ANNUAL HEALTH SURVEY FACT SHEET KEY FINDINGS

Dr. C. Chandramouli
Registrar General & Census Commissioner, India

 Reproductive health and rights are integral to sustainable development and poverty reduction. Investing in universal access to reproductive health is crucial investment in healthy societies and a more sustainable future.
Ban Ki-moon, Secretary-General, UN on World Population Day, 2012

 Working for the survival and the well being of women and girls is a human right imperative. And in order to take advantage of womens full potential in the development of their nations, they must be able to plan their lives and families. Babatunde Osotimehin, Executive Director, UNFPA on World Population Day, 2012

AHS provides key indicators on Reproductive and Child Health at District level in 8 EAG States and Assam

Vital inputs for evidence based intervention and monitoring

 There should be an Annual Health Survey of all districts which could be published/monitored and compared against benchmarks -Dr. Manmohan Singh, Prime Minister of India In the meeting
of National Commission of Population, 2005

OBJECTIVE OF AHS
AHS yields a comprehensive, representative and reliable dataset on core vital indicators including composite ones like IMR, MMR and TFR along with their co-variates (process and outcome indicators) at the district level and maps changes therein on an annual basis. These benchmarks would help in better and holistic understanding and timely monitoring of various determinants on well-being and health of population particularly Reproductive and Child Health.

Coverage : Annual Health Survey

Uttarakhand

Rajasthan

Uttar Pradesh Assam Bihar Jharkhand

Madhya Pradesh

Chhattisgarh Odisha

WHY AHS?
o

AHS States constitute: 48 percent of countrys Population 59 percent of Births 70 percent of Infant Deaths 75 percent of Under 5 Deaths 62 percent of Maternal Deaths
Enable direct monitoring of UN Millennium Development Goals on Child Mortality and Maternal Health at the district(s) level. Help in identifying high focus districts meriting special attention in view of stark inter-district variations in these States. Provide critical inputs to assess the milestones of various interventions including NRHM and pave the way for evidence based planning.

KEY FEATURES
Coverage- All the 284 districts of 8 EAG States and Assam. Sample

Units- 20,694 statistically selected sample unit (Census Enumeration Blocks in urban areas and Villages or a part thereof in rural areas)

Sample Identification Work- to uniquely identify the sample units on

ground, firm up its boundaries, demarcate the localities and prepare a notional map of the sample unit was done by the staff of ORGI.

Sample Units per district- 73. Sample Population- About 20.1 million

The Largest Sample Survey in the World

KEY FEATURES

Contd

Sample Population per district - About 71 thousand.

Sample Households - 4.1 million households.

Sample households per district - About 14.5 thousand. Conduct of Field Work - hybrid approach wherein fieldwork has

been outsourced and supervision is being done by the ORGI.

Primary Level of Aggregation District Periodicity- Annual

Indicators under AHS

In all, 161 indicators are available from AHS baseline:
Fertility- 13 Sex Ratio- 3 Marriage- 5 Mortality- 7 Mother & Child Care- 63
Ante Natal Care: 11 Post Natal Care: 5 Immunization: 8 Birth Weight: 2 Birth Registration: 2 Awareness in Mothers: 4 Delivery Care: 8 Janani Suraksha Yojana (JSY): 3 Vitamin A & Iron Supplements: 2 Childhood Disease: 6 Breastfeeding & Supplementation: 12

Abortion- 6 Family Planning Practices- 15 Disability- 1 Morbidity- 19 Personal Habits:adults-4 Housing & HH Characteristics- 13 Others- 12

Indicators under AHS

Contd

Under 1st phase of AHS following 9 indicators have already been released:
Crude Birth Rate (CBR) Infant Mortality Rate (IMR) Crude Death Rate (CDR) Neo-Natal Mortality Rate (NNMR)

Under Five Mortality Rate (U5MR) Maternal Mortality Ratio (MMR)

Sex Ratio at Birth (SRB)

Sex Ratio (All ages)

Sex Ratio (0-4 years) and

Remaining 152 indicators are being released under present phase of dissemination.

Five Core Themes Covered

The presentation focuses on results pertaining to 5 core themes:
Total Fertility Rate

Family Planning: Current Usage & Total Unmet Need

Ante Natal Care Delivery & Post Natal Care Immunization and Breast Feeding Practices

Total Fertility Rate (TFR)

TFR is the average number of children born to a woman during her entire reproductive span.
4.0 3.5 3.0 3.9 3.9 Bihar 2.8 2.5 Total Rural Urban

Total Fertility Rate

3.5

3.3

2.7

2.9

2.6

2.4

2.4

2.3

2.3

1.9

1.0 Uttarakhand Odisha Assam Chhattisgarh Jharkhand Madhya Pradesh Rajasthan Uttar Pradesh

Uttarakhand & Odisha and UP & Bihar reflects the two extremes. Significant Rural-Urban variation across all 9 AHS States, the max. in Uttar Pradesh.

1.9

1.5

2.0

2.3

2.4

2.4

2.5

2.7

2.0

3.1

3.1

3.1

3.2

3.4

3.6

3.7

Total Fertility Rate (TFR)

State Assam Bihar Jharkhand Madhya Pradesh Chhattisgarh Odisha Rajasthan Uttar Pradesh Uttarakhand State value 2.6 3.7 3.1 3.1 2.9 2.3 3.2 3.6 2.3

Contd
Range 2.2 1.9 1.6 2.3 1.3 1.7 2.1 3.6 1.4

Total Fertility Rate (TFR) Minimum Maximum Kamrup (2) Hailakandi (4.2) Patna (2.8) Sheohar (4.7) Purbi Singhbhum (2.4) Lohardagga (4) Indore (2.2) Shivpuri (4.5) Koriya (2.4) Kawardha (3.7) Jharsuguda (2) Boudh (3.7) Kota (2.6) Barmer (4.7) Kanpur Nagar (2.3) Shrawasti (5.9) Pithoragarh (1.7) Haridwar (3.1)

Within a State, the minimum variability of 1.3 reported in Chhattisgarh and the maximum, 3.6 in Uttar Pradesh.
Across 284 districts in 9 AHS States, it ranges from 1.7 in Pitthoragarh (Uttarakhand) to 5.9 in Shrawasti (UP)- a variability of more than 4 children.

Total Fertility Rate (TFR) Contd

Frequency distribution of districts by level of Total Fertility Rate State Assam Bihar Chhattisgarh Jharkhand Madhya Pradesh Odisha Rajasthan Uttar Pradesh Uttarakhand All States 0-2.1 3 0 0 0 0 10 0 0 7 20 2.2-3.0 16 1 12 8 15 18 16 9 5 100 3.1-4.0 3 26 4 10 25 2 13 48 1 132 4.1 & above 1 10 0 0 5 0 3 13 0 32 Total Districts 23 37 16 18 45 30 32 70 13 284

20 districts namely Kamrup, NC Hills, Nalbari (Assam); Puri, Khordha, Angul, Jajpur, Jagatsinghpur, Baleshwar, Sundargarh, Doegarh, Jharsugdha, Bargarh (Odisha); Nainital, Almora, Bageshwar, Pitthoragarh, Rudraprayag, Chamoli, Uttarkashi (Uttarakhand) have already achieved the replacement level of 2.1. 46 districts have TFR below the current National average of 2.5 (SRS 2010).
164 districts have recorded TFR of 3.1 and above, the National level TFR of 2001 (SRS).

Total Fertility Rate (TFR) Contd

Family Planning: Current Usage

Contraceptive Prevalence Rate (CPR) is the percentage of currently married women aged 15-49 yrs who are using any method of contraception (modern/traditional).
Current Usage- any method (%)
70 Total 60 Rural Urban

50
66.0 64.1 64.5 62.7 62.4 62.7 61.2 58.4 58.2 58.4 56.2

53.9

49.7

47.8

49.9

37.6

20 Bihar Jharkhand Uttar Pradesh Chhattisgarh Odisha Assam Madhya Pradesh Uttarakhand Rajasthan

Current usage of any method varies from 37.6 in Bihar to 64.5 per cent in Rajasthan. Rural Urban divide is significant in Jharkhand and Bihar.

35.8

30

44.1

47.6

52.7

54.9

56.9

40

57.9

59.9

61.4

63.1

68.6

Family Planning: Current Usage Contd

State Assam Bihar Jharkhand Madhya Pradesh Chhattisgarh Odisha Rajasthan Uttar Pradesh Uttarakhand Current Usage of Family Planning- any Method (%) State value Minimum Maximum 57.9 Dhubri (33.2) Lakhimpur (67.6) 37.6 Siwan (26) Muzaffarpur (52.2) 47.8 Paschimi Singhbhum (32.7) Dhanbad (61.9) 61.2 Sidhi (45.9) Damoh (74.9) 53.9 Dantewada (33.4) Dhamtari (68.7) 56.2 Kandhamal (28.6) Baleshwar (73.4) 64.5 Dhaulpur (49) Ganganagar (79.2) 49.9 Sitapur (21.9) Jhansi (74.1) 62.7 Haridwar (53.7) Dehradun (67.1) Range 34.4 26.2 29.3 29.0 35.2 44.8 30.2 52.2 13.4

Within a State, the least variation is reported in Uttarakhand whereas the most, in Uttar Pradesh.
At district level, current usage of family planning ranges from 21.9 in Sitapur (UP) to 79.2 in Ganganagar (Rajasthan) exhibiting a variability of 4 times.

Family Planning: Current Usage Contd

Frequency distribution of districts by current usage of family planning- any method (%) State 0-30 30-50 50-70 70 & above Total Districts Assam 0 3 20 0 23 Bihar 4 31 2 0 37 Chhattisgarh 0 7 9 0 16 Jharkhand 0 13 5 0 18 Madhya Pradesh 0 2 40 3 45 Odisha 1 9 19 1 30 Rajasthan 0 1 24 7 32 Uttar Pradesh 3 24 42 1 70 Uttarakhand 0 0 13 0 13 All States 8 90 174 12 284

As high as 98 districts are reporting less than 50% current usage of any method of family planning.
Only 12 districts namely Damoh, Betul, Jabalpur (MP), Baleshwar (Odisha), Ganganagar, Hanumangarh, Jhunjhunu, Alwar, Udaipur, Dungarpur, Banswara (Rajasthan) and Jhansi (UP) feature in 70% & above category. 35 out of 37 districts of Bihar have reported less than 50% usage of any method of family planning.

Family Planning: Current Usage Contd

Family Planning: Current Usage Contd

Share of sterilization in any modern method of family planning (%) Assam Uttar Pradesh Jharkhand Bihar Odisha Uttarakhand Rajasthan Chhattisgarh Madhya Pradesh

Female Male

35.3 0.6

55.0 0.6

76.3 1.2

86.7 0.9

68.4 0.7

58.7 2.8

76.7 0.7

92.3 2.0

83.6 1.7

Unmet Need for Family Planning

Currently Married Women who are not using any method of contraception but who do not want any more children or want after a period of 2 years are defined as having an unmet need.
45.0 40.0 35.0 30.0 Total Rural Urban

Unmet Need for Family Planning (%)

31.5

30.5

33.6

25.0 24.7 24.0 25.0 26.4 27.1 23.3 23.2 23.2 23.5 23.7 22.4 23.2 20.0 19.6 20.5 16.9 15.0 10.0 29.7

39.2

40.6
Bihar

21.7

20.6

Rajasthan

Madhya Pradesh

Uttarakhand

19.5

Odisha

Assam

19.6

Chhattisgarh

Uttar Pradesh

Jharkhand

Total unmet need varies from a minimum of 19.6% in Rajasthan to 39.2% in Bihar. Rural- Urban gap is prominent in Jharkhand, Bihar and Uttar Pradesh. Unmet need for Family Planning is a crucial indicator for assessing the future demand for Family Planning services / supplies.

21.5

30.0

Unmet Need for Family Planning Contd

Total unmet need for Family Planning(%) Minimum Maximum value Sibsagar (15.3) Dhubri (42.9) Patna (24.6) Kishanganj (52.5) Bokaro (18.2) Godda (42.8) Jabalpur (14.3) Rewa (34.2) Dhamtari (14.5) Bastar (36) Baleshwar (6.1) Boudh (48.3) Ganganagar (10.0) Dhaulpur (32.4) Mahoba (15.1) Sitapur (61.3) Dehradun (16.8) Haridwar (29.2)

State Assam Bihar Jharkhand Madhya Pradesh Chhattisgarh Odisha Rajasthan Uttar Pradesh Uttarakhand

State value 24.0 39.2 30.5 22.4 26.4 23.2 19.6 29.7 23.2

Range 27.6 27.9 24.6 19.9 21.5 42.3 22.3 46.3 12.4

The minimum variability within a State is in Uttarakhand whereas the maximum in Uttar Pradesh.

Baleshwar (6.1%) in Odisha and Sitapur (61.3%) in Uttar Pradesh are the two extremes across 284 districts.

Unmet Need for Family Planning Contd

Frequency distribution of districts by total unmet need for family planning (%) State 0-20 20-40 40-60 60 & above Assam 6 16 1 0 Bihar 0 20 17 0 Chhattisgarh 4 12 0 0 Jharkhand 2 13 3 0 Madhya Pradesh 18 27 0 0 Odisha 12 15 3 0 Rajasthan 16 16 0 0 Uttar Pradesh 9 52 8 1 Uttarakhand 2 11 0 0 All States 69 182 32 1

Total Districts 23 37 16 18 45 30 32 70 13 284

Only in 69 out of 284 districts, the total unmet need for family planning is below 20%. Bihar and Uttar Pradesh dominate in 40% & above category.

Mean Age at Marriage- Female

Mean Age at Marriage is based on the marriages taken place during 2007-2009.
Mean Age at Marriage- Female
23.4 22.1 22.0 22.4

Total
21.4

Rural
21.1

Urban
21.6 20.6

22.9

21.7

21.5

21.8

21.5

22.0

20.9

21.0

20.2

19.7

19.7

20

15 Rajasthan Bihar Jharkhand Madhya Pradesh Chhattisgarh Uttar Pradesh Odisha Assam Uttarakhand

Mean age at marriage of females varies from 19.7 in Rajasthan to 22.0 years in Uttarakhand. Rural Urban differential is of at least 1.4 years in all AHS States. This is quite prominent (2.3 years) in Madhya Pradesh & Rajasthan.

19.1

19.5

19.7

19.8

20.5

20.6

21.4

23.2

25

Marriages among Females below Legal Age (18 yrs)

Based on marriages taken place during 2007-2009.
Marriages among Females below legal age (%)
30
21.0 20.2 21.7 21.9 11.1

Total 20

Rural

Urban
17.2 17.6

10.7

10.2

11.4

12.5

26.8

8.9

6.5

5.9

6.0

6.8

5.1

10
3.7
3.0 1.3

3.2

3.7

Uttarakhand

Odisha

Chhattisgarh

Uttar Pradesh

3.0

Assam

Madhya Pradesh

4.1

Jharkhand

8.4

Bihar

Rajasthan

Varies from 3.0% in Uttarakhand to 21.9% in Rajasthan. In rural areas, every 4th marriage among females in Rajasthan and every 5th in Bihar & Jharkhand take place below the legal age. Rural- Urban differential is quite significant across all AHS State.

9.0

Ante Natal Care (ANC)

Any ANC exceeds 80% in all AHS States. ANC in 1st trimester: 40% in UP & Bihar to 65% in Chhattisgarh and Madhya Pradesh.

Mothers receiving 3 or more ANCs: UP-29.6% to Orissa -76.0 %

Mothers who consumed IFA 100 days or more: 6.5% in UP to 23.8% in Chhattisgarh. Low performance in IFA consumption is the main reason for sluggish full ANC: 3.9% in UP to 19.5% in Chhattisgarh.

Full Ante Natal Check-up

Full ANC comprise 3 or more ANC, at least one TT injection and consumption of IFA for 100 or more days.
28.9 35 30 25 17.2 17.4 20 9.1 15 10 3.9 5 0 Uttar Pradesh Bihar Rajasthan Uttarakhand Assam Jharkhand Madhya Pradesh Odisha Chhattisgarh 2.8 Total Rural Urban

Full Ante Natal Check-up (%)

22.3

20.0

19.0

18.5

18.6

19.5

11.1

11.9

13.1

13.3

10.5

8.5

5.9

Uttar Pradesh reports the minimum coverage of 3.9%; Chhattisgarh, the maximum 19.5%.
Full ANC coverage in urban areas is remarkably better than the rural areas.

In 5 States, namely Bihar, UP, Rajasthan, Uttarakhand and Jharkhand urban coverage is more than double that of Rural.

4.7

6.1

8.3

10.4

10.9

16.9

18.0

26.5

Full Ante Natal Check-up

State Assam Bihar Jharkhand Madhya Pradesh Chhattisgarh Odisha Rajasthan Uttar Pradesh Uttarakhand

Contd
Range 16.1 14.0 28.1 28.9 23.6 30.6 17.8 14.3 19.0

Mothers who had full antenatal check-up (%) State value Minimum Maximum 11.9 Dhubri (2.1) Jorhat (18.2) 5.9 Madhepura (2.4) Patna (16.4) 13.1 Garhwa (3.6) Purbi Singhbhum (31.6) 13.3 Sheopur (1.8) Balaghat (30.8) 19.5 Korba (10.9) Dhamtari (34.5) 18.6 Jajpur (5.4) Jagatsinghpur (36.0) 8.5 Karauli (1.7) Jaipur (19.5) 3.9 Balrampur (0.6) Kanpur Nagar (14.8) 11.1 Rudra Prayag (3.7) Dehradun (22.7)

Bihar has reported the minimum variability among the districts compared to Odisha reporting the maximum. Less than 1% coverage of full ANC has been reported in Balrampur of Uttar Pradesh; on the other hand Jagatsinghpur of Odisha has reported the maximum 36%.

Full Ante Natal Check-up

State Assam Bihar Chhattisgarh Jharkhand Madhya Pradesh Odisha Rajasthan Uttar Pradesh Uttarakhand All States <5 6 17 0 3 7 0 7 52 2 94 5-10 7 17 0 7 11 3 16 15 7 83 10-15 6 2 4 4 10 7 7 3 2 45 15-20 4 1 4 3 7 10 2 0 1 32 20-25 0 0 5 0 6 3 0 0 1 15

Contd
25 & above Total Districts 0 0 3 1 4 7 0 0 0 15 23 37 16 18 45 30 32 70 13 284

Frequency distribution of the districts by level of full antenatal check up (%)

As high as 94 out of 284 districts report less than 5% coverage of full ANC. Only 15 districts namely Raigarh, Mahasamund, Dhamtari (Chhattisgarh), Purbi Singhbhum (Jharkhand), Indore, Bhopal, Narsimhapur, Balaghat (MP) and Jharsuguda, Mayurbhanj, Jagatsinghpur, Cuttack, Ganjam, Kandhamal, Naupada (Odisha) have reported 25% & above coverage of full ANC.

Ante Natal Check-up

Institutional Delivery
Institutional Delivery (%)
80 70 60 50 40 30 37.6 47.7 50.5 57.7 70.2 71.3 76.1
100 90 80 70 60 50 40 30

Share of Govt. & Private Hospitals in Total Instritutional Delivery

22.6 20.7 13.8 12.9

40.2 55.5

38.9

30.5

30.9

45.6

59.1 42.5

60.8

68.5

69.0

77.1

78.6

86.0

86.4

Private Govt.

34.9

20 10 0

Institutional Delivery: Ranges from 34.9% in Chhattisgarh to 76.1% in MP. More than 85% of total births have taken place in Govt. Institutions in Madhya Pradesh & Odisha and it is more than 60% in remaining States except Jharkhand & Uttarakhand. Jharkhand is the only State where more than 50% of the births are taking place in Private Hospitals.

Balrampur, UP

Indore, MP

Institutional delivery is below 60% in 170 districts.

Balrampur (UP) recorded the least 16.8% institutional delivery whereas Indore (MP) the most 92.5%, showing a variability of more than 5 times.

Safe Delivery
Safe delivery comprise institutional deliveries and domiciliary deliveries assisted by doctor/nurse/ANM/LHV. Safe Delivery (%)
100

90
80 70 60 50 47.1 39.0 49.5 44.3 51.3 48.4 75.1 73.4 64.7 53.5 77.6 73.0 70.1 67.7

86.9 81.9 75.2 73.3 76.2 72.8

88.6
82.2 78.4

92.8

56.9
51.4 49.4

40
30

Jharkhand

Chhattisgarh

Uttar Pradesh

Bihar

Uttarakhand

Assam

Odisha

Rajasthan

Madhya Pradesh

Safe Delivery: 47.1 % in Jharkhand to 82.2% in Madhya Pradesh. Rural- Urban differential is quite prominent in Jharkhand, Chhattisgarh and Uttarakhand.

Safe Delivery
Safe delivery (%) Minimum Karimganj, Hailakandi (34.8) Sheohar (30.2) Pakaur (24.8) Dindori (45.5) Surguja (32.6) Nabarangpur (35.6) Jaisalmer (48.6) Balrampur (22.0) Tehri Garhwal (43.1)

Contd

State Assam Bihar Jharkhand Madhya Pradesh Chhattisgarh Orissa Rajasthan Uttar Pradesh Uttarakhand

State value 70.1 53.5 47.1 82.2 49.5 75.2 76.2 51.3 56.9

Maximum Sibsagar (88.2) Munger (80.4) Purbi Singhbhum (69.0) Indore (96.3) Kanker (69.4) Puri (92.7) Jaipur (92.2) Jhansi (89.4) Nainital (79.5)

Range 53.4 50.2 44.2 50.9 36.8 57.1 43.6 67.4 36.4

Uttarakhand has exhibited the least variability among districts whereas Uttar Pradesh, the most.
Balrampur (UP) has reported the minimum against Indore (MP) reporting the maximum.

Safe Delivery

Contd

Frequency distribution of districts by safe delivery (%) State Assam Bihar Chhattisgarh Jharkhand Madhya Pradesh Odisha Rajasthan Uttar Pradesh Uttarakhand All States <30 0 0 0 3 0 0 0 4 0 7 30-50 2 12 9 9 1 3 1 20 3 60 50-70 12 19 7 6 5 5 8 39 7 108 70-90 9 6 0 0 29 20 21 7 3 95 90 & above 0 0 0 0 10 2 2 0 0 14 Total Districts 23 37 16 18 45 30 32 70 13 284

About 1/4th of the districts have reported less than 50% of the safe deliveries. Out of 14 districts reporting 90% & above safe deliveries, 10 belongs to Madhya Pradesh.

Janani Suraksha Yojana

70 60 50 40 53.9 54.1 53.1 30 44.8 45.8 30.4 30.6 26.9 26.7 27.3 28.7 20 21.7 21.8 18.2 14.6 15.8 9.3 13.5 10 0 17.8 21.6 40.1 61.1 Total Rural Urban 68.7

Mothers who availed Financial Assistance under JSY (%)

54.1

61.6

63.4

Jharkhand

Uttar Pradesh

Chhattisgarh

Uttarakhand

Bihar

Assam

Rajasthan

Madhya Pradesh

Odisha

Mothers availing JSY: 14.6% in Jharkhand to 61.6% in Odisha. Rural- Urban differential is acute in the States of Madhya Pradesh, Odisha and Jharkhand.

50.5

Post Natal Care

90 80 70 87.5 81.5 76.6 60 57.0 50 40 Assam Uttarakhand Jharkhand Bihar Chhattisgarh Uttar Pradesh Rajasthan Madhya Pradesh Odisha 79.1 82.6 85.4 85.9

Mothers who received Post-natal Check up within 48 hrs of delivery (%)

Total Rural Urban

74.9

74.9

73.3

74.2

74.5

70.0

68.4

64.8

60.8

59.1

59.1

53.1

Mothers receiving PNC within 48 hrs of delivery varies from 57% in Assam to 74.5% in Odisha.
50 40 30 42.9 30.9 34.4 35.8 36.9 20 26.3 26.0 26.0 28.1 22.1 23.0 23.2 19.6 21.1 12.1 39.6 40.5

51.0

Mothers who did not receive any Post-natal Check up (%)

Total Rural Urban

53.3

59.3

60.9

29.5

30.4

67.0

21.4

25.2

69.3

72.6

16.5

Odisha

Madhya Pradesh

Rajasthan

Chhattisgarh

10.3

10.4

10.5

Uttar Pradesh

Bihar

Jharkhand

Uttarakhand

16.1

10

Assam

At least 1 in every 5 mothers did not receive any post natal check up across all AHS States..

19.3

New Born Check up

90

New Born Checked up within 24 hrs of birth (%)

Total Rural Urban

80

70

86.1

81.3

75.3

74.7

74.7

74.9

70.0

73.1

68.2

66.8

65.0

52.6

55.3

55.9

51.2

51.4

40
Bihar Assam Jharkhand Uttarakhand Chhattisgarh Uttar Pradesh Rajasthan Madhya Pradesh Odisha

New born checked up within 24 hrs of birth exceeds 50% in all AHS States. It varies from 52.6% in Bihar to 74.9% in Odisha.

Significant Rural- Urban divide is noticed in Uttarakhand, Jharkhand, Assam and Chhattisgarh.

50.6

51.4

56.6

50

59.3

60.6

66.1

68.4

73.1

60

79.0

83.4

85.8

Full Immunization
Children are considered fully immunized when they have received vaccination against Tuberculosis, 3 doses of DPT & Polio and 1 dose of measles.
80 Total 70 60 77.3 78.7 75.4 70.8 71.4 50 54.9 40 30 Uttar Pradesh Madhya Pradesh Odisha Assam Jharkhand Bihar Rajasthan Chhattisgarh Uttarakhand 48.1 51.1 69.0 73.0 73.8 74.1 79.9 Rural Urban

Children aged 12-23 months fully immunized (%)

64.9

64.5

63.7

63.7

59.5

59.0

55.0

45.3

All States except Uttar Pradesh have at least half of their children aged 12-23 months fully immunized.
Uttar Pradesh reports the minimum percentage of children fully immunized whereas Uttarakhand, the maximum. Rural-Urban gap exceeds 10% in Madhya Pradesh & Jharkhand.

44.7

54.3

58.2

61.1

64.3

66.1

Full Immunization Contd

State Assam Bihar Jharkhand Madhya Pradesh Chhattisgarh Odisha Rajasthan Uttar Pradesh Uttarakhand Children age 12-23 months Fully Immunized (%) State value Minimum Maximum Range

59.0 64.5 63.7 54.9 74.1 55.0 70.8 45.3 75.4

Dhubri (29.9) Kishanganj (26.6) Giridih (28.0) Jhabua (23.8) Surguja (55.3) Rayagada (11.9) Dhaulpur (37.4) Etah (13.5) Haridwar (55.3)

Dibrugarh (83.8) Samastipur (83.9) Purbi Singhbhum (82.7) Indore (77.6) Kanker (93.2) Kendrapara (82) Hanumangarh (91.4) Basti (73.8) Pithoragarh (87.5)

53.9 57.3 54.8 53.9 37.9 70.0 54.0 60.3 32.2

The variability among the districts within a State ranges from 32.2% in Uttarakhand to 70.0% in Odisha. Across all 284 districts, the minimum has been observed in Rayagada of Odisha and the maximum in Kanker of Chhattisgarh.

Full Immunization Contd

Frequency distribution of districts by children age 12-23 months Fully immunized (%)

State
Assam Bihar Chhattisgarh Jharkhand Madhya Pradesh Odisha Rajasthan Uttar Pradesh Uttarakhand All States

0-30 1 1 0 1 2 8 0 11 0 24

30-50 4 2 0 4 14 7 4 31 0 66

50-70 14 23 6 7 24 6 10 20 2 112

70-90 4 11 9 6 5 9 17 8 11 80

90 & above 0 0 1 0 0 0 1 0 0 2

Total Districts 23 37 16 18 45 30 32 70 13 284

90 districts are below 50% level of full immunization. Only 2 districts 1 each from Chhattisgarh & Rajasthan feature in 90% & above category.

100

Children age 12-23 months who have received BCG(%)

96.8 97.5 90 85 80 75 70

Children age 12-23 months who have received 3 doses of Polio vaccine(%) 82.3 83.2

95 90.6 90 91.8 91.9

93.3

93.9

94.2

74.7 69.4

75.5

77.5

78.1

79.9

85

83.4

65 60

58.5

80
55 75 50

Constituents of full immunization

Children age 12-23 months who have received 3 doses of DPT vaccine(%) Children age 12-23 months who have received Measles vaccine (%)

90 80

90 83.0 79.0 80.7 81.8 82.6

86.7 77.3

87.9

77.0 71.8 72.2 72.9 66.6 55.9

78.7

81.6

80

75.7

70
60 50

70 60.5 60

50

FULL IMMUNIZATION

Full Immunization Contd

Vitamin A Supplementation to Children

Children aged 6-35 months who received a Vitamin A dose during last six months (%)
80 71.7 70 60 50 40 30 37.2 59.4 54.5 55.0 60.1 61.9 63.4 72.0

At least every 2nd child aged 6-35 months has received Vitamin A supplement in all AHS States except Uttar Pradesh where it is every 3rd child.

IFA Supplement to Children

Children aged 6-35 months who received IFA tablet/syrup during last 3 months (%)

40
30 20 10 0 9.4 10.6 27.7 29.0

37.7

23.3 14.2 14.3

24.8

IFA supplement to children aged 6-35 months during last 3 months ranges from 9.4 in Rajasthan to 37.7% in Chhattisgarh.
Situation merit attention across all AHS States however it is quite alarming in Rajasthan & Uttar Pradesh.

Breast Feeding Practices

Children under 3 Years breastfed within one hour of birth (%)
80 69.6 61.5 60 48.6 63.2 63.9 71.5

70

50

40 30.3 30 32.9

37.9

20

Bihar & UP and Assam & Odisha constitute 2 extremes.

Breast Feeding Practices

Children age 6-35 months exclusively breastfed for at least six months (%)

50 45.6

47.5

40

36.8

38.2

39.2

30 24.7 20 17.7 24.8

28.5

10

Children exclusively breastfed for at least 6 months ranges from 17.7 in UP to 47.5 % in Chhattisgarh.

KEY FINDINGS
Replacement level of TFR 2.1 has been achieved in only 20 out of 284 AHS districts.

In 164 districts, on an average a woman bears more than 3 children.

More than half of currently married woman aged 15-49 years are not using any method of family planning in UP, Jharkhand and Bihar. Female Sterilization constitutes the most dominant method of family planning among the modern methods across all AHS States except Assam. Male Sterilization is the least preferred modern method across all AHS States. At least 1/5th of currently married women are yet to meet their family planning requirement (Unmet Need) across all AHS States.

KEY FINDINGS

Contd

Marriages among female taking place below legal age (18 years) is rampant in rural areas as compared to urban areas. Despite wider penetration of `Any ANC, the coverage under `first trimester ANC as well as `3 or more ANCs needs further improvement. Poor performance of full ANC is primarily due to low IFA consumption. Universal coverage of JSY remains a concern even in better performing States like Odisha, MP & Rajasthan; the situation in Jharkhand & UP needs immediate attention. Seven out of every 10 deliveries are `safe in Madhya Pradesh, Rajasthan, Odisha and Assam whereas it is less than 5 in Jharkhand and Chhattisgarh.

KEY FINDINGS

Contd

In spite of better reach of Post Natal Care to Mothers and New-borns in Odisha, MP & Rajasthan, every fifth mother has not received any PNC. In full immunization, even the better performing States like Uttarakhand, Chhattisgarh and Rajasthan fall short by 25-30 percentage points in achieving universal coverage. Improvement has been noticed in most of the indicators as compared to NFHS-3 as well as DLHS-3. Availability of 63 indicators (co-variates) on various facets of Mother & Child Care at the district level will help in understanding the dynamics of composite indicators like IMR, U5MR and MMR. For the first time, the data on TFR, Injury, Morbidity, Personal Habits are available at the district level. This would provide new insight in evidence-based planning and facilitate appropriate interventional strategies.

WAY FORWARD
The fieldwork for 1st updation round is over and the indicators on vital rates reflecting the change vis--vis baseline survey are likely to be released shortly.

A Component of Clinical-Anthropometric & Bio-chemical (CAB) Test on a sub-sample basis is scheduled to be introduced in October.