% |
This reflects improved implementation of family planning programmes and greater awareness among couples.However, female sterilisation continues to dominate while male participation remains negligible.
Child marriage remains one of Bihar's biggest social challenges.According to NFHS-5:
Despite this, only 19 cases were registered under the Prohibition of Child Marriage Act (2020–2024), highlighting poor enforcement.The Bihar Government has announced:
NFHS-5 presents a worrying picture regarding child malnutrition.Bihar remains among the worst-performing states for:
More than 40% of children under five years are stunted in Bihar, placing it among the highest in India.Top States
| Highest Stunting |
|---|
| Meghalaya |
| Bihar |
Every fourth child in Bihar suffers from acute malnutrition.Worst-performing states include:
Best-performing states:
Bihar records the highest prevalence.
| Rank | State |
|---|---|
| 1 | Bihar |
| 2 | Gujarat |
| 3 | Maharashtra |
Bihar remains among the best-performing states with one of the lowest percentages of overweight children.
Bihar recorded the highest prevalence of diarrhoea among children below five years.
| Indicator | Percentage |
|---|---|
| Rural | 12.6% |
| Urban | 13.9% |
| Overall | 13.7% |
Previous Survey
Top States
| Rank | State |
|---|---|
| 1 | Bihar |
| 2 | Meghalaya |
| 3 | Maharashtra |
Bihar has reduced neonatal mortality and infant mortality but still remains above the national average.
| Indicator | NFHS-4 | NFHS-5 |
|---|---|---|
| Neonatal Mortality Rate | 36.7 | 34.5 |
| Infant Mortality Rate | 48.1 | 46.8 |
National Comparison
| Indicator | NFHS-4 | NFHS-5 |
|---|---|---|
| Neonatal Mortality | 29.5 | 24.9 |
| Infant Mortality | 40.7 | 35.2 |
NFHS-5 reveals an interesting trend.Although Bihar is officially a dry state, alcohol consumption among men aged 15 years and above was reported to be higher than Maharashtra and Jammu & Kashmir.Tobacco consumption among men also increased compared to earlier surveys.Among women, tobacco consumption remained below 5%.
Despite improvements in fertility and family planning, Bihar continues to experience severe gender inequality.Important indicators include:
These factors continue to affect maternal health, child nutrition and demographic outcomes.
The NFHS-5 findings suggest that Bihar has entered the demographic transition phase, but demographic improvements have not translated into proportional gains in human development. Sustainable progress requires strengthening public health systems, promoting girls' education, delaying age at marriage, expanding reproductive healthcare, improving nutrition programmes, enhancing sanitation, encouraging male participation in family planning and reducing gender discrimination through behavioural and institutional reforms.
Updated – 17 July 2026