The Ministry of Health and Family Welfare released the latest National Family Health Survey (NFHS-6 (2023-24)) fact sheets on 29 May 2026, covering nearly 6.79 lakh households across 715 districts. Compared with NFHS-5 (2019-21), the latest survey points to broad-based gains across maternal health, child immunisation, and nutrition. Institutional deliveries reached 90.6 percent (up from 88.6 percent), antenatal care coverage rose to 95.9 percent (from 92.6 percent), and skilled birth attendance improved to 91.3 percent. Full immunisation coverage among children aged 12–23 months reached 87.1 percent, with rotavirus vaccination more than doubling from 36.4 percent to 85.4 percent.
On adult nutrition, both ends of the BMI distribution worsened simultaneously (Figure 1)—the share of overweight or obese women rose from 24.0 percent to 30.7 percent, and that of men from 22.9 percent to 27.3 percent, while underweight prevalence also increased among both sexes—a textbook double burden of malnutrition
Contrasted against these impressive gains, several indicators moved in the wrong direction. Exclusive breastfeeding among infants under six months fell from 63.7 percent to 55.8 percent. The share of institutional births occurring in public facilities declined from 61.9 percent to 58.6 percent, pointing to a quiet shift towards private delivery care—possibly financed by large publicly funded insurance schemes—even as overall institutional delivery rates rose. The caesarean section rate climbed from 21.5 percent to 27.2 percent, with increases recorded in both public and private facilities. Modern contraceptive use slipped from 56.4 percent to 52.7 percent, replaced by a corresponding rise in traditional methods. On adult nutrition, both ends of the BMI distribution worsened simultaneously (Figure 1)—the share of overweight or obese women rose from 24.0 percent to 30.7 percent, and that of men from 22.9 percent to 27.3 percent, while underweight prevalence also increased among both sexes—a textbook double burden of malnutrition, an emerging challenge previously explored in detail by ORF researchers.
Figure 1: The Double Burden of Malnutrition
Source: Data from NFHS Fact Sheets (various years) compiled by the author and visualised using Claude.
Social Determinants of Health in Practice in India
Over the last two decades, some of the most consequential public health shifts in India have emerged from interventions that sat outside the formal boundaries of the health ministry: drinking water, sanitation, nutrition, road access, clean cooking energy, women’s education, financial inclusion, and food security, among other factors. India has not always framed this as a formal Social Determinants of Health (SDH) approach, nor has it built a single institutional architecture around it. Yet, in practice, large welfare and infrastructure programmes have steadily entered the terrain where health is produced.
The NFHS is one of India’s foremost sources of health information and allied themes, and the latest release of topline findings offers an opportunity to take stock of gains across various SDH indicators. There is ongoing debate over the health ministry’s decision to omit several indicators that were included in NFHS-5. While the official fact sheet and press releases do not provide a methodological explanation for these omissions, it was reported that the omissions were part of an attempt at data harmonisation because some parameters are covered by other government data systems.
It remains unclear whether these omissions are confined to the fact sheets or were also reflected in the data collection process. Once the detailed reports, questionnaires, and unit-level data are released, these questions can be answered more definitively. At the same time, India’s official SDG National Indicator Framework 2025 continues to list NFHS as the source for anaemia, an indicator dropped from the NFHS-6 fact sheet, creating an unresolved gap.
Given this broader context, this article examines India’s progress over the last two decades in addressing social determinants of health across a range of sectors, using the NFHS-6 fact sheets. Alternative official sources are used in place of indicators dropped from the latest fact sheet.
Educational attainment among adults has improved steadily across all four survey rounds covering 2005–06 to 2023–24. The share of women aged 15–49 with ten or more years of schooling rose from 22.3 percent in 2005–06 to 46.4 percent in 2023–24, more than doubling over two decades (Figure 2). The corresponding figure for men, available from NFHS-4 onwards, increased from 47.1 percent to 54.6 percent. The gender gap in schooling, while narrowing, remains substantial, and further improvements and convergence are likely to yield additional health benefits across the country.
Figure 2: Educational Attainment among Women and Men
Source: Data from NFHS Fact Sheets (various years) compiled by the author and visualised using Claude.
Child undernutrition has improved, albeit often slowly, across all three anthropometric measures (Figure 3), with stunting falling from 48.0 percent to 29.3 percent between 2005–06 and 2023–24, a reduction of nearly 20 percentage points that reflects cumulative gains in maternal nutrition, sanitation, and child feeding practices. Wasting has remained stubbornly high at 19.0 percent, while the prevalence of underweight children stands at 31.8 percent, indicating that progress in child nutrition remains incomplete and requires additional effort. The decline in exclusive breastfeeding from 63.7 percent in 2019–21 to 55.8 percent in 2023–24 is a concerning reversal that warrants specific programmatic attention. Among adults, both ends of the BMI distribution have worsened since 2019–21 (Figure 1), a transition that demands policy responses beyond the conventional undernutrition frame.
Figure 3: Child Nutrition in India
Source: Data from NFHS Fact Sheets (various years) compiled by the author and visualised using Claude.
Living conditions have shown steady improvement over the last two decades. Access to electricity, drinking water, and sanitation has expanded substantially, as tracked using NFHS and other official sources (Figure 4). Household electricity access rose from 67.9 percent to 98.3 percent, and improved drinking water coverage increased from 87.6 percent to 96.5 percent. Clean cooking fuel use, at 63.4 percent in 2022–23, continues to lag considerably behind, with rural coverage remaining below 50 percent, representing a significant and ongoing source of indoor air pollution and respiratory disease burden.
Figure 4: Living Conditions over the Last Two Decades
Source: Data from NFHS Fact Sheets (various years)and NSS CAMS survey report, compiled by the author and visualised using Claude.
Parallel to these developments, health insurance coverage among households expanded from a very low 4.8 percent in 2005–06 to 60.2 percent in 2023–24, a transformation driven largely by publicly financed schemes, most recently Ayushman Bharat PM-JAY. Women’s ownership of bank accounts they themselves use rose from 15.1 percent to 89.0 percent over the same period, reflecting both the Jan Dhan financial inclusion drive and the direct benefit transfer architecture (Figure 5). These two indicators together suggest meaningful gains in the institutional arrangements that protect households from potential health shocks.
Figure 5: Health Protection and Financial Inclusion
Source: Data from NFHS Fact Sheets (various years) compiled by the author and visualised using Claude.
Lastly, although these factors are not considered within the broad framework of SDH, NFHS allows for tracking behavioural risk factors such as tobacco and alcohol use, which have an enormous impact on both morbidity and mortality in India. NFHS results show that tobacco use has declined among both men and women since 2005–06 (Figure 6), with male prevalence falling from 57.0 percent to 36.3 percent over two decades, though it remains high by public health standards. Alcohol consumption among men has also fallen, from 31.9 percent to 18.9 percent, while female levels remain low across all rounds. While the age-group definition shifted between NFHS-4 and NFHS-5, these comparisons still offer a useful view of long-term trends.
Figure 6: Alcohol and Tobacco Consumption in India
Source: Data from NFHS Fact Sheets (various years) compiled by the author and visualised using Claude.
For the public health community in India, the NFHS-6 findings present a mixed picture. Even as historical gains continue, wasting has plateaued and fresh concerns have emerged around breastfeeding, the caesarean section rate, and the double burden of adult malnutrition. At the same time, the omission of several indicators available in earlier rounds, on grounds of data harmonisation with other government systems, raises questions about the continuity of a series that derives much of its value from long-term comparability. However, greater clarity will emerge once the unit-level data are disseminated in the coming weeks.
Oommen C. Kurian is Senior Fellow and Head of the Health Initiative at the Observer Research Foundation.
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