Which of the following does NOT show an improvement in rural areas from the National Family Health Survey 4 to National Family Health Survey 5?

Correct — B, Obesity in women. Between the fourth National Family Health Survey of 2015-16 and the fifth of 2019-21, the share of rural women whose body mass index is above normal rose from 15.0 per cent to 19.7 per cent. A rise in that indicator is a deterioration, not an improvement, and it is the finding the survey itself highlighted as India's double burden of malnutrition — undernutrition receding while overweight and obesity climb, in villages as well as towns. The two indicators that clearly improved are the ones falling: rural infant mortality came down from 46 to about 38 per thousand live births, and the rural total fertility rate fell from 2.4 to 2.1, reaching replacement level. Candidates should know that anaemia in children moved the wrong way over the same period as well, which makes option (c) defensible too; the obesity figure is the one the survey's own commentary treats as the emerging problem, and it is the answer this item is looking for.

• (a)Infant mortality rate — Rural infant mortality fell from 46 per thousand live births in the fourth survey to about 38 in the fifth. A falling death rate among infants is an improvement, so this option does not fit the stem.
• (c)Anaemia in children — This is not a clean distractor. Anaemia among rural children aged six to fifty-nine months rose from 59.5 per cent to 68.3 per cent, so it did not improve either, and a candidate who marked it has read the data correctly. Between the two, the obesity figure is the deterioration the survey report frames as its headline nutrition finding.
• (d)Total fertility rate — The rural total fertility rate fell from 2.4 to 2.1 between the two surveys, bringing rural India to replacement-level fertility. That is the improvement the survey is best known for.

The National Family Health Survey is a large sample survey of households run by the International Institute for Population Sciences for the Ministry of Health and Family Welfare, with results reported separately for rural and urban areas and for every State and district. Its fourth round covered 2015-16 and its fifth 2019-21. Because the same indicators are measured the same way in each round, the survey is designed to be read as a change over time rather than a snapshot.

This item is imperfectly framed, and a candidate who noticed that lost time rather than marks. Two of the four options moved the wrong way between the two rounds: overweight and obesity among rural women rose by nearly five percentage points, and anaemia among rural children rose by nearly nine. Only the two mortality and fertility measures improved. In the hall the practical response is to eliminate the two that clearly improved, then pick the deterioration the examiner is most likely to have in mind, which for a nutrition-and-lifestyle question is the obesity figure. It is worth carrying both numbers, since either could be asked directly.

• Rural women with a body mass index above normal rose from 15.0 per cent in the fourth survey to 19.7 per cent in the fifth.
• Rural infant mortality fell from 46 to about 38 per thousand live births between the two rounds.
• The rural total fertility rate fell from 2.4 to 2.1, reaching replacement level.
• Anaemia among rural children aged 6 to 59 months rose from 59.5 per cent to 68.3 per cent.
• The fourth round covered 2015-16 and the fifth 2019-21, both conducted by the International Institute for Population Sciences.

• Assuming every headline indicator improved between the two rounds; anaemia and obesity both worsened.
• Reading a rise in an indicator as good news without asking which direction counts as improvement.
• Applying all-India figures to a question that specifies rural areas.

A which-one-did-not-improve item drawn straight from the survey factsheet, testing whether a candidate has read the direction of change and not merely the level.

• practice — not a real PYQ

  The fifth round of the National Family Health Survey covered which period?

  • (a)2014-15
  • (b)2015-16
  • (c)2019-21
  • (d)2022-23

  Answer(c) 2019-21 — the fourth round covered 2015-16.

• practice — not a real PYQ

  According to the fifth National Family Health Survey, India's total fertility rate had reached

  • (a)2.0
  • (b)2.1
  • (c)2.4
  • (d)2.7

  Answer(a) 2.0 at the all-India level, with the rural figure at 2.1 — both at or below replacement level.