National Family Health Survey (NFHS-6): Progress, Challenges, and the Way Forward

General Studies Paper – II: Governance, Constitution, Polity, Social Justice, and International Relations.

Context

The National Family Health Survey (NFHS) is a premier survey conducted under the direction of the Ministry of Health and Family Welfare, Government of India, by the International Institute for Population Sciences (IIPS), Mumbai. It provides state-wise and national data on child health, nutrition, maternal health, immunization, gender indicators, and socio-economic status. This survey is the cornerstone of India's health policy-making.

NFHS-6

NFHS-6 is the sixth comprehensive national survey conducted in the year 2024-25. It is part of the global 'Demographic and Health Surveys' (DHS) program, which is operated in over 90 countries. Its main objectives include the measurement of child nutrition (stunting, wasting, undernutrition), assessment of reproductive and maternal health, immunization coverage, and analysis of infrastructure (water, sanitation, housing).

Key Points of Discussion

• Positive Aspects:

  • Decline in Stunting: The rate of stunting has decreased from 35.5% to 29.3%, which is a major achievement in the direction of improving child nutrition.
  • Institutional Deliveries: This has reached the 90% level, indicating the expanded reach of the public health system.
  • Immunization: Full immunization coverage (12-23 months) has reached 87%, the credit for which goes to the efforts of ASHA, Anganwadi Workers (AWW), and ANM.
• Concerning Aspects:
  • Wasting (Acute Malnutrition): There has been no significant improvement in this area.
  • Dietary Quality: Only 15% of children aged 6-23 months are receiving an adequate diet.
  • Maternal Time Poverty: 'Lack of time' for mothers as a determinant of nutrition has been highlighted seriously for the first time.
  • Processed Food: Expenditure by families on processed food items has increased, which is a new nutritional crisis.

Key Statistics: Comparative Details

Current Situation and Challenges

NFHS-6 presents a mixed progress card. Access to health services (immunization, delivery care) has improved, but progress in dietary quality and food habits remains slow.

• Maternal Time Poverty: Approximately 30% of women are bearing the double burden of paid work along with domestic and agricultural work. The lack of creche facilities is having a negative impact on child nutrition.
• Data for 0-2 Age Group: The absence of separate data for this period, which is crucial for brain development, is a policy gap.
• Regional Inequality: The situation is more challenging in states like Uttar Pradesh, Bihar, Jharkhand, Madhya Pradesh, and Rajasthan, especially among marginalized communities (Tribal, Scheduled Castes, Migrant families).

The Way Forward

• Frontline Empowerment: Capacity building of Anganwadi and ASHA workers and enabling them to provide age-appropriate dietary guidance through digital tools.

• Policy on 'First 1,000 Days': Developing a separate monitoring system for the 0-2 age group. Prioritizing prevention alongside treatment in the 'POSHAN Abhiyaan'.
• Social Infrastructure: Expansion of the creche network in rural areas so that mothers' time management improves and children receive proper care.
• Multi-sectoral Convergence: Coordinating departments of health, agriculture, water, education, and social security. Making child nutrition a permanent agenda in Gram Sabhas.
• Cultural Engagement: Linking cultural practices like Annaprashan with nutritional counseling and promoting local/affordable food items (millets, pulses, green vegetables).

Conclusion

NFHS-6 makes it clear that India's nutrition journey is at a crossroads. While we have set global standards in immunization and delivery facilities, an integrated and data-driven strategy is needed to deal with the deeper challenges of dietary quality and malnutrition. Unless maternal health, creche facilities, and district-level nutrition expertise are made the center of policy, achieving the comprehensive nutrition goals (SDG 2030) will be difficult. This report is not just a collection of statistics, but a mirror of accountability for our future generation.

Strict Rules on Syrup-Based Medicines: The Challenge of Restoring the Credibility of the 'Pharmacy of the World'

General Studies Paper – II: Governance, Constitution, Polity, Social Justice, and International Relations.

Context

India, known as the 'Pharmacy of the World', has been facing global challenges regarding the quality of its pharmaceutical exports in recent years. Since 2022, the deaths of children due to the presence of toxic substances in cough syrups manufactured in India across several countries have raised serious questions about the country's image and its regulatory mechanism. Against this backdrop, the government has made a doctor's prescription mandatory for the purchase of syrup-based medicines to restore trust in the pharmaceutical supply chain.

What are the 'Drugs Rules, 1945'?

The 'Drugs Rules, 1945' are essentially the rules framed under the 'Drugs and Cosmetics Act, 1940', which regulate the import, manufacture, sale, and distribution of drugs in India.

• Objective: To ensure that the medicines sold in India are safe, effective, and of high quality.
• Schedules: These rules contain various schedules (such as Schedule H, Schedule K, Schedule X), which define the classification of drugs and the conditions for their licensing, labeling, and sale.
• Schedule K: It lists the drugs or conditions that are exempted from certain specific provisions (such as license or prescription). Under the recent change, 'syrup' has been removed from this list.

Reasons for Discussion

This issue is being discussed due to the following reasons:

• Contamination: The presence of deadly chemicals like Ethylene Glycol (EG) and Diethylene Glycol (DEG) in cough syrups manufactured in India.
• Deaths of Children: The tragic death of over 300 children across various countries since 2022 due to medicines made in India.
• Regulatory Failure: Questions regarding the effectiveness of the government's export quality control system.
• Health Concerns: Side effects resulting from the arbitrary and incorrect use of cough syrups (such as rapid heart rate, fainting, etc.).

Mandatory Prescription

According to the latest notification, the Ministry of Health has removed the word "syrup" from Schedule 'K' of the 'Drugs Rules, 1945'. This simply means that now no person will be able to purchase cough or other syrup-based medicines from medical stores without a valid prescription from a registered medical practitioner. This step imposes an effective ban on over-the-counter (OTC) sales in pharmacies.

Why is this needed?

• Preventing Misuse: Many OTC syrups contain narcotic elements or components that can be harmful to health due to uncontrolled use.

• Curbing Self-Medication: People in India often take medicines for minor ailments without a doctor's advice, which can be dangerous.
• Accountability: Mandatory prescription will ensure a record of medicine distribution, making it easier to track medicines when needed.

WHO Guidelines

The World Health Organization (WHO) has repeatedly warned that the presence of DEG and EG in cough syrups used for children is 'unacceptable'. The WHO has urged countries to:

• Strengthen 'upstream' (raw material testing) quality checks in the supply chain.
• Make national regulatory systems stricter.
• Continuously monitor medicines available in the market.

Potential Consequences

• Enhanced Safety: A reduction in side effects and the intake of incorrect medicines.

• Compliance with Pharmacy Rules: Pharmacists will now have to maintain prescription records.
• Pressure for Improvement: Increased pressure on small manufacturers to adopt quality control standards.

Other Important Points

• Rural Healthcare: Pharmacists in India often act as primary care providers in rural areas; they will have to change their working methods due to this rule.

• Shortage of Inspectors: There is a severe shortage of state-level drug controllers and inspectors in the country, without whom implementing this rule on the ground will be challenging.

Analysis

The government's decision is a welcome defensive move, but it is not a complete solution to the root cause—namely, the gaps in manufacturing and quality testing. Merely making prescriptions mandatory cannot prevent contaminated products already in the market from being produced; for this, strict monitoring and increasing the number of inspectors is essential.

​​​​​​​Way Forward

• Strict Enforcement: Notification alone is not enough; random sampling of medicine batches and laboratory testing must be increased at the ground level.

• Manufacturer Accountability: Strict adherence to 'Good Manufacturing Practices' (GMP) must be ensured for all manufacturers, both small and large.
• Digitization: Monitoring the sale of medicines will be possible through the digitization of prescription records.

Conclusion

India’s move is a necessary reform to rebuild the credibility of its pharmaceutical exports and strengthen domestic health security. However, to maintain its reputation as the 'Pharmacy of the World', the government needs to go beyond just sales regulations and make more concrete efforts to address the gaps at the manufacturing level and empower the regulatory machinery.

New Barriers to Trade: Transition from Tariffs to Regulatory Barriers (NTBs)

General Studies Paper – III: Technology, Economic Development, Biodiversity, Environment, Security, and Disaster Management.

Reference

There has been a epochal shift in global trade diplomacy. Traditionally, the focal point of trade negotiations has been 'tariffs' (customs duties), but in the hyper-regulated global economy of the 21st century, 'non-tariff barriers' (NTBs) have become the most effective and invisible weapon of trade.

Transition from Tariffs to Regulatory Barriers

In the last few decades, the yardstick for the success of trade negotiations has been the reduction in customs duties. Since the establishment of the World Trade Organization (WTO) in 1995, average tariff rates among member countries have fallen by nearly half. However, governments have not abandoned protectionism, but have reorganized it in the form of 'regulatory barriers' (NTBs).

• What are NTBs?: These are rules, certifications, licensing, and product standards that are mandatory before entering a market. This includes technical regulations, environmental, health and safety standards, and packaging procedures.
• Expansion of NTBs: Today, about 90% of global trade is affected by these barriers, representing a six-fold increase over the past three decades. More than half of the 20,000 global product and safety regulations introduced in the last 70 years have emerged only since 2000.
• Data Evidence: In the year 2025 alone, governments submitted over 7,700 notifications of NTBs and health-related trade measures, which is 10 times more than in 1995.

Perspective of Major Economies

• European Union (EU): It is the most extensive user of NTBs. According to WTO and World Bank data, about 94% of imports entering the EU are under the ambit of non-tariff measures (compared to 77% in the US and 45% in India). The EU has implemented strict rules like the 'Carbon Border Adjustment Mechanism' (CBAM) and the 'Deforestation Regulation'.

• America: American NTBs are focused on strategic competition, security concerns, and technological dominance. It is controlling supply chains through export controls, entity lists, and restrictions on semiconductors, AI chips, and advanced hardware.

India's Experience: FTA and the Ground Reality

India's record of Free Trade Agreements (FTAs) clearly demonstrates this shift:

• ASEAN-India Agreement: Despite being in force since 2010, the preferential tariff utilization among Indian businesses is below 50%. The main reason for this is that Indonesian registration rules and Thai customs procedures make Indian exports commercially impractical.
• Japan and South Korea: Even after an FTA with Japan, Indian pharmaceutical exports remain negligible because market approvals take 5-7 years. Despite bilateral trade with South Korea reaching $27 billion, India's share was only $6.5 billion (2024-25). India's overall FTA utilization rate is only 25%, while for developed economies, it is 70-80%.

Strategic Shift and 'The Next Frontier of Trade'

India has changed its industrial strategy. Now, New Delhi is expanding quality regulations on electronics, machinery, and chemicals to boost domestic manufacturing and reduce supply chain dependency.

• Nature of New Agreements: India's recent agreements signal a real shift:
  • UAE-CEPA: Mandates automatic recognition of medicines and mutual acceptance of laboratory testing.
  • India-EFTA Agreement (October 2025): For the first time, it makes NTB reduction a legally binding obligation and focuses on mutual recognition of standards.

Way Forward

If India is to become a global economic superpower, focusing only on tariff cuts will not be enough. The following steps are necessary for this:

• Institutional Diplomacy: Formation of dedicated sub-committees to eliminate NTBs and legally binding bilateral agreements.
• Transparency and Proportionality: Making regulatory systems transparent so that the global supply chain does not fragment.

Conclusion

The economics of trade has moved beyond tariffs and focused on regulatory compliance. In the 21st century, real trade barriers are in laboratories and law offices. If India is to become a global economic pivot, it will be mandatory to focus on making regulatory barriers (NTBs) transparent, proportionate, and focusing on mutual standard recognition rather than just focusing on tariff cuts.

New Barriers to Trade: Transition from Tariffs to Regulatory Barriers (NTBs)

General Studies Paper – III: Technology, Economic Development, Biodiversity, Environment, Security, and Disaster Management.

Reference

There has been a epochal shift in global trade diplomacy. Traditionally, the focal point of trade negotiations has been 'tariffs' (customs duties), but in the hyper-regulated global economy of the 21st century, 'non-tariff barriers' (NTBs) have become the most effective and invisible weapon of trade.

Transition from Tariffs to Regulatory Barriers

In the last few decades, the yardstick for the success of trade negotiations has been the reduction in customs duties. Since the establishment of the World Trade Organization (WTO) in 1995, average tariff rates among member countries have fallen by nearly half. However, governments have not abandoned protectionism, but have reorganized it in the form of 'regulatory barriers' (NTBs).

• What are NTBs?: These are rules, certifications, licensing, and product standards that are mandatory before entering a market. This includes technical regulations, environmental, health and safety standards, and packaging procedures.
• Expansion of NTBs: Today, about 90% of global trade is affected by these barriers, representing a six-fold increase over the past three decades. More than half of the 20,000 global product and safety regulations introduced in the last 70 years have emerged only since 2000.
• Data Evidence: In the year 2025 alone, governments submitted over 7,700 notifications of NTBs and health-related trade measures, which is 10 times more than in 1995.

Perspective of Major Economies

• European Union (EU): It is the most extensive user of NTBs. According to WTO and World Bank data, about 94% of imports entering the EU are under the ambit of non-tariff measures (compared to 77% in the US and 45% in India). The EU has implemented strict rules like the 'Carbon Border Adjustment Mechanism' (CBAM) and the 'Deforestation Regulation'.

• America: American NTBs are focused on strategic competition, security concerns, and technological dominance. It is controlling supply chains through export controls, entity lists, and restrictions on semiconductors, AI chips, and advanced hardware.

India's Experience: FTA and the Ground Reality

India's record of Free Trade Agreements (FTAs) clearly demonstrates this shift:

• ASEAN-India Agreement: Despite being in force since 2010, the preferential tariff utilization among Indian businesses is below 50%. The main reason for this is that Indonesian registration rules and Thai customs procedures make Indian exports commercially impractical.
• Japan and South Korea: Even after an FTA with Japan, Indian pharmaceutical exports remain negligible because market approvals take 5-7 years. Despite bilateral trade with South Korea reaching $27 billion, India's share was only $6.5 billion (2024-25). India's overall FTA utilization rate is only 25%, while for developed economies, it is 70-80%.

Strategic Shift and 'The Next Frontier of Trade'

India has changed its industrial strategy. Now, New Delhi is expanding quality regulations on electronics, machinery, and chemicals to boost domestic manufacturing and reduce supply chain dependency.

• Nature of New Agreements: India's recent agreements signal a real shift:
  • UAE-CEPA: Mandates automatic recognition of medicines and mutual acceptance of laboratory testing.
  • India-EFTA Agreement (October 2025): For the first time, it makes NTB reduction a legally binding obligation and focuses on mutual recognition of standards.

Way Forward

If India is to become a global economic superpower, focusing only on tariff cuts will not be enough. The following steps are necessary for this:

• Institutional Diplomacy: Formation of dedicated sub-committees to eliminate NTBs and legally binding bilateral agreements.
• Transparency and Proportionality: Making regulatory systems transparent so that the global supply chain does not fragment.

Conclusion

The economics of trade has moved beyond tariffs and focused on regulatory compliance. In the 21st century, real trade barriers are in laboratories and law offices. If India is to become a global economic pivot, it will be mandatory to focus on making regulatory barriers (NTBs) transparent, proportionate, and focusing on mutual standard recognition rather than just focusing on tariff cuts.

Mandatory Reforms: Updates to India's Statistical System

General Studies Paper – III: Technology, Economic Development, Biodiversity, Environment, Security, and Disaster Management.