NFHS-5 Report: Bihar Shows Improvement in Fertility, Sex Ratio and Family Planning, Yet Health Challenges Persist

Introduction

The National Family Health Survey-5 (NFHS-5) highlights significant improvements in Bihar's demographic and health indicators between NFHS-4 (2015-16) and NFHS-5 (2019-21). Bihar has registered progress in fertility decline, contraceptive use, sex ratio, neonatal and infant mortality, and sanitation. However, the State continues to face major concerns relating to high Total Fertility Rate (TFR), anaemia, malnutrition, child mortality and gender-based violence. Given Bihar's large population, these improvements have important implications for India's demographic transition.

Analysis

Bihar's Fertility Rate Declining but Still Highest Among Major States

The Total Fertility Rate (TFR) in Bihar declined from 3.4 (NFHS-4) to 3.0 (NFHS-5), indicating progress in family planning and reproductive health. However, Bihar still records the highest fertility rate in India and remains above the replacement level fertility (2.1) as well as the national average of 2.0.Among neighbouring states:

Although Bihar witnessed the largest absolute decline (0.4), its fertility level continues to remain significantly higher than both Uttar Pradesh and Jharkhand.

Major Improvement in Contraceptive Use

One of Bihar's biggest achievements has been the sharp rise in the Modern Contraceptive Prevalence Rate (mCPR).The proportion of couples using modern contraceptive methods almost doubled:

• 23.3% (NFHS-4) → 44.4% (NFHS-5)

Overall modern contraceptive use at the national level increased from 47.8% to 56.5%, while Bihar recorded one of the most remarkable improvements among all States.The most commonly adopted method remains female sterilisation (35.3%), followed by condoms. Male sterilisation continues to remain negligible. Increased awareness, improved outreach and better access to reproductive health services have contributed to this improvement.

Improvement in Sex Ratio

Bihar has recorded encouraging progress in the overall sex ratio (females per 1000 males).

The improvement indicates better survival of women and gradual enhancement in gender outcomes compared to previous years.

Decline in Neonatal and Infant Mortality

Health outcomes have shown moderate improvement.

Neonatal Mortality Rate (NNMR)

• Bihar: 36.7 → 34.5
• India: 29.5 → 24.9

Infant Mortality Rate (IMR)

• Bihar: 48.1 → 46.8
• India: 40.7 → 35.2

Although Bihar has registered improvements, both indicators remain considerably worse than the national average, indicating continued weaknesses in maternal and child healthcare.

Improvement in Child Immunisation

Full immunisation among children aged 12–23 months increased substantially.

• NFHS-4: 61.7%
• NFHS-5: 71.0%

Expansion of vaccination programmes and better institutional healthcare contributed to this progress.

Child Nutrition: Mixed Performance

Bihar has shown improvements in some nutrition indicators while deterioration continues in others.

Improvements

• Stunting: 48.3% → 42.9%
• Underweight children: 43.9% → 41%

Areas of Concern

• Wasting: 20.8% → 22.9%
• Overweight children: 1.2% → 2.4%

The findings indicate that while chronic undernutrition is declining, acute malnutrition continues to remain a serious concern.

Anaemia Continues to be a Major Public Health Challenge

Anaemia remains one of Bihar's biggest health concerns.

Children (6–59 months)

• 63.5% → 69.4%

Women (15–49 years)

• 60.3% → 63.5%

Men

• 32.3% → 29.5%

The rising prevalence among women and children indicates continued deficiencies in nutrition, antenatal care and iron supplementation.

Better Menstrual Hygiene

Women aged 15–24 years using hygienic menstrual methods increased significantly.

• 31.0% → 58.8%

This reflects greater awareness, improved accessibility and behavioural change regarding menstrual hygiene.

Drinking Water and Sanitation

Access to basic services has improved considerably.

Improved Drinking Water

• 98.4% → 99.2%

Improved Sanitation

• 26.5% → 49.4%

Despite progress, large rural-urban disparities continue in sanitation access.

Gender and Social Concerns

NFHS-5 also highlights persistent social challenges.

• 40% of married women reported experiencing spousal violence.
• Early marriage remains prevalent, with 41% of women aged 20–24 years married before 18 years.
• Women whose husbands frequently consume alcohol experience significantly higher levels of domestic violence.

Top 3 Performing States/UTs (As Mentioned in Input)

Fertility Rate (Lowest)

1. India has reached replacement fertility (2.0).
2. Bihar has shown the largest decline (0.4) among neighbouring major states.
3. Thirty out of thirty-six States/UTs improved contraceptive use.

Contraceptive Improvement

1. Bihar – Largest increase (more than doubled).
2. Uttar Pradesh – Significant improvement.
3. Jharkhand – Moderate improvement.

Bottom 3 (Among Compared States in the Input)

Implications

The NFHS-5 findings indicate that Bihar is gradually progressing through the demographic transition by reducing fertility and improving family planning adoption. Improved sex ratio, sanitation and immunisation suggest better public health outreach. However, persistent challenges such as high fertility, widespread anaemia, child malnutrition, early marriage and gender-based violence continue to impede inclusive human development. Sustained investments in maternal health, nutrition, women's education, reproductive healthcare and behavioural change remain essential for achieving the Sustainable Development Goals.

Static Part

National Family Health Survey (NFHS)

Established

• First conducted in 1992–93 (NFHS-1).

Conducting Institution

• International Institute for Population Sciences (IIPS), Mumbai

Ministry

• Ministry of Health and Family Welfare (MoHFW), Government of India

Headquarters of IIPS

• Mumbai, Maharashtra

Present Director (As per input)

• Not mentioned in the provided input.

Purpose

• Collects nationally representative data on:
  • Population
  • Fertility
  • Family planning
  • Nutrition
  • Maternal health
  • Child health
  • Mortality
  • Women's empowerment
  • Domestic violence
  • Sanitation
  • Drinking water
  • Health indicators

Reports Mentioned in the Input

• National Family Health Survey-5 (NFHS-5)

Updated – 28 November 2021 | 08:15 AMNews Source: Live Hindustan, Indian Express, Down To Earth, NDTV Banega Swasth India