Coverage Evaluation Survey - 2002 - IPPI, Routine Immunization and Maternal Care - National Report

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Coverage Evaluation Survey - 2002
IPPI, Routine Immunization and Maternal Care
National Report
Department of Family Welfare, Organized by Unicef, India Country Office

Ministry of Health and Family Welfare Funded by USAID and Japan Government
Government of India, Nirman Bhavan, New Delhi
CES-02 INDIA - FINAL REPORT

TABLE OF CONTENTS
1 EXECUTIVE SUMMARY ......................................................................................................................................7
INTRODUCTION.........................................................................................................................................................17
2 INTRODUCTION ..................................................................................................................................................18
2.1 RESEARCH OBJECTIVES ...................................................................................................................................19
2.2 RESEARCH DESIGN..........................................................................................................................................20
2.2.1 Universe....................................................................................................................................................20
2.2.2 Respondents ..............................................................................................................................................20
2.2.3 Sampling Design.......................................................................................................................................21
Qualitative Sampling Design ....................................................................................................................................23
2.2.4 Universe....................................................................................................................................................23
2.2.5 Respondents ..............................................................................................................................................24
2.2.6 Sample Distribution ..................................................................................................................................24
2.2.7 Weights .....................................................................................................................................................24
2.2.8 Recruitment, Training and Fieldwork.......................................................................................................25
DETAILED FINDINGS ...............................................................................................................................................26
QUANTITATIVE .........................................................................................................................................................26
3 RESPONDENT PROFILE ....................................................................................................................................27

3.1 PRIMARY CARE TAKER ....................................................................................................................................27
3.2 PRIMARY CARETAKER’S EDUCATION ..............................................................................................................28
3.3 EDUCATION OF THE FATHER.............................................................................................................................29
3.4 BACKGROUND CHARACTERISTICS OF THE SAMPLE COVERED ..........................................................................30
4 INTENSIFIED PULSE POLIO IMMUNIZATION............................................................................................31
4.1 DISTANCE OF THE PPI BOOTH..........................................................................................................................31
4.2 COVERAGE BY DOSES .......................................................................................................................................33
4.3 COVERAGE ACROSS STATES ..........................................................................................................................35
4.4 COVERAGE BY ROUNDS ....................................................................................................................................36
4.4.1 Reach by rounds by age categories ..........................................................................................................37
4.5 COVERAGE BY ROUND ACROSS STATES ..........................................................................................................38
4.6 IPPI COVERAGE OF CHILDREN ABOVE 5 YEARS OF AGE ..................................................................................39
4.7 ZERO DOSE CHILDREN .....................................................................................................................................40
4.7.1 Zero dose children by age cohorts............................................................................................................42
4.8 ZERO DOSE CHILDREN BY STATES ..................................................................................................................43
4.9 PLACE WHERE DOSAGE WERE ADMINISTERED ...............................................................................................43
4.9.1 Place of administration of doses by States................................................................................................45
4.10 REASONS FOR NOT RECEIVING ONE OR MORE DOSES ......................................................................................46
4.10.1 Reasons for non compliance amongst campaign zero dose children........................................................49
4.10.2 Reasons for non compliance among lifetime zero dose children ............................................................51
4.11 SOURCE OF KNOWLEDGE .................................................................................................................................52
4.12 ADVICE ON VACCIANTION OTHER THAN POLIO ................................................................................................56
4.13 PERCEPTION REGARDING THE IMPORTANCE OF ROUTINE IMMUNIZATION .......................................................57
4.14 KNOWLEDGE ABOUT THE SYMPTOMS OF POLIO LIKE DISEASE.........................................................................58
4.15 KNOWLEDGE REGARDING THE PLACE TO REPORT THE OCCURRENCE OF POLIO ..............................................59
5 NUTRIENTS...........................................................................................................................................................60
5.1 VITAMIN A SUPPLEMENT .................................................................................................................................60
5.2 IFA SUPLLEMENT ...........................................................................................................................................63
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6 ROUTINE IMMUNIZATION...............................................................................................................................65
6.1 ROUTINE IMMUNIZATION SESSIONS .................................................................................................................65
6.2 IMMUNIZATION CARD ......................................................................................................................................68
6.3 ROUTINE IMMUNIZATION SESSIONS BY STATES ..............................................................................................69
6.4 BCG VACCINATION .........................................................................................................................................70
6.5 DPT VACCINATION..........................................................................................................................................71
6.6 OPV VACCINATION .........................................................................................................................................73
6.7 MEASLES VACCINATION ..................................................................................................................................75
6.8 FULLY VACCINATED .......................................................................................................................................77
6.8.1 Vaccines received across States................................................................................................................79
6.8.2 Correlation of Coverage with Access to Immunization Service................................................................81
6.8.3 Timeliness of Immunization ......................................................................................................................82
6.9 PLACE OF IMMUNIZATION ................................................................................................................................83
6.9.1 Source of immunization services across states .........................................................................................85
6.10 REASONS FOR NON COMPLIANCE ....................................................................................................................86
7 INJECTION SAFETY ...........................................................................................................................................88
7.1 INJECTIONS SAFETY .........................................................................................................................................88
7.2 INJECTION SAFETY ACROSS STATES .................................................................................................................89
8 MATERNAL CARE...............................................................................................................................................90
8.1 AGE AT FIRST PREGNANCY ...............................................................................................................................90
8.1.1 Pregnancy wastage and children surviving ..............................................................................................91
8.1.2 Pregnancy details across states ................................................................................................................92
8.2 ANTENATAL CARE ...........................................................................................................................................93
8.2.1 ANC across states .....................................................................................................................................95
8.2.2 ANC Service Provider...............................................................................................................................95
8.3 ANC SERVICE PROVIDER BY STATES ..............................................................................................................96
8.3.1 Components of Antenatal Care.................................................................................................................97
8.3.2 Components of Antenatal Care by state....................................................................................................98
8.3.3 TT Immunization.......................................................................................................................................99
8.3.4 TT Coverage by State..............................................................................................................................100
8.4 IRON FOLIC ACID (IFA) SUPPLEMENT...........................................................................................................101
8.4.1 IFA coverage by state .............................................................................................................................102
8.4.2 Source of receiving IFA ..........................................................................................................................103
8.4.3 Source of receiving IFA tablets by State.................................................................................................104
8.5 NIGHT BLINDNESS .........................................................................................................................................105
8.6 NIGHT BLINDNESS ACROSS STATES ..............................................................................................................106
8.7 KNOWLEDGE ABOUT COMPLICATIONS DURING PREGNANCY.........................................................................106
8.7.1 Knowledge about Complications during Pregnancy by State.................................................................109
8.8 KNOWLEDGE ABOUT THE PLACE OF CONSULTATION FOR PREGNANCY COMPLICATIONS ...............................110
8.9 COMPLICATIONS EXPERIENCED DURING PREGNANCY ....................................................................................112
8.10 COMPLICATION EXPERIENCED DURING DELIVERY ..........................................................................................115
8.11 PLACE OF DELIVERY AND ASSISTANCE AT DELIVERY ...................................................................................116
8.11.1 Nature of delivery ...................................................................................................................................120
8.11.2 Delivery Details across States ................................................................................................................121
8.11.3 Clean Delivery Practices at Home..........................................................................................................122
8.11.4 Clean Delivery Practices at home by States ...........................................................................................124
8.12 POSTNATAL CARE ..........................................................................................................................................125
8.14 INITIATION OF BREAST FEEDING ....................................................................................................................127
8.14.1 Initiation of Breast feeding by state ........................................................................................................129
8.15 IMMUNIZATION STATUS OF INFANTS..............................................................................................................130
8.15.1 Immunization Status of Infants by State..................................................................................................131
9 HIGH-RISK DISTRICTS....................................................................................................................................132
9.1 PULSE POLIO IMMUNIZATION.........................................................................................................................132
9.1.1 PPI Coverage..........................................................................................................................................132
9.1.2 Dosage received......................................................................................................................................133
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9.1.3 Zero dose cases.......................................................................................................................................134
9.1.4 Reasons for not receiving one or more IPPI doses.................................................................................135
9.1.5 Source of Knowledge ..............................................................................................................................136
9.1.6 Nutrients .................................................................................................................................................138
9.2 ROUTINE IMMUNIZATION ...............................................................................................................................139
9.2.1 Routine Immunization Sessions...............................................................................................................139
9.2.2 Routine Immunization Coverage.............................................................................................................140
9.2.3 Source of Immunization ..........................................................................................................................141
9.2.4 Reasons for Non Compliance..................................................................................................................143
9.2.5 Injection safety........................................................................................................................................144
9.3 MATERNAL CARE ..........................................................................................................................................145
9.3.1 Pregnancy details ...................................................................................................................................145
9.3.2 ANC received ..........................................................................................................................................146
9.3.3 ANC Service Provider.............................................................................................................................146
9.3.4 Details of ANC........................................................................................................................................148
9.3.5 TT Coverage ...........................................................................................................................................149
9.3.6 IFA tablets ..............................................................................................................................................150
9.3.7 Source of receiving IFA tablets...............................................................................................................151
9.3.8 Night Blindness .......................................................................................................................................152
9.3.9 Knowledge about pregnancy complication.............................................................................................153
9.3.10 Birth Attendance .....................................................................................................................................154
9.3.11 Clean Deliveries .....................................................................................................................................155
9.3.12 Postnatal checkups .................................................................................................................................156
9.3.13 Breast Feeding practice..........................................................................................................................157
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Fact Sheet
S.NO. INDICATORS COVERAGE (%)

NATIONAL RURAL URBAN
1 IPPI Coverage by Rounds

2nd December 2001(NID) 93.6 92.7 96.4
20th January 2002 (NID) 96.1 95.7 97.3
2 Coverage for At least 2 Doses 95.6 95.2 96.7
3 Campaign Zero Doser 2.9 3.3 1.6
4 Life time Zero Doser 0.9 1.1 0.5
5 Booth Coverage by Round
2nd December 2001(NID) 85.5 84.5 88.6
20th January 2002 (NID) 85.4 84.3 88.7
6 Advised on Vaccinations Other Than Polio during 20.5 20.6 20.2
PPI sessions
7 Knowledge on Importance of Routine Immunization 81.4 80.2 85.1
8 Immunization Session at least once a month on a 51.5 51.2 52.2
particular day
9 Immunization Site not very far 71.1 70.5 72.7
10 Possession of Immunization Card 53.8 48.5 68.9
11 Coverage by Antigens
BCG 74.0 69.0 88.3
DPT1 70.6 65.4 85.3
DPT2 67.1 61.4 83.2
DPT3 63.8 58.0 80.5
OPV1 75.1 70.6 88.0
OPV2 71.5 66.5 85.8
OPV3 68.3 63.0 83.5
Measles 61.4 55.4 78.3
DPT Booster 43.2 39.1 54.8
12 Coverage
Fully Vaccinated 56.6 50.3 74.4
Partially Vaccinated 23.6 26.1 16.7
Not Vaccinated 19.8 23.7 8.9
13 Vitamin A Coverage1
1 dose 26.0 23.2 34.1
2-3 doses 11.1 10.9 11.9
4+ doses 2.3 2.3 2.4
14 IFA Coverage Among U5 Children 10.3 10.5 9.8
15 Ante Natal Contact in First Trimester 42.6 36.7 55.9
16 At least 3 Ante Natal Contacts 55.0 45.7 76.3
17 Components of ANC
Abdominal Check-up (at least 3 times) 35.5 27.7 53.3
Weight taken (at least 3 times) 32.4 25.0 49.4
BP Check-up (at least 3 times) 32.6 25.3 49.2
18 TT2/Booster Coverage 78.3 74.6 86.9
19 IFA Coverage (90+ consumed) 13.6 11.2 19.3
20 Prevalence of Night Blindness 11.9 14.5 6.0
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Base: All children above 9 months
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S.NO. INDICATORS COVERAGE (%)
NATIONAL RURAL URBAN
21 Knowledge of Pregnancy complications 69.8 66.6 77.2
22 Experience of Pregnancy complications 52.3 50.2 56.9
23 Service delivery point visited during pregnancy 81.4 77.4 89.4
complication2s
24 Place of Delivery
Govt. Health Institution 25.2 18.8 39.8
Private Health Institution 23.5 17.1 38.1
Home 51.0 63.7 22.1
Others 0.2 0.3 0.0
25 Delivery Assistance at institution3
Govt. Doctor 42.2 44.1 40.2
Pvt. Doctor 42.3 40.5 44.1
Nurse/LHV 12.3 12.4 12.3
ANM 2.0 1.5 2.5
26 Delivery Assistance at Home4
Govt. Doctor 1.0 1.1 0.7
Pvt. Doctor 5.0 4.7 7.2
LHV/Nurse 3.9 3.5 6.7
ANM 4.1 3.9 5.6
Trained Dai 11.4 11.3 12.1
Untrained Dai 43.2 43.7 39.8
Friends/Relatives 29.4 29.7 27.3
27 Caesarian Section 8.9 6.2 15.1
28 At least 3 Post Natal Check-up 18.6 14.1 28.5
29 Breastfeeding within 2hrs. of delivery 28.9 26.9 33.6
30 Percentage of women who fed colustrum 60.0 56.9 66.9
31 Knowledge of number of times visited for Routine
Immunization
Less than five 10.4 9.7 11.9
Five to six 14.5 12.6 18.6
More than six 10.5 8.3 15.5
Would go whenever are asked to 15.0 14.4 16.4
Don't know 48.5 53.9 36.1
32 Safe Injection Practices during Immunization 48.1 41.3 67.5
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Base : All women who had experienced a complication during pregnancy
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Base: All women who delivered had an Institutional delivery
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Base: All women who delivered at home
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1 EXECUTIVE SUMMARY
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BACKGROUND
The Government of India launched the Pulse Polio Immunization Program, in an effort to eradicate
Polio from the country and to free children from the danger of this dreaded disease. To achieve this
objective, children below the ages of 5 years are administered supplementary Polio drops during
National Immunization Days (NIDs). Besides these, some High-risk states have been identified,
depending on the consistent occurrence of wild polio cases, where additional doses are administered
on SNIDs. The program is now in its seventh year of implementation. The Government of India had
entrusted UNICEF to assess the reach, coverage and peoples response to this program each year.
Routine immunization being one of the four pillars of polio eradication, this opportunity was utilized to
assess the coverage level of routine immunization. In addition, maternal care component was also
included in this evaluation.
UNICEF engaged professional research agency through competitive bidding to carryout Coverage
Evaluation Survey for IPPI, RI and Maternal Care.
APPROACH
The CES was conducted in 18 states covering around 85% of the country’s target population. In
addition, 4 districts and 6 cluster of districts of UP and Bihar were also evaluated to understand the
reasons for non-compliance of some of the families. The evaluation covered three broad areas of IPPI,
Routine Immunization and Maternal Care. This is the executive summary of the national, state
and district findings.
SAMPLE SIZE
In select major states, a total of 540 clusters were selected using random cluster sampling technique.
Of these, 270 were Rural clusters and 270 were Urban clusters. In these clusters a total of
• 10800 mothers/ primary care takers of children up to the age of 5 years, born between 27th
January 1997 to 26th Jan 2002 for IPPI.
• 4320 mothers/ primary care takers of 12-23 months old children, born between 27th January 2000
-26th January 2001 for Routine Immunization.
• 4320 women whose pregnancy of at least 28 weeks completed/terminated between 27/1/2001 and
26/1/2002 were interviewed for Maternal Care.
In specially identified districts, a total of 360 clusters (210 - Rural and 150 – Urban) were selected. In
these clusters a total of
• 7200 mothers/ primary care takers of children up to the age of 5 years for IPPI.
• 2880 mothers/ primary care takers of 12-23 months old children for Routine Immunization.
• 2880 women whose pregnancy of at least 28 weeks completed/terminated between 27/1/2001 and
26/1/2002 were interviewed for Maternal Care.
Data was collected during the month of July and August 2002.
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NATIONAL AND STATES FINDINGS
INTENSIFIED PULSE POLIO IMMUNIZATION
REACH AND COVERAGE OF IPPI:

Reach is defined as the proportion of the eligible children who had received at least one dose of OPV
through the IPPI campaign. Overall 97.1% of the children were reached during the campaign. The
coverage for at least 2 doses was 95.6%. Analysis by age cohort revealed that coverage was
significantly higher among older children ( 4+ months old – 94-97%) as compared to 0-3 months
children (86%), indicating risk to younger infants.
It is observed that the coverage for at least two doses was significantly higher in Andhra Pradesh,
Delhi, Karnataka, Madhya Pradesh, Punjab, Tamil Nadu and Uttaranchal (around 97%). However this
coverage in states like Assam, Jharkhand and Rajasthan is much lower (80-88%) than the national
average level thus indicating a need for large scale concentrated efforts in these states to minimise the
risk of re-emergence of polio.
COVERAGE BY ROUNDS:
The national coverage significantly increased from 93.6% in December 01 NID to 96.1% in January 02.
The improvement in January round was mostly in rural areas and among Muslims, which could be
attributed to intensive mobilisation efforts among minority community. The same had also led to
improvement in coverage among children of illiterate parents.
Over the two rounds, coverage increased by 2 points, which is significant in AP and Bihar, while
dropped by 3 point in Jharkhand in January NID compared to December.
IPPI COVERAGE OF >5 YEARS:

At national level, among those children who received OPV doses during IPPI campaign, 9% were
above 5 years of age.
ZERO DOSE CHILDREN:

Overall 2.9% of children had not received any dose during 2001-02 IPPI cycle, while 1% had never
received OPV drop. Among 0-3 months children, 11.9% were zero doser, while 3.5% among 4-6
months and 1.8% among 7-11 months. The overall zero dose proportion among under 1 year was
5.2%. In other age groups 2-3% of the target children were Zero dosers.
Out of the total children unreached during 2001-02 IPPI cycle, 0-3 months children alone contributed
24% of the total Zero dose cases. Children under 1 contributed 37% of zero doser, while contribution
from rest of the age cohort was between 15-18%.
The proportion of Zero dose case during current campaign was reported to be significantly higher, than
the national level, in Assam (11%) and Rajasthan (8%). However, in the states of Karnataka, Punjab,
Madhya Pradesh, Tamil Nadu and Uttaranchal the proportion of Zero dosers was significantly lower
(<1%) as compared to the national average.
PLACE WHERE DOSES WERE ADMINISTERED:
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Majority of the respondents (82%) got their children Polio drops administered only at the booth. Nearly
11% children received PPI doses at home. The HtH campaign benefited higher proportion of children
in rural areas, among Muslim, non-SC/ST, illiterate and young children of 0-3 months age. Analysis by
state revealed that sizeable proportion of children in Uttar Pradesh (24%), Rajasthan (22%), Bihar
(19%), Delhi (17%), Uttaranchal (17%), Haryana (15%) and Jharkhand (16%) received all OPV doses
at home.
REASONS FOR NOT RECEIVING ONE OR MORE IPPI DOSES:

Overall 6.1% children missed one or more PPI dose. Of these equal proportions were from Rural and
Urban areas. For these children, “Lack of motivation" was the main reason for non-compliance (61%).
This included reasons such as "No one came to my house" or "There was no one to take the child to
the booth", indicating an overall inertia towards the programme. Also a belief that the child was too
young exists and is the highest for the 0-3 months age cohort. The other reasons that got mentioned
were “lack of awareness (39%)” i.e. "not aware of place of booth or when they would come home".
SOURCE OF INFORMATION:
Overall, interpersonal communications were mentioned by 78% of the people. Amongst these, Health
Workers (42%) were most active informants followed by Anganwadi workers (28%) and
Relatives/friends (19%). Teachers too seem to be active informants with 15% respondents mentioning
them as source of information.
In Karnataka and Assam nearly 92% of the respondents mentioned interpersonal sources as source of
information. The other states where the mention of interpersonal sources was significantly higher than
the national average were – Gujarat, Haryana, Jharkhand, Kerala, Madhya Pradesh, Maharashtra,
Rajasthan and Tamil Nadu.
Overall, Mass media reached 46% of the target population. Amongst the mass media methods,
Mike/Drumbeating (24%) emerged to be the major source of information followed closely by TV (22%).
Radio was mentioned by 8% of the respondents whereas Newspaper/Magazine and Wall paintings
were mentioned by 5%.
In Punjab nearly 90% of the population was reached by mass media, whereas in West Bengal and
Delhi, nearly three fourth of the respondents were reached by this. The reach of mass media was quite
low in the states of Bihar, Gujarat and Jharkhand.
PERCEPTION REGARDING THE IMPORTANCE OF ROUTINE IMMUNIZATION:

Overall 81% of the respondents reported that in addition to polio drops during IPPI campaign, other
vaccination was also necessary. Only 21%, of the respondents reported that during the PPI campaign
they were advised on the need of other vaccination.
KNOWLEDGE ABOUT THE SYMPTOMS OF POLIO LIKE DISEASE (AFP) AND REPORTING
NEED:
37% mentioned weakness of limbs, while around 7% of respondents referred no movement of limbs as
the symptom of polio like disease. Another 8% mentioned fever followed by sudden weakness of limbs
as the symptom. 44% of the respondents were not aware of any symptom. Percentage of such
respondents was significantly higher in rural areas, among SC/ST and illiterate population.
Nearly two third of the respondents mentioned that they would report the Polio case in the close by
Govt. /Municipal Hospital followed by 29% who said that they would report in the close by Private
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hospital /Private Clinic. PHC/Sub centre was mentioned by only 14% of the respondents.
NUTRIENTS
VITAMIN A SUPPLEMENT:
Close to 40% of the children in age group 9-59 months have received at least first dose of Vitamin A.
The proportion of such children was significantly higher in Urban areas, among Christian, ST and
literate parents compared to Rural, Muslim, SC and illiterate.
Amongst those who received Vitamin A, 66% received only one dose, 28% 2-3 doses, while 6%
received more than 4 doses. Analysis by age revealed that 34 to 42% of the children in different single
year age cohort have received at least first dose of Vitamin A. Among total 12-23months children
surveyed, 12% received 2-3 doses, while among older age cohort, 2-3% received 4 or more doses.
IFA SUPPLEMENT:
At national level only 10% of children in age group 9-59 months have ever received IFA
Tablets/Syrups. Among these, only 3% had consumed more than 100 tablets in last one year.
ROUTINE IMMUNIZATION
AVAILABILITY OF IMMUNIZATION SERVICES:

In 82% of the clusters, key informants reported that Routine Immunization session was held within the
cluster/area, while 76% (75% in Rural and 80% in Urban) of the respondents reported this. This
percentage was significantly higher than previous year (62%) indicating the improved efforts in the
corresponding years. Only 52% of the respondents reported that at least monthly session was
organised on a particular day in their cluster.
In Madhya Pradesh, 100% respondents reported that RI sessions were held in their cluster/area,
followed by Chattisgarh (96%) and West Bengal (97%) respectively. Percentage of such respondents
was lowest in Bihar (33%).
AVAILABILITY OF IMMUNIZATION CARDS:

Overall, 54% of the respondents mentioned that they have an Immunization Card or some written
document. Presence of Immunization cards was high in Kerala (96%) and West Bengal (94%). The
evidence of RI services being availed (Immunization cards) was found with around one third of the
respondents in UP (27%), Rajasthan (32%) and Bihar (33%).
BCG VACCINATION:
Overall 74% of children had received BCG, and 75% of them had scar. Only 64% of those who were
administered the BCG had received it in the first month of birth while 29% received it within 2-6 months
after birth.
DPT VACCINATION:
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71% of children had received DPT 1 while this figure fell to 67% for DPT 2 and 64% for DPT 3. The
drop out ratio from the first to the third dose was close to 10%.
Close to 66% of the children received DPT1 within 1½ -2 months after birth. The proportion who
received all three doses of DPT with a gap of one month was about 65%.
OPV VACCINATION:
Overall, 75% of children in age 12-23 months received OPV1 dose under Routine Immunization. The
proportion of OPV2 came down to 72% and further down to 68% for OPV3. The drop out ratio from
OPV1 to OPV3 was 9%.
Close to 66% of the children received OPV1 within 1½ -2 months after birth and the proportion of
children who received the OPV with a gap of one month was 65%.
MEASLES VACCINATION:
Overall, 61% of the children in the age group of 12-23 months were given the measles vaccination.
Close to 88% of them received the measles vaccination at the recommended age of 9-12 months.
FULLY IMMUNISED
Overall, 57% of the children had received all vaccines, while 50% received all vaccines before
completion of 12 months of age. These proportions increased significantly compared to previous year
(fully vaccinated increased from 50% to 57% while fully vaccinated by 12 months of age
increased from 44% to 50%). Analysis by background characteristics revealed that significantly
higher proportion of children from Urban areas (68%), belonging to Hindu families (51%) and literate
parents (55-86%) received all vaccines before 12 months compared to Rural (44%), Muslim (40%) and
illiterate (27%).
The results showed strong correlation between access and utilization of services. Percentage of fully
vaccinated among those who reported at least monthly session in their cluster/area was 67%, which
was 33% among those who had reported less than monthly sessions in their cluster/area.
In states like Andhra Pradesh, Madhya Pradesh, Kerala, Delhi, Karnataka, Maharashtra, Punjab,
Tamilnadu and West Bengal more than 70% children were reported to be fully immunised. However, in
only four states, namely Tamilnadu, Maharastra, Karnataka and Kerala more than 70% were
immunised before 12 months.
In Rajasthan (20%), Uttar Pradesh (27%), Bihar (13%) and Jharkhand (26%), less than one third of the
children were fully immunised.
Compared to the previous year, percentage of fully vaccinated children increased significantly in
Andhra Pradesh (42% to 72%), Karnataka (60% to 81%), Madhya Pradesh (50% to 77%), Uttar
Pradesh (46% to 59%) and West Bengal (56% to 78%) while declined in Rajasthan (30% to 20%).
PLACE OF IMMUNISATION:
Govt. /Municipal hospitals were the most frequently accessed source for Immunization services with
37% accessing them. PHC/ UHFWC were accessed by 16% of the respondents and Private hospitals
by (10%). Outreach sessions catered to 32% of the respondents.
In Karnataka, Kerala and Maharashtra, 50-60% of the respondents accessed Govt./ Municipal
Hospitals, while in Assam (51%), Chattisgarh (73%), Haryana (58%) and Punjab (50%), majority got
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their child vaccinated in outreach sessions. Private sector contributed significantly in Delhi (21%) and
Kerala (25%).
REASONS FOR NON COMPLIANCE:

Overall 33% of the eligible children did not receive all vaccines and the main reason mentioned was
“lack of awareness”. This includes reasons such as- “not aware of the need of all vaccinations (58%)”,
and “not aware of time /place of vaccination (28%).
For 12% of the children, lack of motivation was the main reason for not completing the primary
vaccination. “Fear /rumour of side effects” (4%) and “ fear of getting diseases” (6%) were the two major
obstacles which were mentioned and this fears were higher amongst Muslims.
Looking across states, in Jharkhand, Karnataka, Madhya Pradesh, Rajasthan and Haryana, 75%-85%
of the non-compliers were not aware of the need of all vaccinations.
SAFE INJECTION PRACTICES

It was surprising to note that despite large supply of sterilisation equipment, only 5% of the respondents
reported the use of Autoclave / double rack steriliser. Overall, 42% mentioned the use of Disposable
syringes, while only 7% reported “Boiling in a saucepan for at least 20 minutes”.
At national level after disposable syringes, the next most common practice followed was cleaning the
syringes and needles in once boiled water (13%). It is a concerning issue. Even the use of disposable
syringes does not ensure injection safety.
Use of disposable syringes was more than 70% in Delhi and Haryana, between 60-70% in Jharkhand,
Punjab, Rajasthan and Uttaranchal, while it was lowest in Madhya Pradesh (18%). Use of equipment
supplied under immunization programme (autoclave and double rack sterilizer) were reported by more
than 10% of the respondents only in Gujarat, Karnataka, Maharashtra and West Bengal. In Andhra
Pradesh, Assam, Karnataka and West Bengal, more than 15% of the children were vaccinated by
syringes and needles boiled in saucepan for 20 minutes.
Across states, Unsafe injection practises were reported by more than one fourth of the respondents in
Tamilnadu (34%), Uttaranchal (27%) and Uttar Pradesh (30%) closely followed by Bihar (24%). This
proportion was lowest for Gujarat and Punjab at 2%.
MATERNAL CARE
ANTENATAL CARE:
Overall, 77% of the women received at least one antenatal check up (ANC1). This was significantly
higher in Urban areas (91%), among non-ST/ST (79%) and women staying with their own parents
(87%). Year of schooling shown strong correlation with the ANC1 coverage. It increased from 61%
among illiterate to 97% among women of 15+ years of schooling.
Nationally, 42% of the pregnant women received check up in first trimester, while 55% received it al
least thrice. Compared with the previous year’s data, ANC3 coverage remained more or less the same.
ANC3+ was over 80% in Andhra Pradesh, Karnataka, Kerala and Tamil Nadu. Whereas, it was less
than 30% in Bihar, Rajasthan and Uttar Pradesh.
Amongst the women who had received ANC, 44% accessed Private physicians, while 37% Govt.
12
doctors. ANM catered to 12% and LHV 11% of those women.
COMPONENTS OF ANTE NATAL CARE:

Nearly 63% of the women confirmed that the fundal examination was done during ANC visit. Amongst
these 56% had this thrice or more. Overall, blood pressure of 58% of the pregnant women was
checked and among these, 56% was checked at least thrice. The weight of 51% of the respondents
was taken and was taken at least thrice for 64% of them. Overall only 21% of the women had
undergone all these three check-ups at least thrice. Data revealed that location, caste and religion
influenced quality and frequency of antenatal check-ups.
TT IMMUNISATION:
78% of the respondents received TT2/Booster, which was significantly higher in urban (87%)
compared to rural (75%). Data revealed that ST, Hindu and Muslim women were poorly covered.
Among the vaccinated women, 49% accessed the Govt. health services for TT Immunization while
29% utilised Private health services. Both Govt. and Private facilities were equally accessed in Urban
areas.
In West Bengal, Tamil Nadu, and Kerala the proportion receiving TT2 booster was more than 90%. In
Rajasthan, Uttar Pradesh, Jharkhand, Andhra Pradesh and Bihar, less than 70% of pregnant women
were protect against tetanus.
In states like Andhra Pradesh, Karnataka, Punjab and Kerala more than 40% of the respondents
reported to have received TT immunization from private physicians. Interestingly, in Bihar close to one
fifth of the respondents mentioned Chemists.
IFA SUPPLEMENTS:
65% of the pregnant women received IFA tablets, which was significantly higher in Urban areas (76%),
among Hindus (67%), those staying with own parents (72%) and educated (64-91%).
Countrywide, only 19% of the beneficiaries received the recommended number of 90-100 tablets and
14% consumed it, indicating the need of proper follow-up and counseling. Consumption of more than
90 tablets was highest among women (47%) with 15+ years of schooling. Among the study states, this
was highest in Kerala (59%) distantly followed by Delhi (34%) and Tamil Nadu (32%).
Majority (70%) of the respondents received it from Government health/ICDS centres. Among the
various government health/ICDS centres, 35% received from hospital followed by outreach sessions
(21%) and PHC (10%). Around 6% of the pregnant women received IFA tablets from AWCs.
KNOWLEDGE ABOUT COMPLICATIONS DURING PREGNANCY:

More than 30% of the respondents reported “Severe Weakness” (34%), “Swelling of face/feet” (32%)
as the pregnancy complication, followed by “Severe headache” (10%), “Bleeding/spotting” (7%) and
“Very high fever (7%). Around 30% were not aware of any pregnancy-related complications
Awareness of pregnancy related complications were high in Tamilnadu, Madhya Pradesh, Karnataka
and Maharashtra (86-97%), and low in Delhi, Uttaranchal and Uttar Pradesh (50% or less).
KNOWLEDGE ABOUT PLACE OF CONSULTATION FOR PREGNANCY COMPLICATION:

For consultation during pregnancy complication, Government doctors were mentioned maximum
13
(44%) followed by Private doctors (36%). A distant third was ANM/LHV/Nurse (9%). More than 9% of
women mentioned that they would not consult anybody.
COMPLICATION EXPERIENCED DURING PREGNANCY

More than half of the women had pregnancy complication. The percentage of such respondents was
significantly higher in urban (57%) compared to rural (50%). 17% reported that they had swelling of
face/feet and 24% had severe weakness. High fever and severe headache was reported by 9%, while
3% had abnormal representation.
43% of these women consulted a Private Doctor, while 28% visited Govt. doctor. ANM and LHV/ Nurse
were consulted by 8% of the respondents. Overall 18% did not consult anybody.
PLACE OF DELIVERY AND ASSISTANCE AT DELIVERY:

Institutional deliveries were accounted for 49% of the total deliveries, while 51% at home. Govt.
hospitals and Private hospitals contributed equally. Institution delivery was significantly higher in urban
(78%) and among educated women (45-94%) compared to rural (36%) and illiterate (25%). This could
be because of low accessibility to health institutions and ignorance regarding the importance of
institutional delivery.
Most of the home deliveries were conducted by untrained dai (43%) followed by relatives and friends
(29%) and trained dai (11%). Skilled birth attendant conducted hardly 14% of the home deliveries.
In states like Delhi, Kerala Maharashtra and Tamilnadu more than 70% of the deliveries were
institutional. However in Bihar and Uttar Pradesh, the institutional deliveries were less than 20%.
POST NATAL CHECKUPS:

Only 19% of the women reported that they were checked at least three during postnatal period, while
52% had no such opportunity. The PNC3 coverage was 43-47% in Kerala, Karnataka and Tamil Nadu.
BREAST FEEDING:
Only 29% of respondents initiated breast feeding within 2 hours of birth. An additional 26% initiated
within 2-24 hours. However, there was a substantial segment comprising 16%, who initiated only after
72 hours. Overall, 60% of the women fed colostrum to their newborns.
A large majority in Tamil Nadu (87%) had initiated breastfeeding within 2 hours of birth. It is surprising
that despite 100% institutional deliveries in Kerala, only 62% initiated breastfeeding within 2 hours.
HIGH-RISK DISTRICTS FINDINGS

In addition to the 18 states, 6 very high-risk districts: Moradabad, Rampur, Badayun, Bareilly, Bhagalpur and Muzaffarpur and
4 Cluster of high-risk districts –
Cluster A - Muzaffarnagar, Meerut, Bulandshar & J.P. Nagar
Cluster B - Sultanpur, Faizabad, Basti, Gonda
Cluster C - Jamui, Banka, Lakhisarai, Munger
Cluster D - Madhubani, Darbhanga, Sitamarhi
were identified from UP and Bihar based on the wild polio cases.
14
INTENSIVE PULSE POLIO IMMUNIZATION
The PPI coverage at least two doses was significantly higher than national average in Bareilly, cluster
A, Bhagalpur, Muzaffarpur and cluster D, indicating the effectiveness of the extra efforts done in these
areas. The house to house activities benefited significantly higher proportion of children in these
districts. Around 50% of the children in UP districts received all doses at home, except in cluster A,
where 70% children all doses at booth. In the districts of Bihar, people accessed both the approaches
in different rounds.
Despite all the extensive efforts, around 3% of the target children were unreached during the current
campaign in Rampur and cluster B. In Cluster D (0.5%), Bhagalpur (0.7%), Bareilly (1.4%) and cluster
C (1.4%), it was significantly lower than the national average.
Lack of awareness of place and time was mentioned as the major reason for non-compliance in the
districts of Bihar, while in Uttar Pradesh, lack of motivation was the major constraint. Interpersonal
communication could be helpful in overcoming these constraints. The study showed that this was the
major source of information, except Rampur and Cluster A. In these districts, mass media had wider
reach. Among the different mass media methods, miking and drum beating contributed most.
Nutrients
In Bareilly, clusters A and B, Bhagalpur and Muzaffarpur, significantly higher proportion of children
received vitamin A compared to their state average. However, the coverage was less than 20% in UP
districts and less than 25% in Bihar districts. Data revealed that less than 4% of the children had
received two or more doses.
IFA coverage was abysmally low. Only 3-8% of the children in these districts had ever received IFA
supplementation.
ROUTINE IMMUNZIATION
Accessibility of immunisation services in both the states, particularly in Bihar is a major concern. In
Bhagalpur, Muzaffarpur, Moradabad, Rampur, Clusters A and B, only around 30% of the respondents
reported that at least monthly session on a particular day were organized in their cluster/area, while in
clusters C and D, less than 3% of respondents reported that.
Slightly less than half of the respondents showed immunisation card or any written immunisation
document in Bhagalpur (45.5%) followed by Muzaffarpur (42.5%), Cluster A (36.6%). It was lowest in
cluster ‘B’ (20.5%) and Badayun (17.8%).
Only around one forth of the children were fully vaccinated in Bareilly, Muzaffarpur, Clusters A and B.
In other study district, less than 20% of the children received all primary vaccines. The most frequently
mentioned reasons for non-compliance was lack of knowledge on the need for all the vaccines. This
proportion was particularly high in cluster D (82.7%) and Badaun (81.1%) and lowest in Moradabad
(38.4%). In Bareilly, half of the non-compliers (49%) were unaware of the place/time of vaccination.
Efforts to improve accessibility and strong IEC are the need of hour.
In Bhagalpur, Clusters C and D, more than 60% of the respondents reported that disposable syringe
and needle were used for vaccinating their child. This was around 50% in Bareilly, Cluster A and
Muzaffarpur. Use of autoclave/double rack steriliser was hardly mentioned.
15
MATERNAL CARE
Among the study districts, cluster A (61%), Rampur (66.0%) and Bareilly (64.2%) did fairly good with
almost two thirds of respondents having at least one Antenatal Check-up. ANC3 coverage varied
between 11% to 28%, significantly lower than the national average of 55%. In U.P, government
facilities (65%) were more accessed than the private (35%). In Bihar, however, the Private doctor were
the service providers in almost three fourth of the cases.
On the components of ANC, only in cluster A, BP and weight of more than 10% of the women were
checked at least thrice during pregnancy. In other districts, it was ever less.
TT2/booster coverage was more than 50% in all the study districts except Badayun and Moradabad.
Unlike national trend, contribution of private sector was more for TT vaccination in these districts.
The receipt and consumption of more than 90 IFA tablets was in the range of 3.5 to 22% and 2 to 14%
respectively. The proportion of women who consumed more than 90 tablets was significantly lower
than those received it in Moradabad and Cluster C.
In Bhagalpur, Clusters A and D, more than 20% of the deliveries were institutional. It was hardly 7% in
cluster C. Majority of the deliveries were conducted by untrained dais in these study districts.
Surprisingly, in cluster B, 35% of the respondents reported that they have been checked thrice during
the postnatal period. The PNC3 coverage was 19% in Rampur and 16% in cluster A. In other districts,
coverage was less than 10%.
Less than 8% of the newborns were breastfed within 2 hours of delivery, while more than 40% were
fed after 24hours of delivery in all these districts.
16
INTRODUCTION
17
.
2 INTRODUCTION
Immunization against infectious diseases is one of the key inventions of the last century and a
significant success of modern medicine. Generations of today’s healthy adolescents/adults owe their
lives to the fact that they were immunized as children and protected against life threatening diseases.
The material and human progress so many societies have made rests heavily on public health
improvements, of which immunization is the lynchpin.
In India immunization history goes back to the era of vaccine against small pox in late 1940’s.
However, a formal program under the name of Expanded Program of Immunization (EPI) was
launched in 1978. This gained momentum in 1985 under Universal Immunization Program (UIP) fully
supported by UNICEF. The main objectives of this program were universal immunization, reduction in
mortality and morbidity due to VPDs, obtain self-sufficiency in vaccine production; establish a well
functioning cold chain system and introduction of district level monitoring system. This was merged in
Child Survival and Safe Motherhood (CSSM) in 1992-93. Since 1997, immunization activities are an
important component of national Reproductive and Child Health (RCH) program.
Immunization services are provided through a network of sub-centers, Primary Health Centers (PHC)
and Community Health Centers (CHC) in Rural areas. In Urban areas, most of the government
hospitals and postpartum centers provide the immunization services. All states have fixed
immunization days especially for the outreach sessions. Villages having more than 1000 population are
scheduled to be visited at least a month. The fixed immunization day is a major gain of UIP during
1985-90. This has been subsequently used to provide other primary care service package which
includes Antenatal Care, IFA and Vitamin A supplementation, Contraceptive distribution, Nutrition
counseling etc. The immunization schedule under the UIP program currently includes vaccinations
against childhood Tuberculosis (BCG), Diphtheria, Pertusis, Tetanus (DPT), Measles and Polio. For
the above diseases except Polio, the current immunization strategy seeks to contain and provide
individual immunity to the child, while for Polio the efforts are on to eradicate the scourge.
Polio eradication has been one of the goals of World Summit of Children (1990) and India being a
signatory to the Summit goals ventured additional efforts to eradicate Polio. Learning from the Latin
American experiences and realizing that the strategies followed until 1995 would not be able to
eradicate Polio in India, the Government of India (GOI) launched Pulse Polio Immunization (PPI) i.e.,
having two National Immunization Days (NIDs) every year beginning from December 1995. The aim
was to interrupt the circulation of wild Poliovirus by immunizing all targeted children simultaneously
over a short period of 1- 4 days during low transmission season.
Till 1998, the PPI Campaign approach was to immunize targeted children at fixed booths on two NIDs
held 4-6 weeks apart. Although number of Polio cases declined, transmission of wild Poliovirus
continued. In year 1998-99, in addition to the two NIDs, third round of PPI was introduced in High-Risk
pockets. Additionally, an action research was carried out during the same year at the request of
MoHFW to find out the impact of offering of OPV drops at home to those who did not turn up at the
booth. Findings of the research were encouraging and concluded that House to House approach had
added value. This led to the intensification of the program in the year 1999-2000 in terms of number of
NIDs (four rounds) and sub-NIDs (two rounds) and adoption of mixed strategy of booth and House to
House immunization. Data on virologically confirmed wild Polio cases in the following year clearly
reflected the impact of the intensification as the number of confirmed wild Polio cases dropped from
1124 (1999) to 268 (2001). Based on the epidemiological situation during 2001-02, one SNID (14th
October 2001) was carried out in UP, Bihar, Delhi, WB and in some parts of Maharashtra, Gujarat and
18
Karnataka, in addition to the two NIDs (2nd December 01 and 20th January 02).
Research findings in 2001 from the Process Evaluation, coverage evaluation study and other IPPI
studies indicated a need for a substantial shift in the communication/social mobilization strategy for
Polio eradication, especially in relation to the ‘hot 4’ districts of Uttar Pradesh - Rampur, Moradabad,
Bareilly and Badayun. UNICEF responded by recruiting, training and deploying a Social Mobilization
Co-ordinator (SMC) in 10 High-Risk districts in UP. UNICEF also recruited and trained block level
mobilizers (BMCs) for the four hot districts. At grass root level, around 2000 Community Mobilization
Co-ordinators (CMCs) were identified in a total of 20 districts to mobilize reluctant families in their
village/mohalla. This strategy was well appreciated and decided to be sustained and further expand in
2002.
Since 1995, UNICEF has been entrusted with the task of conducting the Process Evaluation and
Coverage Evaluation Survey to validate the process followed and coverage reported for the
campaign each year, by Min. of Health and Family Welfare, GoI.
Sustaining high level of routine immunization is one of the four corners of Polio eradication strategy.
Therefore, this year the opportunity of PPI household survey is being utilized to evaluate the Routine
Immunization and Maternal Health Care coverage. In order to assess and understand the perception of
Beneficiaries, Service Providers and Influencers regarding these interventions, qualitative research was
also carried out in states of Uttar Pradesh and Bihar only.
Quantitative study was carried out in 18 states where confirmed Polio cases were reported in last three
years. Apart from that, 6 High-Risk districts and 4 cluster of districts from UP and Bihar were also
identified as particularly High Risk and thus a separate independent sample for these were studied.
This document is the final report for All India.
2.1 RESEARCH OBJECTIVES
The research objectives for the study were to assess:

• The reach and coverage of children below 5 years with the Oral Polio Vaccine (OPV) in the PPI
campaign from October 2001 to January 2002
• Place of getting the OPV dose
• Lifetime and 2001-02 cycle zero doser
• Reason for non-compliance
• Source of information
• Knowledge of place and time of RI sessions
• RI coverage amongst 12-23 months old
• Place of routine immunization
• Reason for non-compliance
• ANC of women5 during their pregnancy which ended within the reference period
• Components of ANC
• Place of delivery and assistance
• Complication
5
All women whose pregnancy of more than 28 weeks completed/terminated in between 27/1/2001 to 26/1/2002
19
• Postnatal Check ups
• Injection practices during immunization
The qualitative module was to assess the gap between the expectations, service and it's utilisation by
the community. This was undertaken only in High Risk with an aim to understand the factors that
influenced compliance and non-compliance with the above issues. The study also aimed to assess the
effect of IEC/Social mobilization in motivating the community for compliance.
2.2 RESEARCH DESIGN
A combination of both qualitative and quantitative research methodologies was adopted to meet the
research objectives. The quantitative module was provided an assessment of important variables
related to the coverage with OPV, Routine Immunization and Maternal Care. The two modules were
conducted simultaneously.
The research methodology comprised of interviews. The questionnaires were largely structured with
scope for a few open-ended questions (enclosed as annexure I). The survey was divided in to three
major modules each catering to one of the three major objectives of assessing PPI, Routine
Immunization and Maternal Care Coverage.
Quantitative Sampling Design
2.2.1 Universe
A total of 18 States were selected, viz. – Uttar Pradesh, Bihar, Maharashtra, Karnataka, Assam,
Gujarat, Haryana, Punjab, Rajasthan, Kerala, Madhya Pradesh, Delhi, Tamil Nadu, Andhra
Pradesh, West Bengal, Uttaranchal, Chhatisgarh and Jharkhand. Additionally,
4 Cluster of districts: i) Muzaffarnagar, Meerut, Bulandshar & J.P. Nagar
ii) Sultanpur, Faizabad, Basti, Gonda
iii) Jamui, Banka, Lakhisarai, Munger
iv) Madhubani, Darbhanga, Sitamarhi
& 6 Individual districts: i) Moradabad
ii) Rampur
iii) Badayun
iv) Bareilly
v) Bhagalpur
vi) Muzaffarpur
were also covered
2.2.2 Respondents
The respondents’ definition for each of the modules was different.

PPI Coverage: The information was obtained from households, which have at least one child below 5
years and interviews were conducted with the principal caretakers of the eligible children. The child
however should have been born between 27th January 1997 to 26th Jan 2002.
20
Routine Immunization Coverage: - The interviews were conducted with the primary care takers of 12-
23 months old children (born in between 27th January 2000 -26th January 2001).
Maternal Care Coverage: - Women whose pregnancy of more than 28 weeks ended in between
27/1/2001 to 26/1/2002 were eligible to be interviewed under Maternal Care Module.
2.2.3 Sampling Design
Multi-stage cluster sampling technique was used for this study. In India, a total of 540 clusters were
selected. In order to have estimates for Urban and Rural separately for PPI, 270 clusters were
identified from Urban and 270 from Rural areas.
For IPPI coverage, sample size of 200 was sufficient at 5% level of significance and absolute
precision of 3% at 95% coverage level. Considering the design effect to be 1.5, sample size was
worked out to be 300. Since, for IPPI, analysis was planned separately for Urban and Rural areas,
sample size of 20 per cluster (20*15=300) was taken. At national level, precision was 1%.
For Routine Immunization and Maternal Care components, sample size of 120 was sufficient at
5% level of significance and absolute precision of 10% at 50% coverage level. Considering the design
effect of 2, sample size was worked out to be 240, i.e. 8 per cluster. At national level with the sample
size of 4320, precision was 2%.
Once the minimum number of clusters to be covered in the state and across Rural/Urban areas were
worked out, random cluster sampling methodology was used.
The villages comprised the primary sampling unit in Rural areas whereas a Municipal ward formed the
primary sampling unit in Urban areas.
Clusters were identified using PPS technique from the list of villages for Rural and list of wards for
Urban. Due to non-availability of Census 2001, 1991 census list of villages and wards were used as the
universe. In case of divided states/districts, districts (in case of state) and blocks (in case of districts),
which were left or present in newly carved state/districts after division were taken for the sampling.
From each selected cluster or the primary sampling unit, four segments were selected
randomly after listing all localities (lanes, mohallas etc).
In each segment 5 interviews were conducted with primary care takers of children under five years for
the PPI coverage Module. In case there was more than one child eligible in the household, the
interview was conducted only for the youngest. These 5 interviews were divided across the five age
cohorts of (0-11 months, 12-23 months, 24-35 months, 36-47 months and 48-59 months). The sample
was divided equally across males and females in each cluster.
The primary care takers for the children in the age group of 12-23 covered for PPI module were also
the respondents for Routine Immunization module. A total of 2 interviews per segment or 8 per cluster
were conducted for the Routine Immunization module.
For the Maternal Care Coverage module, women whose pregnancy had completed/terminated in
between 27th Jan 2001 to 26th Jan 2002 were interviewed. Two interviews per segment or 8 per
cluster were conducted.
2.2.3.1 Sample sizes
A total of 10800 interviews were conducted with mothers/ primary caretakers of children up to five
years of age. In addition 4320 interviews were conducted with women whose pregnancy of more than
28 weeks was completed/terminated between 27/1/2001 and 26/1/2002.
21
These sample interviews were done in a total of 540 cluster with a distribution as shown below.
Sample Size Urban Rural Grand Total

PPI Component 5400 5400 10800
Routine Immunization 2160 2160 4320
Maternal Care 2160 2160 4320
2.2.3.2 Rural Sampling
In the Rural areas, at the first stage, villages were selected according to PPS from the list of villages
taken from Census 1991.
At the second stage, each village was divided in to smaller segments. In larger villages, the segments
of relative socio-economic homogeneity were identified in consultation with the village key informants.
Four such segments were then randomly selected (Exhibit A). In smaller villages (of less than or equal
to 200 households) complete village was divided into four segments taking socio-economic variations
in consideration.
Exhibit A : Showing segmentation and numbering of the segments for random selection
3 Hamlet 3 4 1 Hamlet 1
9
8
5
7 6
2 Hamlet 2
At the third stage, within the selected segments, the house of any key personnel in that segment was
identified. First household to be contacted was randomly selected with the help of random number
tables. Using the first selected house (identified house of the key personnel) as the starting point,
random contacts according to the Right Hand Rule6 were conducted. If the contacted household had
any of the target respondents further forms were filled, else next household was contacted
6
According to this rule, the household falling right to the starting point is the next household to be contacted.
22
2.2.3.3 Urban Sampling
In Urban areas, all wards of the state were listed and ward selection was done according to PPS. At
the second stage, the selected ward was treated in a similar manner as the selected villages in the
Rural areas and segmentation and segment selection were undertaken. The third stage of selection of
the respondent households in the selected segment was also similar to the one described for the Rural
areas.
Special cases in Urban sampling:
For the Urban sampling, as mentioned before, the wards were taken as the Primary sampling unit. The
wards were selected from the Census 1991. In many states the wards boundaries had undergone
major reorganization since 1991. Since the sampling was undertaken based on the ward boundaries of
1991, all efforts were made to identify the boundaries as they were then. This attempt had led to a few
special cases where the following actions were undertaken:
Case #1: Mohalla name guiding principle for ward: Ward boundary of 1991 was not available
but it is known that so and so mohalla comprised the selected ward (say Rampur Mohalla was
ward 10). In such cases the Mohalla was taken as the cluster and rest of the steps for selection of
households were followed. If there were more colonies/mohallas, all of them were taken into the
cluster sampling frame.
Case #2:- 1991 Ward no. the guiding principle: If the selected ward (Ward 10 in 1991) has
been divided in to new wards say 10, 12, and 14 now, then the new wards (10,12 and 14) were
considered as parts of the cluster and rest of the steps were followed.
Case #3:- Neither the boundary nor the colonies comprising ward is known, guided by at
least 1 colony which was a part of selected ward :– In certain situation, no one knew exact
boundary of the selected ward nor was it clear which all colonies were included in the selected
ward. In such cases, efforts were made to identify at least one colony, which did form a part of the
selected ward. One common point/ well known point was identified in that colony and taking that
as the centre a boundary was made that consisted close to 800 houses in it. A common public
place (such as School, Hospital/PHC, Temple/ religious place, Park, Bridge, well known
government offices etc.) was identified in the colony. From that point, a boundary was drawn that
contained approximately 800\1000 houses. This boundary was considered as the selected cluster
and rest of the steps for selection of households were followed
Case #4:- No past information at all – guided by new ward boundary: As a last resort when
the previous boundaries were not possible to identify, the current boundaries were used.
Case #5:- Ward too big : Some of the wards were too big exceeding 8000-10000 population. In
such cases all colonies in the ward were taken as the given segments. Out of them 4 segments
were randomly selected.
Qualitative Sampling Design
2.2.4 Universe
Ten individual and group of districts (mentioned in quantitative section) were taken for qualitative
research.
23
2.2.5 Respondents
• Parents of under 5 children
• Service provider – people involved in providing services on IPPI and RI – ANM, male & female
health supervisors, Medical Officer, AWW, teachers, etc.
• Influencer – people who have influenced community to accept or not to accept polio drops during
IPPI campaign – religious leaders, local doctor, Panchayat member, etc.
• Polio afflicted families
• SMCs and BMCs - Social mobilization co-ordinators involved at district and block level
2.2.6 Sample Distribution
For qualitative research, 7 clusters were selected from each of the individuals and group of districts. In
UP, out of 7 clusters, 3 were randomly selected from the list of villages with CMC (1 from urban and 2
from rural), 3 (1 from urban and 2 from rural) from the list of non-CMC villages and one from the list of
villages with virologically confirmed wild polio cases reported in 2001. In Bihar, 4 clusters were selected
from the list of villages while 2 from urban wards and one from the list of villages with confirmed polio
cases reported in 2001. Focus Group Discussions (FGDs) and Depth Interviews (DIs) were used for
data collection. FGDs were conducted with parents of under 5 children and neighbours of polio afflicted
families, while DIs were conducted with service provider, influencer, polio afflicted family and social
mobilization co-ordinators. Guidelines were developed before hand for FGD and DI for different
segments.
Thus a total of 70 FGDs and 190 DIs were conducted with beneficiaries, service provider, influencer,
polio afflicted families and social mobilization co-ordinators across 10 geographical areas.
2.2.7 Weights
The Rural and Urban population and Male and Female population proportions of the 18 states were
used to weight the data so as to arrive at the India figures. The survey was conducted in 18 major
states and the All India figures were generated on basis of them. Apart from these 18 states, additional
High Risk districts were covered in two states (UP and Bihar) so as to have separate estimates for the
High Risk districts. These districts’ samples were not included while calculating the overall National
figures so as to avoid double counting as their states were already covered through an independent
sample.
For a state, the sample was divided across the various respondent categories. As mentioned in
sections above, for the PPI section, separate quotas were maintained for ages 0-11, 12-23, 24-35, 36-
47, 48-59 months across male and female children. From the 1991 census, the proportion of each of
these age brackets in Rural and Urban areas of the state was calculated. Considering the age wise
proportions as given, we had multiplied them to Rural and Urban population in 20017. This gave us an
estimate of the total number of children in Rural and Urban areas of a particular state in each of these
age brackets. The sample responses were projected to these universe numbers resulting in the state
level picture. Similar steps were taken for the RI and Maternal care section based on the respondent
definition of those sections.
7
The total Rural and Urban population of the state was available from Census, 2001
24
For national figures, the projection factors for a state were same as those used for the state level
estimates. Each state’s sample was projected to its state universe. Together all states totaled to
the national universe.
2.2.8 Recruitment, Training and Fieldwork
In order to maintain uniform survey procedures across the states and districts, two set of briefing notes
for supervisors and interviewers were developed. One of the notes was on sampling designed for the
supervisor and other one was on questionnaires for the interviewers. Initial training of qualitative teams
from Delhi, UP and Bihar was organized in Delhi. This was followed by pilot in Gaziabad district. The
guidelines were revised based on the feedback. For quantitative research Pilot was done in Jaipur,
Lucknow and Gaziabad, followed by zonal briefing of field managers and state level briefing of
investigators. The data was collected in the month of July and August 2002.
25
DETAILED FINDINGS
QUANTITATIVE
26
3 RESPONDENT PROFILE
3.1 PRIMARY CARE TAKER
The responsibility of childcare generally lies with the mother, she being the primary care taker of the
child. In absence of the mother or when mother is not living there any other reliable resident of the
household (grandmother, aunt, elder sister, etc.), is normally the primary caretaker of the child. For the
survey, the primary caretaker of the child was the respondent who answered the questions pertaining
to the selected child.
Across All India, for nearly 94% of the children, mother herself was the primary caretaker. For nearly
3% of children grandparents were the primary care takers whereas 2% were primarily looked after by
the father.
Table 1 Primary Caretaker
Base : All children Base Mother Father Grandparents Elder Sibling Aunt
% across
ALL 10800 94.1 1.6 3.4 0.5 0.3
LOCATION
Rural 5400 93.8 1.7 3.5 0.5 0.2
Urban 5400 94.7 1.1 3.3 0.4 0.3
RELIGION
Hindu 8720 94.0 1.6 3.6 0.4 0.3
Muslim 1436 94.4 1.4 2.6 0.5 0.2
Christian 224 91.4 2.2 4.0 2.1 0.4
Sikh 342 93.7 0.4 4.8 0.1 0.6
Jain 62 100.0 0.0 0.0 0.0 0.0
Others 16* 100.0 0.0 0.0 0.0 0.0
CASTE
SC 2335 94.8 1.4 3.3 0.3 0.1
ST 880 95.0 2.0 2.3 0.6 0.1
Others 7585 93.7 1.6 3.7 0.5 0.3
GENDER
Male 5400 94.1 1.8 3.4 0.5 0.3
Female 5400 94.1 1.3 3.5 0.4 0.3
AGE OF THE CHILD
0-3 Months 759 97.9↑ 0.6 1.2 0.1 0.3
4-6 Months 640 97.0 0.7 2.1 0.0 0.2
7-11 Months 762 96.6 1.0 2.2 0.2 0.2
12-23 Months 2159 94.4 1.1 3.8 0.5 0.2
24-35 Months 2161 92.7↓ 2.5 3.5 0.5 0.2
36-47Months 2158 93.4 1.2 4.5 0.7 0.3
48-59 Months 2161 93.5 2.0 3.4 0.5 0.3
* Base too low
27
3.2 PRIMARY CARETAKER’S EDUCATION
Literacy and educational levels are important indices of human development. Many of the positive
health and other behaviours (such as health care for themselves and their families) often depend on
literacy and education levels. Literacy here is defined as the ability to read and write with understanding
short simple sentences.
At the aggregate level, 51% of the caretakers were reported to be literate, with Rural caretakers
reporting a lower literacy level at 42% when compared to the 76% of the Urban caretakers. According
to 2001 Census the female literacy for All India is at 54%, which is well comparable to the estimates
from this survey for the All India.
Table 2 Primary Caretaker’s education
Completed years of schooling

Base : All Base Illiterate 1- 4 years 5-8 9-12 15+
% across
ALL 10800 49.4 9.6 19.9 17.7 3.4

LOCATION
Rural 5400 57.7↑ 10.0↑ 18.8↓ 12.5↓ 1.0↓
Urban 5400 24.2↓ 8.3↓ 23.3↑ 33.3↑ 10.6↑
RELIGION
Hindu 8720 49.8↑ 7.7↓ 20.7↑ 18.0↑ 3.7↓
Muslim 1436 50.5 20.7↑ 14.8↓ 12.7↓ 1.1
Christian 224 25.8↓ 9.9 17.4↓ 37.3↑ 9.1
Sikh 342 38.8↓ 2.9 29.6↑ 25.2↓ 3.5↓
Jain 62 32.6↓ 5.7 15.4 30.3 16.0↑
Others 16* 65.0 2.1 13.3 19.7 0.0
CASTE
SC 2335 57.8↓ 9.3 19.3↑ 12.6↓ 1.0
ST 880 67.9↑ 8.2 13.7↓ 9.8 0.5
Others 7585 43.8 9.9 21.0 20.5↑ 4.7
GENDER
Male 5400 48.6 9.4 20.6 17.9 3.3
Female 5400 50.1 9.8 19.2 17.3 3.5
AGE OF THE CHILD
0-3 Months 759 47.1 7.0↓ 23.0 19.5 3.5
4-6 Months 640 46.4 7.7 24.8↑ 18.0 3.1
7-11 Months 762 44.0↓ 9.9 19.9 22.6↑ 3.6
12-23 Months 2159 46.3 9.9 20.1 19.7 4.1
24-35 Months 2161 50.7 9.8 19.2 16.6 3.5
36-47Months 2158 50.0 10.8↑ 18.8↓ 16.7 3.6
48-59 Months 2161 52.2↑ 9.1 19.6 16.3↓ 2.7
*Base too low. The arrows indicate significant difference.
Comparing across the background characteristics of religion and caste, illiteracy was significantly lower
among Christian and Sikh. It is lowest among non-SC/ST followed by SC
28
& ST. Around 11% of urban respondent had 15+ year of schooling, which is significantly higher than
rural (1%). Higher proportion of Hindu respondent had primary education (5+) when compared to
Muslim.
3.3 EDUCATION OF THE FATHER
Going by the traditional difference between male and female literacy, the education levels of fathers
were better than mothers/primary caretakers. The overall literacy level amongst fathers at 73% is well
comparable with the Census 2001 provisional figures for male literacy (76%) for All India.
It is observed that there is a significant difference between the literacy levels among the fathers in the
Rural areas when compared to the Urban areas. The fathers in the Urban areas were more educated
(88%) than the fathers in the Rural areas (68%) particularly for higher level of schooling. Significantly
higher proportion of Muslim fathers (37%) were illiterate than Hindu (25%). Similarly, higher proportion
of SC/ST fathers was illiterate as compared to others.
Table 3 Father’s education
Completed years of schooling

Base : All Base Illiterate 1- 4 years 5-8 9-12 15+
% across
ALL 10800 26.8 10.2 22.2 30.2 9.6

LOCATION
Rural 5400 31.8↑ 11.5↑ 22.7 26.8↓ 6.2↓
Urban 5400 11.5↓ 6.5↓ 20.7 40.5↑ 20.0↑
RELIGION
Hindu 8720 25.3↓ 9.3↓ 22.3↓ 31.9↑ 10.4↓
Muslim 1436 36.8↑ 16.1↑ 21.0 19.5↓ 5.2
Christian 224 16.1 9.9 21.5 38.0 13.3
Sikh 342 20.9 5.2 33.3↑ 33.7 7.0
Jain 62 18.8 5.1 12.6 36.1 23.7↑
Others 16* 14.9 1.9 6.1 33.6 1.0
CASTE
SC 2335 33.4↑ 11.4↑ 24.7↑ 23.7↓ 5.8↓
ST 880 34.5 15.1 23.1 22.1 4.0
Others 7585 23.4↓ 9.1↓ 21.2↓ 33.6↑ 11.8↑
GENDER
Male 5400 26.8 10.5 22.1 29.8 9.9
Female 5400 26.8 10.0 22.3 30.6 9.3
AGE OF THE CHILD
0-3 Months 759 21.6↓ 10.5 21.8 32.6 12.9
4-6 Months 640 25.7 10.1 20.8 34.9 8.3
7-11 Months 762 22.9 8.6 22.9 35.2↑ 10.3
12-23 Months 2159 24.2 9.2 25.1 30.9 10.1
24-35 Months 2161 28.7↑ 11.1 21.5 28.6 9.6
36-47Months 2158 27.3 10.0 21.9 29.8 9.4
48-59 Months 2161 28.8 10.7 21.7 28.5↓ 8.8
29
*Base too low
3.4 BACKGROUND CHARACTERISTICS OF THE SAMPLE COVERED
The following table compares some of the key sample distribution characteristics with the national
proportion according to 1991 census. The difference in SC population could be because of
misclassification.
Table 4 Sample Coverage for All India
Sample
Base : All Base IPPI 2002 Census ‘1991
% down (% of the sample) (% of population)
ALL 10800 10800 Census

RELIGION
Hindu 8720 80.7 82.0
Muslim 1436 13.3 12.0
Christian 224 2.0 3.0
CASTE
SC 2335 21.6 16.0
ST 880 8.1 8.0
Others 7585 70.2 76.0
* Base too low
30
4 INTENSIFIED PULSE POLIO IMMUNIZATION
4.1 DISTANCE OF THE PPI BOOTH
Across India, Polio drops during the current campaign was administered at the booths on the first day.
In addition, house to house vaccination activities were taken up in subsequent 5-6 days in Uttar
Pradesh, Bihar, Delhi, West Bengal and in few districts of other states with confirmed wild polio cases
in 2001. Booths are organised within the village/ ward/ colony/ area in such a way that it is accessible
to the families of about 250 children. It was hypothesised that distance between the booth and home
may be a barrier for administering the Polio drops, especially in areas with no HtH activities.
Table 5 Distance of the PPI booth
Distance of the PPI booth
Base : All Base Within Walking distance Not very far Too far DK/CS
% across
ALL 10800 84.5 11.4 3.0 1.1
LOCATION
Rural 5400 82.5↓ 12.9↑ 3.7↑ 1.0
Urban 5400 90.6↑ 6.8↓ 1.1↓ 1.6
RELIGION
Hindu 8720 84.5↓ 11.4↑ 3.0 1.0
Muslim 1436 82.8 12.3 3.2 1.7
Christian 224 90.9↑ 8.5 0.1 0.5
Sikh 342 89.2↑ 5.3↓ 4.2 1.2
Jain 62 93.5 3.2↓ 1.9 1.4
Others 16* 99.5 0.0 0.5 0.0
CASTE
SC 2335 88.2↑ 9.0↓ 1.9↓ 0.8
ST 880 78.2↓ 15.5↑ 5.1↑ 1.3
Others 7585 84.2↓ 11.6 3.1 1.2
GENDER
Male 5400 85.1 11.1 2.8 0.9
Female 5400 83.8 11.6 3.2 1.4
EDUCATION OF PARENTS
Both literate 6350 86.9↑ 9.5↓ 2.5 1.1
Both illiterate 1735 82.3↓ 13.3↑ 3.0 1.4
One of them literate 2681 82.2 12.9 3.9 1.0
Not Specified 34 95.7 4.1 0.0 0.2
*Base too low
Overall, 85% of the population said that the booth was within walking distance and nearly 3% of the
respondents felt that the PPI booth was too far from their residences.
It can be observed that only 1% of the respondents in the urban areas reported that the booth was too
far. In the rural areas however, a significantly higher proportion (4%) of respondents felt the distance
was ‘too far’ and thus access of services was not a big concern.
31
Across the religion, the proportion of respondents reporting the booth was too far was not significantly
different, whereas, considering the caste, ST (5%) expressed concern of proximity of the booth.
Further, illiterate parents felt the booth to be too far (3-4%) probably because of the lack of urgency or
knowledge of importance for the additional OPV drops.
The segregated data by urban and rural revealed that religion has significant influence on the
perception of distance of booth location while in rural areas, caste and literacy shown it’s influence. In
Urban areas a significantly lower proportion (88%) of Muslims mentioned that PPI booth was within
walking distance as compared to Sikhs (98%). In Rural areas significantly higher proportion of SC
(88%) and literate households (84%) reported that the booth was within walking distance.
Table 6 Distance of the PPI booth- Rural and Urban Comparison

Distance of the PPI booth
All Rural Urban
% across Base Within Base Within Base Within
Walking Walking Walking
distance distance distance
ALL 10800 84.5 5400 82.5 5400 90.6
RELIGION
Hindu 8720 84.5↓ 4359 82.5 4361 90.8
Muslim 1436 82.8 690 81.2 746 87.8↓
Christian 224 90.9↑ 111 87.7 113 96.9
Sikh 342 89.2↑ 224 86.9 118 97.7↑
Jain 62 93.5 14* 100.0 48 89.7
Others 16* 99.5 2* 100.0 14* 98.8
CASTE
SC 2335 88.2↑ 1321 87.9↑ 1014 89.5
ST 880 78.2↓ 589 76.2↓ 291 88.9
Others 7585 84.2↓ 3490 81.6↓ 4095 91.0
Both literate 6350 86.9↑ 2460 84.4↑ 3890 91.0
Both illiterate 1735 82.3↓ 1266 81.4 469 90.0
One of them literate 2681 82.2↓ 1656 81.0↓ 1025 89.1
Not Specified 34 95.7 18* 98.0 16* 79.1
*Base too low
32
4.2 COVERAGE BY DOSES
During year 2001-02, children in different states had 2-4 opportunity of getting additional doses of OPV.
Analysis of coverage by background characteristics revealed that coverage for at least two doses was
marginally higher in urban area compared to rural. Significantly lower proportion of Muslim children
received two doses (93.5%) compared to Hindu (96%). Genderwise desegregated figure showed that
coverage for at least two doses was same for boys and girls. The major variation was observed for
different age cohorts. The coverage was significantly lower among 0-3 month age cohort, while not
much of difference among the higher age group.
Table 7 Coverage by number of doses
Base: All
% across All Received at least 1 dose All eligible for two Received at least 2 doses
dose
ALL 10800 97.1 10532 95.6
LOCATION
Rural 5400 96.7↓ 5269 95.2↓
Urban 5400 98.4↑ 5263 96.7↑
GENDER
Male 5400 96.7↓ 5267 95.5
Female 5400 97.5↑ 5265 95.7
RELIGION
Hindu 8720 97.2↑ 8512 95.9↑
Muslim 1436 96.0↓ 1388 93.5↓
Christian 224 99.5 216 98.3↑
Sikh 342 98.1 339 96.8
Jain 62 98.4 61 92.5
Others 16* 99.3 16* 98.6
CASTE
SC 2335 97.9↑ 2278 96.1↑
ST 880 94.1↓ 866 92.8↓
Others 7585 97.3 7388 95.8
Both literate 6350 98.2↑ 6173 97.0↑
Both illiterate 1735 96.0↓ 1693 94.2↓
One of them literate 2681 96.2 2633 94.4
Not Specified 34 100.0 33 94.5
AGE OF THE CHILD
0-3 Months 759 88.1↓ 492 85.6↓
4-6 Months 640 96.5↑ 640 93.7↑
7-11 Months 762 98.2 761 97.1
12-23 Months 2159 98.0 2159 96.2
24-35 Months 2161 98.0 2161 96.0
36-47Months 2158 97.7 2158 96.5
48-59 Months 2161 97.3 2161 95.7
33
The coverage by caste indicated that the ST population had significantly lower coverage in rural
areas, which is not evident in urban. Irrespective of location, younger age cohort of 0-3 month
were the least covered, nearly 15% of them were given additional dose of IPPI in both rural and
urban areas.
Table 8 Coverage for at least two doses – Urban and Rural comparison
All Rural Urban
% across All eligible Received at All eligible Received at All eligible for Received
for 2 doses least 2 for 2 least 2 2 doses at least 2
doses doses doses doses
ALL 10532 95.6 5269 95.2 5263 96.7
GENDER
Male 5267 95.5 2627 95.1 2640 96.4
Female 5265 95.7 2642 95.3 2623 97.0
RELIGION
Hindu 8512 95.9↑ 4261 95.5↑ 4251 97.0↑
Muslim 1388 93.5↓ 663 93.0↓ 725 95.1↓
Christian 216 98.3 106 98.4 110 98.0
Sikh 339 96.8 223 96.8 116 97.0
Jain 61 92.5 14* 89.1 47 94.5
Others 16* 98.6 2* 100.0 14* 96.8
CASTE
SC 2278 96.1↑ 1291 95.7↑ 987 97.4
ST 866 92.8↓ 577 92.1↓ 289 96.6
Others 7388 95.8 3401 95.5 3987 96.5
EDUCATION OF
PARENTS
Both literate 6173 97.0↑ 2385 96.9↑ 3788 97.1↑
Both illiterate 1693 94.2↓ 1237 93.9 456 97.4
One of them literate 2633 94.4 1630 94.4↓ 1003 94.6↓
Not Specified 33 94.5 17* 95.1 16* 89.9
AGE OF THE CHILD
0-3 Months 492 85.6↓ 240 86.0↓ 252 84.5↓
4-6 Months 640 93.7 329 92.9 311 96.2
7-11 Months 761 97.1↑ 380 97.6 381 95.7
12-23 Months 2159 96.2↑ 1080 95.7 1079 97.6
24-35 Months 2161 96.0 1081 95.5↑ 1080 97.5↑
36-47Months 2158 96.5 1079 96.3 1079 97.1
48-59 Months 2161 95.7 1080 95.1 1081 97.4
* Base too low
34
4.3 COVERAGE ACROSS STATES
At the national level, 97% children received at least one dose, while 95.6% children received at least
two doses. It is observed that significantly higher proportion of children received at least one dose and
two doses in Karnataka, Madhya Pradesh, Punjab, Tamil Nadu and Uttaranchal compared to national
average. Whereas the coverage in the states of Assam and Rajasthan is much lower than the All India
level thus indicating a need for large scale concentrated efforts to bring the coverage anywhere closer
to the overall India figure. The other states were around the national average.
Table 9 Coverage by number of doses across states

% across Base Received at Received at
least one doses least two doses
Andhra Pradesh 580 96.3 97.3
Assam 572 88.9 80.5
Bihar 588 97.9 95.1
Chhatisgarh 590 97.9 94.5
Delhi 582 98.4 98.2
Gujarat 585 97.1 96.2
Haryana 584 97.8 96.3
Jharkhand 584 96.7 87.8
Karnataka 583 99.2 98.5
Kerala 582 97.8 96.3
Madhya Pradesh 596 99.7 99.1
Maharashtra 587 96.0 95.6
Punjab 591 99.2 97.9
Rajasthan 584 92.3 88.4
Tamil Nadu 586 99.1 98.3
Uttar Pradesh 579 97.9 97.3
Uttranchal 586 98.8 98.3
West Bengal 593 96.9 96.3
All India 10532 97.1 95.6
*The figures in green colour refer to the states that have significantly higher coverage as compared to national level.
**The figures in red colour refer to the states that have significantly lower coverage as compared to national level.
35
4.4 COVERAGE BY ROUNDS
The national coverage significantly increased from 93.6% in December round to 96.1% in January.
The improvement in January round was mostly in rural area. The significant improvement of over 8
point was seen among Muslims during the January NID, which could be attributed to intensive
mobilisation efforts among minority community. The same had also led to improvement in coverage
among children of illiterate parents.
Table 10 Coverage across various rounds

ROUNDS
JAN 2002 DEC 2001
Base : All Base Recd (%) Base Recd (%)
% across
ALL 10796 96.1 10532 93.6
LOCATION
Rural 5396 95.7↓ 5269 92.7↓
Urban 5400 97.3↑ 5263 96.4↑
RELIGION
Hindu 8719 96.3↑ 8512 94.8↑

Muslim 1433 94.5↓ 1388 86.4↓
Christian 224 99.3 216 94.6
Sikh 342 97.8 339 97.1

Jain 62 97.0 61 92.9
Others 16* 98.6 16* 96.8
CASTE
SC 2334 96.8↑ 2278 94.9↑
ST 880 93.3↓ 866 91.2↓

Others 7582 96.2 7388 93.5
GENDER
Male 5397 95.8 5267 93.3
Female 5399 96.3 5265 93.9
Both literate 6349 97.4↑ 6173 95.2↑

Both illiterate 1733 94.8↓ 1693 91.4
One of them literate 2680 94.9 2633 92.8↓
Not Specified 34 98.8 33 95.2
*Base too low
36
4.4.1 Reach by rounds by age categories
In this section, the age of the child was calculated with retrospective effect. That is for each of the
rounds; the age of the child at the time of that particular round was calculated. For the next round, the
new additions to the cohorts were included and the age of the older children was recalculated to reflect
the current age at the time of that particular round.
The following table is a result of the above exercise. Analysing the coverage in all rounds across the
age cohort, we find that the coverage was lowest for the age cohort 0-3 months. The children below 3
months are either considered to be too small or there exist some other barriers.
In December round, coverage in Urban areas was significantly higher for children in the age group 4-6
months and among children aged more than 11 months. Similarly in January round, except for 7-11
months age cohort, coverage in Urban is significantly higher.
Table 11 Reach by rounds by age categories
Base India Rural Urban
JANUARY 2002 ROUND

Base 10796 5396 5400
0-3 Months 755 87.5 86.4↓ 91.1↑
4-6 Months 640 94.3 93.5↓ 97.0↑
7-11 Months 762 97.9 98.2↑ 96.7↓
12-23 Months 2159 96.6 96.1↓ 98.1↑
24+ Months 6480 96.7 96.4↓ 97.7↑
All 10796 96.1 95.7↓ 97.3↑
DECEMBER 2001 ROUND
Base 10532 5269 5263
0-3 Months 492 84.7 84.6 85.4
4-6 Months 640 92.9 91.7↓ 97.0↑
7-11 Months 761 94.6 94.5 95.1
12-23 Months 2159 94.1 92.9↓ 97.6↑
24+ Months 6480 94.0 93.0↓ 96.8↑
All 10532 93.6 92.7↓ 96.4↑
* March round was held only in Assam
37
4.5 COVERAGE BY ROUND ACROSS STATES
As reported in the earlier section the overall reach in India was 97.1%. Over the two rounds, coverage
increased by 2 points, which is significant in AP and Bihar, while dropped by 3 point in Jharkhand in
January NID compared to December.
Table 12 Reach of PPI across states
Base January December
2002 2001
Assam*** 600 88.4 0.0
Bihar 600 95.2 93.5
Delhi 600 97.5 97.2
Gujarat 600 96.4 96.6
Haryana 600 97.1 97.0
Jharkhand 600 90.8 93.9
Karnataka 600 98.8 98.8
Kerala 600 97.2 96.9
Punjab 600 98.6 98.4
Rajasthan 600 90.7 90.0
Tamil Nadu 600 98.7 98.7
All India 10800 96.1 93.6
***NID was not held in Assam in December
38
4.6 IPPI COVERAGE OF CHILDREN ABOVE 5 YEARS OF AGE
During the Pulse Polio campaign, the OPV drops are to be given to every child within 0-5 years of age.
Sometime even children above the age of 5 years were given as the correct age could not be
assessed due to poor nutritional status. The table below reports the total number of children in the
sampled households who had received OPV dose in the campaign and of them how many were above
the age of 5 years at the beginning of the campaign.
Overall, out of total children received OPV during the IPPI campaign, 9% were above 5 years of age.
Analysis across background characteristics indicated that religion, caste and education had significant
influence on this coverage. Data revealed that the proportion of such children was significantly higher
among Sikh (18.4%) compared to other religion (9%). Further, the proportion of older children
vaccinated among illiterate parent was high and lowest among ST. Among boys and girls, one point
difference in favour of boys was observed.
Table 13 IPPI coverage of children above 5 years of age
Base :All Children who received OPV dose from sampled household
Base % of children above 5years
ALL 19548 9.1
LOCATION
Rural 10000 9.0
Urban 9548 9.4
GENDER
Male 9682 9.5
Female 9866 8.6
RELIGION
Hindu 15631 8.8↓
Muslim 2785 9.5
Christian 339 8.4
Sikh 654 18.4↑
Jain 101 4.6
Others 38 1.9
CASTE
SC 4388 10.9↑
ST 1612 5.0↓
Others 13548 9.1
Both literate 11022 8.2↓
Both illiterate 3369 10.9↑
One of them literate 5105 9.0
Not specified 52 0.7
39
4.7 ZERO DOSE CHILDREN
The proportion of children who did not receive any dose during the entire campaign has been one of
the prime coverage evaluation indicators. Identifying the characteristics associated with such Zero dose
children is one of the challenges for ensuring 100% coverage. The table below shows the proportion of
children who did not get any dose during this campaign (Zero dose in the current campaign)
Further, the study also estimated the proportion of the children who have never taken OPV in their
lifetime either during IPPI or RI (Zero dose lifetime). At national level, around 3% with confidence
interval of (2.9 ± 0.3) at 5% level of significance were campaign zero dosers. Considering the total
under 5 years population as 150 million, the left out during the campaign was approximately 4.3 million.
Further, 0.9% (0.9 ± 0.1) children were never reached with OPV (Zero dose lifetime), i.e approximately
1.5 million were never reached with OPV.
Across the various background characteristics it is seen that the proportion of Zero dosers in the
current campaign was significantly higher in Rural areas (3.3%), among Muslims (4%), among ST
(5.9%) and children of illiterate parents (4%).
Table 14 Zero dose Children
Base Zero dose children in Life time Zero dose
the current campaign children (%)
(%)
ALL 10800 2.9 0.9
LOCATION
Rural 5400 3.3 1.1
Urban 5400 1.6↓ 0.5
RELIGION
Hindu 8720 2.8↓ 0.9
Muslim 1436 4.0 1.5
Sikh 342 1.9 0.0
Jain 62 1.6 0.1
Others 16* 0.7 0.0
CASTE
SC 2335 2.1↓ 0.5
ST 880 5.9↑ 2.0
Others 7585 2.7 0.9
GENDER
Male 5400 3.3↑ 1.2
Female 5400 2.5↓ 0.7
Both literate 6350 1.8↓ 0.6
Both illiterate 1735 4.0↑ 1.0
One of them literate 2681 3.8 1.4
Not Specified 34 0.0 0.0
40
Comparing the Urban and Rural data of zero dosers one observes that there were significant
differences across the education level of parents. In both Urban as well as Rural areas the proportion
of zero dosers were significantly lower among the literate households. Across the background
characteristics of caste in Rural areas the proportion of zero dosers was significantly higher among STs
(6.5%).
Table 15 Zero dose Children in the current campaign

All Rural Urban
Base Zero dose in Base Zero dose in Base Zero dose in
the current the current the current
campaign (%) campaign (%) campaign (%)
ALL 10800 2.9 5400 3.3 5400 1.6
RELIGION
Hindu 8720 2.8↓ 4359 3.2 4361 1.6
Muslim 1436 4.0↑ 690 4.7 746 2.0
Christian 224 0.5 111 0.6 113 0.3
Sikh 342 1.9 224 2.0 118 1.6
Jain 62 1.6 14* 0.3 48 2.4
Others 16* 0.7 2* 0.0 14* 1.6
CASTE
SC 2335 2.1↓ 1321 2.3↓ 1014 1.5
ST 880 5.9↑ 589 6.5↑ 291 2.4
Others 7585 2.7 3490 3.2 4095 1.6
GENDER
Male 5400 3.3↑ 2697 3.9 2703 1.6
Female 5400 2.5↓ 2703 2.8 2697 1.6
Both literate 6350 1.8↓ 2460 2.1↓ 3890 1.4↓
Both illiterate 1735 4.0↑ 1266 4.3↑ 469 0.9
One of them literate 2681 3.8↑ 1656 4.0↑ 1025 2.7↑
Not Specified 34 0.0 18* 0.0 16* 0.0
* Base too low
41
4.7.1 Zero dose children by age cohorts
Distribution of Zero dosers in different age cohort reflects that 11.9% of the children of age group 0-3
months were Zero dosers and 3.5% among 4-6 months children. The overall zero dose proportion
among under 1 year was 5%, which was double compared to other age cohort. Further out of total
unreached children during 2001-02 IPPI cycle, 0-3 months children contributed to 24%. The proportion
of lifetime zero dosers was maximum in the 0-3 months age cohort (8.8%) due to low routine
immunization efforts and lesser number of opportunity for additional rounds.
Table 16 Zero dose children by age cohorts

Zero dose children in the current Life time Zero dose children
campaign
AGE OF THE CHILD Base Numbers Distribution Contribution of Numbers Distribution Contribution of
across age age cohorts across age age cohorts
cohort cohort
0-59 MONTHS 10800 309 2.9 96 0.9
0-3 Months 759 75 11.9 24.3 58 8.8 60.4
4-6 Months 640 18 3.5 5.8 10 1.9 10.4
7-11 Months 762 20 1.8 6.5 9 0.7 9.4
12-23 Months 2159 45 2.0 14.6 4 0.3 4.2
24-35 Months 2161 48 2.0 15.5 6 0.4 6.3
36-47Months 2158 49 2.3 15.9 4 0.2 4.2
48-59 Months 2161 54 2.7 17.5 5 0.3 5.2
42
4.8 ZERO DOSE CHILDREN BY STATES
The proportion of zero dose case during current campaign was reported to be significantly higher, than
the national average, in Assam, Rajasthan and Maharashtra. However, in the states of Karnataka,
Punjab, Madhya Pradesh and Tamil Nadu the proportion of zero dosers was significantly lower (<1%).
Table 17 Zero dose children across states

% across Base Zero dose children in Life time Zero dose
the current campaign children
Assam 600 11.1 1.9
Bihar 600 2.1 0.8
Delhi 600 1.6 0.6
Gujarat 600 2.9 1.1
Haryana 600 2.2 0.3
Jharkhand 600 3.3 2.1
Karnataka 600 0.8 0.3
Kerala 600 2.2 1.1
Punjab 600 0.8 0.2
Rajasthan 600 7.7 2.9
Tamil Nadu 600 0.9 0.0
All India 10800 2.9 0.9
Comparing the percentage of zero dose children with previous year, it can be observed that the
campaign zero dose increased slightly from 2.4% in 2000-01 to 2.9% in 2001-02 while due to repeated
efforts, the life time zero dose cases declined from 1.5% to 0.9 % during the same period.
4.9 PLACE WHERE DOSAGE WERE ADMINISTERED
At India level, the dosages were largely administered at the booth. In addition, in some states (U.P,
Bihar, Delhi and West Bengal) and High Risk districts in other states, house to house approach was
also adopted in subsequent 5-6 days. To understand the utilisation of the house to house immunization
service, respondents were asked about the place where OPV dose was administered.
The HtH campaign benefited higher proportion of children from rural Muslim, non-SC/ST, illiterate and
young children of 0-3 months age. Significantly higher proportion of female children also got OPV at
home. A similar trend was observed in both NIDs.
43
Table 18 Place of OPV dose administration
Base : All who received any dose Base Only Booth Only Home Some at booth, some at
(%) (%) home/others (%)
ALL 10491 81.8 10.5 7.7
LOCATION
Rural 5232 80.7↓ 11.4↑ 7.9
Urban 5259 85.0↑ 7.8↓ 7.2
RELIGION
Hindu 8484 82.6↑ 10.3↓ 7.1↓
Muslim 1372 75.8↓ 13.1↑ 11.1↑
Christian 221 95.1↑ 2.1 2.7↓
Sikh 339 79.2↓ 4.5 16.3↑
Jain 60 87.1 5.2 7.7
Others 15* 99.5 0.0 0.5
CASTE
SC 2290 84.4↑ 8.3↓ 7.2
ST 833 85.1 9.5 5.4
Others 7368 80.4↓ 11.4↑ 8.2
GENDER
Male 5236 82.1 9.7↓ 8.2
Female 5255 81.4 11.4↑ 7.2
Both literate 6199 87.2↑ 6.5↓ 6.3↓
Both illiterate 1671 74.3↓ 17.0↑ 8.7↑
One of them literate 2587 79.1↓ 11.9 9.1
Not Specified 34 74.8 1.6 23.6
AGE OF THE CHILD
0-3 Months 684 72.6↓ 18.5↑ 8.9
4-6 months 622 82.5↑ 10.6↓ 6.9
7-11 Months 742 80.7 8.5 10.8
12-23 Months 2114 81.3 10.4 8.3
24-35 Months 2113 83.1 10.8 6.1
36-47 Months 2109 80.6 11.5 7.9
48-59 Months 2107 84.4 7.7 7.8
44
4.9.1 Place of administration of doses by States
House to house efforts benefited in improving coverage in Uttar Pradesh (24%), Rajasthan (22%),
Bihar (19%), Delhi (17%), Uttaranchal (17%), Haryana (15%) and Jharkhand (16%). This effort
has helped these states in building a respectable coverage.
Table 19 Coverage by number of doses across states

Base Only booth Only home
(%) (%)
Assam 572 94.9 2.1
Bihar 588 58.2 18.7
Delhi 582 66.9 16.7
Gujarat 585 88.1 7.5
Haryana 584 79.8 15.2
Jharkhand 584 76.0 15.5
Kerala 582 98.0 0.9
Punjab 591 80.5 8.3
Rajasthan 584 74.9 21.6
Tamil Nadu 586 98.5 0.8
All India 10532 81.8 10.5
The booth coverage has declined by 5 point in 2001-02 compared to previous year. The similar trend is
seen for other background characteristics as shown in Table 24.
Table 20 Comparison with 2000-01

2000-01 All Rural Urban Male Female Hindu Muslim Christian SC ST Others
Base 40731 28595 12136 20388 20342 29422 6103 3309 6917 7100 26710
Proportion 86.9↑ 86.3↑ 88.1↑ 86.7↑ 87.0↑ 87.1↑ 80.9↑ 91.9↓ 87.6 (=) 89.0↑ 86.1↑
receiving OPV
dose at any booth
2001-02
Base 10491 5232 5259 5236 5255 8484 1372 221 2290 833 7368
Proportion 81.8↓ 80.7↓ 85.0↓ 82.1↓ 81.4↓ 82.6↓ 75.8↓ 95.1↑ 84.4 (=) 85.1↓ 80.4↓
receiving OPV
dose at any booth
45
4.10 REASONS FOR NOT RECEIVING ONE OR MORE DOSES
This section outlines the reasons for not getting one or more OPV doses in the various
rounds. Overall 6.1 % of children (645 children) in study states were reported to have not
received one or more PPI dose. Of these equal proportions were from Rural and Urban
areas. For these children, “Lack of motivation" was cited as the main reason for non
compliance (61%). The desegregated data indicates lack of motivation (especially, nobody
visited our home) as more important cause among rural, Hindu, ST and female children.
Lack of awareness especially about place and time of booth and date and time of home visit,
were also more among rural and Hindu families. Rumour of side effect and family doctor
advise against drop were significantly higher among Muslim families.
Table 21 Reasons for not receiving one or more IPPI doses in the 2001-2002 rounds
LOCATION RELIGION CASTE GENDER

% across A Rural Urban Hindu Muslim SC ST Others Male Female
l
l
BASE 645 319 326 494 128 125 70 450 327 318
LACK OF AWARENESS 39.3 40.8 33.1 39.6 36.4 36.7 41.3 39.6 39.1 39.6
Not aware of the place/time 24.0 25.8↑ 16.3↓ 25.9 16.8 17.0 25.3 25.8 21.2 27.1
of the booth
Not aware of the time/day of 13.6 14.6 9.0 12.0 16.2 16.0 21.3 11.1 15.2 11.8
home visit
Not aware of the need for 5.2 4.6 7.8 6.0 2.4 6.0 7.5 4.4 6.6 3.7
additional dosages
Have never heard of PPI 2.9 2.1 6.1 3.1 1.9 3.5 1.0 3.1 4.2 1.5
campaign
LACK OF MOTIVATION 61.2 60.7 63.0 62.7 55.1 62.0 63.2 60.5 56.2↓ 66.4↑
They did not come to my 31.2 32.9↑ 23.8↓ 33.6 23.3 25.4 43.3 30.1 26.7↓ 36.0↑
house
Child was too young 13.2 14.1 9.2 13.1 13.8 8.0 18.0 13.6 15.0 11.3
Nobody there to take the 11.6 12.1 9.2 12.4 7.6 16.4 18.0 8.6 12.0 11.1
child to the booth
We were travelling(were in 7.8 6.8 12.4 8.4 5.3 11.9 7.3 6.8 9.1 6.5
Bus/train etc)
Child was sick during 5.1 4.7 6.9 5.3 4.6 7.9 3.2 4.7 4.1 6.1
campaign
OBSTACLES 17.6 17.8 16.6 14.8↓ 28.1↑ 12.9 20.3 18.4 18.9 16.2
Fear / rumor of side effect 7.3 7.2 7.6 5.9↓ 12.5↑ 3.3 10.7 7.7 7.1 7.5
Doctor advised against 5.9 6.6 2.8 4.7 10.0 1.0 4.1 7.7 6.8 4.8
Fear of getting Polio due to 2.3 2.4 1.9 2.3 2.5 3.3 4.1 1.6 2.2 2.4
vaccine
Have not faith in additional 1.1 0.6 3.5 0.9 1.7 1.9 1.4 0.8 1.3 0.9
dosages
Don't have faith 1.1 1.0 1.6 1.0 1.6 3.5 0.0 0.7 1.5 0.8
OTHERS 9.2 8.7 11.7 8.2 12.9 8.4 5.9 10.2 13.4↑ 4.8↓
* Base too low
46
47
Looking across state- wise data one observes that while awareness of the programme is an issue in Bihar, Jharkhand, Punjab and Rajasthan, lack of
motivation (child too young, child sick, nobody at home, service provider did not visit our home) were prevalent in Andhra Pradesh, Chattisgarh, Haryana,
Karnataka, Jharkhand and Rajasthan. The fear component in Assam might be due to Vitamin A episode in 2001.
Table 22 Reasons for not receiving one or more IPPI doses
BASE :ALL CHILDREN NOT RECEIVING ANY VACCINE/DOSE
LACK OF LACK OF MOTIVATION OBSTACLES
KNOWLEDGE
% ACROSS Base Not Not aware Not aware Child We were Child Nobody Service Inconvenient Fear/ rumour Have no faith Fear of
aware of of the need of the was too travelling was there to take provider did day/timing of side effect in the vaccine getting
the place/ of all time/day of young sick child to Not come to disease
time vaccination home visit booth my house
Andhra Pradesh 20 7.7 0.0 0.0 27.7 2.6 0.0 6.3 1.7 5.7 0.0 0.0 0.0
Assam 146 15.0 5.7 0.4 0.1 0.7 11.9 7.9 3.4 0.2 34.9 0.1 11.2
Bihar 69 36.9 1.0 22.6 8.1 9.2 0.9 5.0 43.2 0.3 3.6 0.2 3.5
Chhatisgarh 32 7.2 20.4 18.5 11.4 21.6 8.3 16.4 18.5 0.0 4.7 0.0 0.0
Delhi 36 15.3 0.0 0.6 5.5 8.0 14.4 1.8 39.2 0.7 0.0 0.0 0.0
Gujarat 33 16.3 10.5 6.8 11.2 6.9 3.9 15.0 14.2 0.0 0.0 0.0 4.4
Haryana 20 16.0 0.0 11.1 4.4 12.9 0.0 27.6 84.6 0.0 0.0 0.0 0.0
Jharkhand 63 47.2 12.6 44.9 3.3 17.8 6.0 17.5 46.4 1.6 6.7 2.7 0.7
Karnataka 12 8.8 29.7 7.0 11.7 28.2 0.0 0.0 33.9 0.0 0.0 10.9 4.8
Kerala 19 0.0 0.0 0.0 38.9 11.2 15.4 0.0 0.0 0.0 2.6 26.8 2.6
Madhya Pradesh 6 0.0 0.0 0.0 33.3 22.2 0.0 23.3 0.0 0.0 0.0 0.0 0.0
Maharashtra 26 12.7 0.0 12.9 8.4 0.0 7.6 0.0 3.0 0.0 12.2 2.7 0.0
Punjab 15 31.0 10.5 16.6 9.8 17.2 5.7 0.0 15.5 0.0 0.0 0.0 0.0
Rajasthan 61 44.5 2.4 23.3 7.5 7.8 2.4 19.0 76.2 0.7 1.4 0.0 0.7
Tamil Nadu 14 12.8 0.0 0.0 0.0 12.8 9.5 0.0 0.0 0.0 0.0 5.3 0.0
Uttar Pradesh 24 12.2 0.0 1.1 45.3 9.2 0.0 16.5 26.0 0.0 7.8 0.0 0.0
Uttranchal 15 7.3 0.0 3.0 3.0 4.4 3.3 46.7 55.2 0.0 4.6 13.4 2.7
West Bengal 34 17.2 25.9 10.2 2.4 0.0 19.5 23.7 23.8 0.0 2.7 0.0 0.0
All India 645 24.0 5.2 13.6 13.2 7.8 5.1 11.6 31.2 0.6 7.3 1.1 2.3

4.10.1 Reasons for non compliance amongst campaign zero dose children
There were overall 309 zero dose children during the current campaign out of 10532
interviewed with almost equally distributed across Rural and Urban areas. The reasons for
remaining zero doser were similar to what was seen in the previous section. Lack of
motivation and not aware of the time/day of home visit were the key reasons for non-
compliance coupled with:
• Lack of motivation especially the excuse of service providers not visiting home, nobody at
home to take the child to the booth was more prevalent among Hindus, SC/ST families.
• The obstacles, mainly fear of side effect and doctors advice against drop were mentioned
significantly in Muslim and ST families.
• Lack of awareness was higher among Hindu, Rural and parents of girl children.
Table 23 Reasons for non-compliance amongst campaign zero dose children

l
l
BASE 309 168 141 236 64 45 47 217 164 145
LACK OF AWARENESS 35.8 36.0 34.7 37.4 27.6 30.0 37.7 36.7 32.2 40.8
Not aware of the place/time 23.4 24.4 17.1 26.0↑ 10.6↓ 22.5 21.6 24.2 18.9 29.6
of the booth
Not aware of the time/day of 9.3 9.5 8.2 8.1 11.6 9.5 14.5 7.6 10.4 7.8
home visit
Not aware of the need for 5.8 5.0 11.1 6.6 3.3 1.9 8.4 6.0 6.3 5.2
additional dosages
Have never heard of PPI 2.8 2.5 4.2 2.8 3.0 0.0 1.4 3.9 3.4 1.9
campaign
LACK OF MOTIVATION 57.1 56.6 60.2 58.5 50.1 69.9 56.1 54.1 53.2 62.5
They did not come to my 28.3 29.1 23.3 32.4↑ 11.4↓ 34.4 39.3 23.2 25.6 32.0
house
Child was too young 16.8 17.4 12.8 16.1 19.1 14.1 15.5 17.9 19.6 13.0
Nobody there to take the 15.0 16.3 6.5 15.6 10.6 26.2↑ 17.1 11.4↓ 16.4 13.1
child to the booth
We were travelling(were in 5.3 4.9 8.2 4.9 6.5 8.6 0.9 6.0 6.0 4.5
Bus/train etc)
Child was sick during 4.7 4.3 7.2 4.3 6.6 9.6 4.6 3.5 1.9 8.7
campaign
OBSTACLES 21.5 21.5 21.5 18.8↓ 32.9↑ 12.5 29.6 21.2 22.6 19.9
Doctor advised against/Said 7.9 8.2 5.8 7.4 10.1 2.2 6.0 9.9 8.6 6.9
was not required
Fear / rumor of side effect 7.6 7.6 7.7 6.3 12.8 2.3 15.7 6.3 6.9 8.5
Fear of getting Polio due to 3.0 3.0 2.8 2.7 4.1 0.0 6.0 2.7 3.2 2.6
vaccine
Fear of too many dosages 1.6 0.8 6.8 0.8 4.6 0.0 2.1 1.9 2.4 0.5
Have not faith in additional 1.0 0.6 3.6 0.5 2.9 0.0 2.1 1.0 1.4 0.6
dosages
OTHERS 9.5 8.7 14.7 8.6 12.8 7.0 6.9 11.0 13.2 4.4

Looking across the states, the number of zero doses were significantly higher in Assam and Rajasthan. In Assam, fear/rumour of side-effect was the major
contributing factor, while in Rajasthan, ‘service provider did not come to my house’ was quoted as the major reason for non-compliance.
Table 24 Reasons for non-compliance among Zero dose children across states
LACK OF KNOWLEDGE LACK OF MOTIVATION OBSTACLES
% ACROSS Base Not aware of Not aware Not aware Child too Out of Child sick Nobody to Service Inconvenient Fear of Have no Fear/
need of all of the of the young station take child to provider day/ timing getting faith in the rumour of
vaccination place/ time time/day of booth did not come disease vaccine side effect
home visit home
Andhra Pradesh 17 0.0 8.5 0.0 30.6 0.0 0.0 7.0 1.9 6.2 0.0 0.0 0.0
Assam 86 6.9 11.8 0.6 0.2 0.9 9.4 8.5 2.8 0.3 19.3 0.0 36.1
Bihar 15 3.8 28.6 10.0 1.0 33.5 0.0 0.0 49.7 0.0 1.8 0.0 2.8
Chhatisgarh 11 13.9 16.9 21.2 27.4 23.5 6.0 26.2 39.2 0.0 0.0 0.0 9.6
Delhi 8 0.0 36.5 0.0 17.3 0.0 17.2 0.0 53.8 0.0 0.0 0.0 0.0
Gujarat 18 14.5 20.4 4.0 11.4 3.4 3.4 13.9 16.5 0.0 7.4 0.0 0.0
Haryana 11 0.0 17.2 18.0 7.2 8.3 0.0 29.5 75.2 0.0 0.0 0.0 0.0
Jharkhand 18 4.9 77.7 27.7 5.9 7.1 11.4 12.0 62.1 5.7 0.0 0.0 19.0
Karnataka 5 55.0 19.4 0.0 25.7 0.0 0.0 0.0 41.4 0.0 10.6 0.0 0.0
Kerala 14 0.0 0.0 0.0 51.7 0.0 6.9 0.0 0.0 0.0 3.4 27.7 3.4
Madhya Pradesh 1 0.0 0.0 0.0 0.0 0.0 0.0 100.0 0.0 0.0 0.0 0.0 0.0
Maharashtra 21 0.0 11.2 11.7 9.8 0.0 9.0 0.0 3.5 0.0 0.0 3.1 14.4
Punjab 4 0.0 25.9 0.0 25.7 0.0 0.0 0.0 25.9 0.0 0.0 0.0 0.0
Rajasthan 38 3.6 43.5 24.3 11.5 8.3 0.0 29.3 71.4 1.1 0.0 0.0 1.0
Tamil Nadu 4 0.0 32.2 0.0 0.0 32.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Uttar Pradesh 10 0.0 22.4 0.0 52.2 0.0 0.0 25.4 25.4 0.0 0.0 0.0 0.0
Uttranchal 9 0.0 7.3 0.0 5.0 0.0 5.4 23.5 35.7 0.0 4.5 22.2 7.7
West Bengal 19 26.5 18.0 10.6 3.8 0.0 17.2 22.6 19.1 0.0 0.0 0.0 1.9
All India 309 5.8 23.4 9.3 16.8 5.3 4.7 15.0 28.3 1.0 3.0 1.0 7.6

4.10.2 Reasons for non compliance among lifetime zero dose children
Data on reasons for being lifetime zero doser revealed that lack of motivation was the
prime reason for 69% such children. In around 32% of the cases lack of awareness was
quoted as the reason for non-compliance followed by obstacles (22%). Location of
residence had shown significant influence on awareness and motivation. Significantly
lower proportion of urban respondents quoted these reasons for non-compliance.
Table 25 Reasons for non-compliance amongst life time zero dose cases
LOCATION RELIGION
% across Base All Rural Urban Hindu Muslim
BASE 96 66 30 71 21*
LACK OF AWARENESS 31 32.3 41.4 12.1 31.8 37.0
Not aware of the place/time of the 22 22.9 31.0 4.9 26.5 12.1
booth
Not aware of the time/day of home 9 9.4 12.2 3.1 6.8 20.0
visit
Not aware of the need for 4 4.2 0.0 13.4 4.0 5.6
additional dosages
Have never heard of PPI campaign 2 2.1 2.1 2.0 2.8 0.0
LACK OF MOTIVATION 66 68.8 86.3 29.7 73.9 60.6
Child was too young 30 31.3 40.2 11.3 34.2 23.8

They did not come to my house 28 29.2 39.2 6.9 31.3 24.9
Nobody there to take the child to 9 9.4 12.2 3.2 9.1 12.1
the booth
Child was sick during campaign 5 5.2 0.0 16.8 5.5 5.2
We were travelling(were in 2 2.1 2.5 1.1 2.4 1.6
Bus/train etc)
Inconvenient day/time/venue 1 1.0 1.5 0.0 1.4 0.0
OBSTACLES 21 21.9 27.1 10.3 18.5 37.2
Fear / rumor of side effect 8 8.3 9.2 6.3 7.9 11.3

Fear of getting Polio due to 7 7.3 7.7 6.4 3.8 20.6
vaccine
Doctor advised against 4 4.2 5.8 0.6 5.6 0.0
Fear of too many dosages 3 3.1 2.9 3.5 0.7 11.9
It will effect the fertility of the child 1 1.0 1.5 0.0 0.0 4.8
Don't have faith 1 1.0 1.5 0.0 1.4 0.0
OTHERS 9 9.4 12.3 2.8 5.6 23.9
• Base is too small.

4.11 SOURCE OF KNOWLEDGE
To assess the reach of the various communications methods and aids used, the respondents
were asked about the different ways in which they came to know about the PPI campaign.
Interpersonal Communication
Overall, in All India, interpersonal sources were mentioned by 78% of the people. The role of
interpersonal sources was found to be significantly more prominent in Rural areas (80%),
among Hindu households (80%) and amongst SC (83%) as compared to their counterparts.
Amongst the interpersonal sources, Health Workers (42%) were most active informants
followed by Anganwadi workers (28%) and Relatives/friends (19%). Teachers too seem to be
active informants with 15% respondents across India mentioning them as source of
knowledge. In Rural areas, Health Workers, AWW & Teachers were more often the source of
knowledge compared to Urban areas.
Among Hindus, AWW, Relatives/friends and Teachers got a higher mention as compared to
Muslims. Across the background characteristics of the education of parents, a significantly
higher proportion of illiterate caretakers mentioned Teachers as compared to literate
caretakers.
Table 26 Source of Knowledge regarding IPPI – Interpersonal Communication (IPC)
Interpersonal Sources
% across Base Through Health AWW Doctor Relatives / Teachers Religious /
IPC worker Friends community
leader
ALL 10800 78.3 41.9 27.5 4.7 18.7 14.5 1.2
LOCATION
Rural 5400 80.1↑ 44.0↑ 29.3↑ 3.7↓ 18.0↓ 15.9↑ 1.2
Urban 5400 72.8↓ 35.5↓ 22.1↓ 7.9↑ 20.9↑ 10.1↓ 1.0
RELIGION
Hindu 8720 79.5↑ 42.0 28.4↑ 4.8 19.4↑ 15.6↑ 1.1
Muslim 1436 74.3↓ 44.6 23.1↓ 4.0 15.7↓ 9.3↓ 1.5
Christian 224 82.7 34.5↑ 41.0 6.4 14.9 14.0 0.4
Sikh 342 51.0 17.1↓ 11.1 4.8 19.1 4.9 4.1
Jain 62 78.3 25.4 40.5 9.7 11.9 8.8 0.0
Others 16* 85.1 73.2 7.5 1.1 1.9 6.7 0.0
CASTE
SC 2335 82.6↑ 42.5↓ 26.8↓ 3.5 18.4 16.9 1.3
ST 880 85.5 50.3↑ 40.0↑ 6.0 20.7 14.2 1.6
Others 7585 75.8↓ 40.4 25.9 4.9 18.5 13.7 1.1
GENDER
Male 5400 77.8 41.6 27.6 5.0 17.9 14.7 1.4
Female 5400 78.8 42.2 27.4 4.4 19.6 14.2 0.9
EDUCATION OF
PARENTS
Both literate 6350 76.6↓ 39.9↓ 29.8↑ 6.3 17.4 10.0↓ 1.4
Both illiterate 1735 78.2 43.7 23.3↓ 2.1 17.8 18.9↑ 0.8
One of them 2681 81.1↑ 43.6↑ 27.2 4.3 21.6 18.1 1.0
literate
Not Specified 34 75.0 38.5 32.0 0.6 11.0 1.4 0.0
* Totals may add up more than 100% because of multi response
CES-02 INDIA - FINAL REPORT 52

In Karnataka and Assam nearly 92% of the respondents mentioned interpersonal sources as
source of information. The other states where the mention of interpersonal sources as the
source of knowledge was significantly higher then the All India level were – Gujarat, Haryana,
Jharkhand, Kerala, Madhya Pradesh, Maharashtra, Rajasthan and Tamil Nadu.
Among the various interpersonal sources Health workers seemed to be quite active in
Assam, Madhya Pradesh, Maharashtra and West Bengal. In Tamil Nadu, Kerala, Karnataka
and Haryana more than 60% mentioned AWW as source of information. However in
Uttaranchal, UP, Bihar and Punjab less than 10% mentioned AWWs.
Relative/friends got high mention in states likes Rajasthan, Uttaranchal, Madhya Pradesh,
Delhi, Assam and Bihar. Teachers had a significantly high mention in Rajasthan (57%)
followed distantly by Andhra, Madhya Pradesh and Jharkhand where nearly 20% mentioned
them as source of information.
Religious and community leaders had low mention across states except for Punjab and
Maharashtra where nearly 6% and 4% respectively mentioned them as source of information.
Govt/Private doctors do not seem to be active in terms of information providers except
Madhya Pradesh where 26% mentioned them as source of information.
Table 27 Source of Knowledge regarding IPPI across states

Base :All Children
Interpersonal sources
% across Base Any Health Anganwadi Govt./Private Relative Teacher Religious /
interpers worker worker Paediatrician /Friend community
onal leader
Andhra Pradesh 600 64.5 32.4 18.8 1.3 9.3 21.4 0.3
Assam 600 92.5 67.2 29.8 2.8 30.1 1.6 1.5
Bihar 600 78.9 38.4 5.8 2.7 31.6 18.6 1.7
Chhatisgarh 600 72.7 35.3 40.9 4.1 11.3 7.4 1.9
Delhi 600 58.2 14.3 12.9 2.6 30.5 3.9 1.3
Gujarat 600 89.1 36.5 42.3 3.9 15.8 10.7 0.0
Haryana 600 83.2 19.3 63.0 3.4 13.4 1.2 1.1
Jharkhand 600 85.9 18.9 29.8 1.4 34.5 19.3 0.0
Karnataka 600 92.2 42.7 69.0 3.8 9.0 9.4 0.3
Kerala 600 83.9 32.9 60.4 4.4 5.6 4.9 0.7
Madhya Pradesh 600 81.7 63.2 56.9 26.1 32.5 21.8 0.6
Maharashtra 600 89.7 68.3 35.3 7.2 4.6 6.4 3.8
Punjab 600 53.3 19.1 8.3 5.1 23.3 3.5 6.3
Rajasthan 600 88.4 32.0 15.4 1.6 33.0 56.9 0.7
Tamil Nadu 600 89.0 24.5 66.1 5.3 3.0 9.9 0.2
Uttar Pradesh 600 65.2 41.4 3.5 1.8 19.2 12.8 0.6
Uttranchal 600 74.2 41.0 4.5 1.8 34.4 19.0 0.0
West Bengal 600 75.6 48.3 19.1 1.8 13.7 0.9 0.8
All India 10800 78.3 41.9 27.5 4.7 18.7 14.5 1.2
*The figures in green colour refer to the states that have significantly higher coverage as compared to national
level.
**The figures in red colour refer to the states that have significantly lower coverage as compared to national
level.
Compared to the previous year, though there was no significant difference in the proportion of
respondents receiving knowledge about IPPI from interpersonal communication channels at
national level, in Rural areas, it’s role declined this year, while it showed an increase in Urban
areas.

2000-01 All Rural Urban Hindu Muslim Christian SC ST Others
Base 41790 29390 12400 30080 6305 3484 7069 7387 27330
Proportion receiving knowledge 79.3 (=) 84.5↑ 67.1↓ 81.4↑ 73.8(=) 76.1(=) 83.9 (=) 82.8↓ 77.2 (=)
about IPPI from any interpersonal
communication channel
2001-02
Base 10800 5400 5400 8720 1436 224 2335 880 7585
Proportion receiving knowledge 78.3 (=) 80.1↓ 72.8↑ 79.5↓ 74.3(=) 82.7(=) 82.6 (=) 85.5↑ 75.8 (=)
about IPPI from any interpersonal
communication channel
Mass Media
Overall, Mass media reached to 46% of the target population. As expected, it was
significantly more active in Urban areas, amongst Sikhs, respondents from other caste and
literate caretakers.
Amongst the mass media methods, Mike/Drum beating (24%) emerged to be the major
source of information followed closely by TV (22%). Radio was mentioned by 8% of the
respondents whereas Newspaper/Magazine and Wall paintings got nearly 5% mention.
Table 29 Source of Knowledge regarding IPPI –Mass Media
Mass Media
% across Base Any TV Radio Newspape Wall/ Mike/ Drum
mass rs/ paintings/ beating
media Magazine posters
s
ALL 10800 46.1 22.4 8.1 5.2 5.3 24.4
LOCATION
Rural 5400 38.7↓ 13.5↓ 7.8 2.1↓ 3.6↓ 24.4
Urban 5400 68.5↑ 49.6↑ 9.0 14.5↑ 10.5↑ 24.5
GENDER
Male 5400 47.4 23.5 8.2 5.2 5.2 25.0
Female 5400 44.8 21.3 8.1 5.1 5.4 23.8
RELIGION
Hindu 8720 44.9↓ 22.9 8.2 5.2 5.5 22.4↓
Muslim 1436 46.8 17.5↓ 7.4 3.7↓ 3.8↓ 30.4
Christian 224 60.2 34.7 12.3 12.0 4.3 29.5
Sikh 342 90.0↑ 29.8 5.8 5.3 7.5 72.6↑
Jain 62 48.4 38.4↑ 12.7 18.4↑ 13.0↑ 10.7
Others 16* 31.3 15.4 1.7 7.8 2.5 20.1
CASTE
SC 2335 45.3 18.3 8.8 2.7 3.2 27.4
ST 880 33.1↓ 13.3↓ 5.1↓ 2.0↓ 3.6↓ 18.9↓
Others 7585 48.3↑ 25.2↑ 8.4↑ 6.4↑ 6.2↑ 24.3↑
EDUCATION OF
PARENTS
Both literate 6350 62.7↑ 38.0↑ 12.3↑ 10.2↑ 8.8↑ 27.5↑
Both illiterate 1735 27.1↓ 6.0↓ 2.9↓ 0.4↓ 1.1↓ 21.6↓
One of them literate 2681 35.1 11.2 5.8 1.0 3.2 21.9
Not Specified 34 30.0 3.7 0.0 0.0 0.4 26.3
*Totals may add up more than 100% because of multi response
Analysis of methods by background characteristics revealed that TV emerged to be the major
source of information in Urban areas and amongst literate caretakers. Mike/Drum Beating got
higher mention amongst Sikhs and literate caretakers as compared to Hindus and illiterate
caretakers. Wall painting/posters and Newspapers/Magazines were mentioned by a higher
proportion of Urban caretakers, amongst Jain and literate caretakers.
Source of information across the state showed that in Punjab nearly 90% of the population
was reached by mass media, followed by Delhi and West Bengal (80% and 75%
respectively). The reach of mass media was less than 30% in the states of Bihar, Gujarat and
Jharkhand.
Table 30 Source of Knowledge regarding IPPI across states

Mass Media
% across Base Any TV Radio Newspapers/ Wall/ Mike/ Nobody/
mass Magazine paintings/ Drumbeating Never heard
media posters of IPPI
Andhra Pradesh 600 67.4 27.4 4.9 4.9 4.3 45.4 0.6
Assam 600 35.5 19.6 6.0 3.7 4.5 17.4 0.0
Bihar 600 19.3 7.1 5.8 1.4 1.4 9.4 0.2
Chhatisgarh 600 62.8 11.8 2.5 3.3 5.6 54.3 0.2
Delhi 600 79.6 70.2 9.9 22.2 23.2 11.6 0.6
Gujarat 600 28.0 11.4 3.0 5.3 6.9 11.5 0.6
Haryana 600 48.9 25.3 4.1 4.3 7.4 26.0 0.1
Jharkhand 600 28.4 14.3 5.9 2.9 4.7 14.2 0.1
Karnataka 600 35.1 20.6 5.7 2.9 4.1 18.3 0.3
Kerala 600 66.2 38.9 23.4 21.6 4.8 27.1 0.1
Madhya Pradesh 600 61.6 37.3 15.9 5.0 15.2 16.8 0.5
Maharashtra 600 38.7 25.4 7.5 8.9 7.5 13.4 1.7
Punjab 600 90.0 39.9 3.4 4.8 8.6 69.9 0.0
Rajasthan 600 33.2 21.5 5.0 6.9 6.1 15.0 1.8
Tamil Nadu 600 51.6 35.9 7.1 4.6 2.9 22.2 0.2
Uttar Pradesh 600 39.4 14.5 5.6 3.5 2.6 21.9 0.3
Uttranchal 600 64.4 38.6 10.5 7.0 8.3 28.6 0.2
West Bengal 600 74.8 25.4 22.5 3.6 2.0 56.6 0.6
All India 10800 46.1 22.4 8.1 5.2 5.3 24.4 0.6
TV emerged as the major source especially in Delhi (70%) followed distantly by Punjab,
Kerala, Uttaranchal and Tamil Nadu where the reach of Television as source of information
was close to 40%. However in Bihar the reach of Television was reported to be less than
10%.
Reach of mike and drum beating was quite high in Punjab followed by West Bengal and
Chhatisgarh with more than half of the respondents mentioning it as a source of information.
Whereas newspapers and magazines had a high reach in Delhi and Kerala, wall paintings
and posters were more popular in Delhi and Madhya Pradesh.
The comparison of national figure with the previous year’s revealed that the reach of any
mass media with IPPI information has declined. The trend was similar across all the
background characteristics except among SC, where it remained same.

2000-01 All Rural Urban Hindu Muslim Christian SC ST Others
Base 41790 29390 12400 30080 6305 3458 7069 7387 27330
Proportion receiving knowledge 55.4↑ 47.2↑ 75.1↑ 51.3↑ 61.6↑ 70.2↑ 46.7 (=) 56.6↑ 57.4↑
about IPPI from any mass media
2001-02
Base 10800 5400 5400 8720 1436 224 2335 880 7585
Proportion receiving knowledge 46.1↓ 38.7↓ 68.5↓ 44.9↓ 46.9↓ 60.2↓ 45.3 (=) 33.1↓ 48.3↓
about IPPI from any mass media
4.12 ADVICE ON VACCIANTION OTHER THAN POLIO

When the parents /caretakers bring their children to the PPI booth, it provides an opportunity
to the service providers to interact with them and offer advice on various issues especially on
need and importance of the routine Immunization. The respondents were asked if they had
received any advice about other vaccinations apart from the Polio doses.
Only 21%, of the respondents have indicated that they were given advice on the other
vaccines that need to be administered to their children. This proportion was significantly
higher among the Hindus (21%), Christians (27%), Sikhs (29%) as compared to Muslims
(15%). Literate parents (24%) had better access to such an information.
Table 32 Advised on Vaccination other than Polio by vaccinators during NIDs

% across Base Received Did not receive
ALL 10800 20.5 79.4
LOCATION
Rural 5400 20.6 79.4
Urban 5400 20.2 79.6
GENDER
Male 5400 20.8 79.1
Female 5400 20.2 79.7
RELIGION
Hindu 8720 21.3↑ 78.7
Muslim 1436 14.7↓ 85.2
Christian 224 27.4 72.6
Sikh 342 29.1 69.7
Jain 62 24.1 75.4
Others 16* 14.9 85.1
CASTE
SC 2335 19.9 80.0
ST 880 22.9 77.1
Others 7585 20.4 79.6
Both literate 6350 23.9↑ 75.9
Both illiterate 1735 15.6↓ 84.4
One of them literate 2681 19.1 80.9
Not Specified 34 13.3 86.1
*Base too low

4.13 PERCEPTION REGARDING THE IMPORTANCE OF ROUTINE IMMUNIZATION
It was hypothesised that many respondents feel that PPI dose in itself is enough and that
other Routine Immunization doses need not be given. Question on this was asked to the
respondents to assess the prevalence of the above perception.
Overall 81% of the total respondents felt the need of RI doses. Significantly higher proportion
of Urban respondents (85%), Hindus (83%) and literate parents (86%) had knowledge
regarding the importance of Routine Immunization when compared to the Rural respondents
(80%), Muslims (72%) and illiterate parents (74%).
Table 33 Knowledge regarding the importance of RI

% across Base Yes No Not Specified
ALL 10800 81.4 12.1 6.5
LOCATION
Rural 5400 80.2↓ 12.2 7.5
Urban 5400 85.1↑ 11.7 3.2
GENDER
Male 5400 81.4 11.7 6.9
Female 5400 81.5 12.5 6.0
RELIGION
Hindu 8720 83.0↑ 10.7 6.2
Muslim 1436 71.6↓ 20.4 8.0
Christian 224 89.2 9.2 1.6
Sikh 342 90.6 3.2 6.2
Jain 62 72.1 9.3 18.6
Others 16* 48.4 50.9 0.7
CASTE
SC 2335 80.3 13.9 5.8
ST 880 80.4 7.6 12.0
Others 7585 82.0 12.2 5.9
Both literate 6350 86.3↑ 11.2 2.5
Both illiterate 1735 73.8↓ 13.1 13.1
One of them literate 2681 80.0 12.7 7.3
Not Specified 34 66.7 17.6 15.6

4.14 KNOWLEDGE ABOUT THE SYMPTOMS OF POLIO LIKE DISEASE
To assess the extent of knowledge, respondents were asked how do they recognise Polio
cases. 37% mentioned weakness of limbs, while for around 7% of respondents, no
movement of limbs was the symptom. Another 8% mentioned fever followed by sudden
weakness of limbs as the symptom. Further, 4% of the primary caretakers had wrong notion
that paralysis since birth was also polio. 44% of the respondents were not aware of any kind
of symptoms of Polio like disease. Percentage of such respondents was significantly higher in
rural areas, SC/ST and illiterate.
Table 34 Knowledge on symptoms of Polio like disease

% across Base Weakness Fever followed Paralysis Sudden Leg & Leg & DK/CS
of the limbs by sudden since birth weakness of hand hand
weakness of limbs followed don't become
the limbs by fever move thinner
ALL 10800 37.2 7.8 3.8 4.5 6.6 2.3 44.1
LOCATION
Rural 5400 34.2↓ 6.7↓ 3.4↓ 4.0↓ 7.0↑ 2.6↑ 47.4↑
Urban 5400 46.5↑ 11.4↑ 5.3↑ 6.3↑ 5.3↓ 1.3↓ 34.4↓
GENDER
Male 5400 37.3 7.9 4.0 4.7 6.6 1.9↓ 44.3
Female 5400 37.2 7.7 3.7 4.4 6.5 2.7↑ 43.9
RELIGION
Hindu 8720 38.2 7.7 4.2 4.4↓ 6.5 2.4 43.6
Muslim 1436 32.0↓ 7.7 2.0↓ 4.9 7.6↑ 2.0 47.5
Christian 224 28.2 9.3 6.4↑ 8.2↑ 1.4↓ 2.0 52.1
Sikh 342 49.2↑ 7.2 3.4 6.3 3.5 0.1 36.4
Jain 62 36.9 7.7 4.7 5.7 8.5 6.9 43.4
Others 16* 17.1 70.7 0.7 0.7 0.0 1.0 23.8
CASTE
SC 2335 30.6↓ 7.0 3.6 3.4 7.7↑ 3.5↑ 48.5↑
ST 880 37.3 5.8↓ 5.3 4.0 3.7↓ 0.7↓ 54.3↓
Others 7585 39.5↑ 8.4↑ 3.7 5.0 6.6 2.1 41.2↓
EDUCATION OF
PARENTS
Both literate 6350 45.2↑ 11.4↑ 5.3 6.2↑ 5.2↓ 1.6↓ 34.9↓
Both illiterate 1735 25.8↓ 4.1↓ 2.2 2.6↓ 7.3↑ 2.5↑ 57.6↑
One of them 2681 34.0 5.0 2.9 3.5 8.1 3.1 48.1↓
literate
Not Specified 34 20.9 17.3 0.0 0.1 4.0 3.4 49.3
*Totals may add up more than 100% due to multi response

4.15 KNOWLEDGE REGARDING THE PLACE TO REPORT THE OCCURRENCE OF POLIO
Respondents were asked where would they report the occurrence of Polio cases. Nearly two
third (66%) of the respondents mentioned that they would report the Polio case in the close
by Govt. /Municipal Hospital followed by 29% of the respondents who said that they would
report the case in the close by Private hospital /Private Clinic. PHC/Sub centre was
mentioned by only 14% of the respondents.
In Urban areas preference for the Private Hospitals/Clinics seems to be significantly higher
(39%). Looking across the other background characteristics significantly higher proportion of
Hindu, Sikh, ST and illiterate respondents said that they would report the occurrence of Polio
in a Govt/Municipal Hospital, while among Christians (42%) and literate households (33%)
significantly higher proportion said they would approach a Private hospital/clinic.
Table 35 Knowledge regarding the place to report the occurrence of Polio

% across Base Govt./ Municipality PHC/ Sub- Private Health Don't know
Hospital center Facility
ALL 10800 65.6 14.1 29.1 2.2
LOCATION
Rural 5400 65.4 16.0↑ 25.8↓ 2.4
Urban 5400 66.4 8.4↓ 39.1↑ 1.4
GENDER
Male 5400 65.3 14.9 28.3 2.0
Female 5400 66.0 13.4 29.9 2.3
RELIGION
Hindu 8720 66.8↑ 14.2 28.1↓ 2.1
Muslim 1436 59.3↓ 14.8 33.2 2.6
Christian 224 54.4↓ 8.7 41.5↑ 2.6
Sikh 342 77.5↑ 13.1 29.3 0.8
Jain 62 67.5 10.5 38.5 3.9
Others 16* 50.4 15.7 43.8 0.0
CASTE
SC 2335 68.7 14.0 27.0 1.6
ST 880 74.9↑ 9.9↓ 19.0↓ 1.1
Others 7585 63.2↓ 14.8↑ 31.4↑ 2.5
Both literate 6350 65.2 14.1 32.9↑ 1.6
Both illiterate 1735 64.0↓ 13.2 26.5 2.7
One of them literate 2681 67.8↑ 15.2 25.1↓ 2.7
Not Specified 34 51.1 5.1 43.8 8.9
* Totals may add up more than 100% due to multi response

5 NUTRIENTS
5.1 VITAMIN A SUPPLEMENT
Vitamin A Deficiency (VAD) can cause eye damage and blindness among children. It impairs
children's immune system, increasing their chances of dying of common childhood diseases
and undermines the health of pregnant and lactating women. Vitamin A supplementation,
food fortification or dietary change can easily prevent it. Guidelines from Ministry of Health
and Family Welfare, India recommends that children age 9-12 months be given Vitamin A
supplements at the time of Measles vaccination and every six months thereafter until the age
of 3 years.
In this study, an attempt was made to estimate the Vitamin A coverage among children in the
age group of 9 to 59 months. Close to two fifth (40%) of the respondents had mentioned that
their children have received first dose of Vitamin A. Significantly higher proportion of children
from Urban area, belonging to Christian, ST and literate parents received Vitamin A as
compared to Rural, Muslim, SC and children of illiterate parents.
Table 36 Vitamin A coverage
Base :All Children above 9 months Among those who received Vitamin A
% across Base Vit A received 1 dose with 1 dose 2-3 doses 4+ doses
measles separately
ALL 8967 39.5 42.7 23.0 28.2 5.9
LOCATION
Rural 4492 36.4↓ 39.1↓ 24.7↑ 29.8↑ 6.3↑
Urban 4475 48.6↑ 51.0↑ 19.1↓ 24.6↓ 4.9↓
RELIGION
Hindu 7232 39.5 43.1↑ 21.4↓ 29.0↑ 6.3↑
Muslim 1196 37.1↓ 39.2 32.8↑ 23.7↓ 4.3↓
Christian 185 59.1↑ 29.6↓ 26.0 40.3 4.1
Sikh 288 37.3 69.6 12.6 15.7 2.2
Jain 53 46.2 57.8 14.4 23.7 4.1
Others 13* 41.9 84.7 11.3 4.0 0.0
CASTE
SC 1945 37.2↓ 36.5↓ 21.8 36.5↑ 5.1
ST 734 42.5↑ 49.1↑ 24.8 22.7↓ 3.1
Others 6288 39.8 43.7 23.0 26.5 6.6
GENDER
Male 4481 39.4 43.6 23.1 28.0 5.1
Female 4486 39.6 41.9 22.8 28.5 6.7
Both literate 5205 53.1↑ 44.2↑ 20.3↓ 28.6 6.6↑
Both illiterate 1475 25.8↓ 38.7↓ 28.5↑ 29.8 3.0↓
One of them literate 2255 29.9 41.7 26.3 26.2 5.7
Not Specified 32 13.4 18.3 45.0 2.1 34.6
AGE OF CHILD
9-11 Months 328 34.1↓ 54.2↑ 18.7 - -
12-23 Months 2159 41.7↑ 46.7↓ 22.9 28.2 -
24-35 Months 2161 39.2 43.3 23.3 28.4 4.9
36-47 Months 2158 39.0 40.2 24.1 28.0 7.7
48-59 Months 2161 39.5 41.0 22.0 28.6 8.0
* Base too low

Amongst children who received Vitamin A, 43% of them received it along with Measles
vaccine and 23% separately. It is noted that 28% had received 2-3 times while less than 6%
had received more than 3 timesThe proportion of such children was higher in Urban,
amongst Hindus, ST children and children of literate parents. Among those who had received
Vitamin A, children with 2 or more doses was significantly higher in Rural as compared to
Urban.
Analysis by age revealed that 34% to 42% of the children in different single year age cohort
have received first dose of Vitamin A. Among total 12-23months children surveyed, 12%
received 2-3 doses, while among older age cohort, 2-3% received 4 or more doses.
Comparing the vitamin A coverage by background characteristics in Rural and Urban areas
showed that the gap in the coverage remained 11-13 point amongest Hindu and Muslims
both in rural and urban situation. No gender bias was seen for vitamin A supplementation. it is
observed that a higher proportion of Christian children and children of literate parents in Rural
areas received Vitamin A..
Table 37 Vitamin A coverage by Rural and Urban
Base :All Children above 9 months Rural Urban
% across Base Vit A Base Vit A Base Vit A
received received received
ALL 8967 39.5 4492 36.4 4475 48.6
RELIGION
Hindu 7232 39.5↓ 3620 36.4↓ 3612 49.1
Muslim 1196 37.1 576 34.6 620 44.7↓
Christian 185 59.1↑ 93 64.1↑ 92 49.7
Sikh 288 37.3 190 35.0 98 45.7
Jain 53 46.2 11* 15.6 42 64.0↑
Others 13* 41.9 2* 26.1 11* 71.1
CASTE
SC 1945 37.2↓ 1100 35.9 845 41.9↓
ST 734 42.5↑ 501 40.8 233 52.3↑
Others 6288 39.8 2891 35.9 3397 49.9
GENDER
Male 4481 39.4 2243 36.3 2238 48.4
Female 4486 39.6 2249 36.5 2237 48.8
Both literate 5205 53.1↑ 1991 51.9↑ 3214 54.9↑
Both illiterate 1475 25.8↓ 1084 25.6↓ 391 27.8↓
One of them literate 2255 29.9 1400 29.1 855 34.4
Not Specified 32 13.4 17* 12.1 15* 23.3
AGE OF CHILD
9-11 Months 328 34.1↓ 172 29.5 156 49.3
12-23 Months 2159 41.7↑ 1080 39.0 1079 49.5
24-35 Months 2161 39.2 1081 37.0 1080 45.9↓
36-47 Months 2158 39.0 1079 35.9 1079 48.0
48-59 Months 2161 39.5 1080 35.7 1081 51.1↑
* Base too low

There were substantial state wise differences that have been detailed in the table below.
Across states, Bihar, Jharkhand, Rajasthan and Uttar Pradesh reported significantly
lower proportions of eligible children who received Vitamin A. Compared to the national
figure of 40%, Jharkhand and U.P. were not even one fourth of it. Kerala, Maharashtra
and West Bengal on the other hand, reported proportions in excess of 70%.
In most cases, the Vitamin A dose was given along with Measles (43%). In the states of
Assam, Bihar, Jharkhand and Tamil Nadu, high proportion of children received vitamin A
separate of measles vaccinations. This indicate that vitamin A could be substantially
improved though routine immunization. The proportion of children received two or more
doses were highest in Andhra Pradesh followed by Rajasthan, Tamil Nadu, West
Bengal, Haryana, Assam and Delhi.
Table 38 Vitamin A coverage by States

Base : All Children above 9 months Among those who received Vitamin A
% across Base Vitamin A 1 dose with 1 dose but 2-3 doses 4+ doses
Received measles separately
Andhra Pradesh 495 46.5 20.2 25 50.4 4.2
Assam 503 62.6 23 39.3 23.8 13.9
Bihar 500 15.6 11.3 63.7 24.2 0.8
Chhatisgarh 507 50.2 56.9 10.4 26.2 5.1
Delhi 501 40.1 52.3 12.9 31.1 3.6
Gujarat 487 54.4 53.4 24.4 19.9 2.2
Haryana 494 16.7 27.9 26.3 38.2 7.6
Jharkhand 497 8.5 27.8 44.1 24 4.1
Karnataka 501 48.9 62.5 18.7 16.4 2.4
Kerala 497 75.5 49.6 7.7 36 6.7
Madhya Pradesh 502 56.4 50.7 24.9 13.4 11.0
Maharashtra 503 74.0 60.9 12.5 25.5 1.1
Punjab 501 42.2 71.7 12.5 12.8 2.9
Rajasthan 496 24.3 31.6 14.1 43.8 10.3
Tamil Nadu 494 38.7 9.3 41.9 40.9 7.5
Uttar Pradesh 496 10.2 68.3 23.3 8.4 0.0
Uttranchal 497 38.3 74.4 1.8 20.4 3.4
West Bengal 496 70.4 21.2 25.2 40.2 12.8
All India 8967 39.5 42.7 23 28.2 5.9
* *The figures in green colour refer to the states that have significantly higher coverage as compared to national
level.
level.
Totals may not add up to 100% because of non response.

5.2 IFA SUPLLEMENT
IFA Tablets or Iron supplements are the most effective measure against Anaemia.
Respondents were asked if they had received IFA tablets/ syrup for their children.
At the aggregate level, about 10% reported that their children have ever received the IFA
Tablets. A significantly higher proportion of ST children, Christian children and children of
literate parents received IFA tablets/syrup.
Amongst all children who received IFA tablets/syrup, hardly 4% received more than 100
tablets in last one year, while 3% consumed it. This indicates the limited way in which
IFA supplementation among children is carried out in the country.
Table 39 IFA coverage
Base :All Children No of IFA received in last one year No of IFA consumed in last one
8
year
% across Base Ever Less 30 - 60 – More Less 30 - 60 60 – More
received than 60 100 than than 30 100 than
IFA 30 100 100
ALL 10800 10.3 63.5 23.9 5.8 3.7 70.8 18.4 4.7 2.9
LOCATION
Rural 5400 10.5 63.7 24.5↑ 5.8 3.1↓ 71.8↑ 18.4 4.6 2.3↓
Urban 5400 9.8 62.7 22.1↓ 5.7 5.3↑ 67.6↓ 18.2 5.1 4.9↑
RELIGION
Hindu 8720 10.4 63.2↑ 23.8 6.2↑ 3.8↑ 70.6↓ 18.5↑ 4.9 3.0
Muslim 1436 9.1↓ 67.5 23.8 3.8↓ 2.2↓ 75.6↑ 15.7↓ 3.7 2.2
Christian 224 19.3↑ 57.1↓ 21.4 5.6 7.6 64.5 18.0 4.7 4.6
Sikh 342 10.0 62.0 25.7 3.0 3.8 62.0 25.7 3.0 3.8
Jain 62 11.7 63.0 29.0 0.0 0.0 63.0 29.0 0.0 0.0
Others 16* 13.1 31.9 68.1 0.0 0.0 31.9 68.1 0.0 0.0
CASTE
SC 2335 9.3↓ 62.2 27.0↑ 6.7↑ 2.7↓ 69.2 22.6 5.1 1.8↓
ST 880 13.0↑ 59.1↓ 26.3 7.2 2.9 65.4↓ 23.1↑ 4.6 2.3
Others 7585 10.3 64.7↑ 22.5↓ 5.3↓ 4.1↑ 72.4↑ 16.2↓ 4.6 3.4↑
GENDER
Male 5400 9.7 62.9 22.6 6.0 4.2 70.3 16.8 5.0 3.5
Female 5400 11.0 64.0 25.1 5.7 3.1 71.3 19.8 4.4 2.4
EDUCATION OF
PARENTS
Both literate 6350 11.6↑ 59.3↓ 23.0 6.9↑ 6.2↑ 66.3↓ 18.0 5.9↑ 5.3↑
Both illiterate 1735 9.1↓ 69.9↑ 23.6 4.7↓ 0.9↓ 78.1↑ 18.5 2.4↓ 0.3↓
One of them literate 2681 9.4 66.3 26.1 4.5 0.8 73.7 19.3 4.2 0.5
Not Specified 34 8.3 100.0 0.0 0.0 0.0 100.0 0.0 0.0 0.0
AGE OF CHILD
9-11 Months 2161 6.1↓ 61.2 26.0 6.8 1.3↓ 68.5 20.0 - -
12-23 Months 2159 9.9 68.8↑ 21.8 3.4↓ 4.3↑ 73.5 18.6 2.3 4.0
24-35 Months 2161 11.0 58.9↓ 28.1↑ 7.5↑ 2.8 69.0 20.5 5.6 2.3
36-47 Months 2158 12.6↑ 68.1 21.5↓ 4.5 3.0 75.8↑ 14.4 4.4 2.4
48-59 Months 2161 11.1 60.7 22.8 6.5 6.0 66.4↓ 20.0 5.1 4.5
8
Base all children who received IFA in last one year
IFA coverage by states showed that in Gujarat, 22% of the children received IFA
tablets/syrups followed closely by Chattisgarh, Maharashtra, Karnataka and Tamil Nadu.
Table 40 IFA coverage across States

Base : All Children IFA received/consumed in last one year
(Base : All who received)
% across Base: IFA > 60 > 30 > 60 100+
Received received consumed consumed Consumed
Andhra Pradesh 600 8.9 0 84.2 0 0
Assam 600 5.1 1.2 66.8 0.5 0
Bihar 600 7.5 6.4 82.1 1.7 0.9
Chhatisgarh 600 18.1 20.3 57.2 12.2 6.4
Delhi 600 13.8 14 61.4 14 6.7
Gujarat 600 21.8↑ 3.2 87.5 3.2 0.0
Haryana 600 6.0 5.9 63.8 2.8 1.0
Jharkhand 600 13.7 8.1 71.1 8.1 3.5
Karnataka 600 17.2 17.3 65.3 15.7 1.6
Kerala 600 15.1 23.1 48.8 18.3 9.9
Madhya Pradesh 600 3.4↓ 0 70.8 0 0
Maharashtra 600 17.3 10.3 65.2 7.7 4.3
Punjab 600 14.4 6.9 54 6.9 2.7
Rajasthan 600 8.6 11.2 79.5 7.8 6.0
Tamil Nadu 600 16.6 6.1 76.6 5.1 2.0
Uttar Pradesh 600 5.5 11.7 79.7 11.7 4.3
Uttranchal 600 12.1 30.7 48.6 26.9 10.1
West Bengal 600 6.7 5.6 45.8 4.5 0.0
All India 10800 10.3 9.4 70.8 7.6 2.9

6 ROUTINE IMMUNIZATION
6.1 ROUTINE IMMUNIZATION SESSIONS
Invention of vaccines against various diseases is one of the prominent achievements of the
20th century. The Government of India is committed to protect every infant from six common
preventable diseases.
As per the National Child Immunization schedule, a child should receive a BCG vaccination
to protect against childhood tuberculosis, three doses of DPT to protect against Diphtheria,
Pertussis, and Tetanus, three doses of Polio vaccine, and a Measles vaccine by the 1st
birthday. It is expected that the routine Immunization session should be held at least once a
month in all villages (with more than a thousand population) for achieving universal access to
immunization.
For convenience and better utilisation, site/day/time for Immunization is fixed. This practice
has far reaching benefits of 1) Beneficiaries remember that Immunization services would be
available on the particular day, 2) It makes the logistics of arranging the vaccines, syringes,
needle etc. a lot easier and it would be a firm commitment on the part of service providers.
In 82% of the clusters’ key informants mentioned that Routine Immunization session is held
within the cluster/area. However, 76% of the respondents reported that that RI session
was held within their area/village (75% in Rural and 80% in Urban), which was
significantly higher than previous year (62%). Across religion and caste, a significantly
higher proportion of Sikhs (90%) and ST (83%) mentioned the session was held within the
area.
Among those who mentioned that immunization sessions were held in their village/area,
51% mentioned that it was organised monthly while 30% reported that the session was
weekly. Weekly session was fairly common in Urban areas (42%) compared to Rural areas
(26%). Whereas monthly session in Rural areas (57%) compared to Urban areas (38%).
Higher proportion of ST respondent’s mentioned that the session was held monthly
compared to SC.
Though 76% respondent knew the occurrence of RI session, 71% reported that it was held
on a fixed day. Significantly higher proportion of Hindus (73.5%) reported this compared to
the Muslims (67%).
Overall, 52% reported that at least monthly session was organised on a particular day in their
cluster.

Table 41 Routine Immunization Session
Frequency9*
% across Base Session Held on a Weekly Twice a Monthly Once in DK/CS
held within particular month two
the area/ day months
village
ALL 4320 76.4 71.3 30.4 6.4 51.4 7.8 2.4
LOCATION
Rural 2160 75.2↓ 70.8 26.2↓ 6.4 56.5↑ 7.9 2.2
Urban 2160 79.8↑ 72.5 41.8↑ 6.5 37.7↓ 7.6 3.1
RELIGION10
Hindu 3428 76.1↓ 72.5↑ 30.3 6.1 51.8 7.8 2.6
Muslim 567 74.9 66.9↓ 28.1 6.8 51.4 9.5 2.2
Christian 81 75.7 78.4 32.5 6.3 52.2 6.1 0.0
Sikh 141 89.8↑ 88.3 67.5 3.4 24.6 2.4 0.5
Jain 25 95.3 44.8 24.6 13.9 49.5 4.6 7.4
Others 78 86.5 41.5 17.7 17.0 61.6 3.7 0.0
CASTE
SC 958 77.4 70.3 32.7↑ 6.7 50.7↓ 5.8↓ 2.9
ST 344 82.6↑ 73.7 18.4↓ 5.1 61.9↑ 13.5↑ 1.1
Others 3018 75.1↓ 71.3 31.5 6.5 50.0 7.6 2.5
GENDER
Male 2160 76.5 72.3 30.4 6.5 51.4 7.3 2.7
Female 2160 76.3 70.2 30.5 6.3 51.4 8.4 2.1
* Totals may not add up to 100% because of non response
Higher proportion of Sikhs (94%) mentioned the session was held within the area compared
to Hindus (75%) in Rural areas. In Urban areas this proportion was higher amongst ST (95%)
compared to other caste respondents (78%).
Table 42 Routine Immunization Session– Urban and Rural
All Rural Urban
% across Base RI session held Base RI session Base RI session held
within the area/ held within the within the area/
village area/ village village
ALL 4320 76.4 2160 75.2 2160 79.8
RELIGION
Hindu 3428 76.1↓ 1716 74.8↓ 1712 79.9
Muslim 567 74.9 282 72.8 285 81.3
Christian 81 75.7 39 72.5 42 81.7
Sikh 141 89.8↑ 88 94.0↑ 53 77.4
Jain 25 95.3 6* 100.0 19* 92.7
Others 78 86.5 29 100.0 49 65.3
CASTE
SC 958 77.4 534 75.8 424 83.0
ST 344 82.6↑ 234 80.2 110 95.0↑
Others 3018 75.1↓ 1392 74.1 1626 77.7↓
* Base too low
9
All who mentioned that RI is held in their village/area
10
Others here included Buddhists and all those who did not specify their religion.
Out of 75% of the respondents who mentioned that the RI session was held in their area,
93% found the distance to the place where RI sessions were held either “within walking
distance” or “not very far” from their home. Thus, for 70% (93% of 75%) of the respondents,
availability and accessibility of routine immunization services is not a problem.
A significantly higher proportion of respondents in Rural areas (77%) found the distance to be
within walking distance as compared to Urban areas (73%). There was not much of
difference in the perception of sessions being far away across other variables.
Table 43 Location of Routine Immunization Session
Base :All mentioning that RI Session held within the area/ village
% across Base Within walking Not very Too far Not
distance far Specified
ALL 3448 75.4 17.7 6.3 0.7
LOCATION
Rural 1768 76.5↑ 17.3 5.4↓ 0.8
Urban 1680 72.5↓ 18.7 8.6↑ 0.3
RELIGION
Hindu 2727 75.4↓ 17.9↑ 6.1 0.5
Muslim 447 72.2 18.6 7.6 1.5
Christian 66 74.3 21.2 4.5 0.0
Sikh 124 77.0 12.9 10.1 0.0
Jain 23* 70.3 17.3 12.4 0.0
Others 61 98.2↑ 1.8↓ 0.0 0.0
CASTE
SC 773 76.8 15.2 6.9 1.0
ST 287 79.1 18.2 2.7 0.0
Others 2388 74.3 18.4 6.7 0.6
Gender
Male 1722 76.2 16.9 6.6 0.3
Female 1726 74.5 18.5 6.0 1.0
PRIMARY CARETAKERS EDUCATION
Illiterate 1177 73.5↓ 20.2↑ 5.4 0.9
1 - 4 Years 291 73.5 18.5 6.3 1.7
5 - 8 Years 817 78.7 14.7 6.6 0.0
9 -14 Years 874 74.8 16.5 8.3 0.4
15+ Years 215 71.1 20.2 7.5 1.2
Not Specified 74 96.5↑ 3.2↓ 0.2 0.0
* Base too low
* Totals may not add up to 100% due to non response

6.2 IMMUNIZATION CARD
Immunization Card is a `Mother and Child’ Immunization card. The card is expected to be
given to the pregnant women at the time of first Ante Natal Check-up (ANC). It has provisions
to record both TT Immunization/IFA supplementation, scheduled for the mother and the
vaccines/ Vitamin A to be provided to the child. The service provider is expected to retain a
counterfoil card and the main card is to be kept with the family. Each time a vaccine is given,
it is recorded in the card. This acts as a default-tracking tool and ensures that both
beneficiaries and service providers are aware of the Immunization schedule and ensure
complete Immunization. In IPPI, mothers of children in the age group 12-23 months were
asked whether they had Immunization card.
Overall, about 54% of the children had immunization card, which was significantly higher
among Urban, Sikh, SC and other caste and literate. In fact, percentage of respondents with
immunization card was directly co-related with year of schooling.
Table 44 Presence of the Immunization Card
% across Base Card Present Card not present
All 4320 53.8 45.8
LOCATION
Rural 2160 48.5↓ 51.1
Urban 2160 68.9↑ 30.7
RELIGION
Hindu 3428 53.1↓ 46.4
Muslim 567 53.9 46.0
Sikh 141 77.8↑ 21.3
Jain 25 60.0 40.0
Others 78 57.0 43.0
CASTE
SC 958 53.9↑ 44.9
ST 344 41.3↓ 58.7
Others 3018 55.6↑ 44.2
GENDER
Male 2160 54.3 45.4
Female 2160 53.4 46.2
PRIMARY CARETAKER’S
EDUCATION
Illiterate 1562 34.6↓ 64.8
1 - 4 Years 356 59.0↑ 41.0
5 - 8 Years 936 68.3↑ 31.6
9 –14 Years 1071 75.2↑ 24.5
15+ Years 298 89.8↑ 8.9
Not Specified 97 57.6↑ 42.4
* Base too low
* Totals may not add up to 100% because of non response

6.3 ROUTINE IMMUNIZATION SESSIONS BY STATES
Overall 76% of the respondents mentioned RI session being held within the area/cluster
however only 51.5% mentioned the frequency of RI session being held at least monthly on a
fixed day. States such as Andhra Pradesh, Chhattisgarh, Gujarat, Kerala, Madhya Pradesh,
Maharashtra, Punjab, Uttaranchal and West Bengal showed much better performance in
terms of holding RI sessions compared to National coverage (90% or above vis-à-vis 76% at
the All India level).
Data reflects that in Chhatisgarh, Kerala, Madhya Pradesh and Punjab, more than 70% of he
respondents reported that sessions are organised at least a month on a fixed day.
Percentage of such respondents was lowest in Bihar (19%), followed by Gujarat (33%),
Rajasthan (37%) and Jharkhand (40%)
Table 45 Routine immunization sessions and presence of immunization card across
states
% across Base RI session At least monthly Card Present
held session on fixed day
Andhra Pradesh 240 90.5 60.3 43.5
Assam 240 56.2 39.6 65.1

Bihar 240 32.5 19.1 32.8
Chhatisgarh 240 95.6 80.7 41.1
Delhi 240 76.1 63.3 72.3
Gujarat 240 90.2 33.0 60.2
Haryana 240 89.0 50.8 61.6
Jharkhand 240 58.8 39.6 43.0
Karnataka 240 84.7 67.2 74.5
Kerala 240 91.0 72.7 96.3
Madhya Pradesh 240 100.0 74.4 70.4
Maharashtra 240 91.7 49.5 66.1
Punjab 240 91.4 86.0 79.3
Rajasthan 240 74.8 36.6 31.9
Tamil Nadu 240 84.1 62.3 52.7
Uttar Pradesh 240 57.9 42.7 26.9
West Bengal 240 96.8 69.1 94.2
Uttranchal 240 90.5 54.6 60.8
All India 4320 76.4 51.5 53.8
level.
level.
At the All India level, 71% mentioned that RI session was held on a particular day while 52%
said the session was held at least once a month on a particular day. Again this proportion
was very low in Bihar (19%) while it ranged between 50-80% in most other states. Punjab
(86%) and Chhattisgarh (81%) had highest proportion of clusters in which RI sessions were
held at least once a month on a particular day.
Overall, in 54% of the cases mothers had Immunization card for their child. Presence of
Immunization cards was over 70% in Kerala, MP, Punjab, Karnataka, Delhi and West
Bengal. The evidence of RI services being availed – the Immunization cards were available
to one third in UP (27%), Rajasthan (32%) and Bihar (33%).

6.4 BCG VACCINATION
BCG is the vaccine against childhood TB and is given as early as possible. Usually the
vaccine is given on the left shoulder where it leaves a scar. The following Table-49 presents
the findings for the 12-23 month old children.
Overall 74% of children had received BCG, and the BCG scar was present in 75% of these
children. Though the recommended timing of receiving BCG is immediately after birth, only
64% of those who were administered the BCG had received it in the first month of birth while
29% received it within 2-6 months after birth.
Table 46 BCG Vaccination
Presence of Scar11 Timing of BCG12
% across Base BCG Given Scar present Scar Scar not BCG BCG+ BCG given BCG
not verified given in given in after six given
visible first 2-6 months DK/CS
month month
ALL 4320 74.0 75.3 13.7 11.0 64.2 29.3 3.6 2.8
LOCATION
Rural 2160 69.0↓ 76.4↑ 13.7 9.9↓ 58.9↓ 33.2↑ 4.5 3.4
Urban 2160 88.3↑ 72.8↓ 13.8 13.4↑ 76.0↑ 20.7↓ 1.7 1.6
GENDER
Male 2160 74.5 75.4 13.8 10.8 63.4 30.4 3.5 2.7
Female 2160 73.6 75.2 13.7 11.2 65.1 28.2 3.8 2.9
RELIGION
Hindu 3428 74.1↑ 76.2 13.3 10.5 63.8↑ 30.2↑ 3.5 2.6
Muslim 567 67.8↓ 73.7 16.3 10.0 57.9↓ 31.9 5.6 4.6
Christian 81 82.8 78.6 11.9 9.6 85.8 9.0↓ 3.6 1.5
Sikh 141 88.5 64.7 14.8 20.4 82.5 14.8 0.4 2.2
Jain 25 91.2 82.5 14.4 3.1 82.9 17.1 0.0 0.0
Others 78 100.0 60.2 13.7 26.1 82.8 15.0 0.0 2.1
CASTE
SC 958 71.6 78.2 12.8 9.1 62.2↑ 32.6 3.3 2.0
ST 344 77.0 81.8 13.1 5.1 53.5↓ 37.9 3.8 4.8
Others 3018 74.5 73.4 14.1 12.5 66.5 27.0 3.7 2.8
PRIMARY
CARETAKERS
EDUCATION
Illiterate 1562 56.1↓ 74.1 16.8 9.0 50.2↓ 40.4↑ 6.2 3.2
1 - 4 Years 356 80.7↑ 79.7 13.1 7.2 60.9↑ 30.0↓ 5.6 3.5
5 - 8 Years 936 86.1↑ 76.4 10.7 12.9 70.2↑ 24.5↓ 1.8 3.5
9 –14 Years 1071 93.5↑ 76.5 13.2 10.3 74.5↑ 21.6↓ 2.0 1.9
15+ Years 298 99.8↑ 71.2 10.8 17.9 81.7↑ 18.0↓ 0.2 0.2
Not Specified 97 98.1↑ 61.3 12.7 25.9 81.5↑ 16.7↓ 0.0 1.8
* Base too low
A significantly higher proportion of children in Urban areas (88%) were administered BCG
compared to those in Rural areas (69%). This was also true for children who received the
vaccine in the first month. Higher proportion of Hindus (74%) received the BCG vaccine
compared to Muslims (69%).
11
All children who received BCG
12
Base : All children who received BCG vaccine
The overall compliance with BCG shows a strong correlation with education of parents.
Coverage was significantly lower amongst children of illiterate primary caretaker (56%).
6.5 DPT VACCINATION
DPT vaccine is given to provide the child immunity against Diphtheria, Pertusis and Tetanus.
Three doses need to be given at 6, 10 and 14 weeks to develop sufficient immunity.
Over all, 71% of children had received DPT 1 while this figure fell to 67% for DPT 2 and 64%
for DPT 3. The drop out ratio from the first to the third dose was close to 10%.
DPT coverage was significantly higher, while dropout from 1st to 3rd dose was lower in urban
areas compared to rural. A higher proportion of Hindu children and children of literate parents
received all the three DPT vaccines. Dropouts were higher among children of Muslim and
illiterate parents.
Table 47 DPT vaccination
Coverage Drop out ratio
% across Base DPT 1 DPT 2 DPT 3 DPT 1 to DPT 1 to DPT 2 to
DPT 3 DPT 2 DPT 3
ALL 4320 70.6 67.1 63.8 9.5 4.9 4.9
LOCATION
Rural 2160 65.4↓ 61.4↓ 58.0↓ 11.3↑ 6.0↑ 5.6
Urban 2160 85.3↑ 83.2↑ 80.5↑ 5.6↓ 2.5↓ 3.2
RELIGION
Hindu 3428 70.7↑ 67.5↑ 64.2↑ 9.2↓ 4.5↓ 4.9
Muslim 567 64.4↓ 58.6↓ 54.9↓ 14.7↑ 8.9↑ 6.4
Christian 81 74.6 74.6 74.6 0.0 0.0 0.0
Sikh 141 86.9 83.9 81.1 6.7 3.5 3.4
Jain 25 61.8 61.8 61.8 0.0 0.0 0.0
Others 78 100.0 100.0 100.0 0.0 0.0 0.0
CASTE
SC 958 68.6 65.1 61.3 10.7 5.1 5.9
ST 344 70.3 64.5 61.3 12.7 8.3 4.9
Others 3018 71.3 68.2 65.1 8.7 4.4 4.5
GENDER
Male 2160 70.5 67.3 64.4 8.6 4.5 4.3
Female 2160 70.7 66.9 63.3 10.5 5.3 5.5
PRIMARY CARETAKERS
EDUCATION
Illiterate 1562 50.6↓ 45.4↓ 40.9↓ 19.2↑ 10.4↑ 9.8↑
1 - 4 Years 356 74.2↑ 70.6↑ 67.5↑ 9.1↓ 4.9↓ 4.3↓
5 - 8 Years 936 85.7↑ 83.3↑ 80.0↑ 6.7↓ 2.8↓ 4.0↓
9 -14 Years 1071 92.4↑ 91.2↑ 89.9↑ 2.7↓ 1.3↓ 1.4↓
15+ Years 298 98.6↑ 98.5↑ 98.3↑ 0.3↓ 0.2↓ 0.2↓
Not Specified 97 98.1↑ 98.1↑ 98.1↑ 0.0↓ 0.0↓ 0.0↓
* Base too low

The first dose of DPT to the child needs to be given at 1½ months of age and the remaining
two doses should be given at an interval of one month each. The following table details the
proportion that received the first dose of DPT by the specified age and received other two
doses at a month interval.
The table below reflects that place of residence, religion and education have significant
impact on the age of receiving DPT1. Significantly lower proportion of Hindus, Muslims, Rural
children and children of illiterate parents received DPT1 during 1½ to 2 months of age.
The proportion who received all three doses of DPT with a gap of one month (DPT vaccines
as per schedule) was close to 65%. A higher proportion of Urban children (70%) and children
of literate parents (63 to 76%) followed the schedule compared to Rural (63%).
Table 48 Age of receiving DPT
Age of receiving DPT1
% across Base 1½ -2 3-6 6+ DK/CS Proportion who
months months followed schedule
ALL 3457 65.6 25.0 4.2 4.3 65.3
LOCATION
Rural 1614 61.9↓ 27.0↑ 5.0↑ 5.1 63.3↓

Urban 1843 73.6↑ 20.6↓ 2.5↓ 2.6 69.7↑
RELIGION
Hindu 2772 65.8↓ 24.9 4.2 4.4 65.9
Muslim 399 59.4 28.3 6.2 4.2 56.8
Christian 69 80.8↑ 15.9 1.7 0.0 83.1
Sikh 122 78.4↑ 16.0 1.7 3.8 71.6
Jain 17* 60.6 32.4 0.0 7.0 45.2
Others 78 75.1 20.8 0.0 4.1 78.7
CASTE
SC 742 63.9 27.4 5.0 2.6↓ 58.9
ST 247 61.7 21.3 4.1 12.2↑ 62.3
Others 2468 66.8 24.7 4.0 3.7 67.9
GENDER
Male 1744 65.7 25.1 4.0 4.1 66.8
Female 1713 65.5 24.8 4.5 4.4 63.7
EDUCATION
Illiterate 919 53.4↓ 32.4↑ 7.2 6.0 54.7↓
1 - 4 Years 284 63.4↑ 27.1 5.6 2.6 61.4
5 - 8 Years 841 69.6↑ 22.0↓ 2.8 4.8 69.7↑
9 -14 Years 1024 76.5↑ 18.1↓ 2.5 2.2 71.4↑
15+ Years 294 72.0↑ 22.4↓ 0.0 4.5 80.8↑
Not Specified 95 75.2↑ 21.3↓ 0.0 3.5 81.6↑
* Base too low

6.6 OPV VACCINATION
OPV or Oral Polio Vaccine is given to provide the child immunity against Polio along with
DPT. The following table details out the coverage of OPV under Routine Immunization. The
dosages given under the PPI program were not included here.
Overall, 75% of children in age 12-23 months received OPV1. The proportion of OPV2 came
down to 72% and further down to 68% for OPV3. The drop out ratio from OPV1 to OPV3 was
9%.
Across doses, a significantly higher proportion of the Urban respondents received OPV
compared to the Rural children, while dropouts from (OPV1 to OPV3) were significantly
higher in case of Rural children (11%) compared to Urban (5%) children.
Children receiving all the three OPV vaccines were lowest among Muslims (62%). Among
illiterate parents, OPV3 coverage was lowest (48%) while the dropout from first to third dose
was highest (17%).
Table 49 OPV Vaccination
Coverage Drop out ratio
% across Base OPV 1 OPV 2 OPV 3 OPV 1 to OPV 1 to OPV 2 to
OPV 3 OPV 2 OPV 3
ALL 4320 75.1 71.5 68.3 9.1 4.8 4.4
LOCATION
Rural 2160 70.6↓ 66.5↓ 63.0↓ 10.8↑ 5.9↑ 5.2↑
Urban 2160 88.0↑ 85.8↑ 83.5↑ 5.1↓ 2.5↓ 2.7↓
RELIGION
Hindu 3428 74.8↓ 71.6↓ 68.4↑ 8.5 4.3 4.4
Muslim 567 72.9 66.3 62.2↓ 14.6 9.0 6.1
Christian 81 74.6 74.6 74.6 0.0 0.0 0.0
Sikh 141 86.8↑ 83.9↑ 81.1↑ 6.7 3.4 3.4
Jain 25 61.8 61.8 61.8 0.0 0.0 0.0
Others 78 100.0 100.0 100.0↑ 0.0 0.0 0.0
CASTE
SC 958 72.7 69.2 65.2 10.3 4.8 5.7
ST 344 76.7 69.2 65.8 14.2 9.8 4.9
Others 3018 75.7 72.6 69.8 7.9 4.1 3.9
GENDER
Male 2160 75.4 72.0 69.3 8.1 4.5 3.8
Female 2160 74.8 70.9 67.3 10.0 5.2 5.1
EDUCATION
Illiterate 1562 57.8↓ 52.4↓ 48.0↓ 17.0↑ 9.4↑ 8.4↑
1 - 4 Years 356 81.1↑ 77.0↑ 73.3↑ 9.6↓ 5.1↓ 4.7↓
5 - 8 Years 936 87.2↑ 84.6↑ 81.9↑ 6.1↓ 2.9↓ 3.3↓
9 -14 Years 1071 93.8↑ 92.5↑ 91.3↑ 2.7↓ 1.4↓ 1.3↓
15+ Years 298 99.4↑ 99.2↑ 98.7↑ 0.7↓ 0.2↓ 0.5↓
Not Specified 97 99.4↑ 99.4↑ 99.4↑ 0.0 0.0 0.0

DPT and OPV doses are in most cases given together. The first dose of OPV like DPT needs
to be given at 1-½ months of age and the remaining two doses should be given at an interval
of one month each. In fact new born are often given an OPV dose immediately after birth as
well which is referred as OPV 0 dose. The following table details the proportion that received
the first dose of OPV by the specified age. It also gives the proportion that followed the
complete schedule timely.
OPV zero was given to around 1% children only, while close to 66% of the children received
OPV1 within 1½ -2 months after birth and the proportion of children who received the OPV
doses as per schedule (within one-month interval) was 65%. A significantly higher proportion
of children in Urban areas (73%) received OPV 1 compared to Rural areas (62%). Lower
proportion of Muslims (57%) received the vaccine within 1½ -2 months after birth compared
to other religions and children of illiterate parents (53%).
Significantly lower proportion of children in Rural areas, among Muslims and children of
illiterate caretakers received all three doses of OPV at one months interval. These groups
need additional efforts to improve OPV coverage under routine immunization schedule.
Table 50 Age of receiving OPV
Base :All Children in the age group of 12-23 months
Age of receiving OPV1
% across Base 0 months 1 ½ -2 3-6 6+ DK/CS Proportion
months months months who
followed
13
schedule
ALL 3579 1.1 65.6 23.6 4.2 5.5 65.0
LOCATION
Rural 1692 1.2 62.1↓ 25.1↑ 5.2↑ 6.5 62.8↓
Urban 1887 1.0 73.4↑ 20.1↓ 2.0↓ 3.4 69.9↑
RELIGION
Hindu 2866 0.9↓ 66.4↑ 23.0↓ 4.0↓ 5.8 65.6↑
Muslim 428 2.9↑ 56.6↓ 29.0↑ 6.3↑ 5.3 57.2↓
Christian 69 1.6 82.5↑ 14.2 0.0 1.7 83.0↑
Sikh 121 0.0 76.8↑ 17.2 1.7 4.3 72.4↑
Jain 17* 0.0 74.6 25.4 0.0 0.0 54.7
Others 78 0.0 74.2↑ 19.5 4.2 2.1 75.8↑
CASTE
SC 764 0.4 65.2 25.4 5.0 4.0↓ 60.6
ST 267 0.0 62.8 18.5 3.0 15.8↑ 60.3
Others 2548 1.5 66.1 23.7 4.1 4.5 67.1
GENDER
Male 1809 1.2 66.1 23.6 3.8 5.4 66.5
Female 1770 1.1 65.1 23.6 4.6 5.7 63.3
EDUCATION
Illiterate 1002 0.9 55.1↓ 29.7↑ 6.6 7.7 55.7↓
1 - 4 Years 299 2.8 62.2 24.9 5.7 4.4 63.1
5 - 8 Years 853 1.3 69.5↑ 19.9↓ 3.6 5.8 68.2↑
9 -14 Years 1033 0.7 76.5↑ 18.0↓ 1.6 3.2 72.1↑
15+ Years 296 1.4 72.1↑ 22.9↓ 0.0 3.6 78.1↑
Not Specified 96 0.0 73.5↑ 19.9↓ 3.5 3.0 78.1↑
* Base too low
13
All who have received OPV1, OPV2 and OPV3 with a gap of one month between each vaccine
6.7 MEASLES VACCINATION
Overall, 61% of the children in the age group of 12-23 months were given the measles
vaccination. Close to 88% of these received the measles vaccination at the recommended
age of 9-12 months. As for other antigens, measles coverage was significantly higher in
Urban areas (78%) and among literate caretakers (67-98%). Among different religions
coverage was lowest among Muslims. Majority of the children (88%) received vaccination at
the prescribed age of 9-11 months.
Table 51 Measles Vaccination
Base :All Children in the age group of 12-23 months
Timing of Measles14
% across Base Measles Measles given Measles Measles Don't
given before 9 given at 9- given after Remember
months 12 months 12 months
ALL 4320 61.4 3.8 87.6 2.8 5.7
LOCATION
Rural 2160 55.4↓ 3.5 86.9 3.2 6.4
Urban 2160 78.3↑ 4.5 89.1 1.9 4.4
RELIGION
Hindu 3428 61.6↑ 3.4↓ 89.3↑ 2.1 5.2
Muslim 567 53.3↓ 5.7↑ 77.8↓ 7.1 9.4
Christian 81 70.1↑ 8.5 86.8 2.8 1.8
Sikh 141 74.9↑ 0.6 93.4↑ 4.1 1.9
Jain 25 67.6 0.0 100.0 0.0 0.0
Others 78 99.2↑ 6.7 82.0 2.1 9.3
CASTE
SC 958 59.9 3.4 84.4 4.3 7.9
ST 344 62.3 3.5 87.7 1.3 7.1
Others 3018 61.8 4.0 88.7 2.5 4.8
GENDER
Male 2160 63.1 3.9 86.8 3.1 6.2
Female 2160 59.6 3.7 88.6 2.5 5.2
EDUCATION
Illiterate 1562 38.2↓ 2.7 84.0↓ 4.2 9.1
1 - 4 Years 356 66.6↑ 6.0 84.0↓ 5.7 4.3
5 - 8 Years 936 76.1↑ 4.4 87.7 2.5 5.3
9 –14 Years 1071 88.2↑ 3.8 91.1↑ 1.3 3.7
15+ Years 298 97.6↑ 1.8 96.4↑ 0.1 1.8
Not Specified 97 98.1↑ 5.6 85.0 1.7 7.7
* Base too low * Totals may be less than 100% due to non response
14
All children who received Measles vaccine

6.8 FULLY VACCINATED
Fully vaccinated refers to those who have received all vaccines viz. BCG, 3 doses of DPT, 3 doses
of OPV and Measles under Routine Immunization. In India, overall 57% of the children had
received all vaccines in 2001-02. Significantly lower proportion of children of illiterate parents (37%)
received all vaccines compared to those of literate respondents. A significantly higher proportion of
Urban children (74%) were fully vaccinated compared to Rural children (50%). This proportion was
also higher amongst Hindu children.
Overall 50% received all vaccines before completion of 12 months of age. However this proportion
does not include the cases/doses where the respondent did not remember the age at which the
dose was given therefore the overall proportion of fully vaccinated before 12 months may be
slightly higher than the proportion shown in the table. Significantly higher proportion of Urban
children (68%) received all vaccines before 12 months compared to Rural children (44%). Higher
proportion of Hindu (51%) children were fully vaccinated as per schedule compared to Muslim
children (40%). Following table revealed strong correlation between percentage of children fully
vaccinated with primary caretaker’s education. The fully vaccination coverage starting around 27%
among illiterate to 86% among children of parents with 15+ years of schooling.
Compared to previous year, the proportion of 12-23 months old children receiving all
vaccines has increased from 50% to 57% while fully vaccinated within 12 months of age
increased from 44% to 50%. This improvement in 2001-02 could be attributed to increase in
measles coverage.

Table 52 Fully Immunised
Base : All Base BCG DPT1 DPT2 DPT3 OPV1 OPV2 OPV3 Measles DPT Received all Received all
15
% across booster vaccines vaccines before
12 months of age
ALL 4320 74.0 70.6 67.1 63.8 75.1 71.5 68.3 61.4 43.2 56.6 50.1
LOCATION
Rural 2160 69.0↓ 65.4↓ 61.4↓ 58.0↓ 70.6↓ 66.5↓ 63.0↓ 55.4↓ 39.1↓ 50.3↓ 43.8↓
Urban 2160 88.3↑ 85.3↑ 83.2↑ 80.5↑ 88.0↑ 85.8↑ 83.5↑ 78.3↑ 54.8↑ 74.4↑ 68.0↑
GENDER
Male 2160 74.5 70.5 67.3 64.4 75.4 72.0 69.3 63.1 43.5 58.0 51.4
Female 2160 73.6 70.7 66.9 63.3 74.8 70.9 67.3 59.6 42.9 55.1 48.8
RELIGION
Hindu 3428 74.1↑ 70.7↑ 67.5↑ 64.2↑ 74.8 71.6↑ 68.4↑ 61.6↑ 43.4↑ 56.9 50.8↑
Muslim 567 67.8↓ 64.4↓ 58.6↓ 54.9↓ 72.9 66.3↓ 62.2↓ 53.3↓ 36.4↓ 47.2↓ 39.7↓
Christian 81 82.8 74.6 74.6 74.6 74.6↓ 74.6 74.6 70.1 52.5 65.9 57.1
Sikh 141 88.5 86.9 83.9 81.1 86.8 83.9 81.1 74.9 50.0 71.4↑ 66.3
Jain 25 91.2 61.8 61.8 61.8 61.8 61.8 61.8 67.6 41.5 61.8 57.4
Others 78 100.0 100.0 100.0 100.0 100.0↑ 100.0 100.0 99.2 80.2 99.2↑ 85.8
CASTE
SC 958 71.6 68.6 65.1 61.3 72.7 69.2 65.2 59.9 40.9 54.0 46.2
ST 344 77.0 70.3 64.5 61.3 76.7 69.2 65.8 62.3 39.4 51.7 45.9
Others 3018 74.5 71.3 68.2 65.1 75.7 72.6 69.8 61.8 44.6 58.1 52.1
EDUCATION
Illiterate 1562 56.1↓ 50.6↓ 45.4↓ 40.9↓ 57.8↓ 52.4↓ 48.0↓ 38.2↓ 26.6↓ 31.4↓ 27.0↓
1 - 4 Years 356 80.7↑ 74.2↑ 70.6↑ 67.5↑ 81.1↑ 77.0↑ 73.3↑ 66.6↑ 43.1↑ 64.4↑ 54.6↑
5 - 8 Years 936 86.1↑ 85.7↑ 83.3↑ 80.0↑ 87.2↑ 84.6↑ 81.9↑ 76.1↑ 56.6↑ 71.3↑ 62.9↑
9 -14 Years 1071 93.5↑ 92.4↑ 91.2↑ 89.9↑ 93.8↑ 92.5↑ 91.3↑ 88.2↑ 61.6↑ 85.5↑ 78.2↑
15+ Years 298 99.8↑ 98.6↑ 98.5↑ 98.3↑ 99.4↑ 99.2↑ 98.7↑ 97.6↑ 62.3↑ 96.7↑ 90.9↑
Not Specified 97 98.1↑ 98.1↑ 98.1↑ 98.1↑ 99.4↑ 99.4↑ 99.4↑ 98.1↑ 78.5↑ 97.4↑ 86.4↑
* Base too low
15
This does not include Vitamin A

6.8.1 Vaccines received across States
Nationally, the proportion of children received BCG was 74%. While majority of states
covered over 80% of their children with BCG, the states of Bihar, Jharkhand, Rajasthan and
Uttar Pradesh were able to cover 39-55% only. DPT3/OPV3 coverage was over 85% in
Andhra Pradesh, Chhatisgarh, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Tamil
Nadu and West Bengal, while, fully vaccinated children was over 85% only in Maharashtra,
Tamil Nadu and Kerala. In addition, the state of West Bengal, Punjab, Madhya Pradeshm
Karnataka, Delhi and Andhra Pradesh fully vaccinated over 70-85% of their children. Only in
Kerala and Maharashtra, over 80% of the children received all primary vaccine before their
first birthday.
In the states of Rajasthan (20%), Uttar Pradesh (27%), Bihar (13%) and Jharkhand (26%),
less than 30% of the children were fully immunised. The proportion was drastically low in
Bihar (13%) and Rajasthan (20%). Bihar again had the lowest coverage for fully immunised
before 12 months of age at 12%.
Compared to the previous year, percentage of fully vaccinated children increased significantly
in Andhra Pradesh (42% to 72%), Karnataka (60% to 81%), Madhya Pradesh (50% to 77%),
Uttar Pradesh (46% to 59%) and West Bengal (56% to 78%) while declined in Rajasthan
(30% to 20%).

Table 53 Fully immunised across States
% across Base BCG DPT1 DPT2 DPT3 OPV1 OPV2 OPV3 Measles Vit A Fully Immunised before
Immunised 12 months
Andhra Pradesh 240 91.2 91.9 91.6 87.9 95.0 95.0 90.3 79.7 68.8 72.4 66.6
Assam 240 78.1 74.3 71.8 68.6 80.6 75.8 71.8 62.6 50.9 57.3 52.2
Bihar 240 39.0 33.9 26.6 21.1 33.8 26.6 21.1 13.8 11.1 12.8 11.6
Chhatisgarh 240 86.1 90.0 86.3 81.4 92.9 90.1 85.8 77.5 57.9 69.3 58.8
Delhi 240 88.8 84.2 81.5 78.3 84.1 81.6 78.4 77.0 50.7 72.9 64.0
Gujarat 240 81.0 79.7 78.6 75.8 92.3 89.1 86.3 71.9 49.8 67.5 58.2
Haryana 240 89.2 84.1 76.0 68.2 87.5 80.0 71.9 63.3 42.4 55.5 48.7
Jharkhand 240 55.5 47.4 43.2 36.9 49.4 43.9 36.9 29.2 22.8 25.7 22.9
Karnataka 240 93.1 90.6 90.1 87.9 90.6 90.1 87.9 85.6 59.5 80.9 73.5
Kerala 240 98.7 98.6 97.5 96.7 98.6 98.1 96.7 93.6 62.9 91.3 83.0
Madhya Pradesh 240 95.2 89.1 87.8 87.0 99.8 99.2 99.0 81.1 59.4 77.1 66.7
Maharashtra 240 97.5 96.5 91.7 87.7 99.5 92.1 88.9 95.0 58.8 84.7 81.5
Punjab 240 88.5 88.5 86.7 83.9 88.7 87.0 84.2 77.6 56.2 74.1 68.0
Rajasthan 240 49.4 42.9 33.2 30.3 46.4 38.6 35.1 24.7 21.9 19.7 17.3
Tamil Nadu 240 99.7 98.6 97.8 94.0 99.6 98.8 95.0 96.1 65.0 91.5 75.6
Uttar Pradesh 240 43.3 36.7 32.9 30.4 46.2 43.2 41.1 29.2 20.1 26.7 22.3
Uttranchal 240 69.4 67.1 65.9 63.8 67.1 65.9 63.8 62.1 46.6 59.4 55.1
West Bengal 240 91.2 89.4 86.8 84.5 91.5 88.2 86.5 86.0 54.3 78.5 65.9
All India 4320 74.0 70.6 67.1 63.8 75.1 71.5 68.3 61.4 43.2 56.6 50.1
Contd…

6.8.2 Correlation of Coverage with Access to Immunization Service
It was considered important to explore the immunization coverage and its relationship with
regular immunization session within the village/area. The responses were tabulated
separately for all those who mentioned that their village/area had regular RI session at least
once a month and those who didn’t mention it.
Among those who reported at least one monthly session in their village/area, 86%of their
children received BCG and 67% were fully vaccinated. Percentage of such children was 49%
and 33% respectively among those who reported that Routine Immunization sessions were
not held at least a month in their village/area. This reflects strong correlation between
accessibility (monthly Routine Immunization session), utilisation (BCG Coverage) and
adequate coverage (fully vaccinated). Further the gap in utilization and adequate coverage
was much wider in rural areas (48 point for utilization and 41 for adequate coverage)
compared to urban areas. This clearly indicates that with holding regular immunziation
sessions, particularly in rural areas need to be emphasized.
Table 54 Routine Immunization reach and Fully Vaccinated in Village having at least
one month session
All who mentioned that RI session is held All who mentioned that RI session is not
within the area at least once a month held within the area at least once a month
16
Base Proportion of Proportion of Base Proportion of Proportion of
children receiving children fully children receiving children fully
BCG vaccine vaccinated BCG vaccine vaccinated
ALL 3037 85.7 67.5 1283 49.4 33.3

LOCATION
Rural 1603 83.6↓ 63.7↓ 557 38.5↓ 22.1↓
Urban 1434 91.3↑ 78.0↑ 726 81.5↑ 66.4↑
RELIGION
Hindu 2406 86.7↑ 68.3↑ 1022 47.9 33.0
Muslim 383 75.6↓ 56.0↓ 184 52.9 30.6
Christian 59 94.1 79.4 22* 57.6 35.8
Sikh 112 94.9 77.2 29 49.5 35.9
Jain 20* 96.6 61.5 5* 63.2 63.2
Others 57 100.0 99.1 21* 100.0 100.0
CASTE
SC 698 83.4 64.1 260 43.0 29.6
ST 256 89.1 62.8 88 47.9 25.3
Others 2083 86.0 69.5 935 51.5 35.5
GENDER
Male 1510 86.9 69.0 650 47.9 34.2
Female 1527 84.4 65.9 633 50.9 32.4
PRIMARY CARETAKER’S EDUCATION
Illiterate 1041 72.8↓ 43.4↓ 521 29.3↓ 12.1↓
1 – 4 Years 260 90.5↑ 78.2↑ 96 57.0↑ 31.1↑
5 – 8 Years 730 93.1↑ 78.2↑ 206 65.0↑ 50.4↑
9 –14 Years 759 97.5↑ 90.9↑ 312 81.9↑ 69.8↑
15+ Years 179 100.0↑ 99.2↑ 119 99.6↑ 93.2↑
Not Specified 68 99.2↑ 98.4↑ 29 93.7↑ 93.7↑
* Base too low
16
All who mentioned that RI session is not held in their village/area
6.8.3 Timeliness of Immunization
It is also important to note if the children have received the vaccines at the prescribed age
mentioned in the schedule. Hence the children are studied across the proportions of those
who are vaccinated at the right age as per the schedule, fully vaccinated but not as per the
schedule, partially vaccinated and not vaccinated.
It was noted that 57% of the children in this age cohort 12-23 months received all vaccines
but only 27% received all vaccines as per schedule (strictly according to schedule). Apart
from this, 24% of the children in this age group are partially vaccinated while 20% were not
vaccinated at all. A significantly higher proportion of children in Urban areas (39%) received
all vaccines as per schedule compared to Rural areas (23%).
It can also be observed that a high proportion of the Rural children (24%), SC children (23%)
and illiterate (34%) were not vaccinated at all compared to Urban (9%) ST (16%) and literate
(0.2% to 13%).
Table 55a Percentage of children Fully Immunized, Partially Immunized and Not
Immunized
Base : All Base Received all Received all Partially Not
% across vaccines as vaccines vaccinated18 vaccinated19
per schedule17
ALL 4320 26.6 56.6 23.6 19.8
LOCATION
Rural 2160 22.5↓ 50.3↓ 26.1↑ 23.7↑
Urban 2160 38.5↑ 74.4↑ 16.7↓ 8.9↓
GENDER
Male 2160 26.6 58.0 22.5 19.5
Female 2160 26.7 55.1 24.8 20.1
RELIGION
Hindu 3428 26.8↑ 56.9↑ 22.7↓ 20.4
Muslim 567 19.7↓ 47.2↓ 32.3↑ 20.4
Christian 81 43.4 65.9 16.9 17.2
Sikh 141 50.3 71.4 18.1 10.5
Jain 25 23.0 61.8 29.4 8.8
Others 78 43.0 99.2 0.8 0.0
CASTE
SC 958 21.4↓ 54.0 23.0↓ 23.0↑
ST 344 23.1 51.7 32.7↑ 15.6↓
Others 3018 28.9↑ 58.1 22.5 19.3
PRIMARY CARETAKER’S EDUCATION
Illiterate 1562 12.0↓ 31.4↓ 34.5↑ 34.1↑
1 - 4 Years 356 26.5↑ 64.4↑ 22.6↓ 13.0↓
5 - 8 Years 936 33.3↑ 71.3↑ 18.1↓ 10.6↓
9 -14 Years 1071 47.2↑ 85.5↑ 10.1↓ 4.4↓
15+ Years 298 56.4↑ 96.7↑ 3.1↓ 0.2↓
Not Specified 97 45.3↑ 97.4↑ 2.6↓ 0.0
• Base too low
17
This is all children who received vaccines as per schedule
18
All children who has not received either of the vaccines
19
All children who have not received any of the vaccines
Table 56b Percentage of children Fully Immunized and Not Immunized at all by
states.
% across Fully Immunised Not immunized at all

Andhra Pradesh 72.4 1.4
Assam 57.3 14.8

Bihar 12.8 58.0
Chhatisgarh 69.3 3.2
Delhi 72.9 10.7
Gujarat 67.5 6.6
Haryana 55.5 4.4
Jharkhand 25.7 39.3
Karnataka 80.9 4.4
Kerala 91.3 0.4
Madhya Pradesh 77.1 0
Maharashtra 84.7 0.5
Punjab 74.1 9.4
Rajasthan 19.7 38.2
Tamil Nadu 91.5 0
Uttar Pradesh 26.7 45.4
Uttranchal 59.4 26.4
West Bengal 78.5 4.7
All India 56.6 19.8
6.9 PLACE OF IMMUNIZATION
Immunization services are still largely availed from the Govt. machinery though, of late, the
private practitioners also have come to play an increasingly important role. To understand the
relative importance of each kind of service outlet, respondents were asked about the most
frequently visited outlet for availing Immunization services.
Government /Municipal institutions were the most frequently accessed source for
Immunization services contributing to over 87%, while private health facilities contributed to
10%. Among the government facilities, 37% utilized service at district and sub-district
hospitals, 32% outreach sessions including sub-center, while 16% PHC/ UHFWC.
A significantly higher proportion of respondents (91%) in rural areas used government

facilities for immunization as against 79% seeking immunization from government facilities in
urban.
Outreach sessions were largely accessed by Rural respondents (41%) compared to Urban
respondents (12%). A significantly higher proportion of Sikhs (51%) and illiterate parents
(44%) utilized outreach sessions.

Table 57 Most frequently used source for immunization services
% across Base Mostly Mostly Mostly Mostly N/A
Govt. PHC outreach Pvt.
/UHFWC session
ALL 3770 36.5 15.9 32 10.4 2.2
LOCATION
Rural 1809 27.9↓ 18.8↑ 40.5↑ 6.1↓ 2.9
Urban 1961 56.9↑ 9.0↓ 12↓ 20.7↑ 0.5
RELIGION
Hindu 3011 36.5↓ 15.8 33.1 10.3↓ 1.3
Muslim 459 34.9 19.6 26.8 8.4 7.4
Christian 74 58.9↑ 9.1 8 20.7↑ 0.0
Sikh 126 25.0 12.9 51.3 9.2 0.0
Jain 22* 47.9 1.6 19.3 18.2 12.9
Others 78 39.2 4.2 34 18.4 0.0
Gender
Male 1896 36.1 16.0 32 10.9 2.5
Female 1874 36.9 15.9 32.1 9.8 1.8
CASTE
SC 806 36.6 18.4 34.8 5.8 1.1
ST 290 31.4 11.5 43.1 3.6 1.6
Others 2674 37.2 15.8 29.5 12.9 2.6
PRIMARY
CARETAKER’S
EDUCATION
Illiterate 1135 26.4↓ 17.7↑ 44.2 3.1↓ 3.8
1 - 4 Years 314 34.0↑ 18.1 31.2 6.2 6.3
5 - 8 Years 875 44.8↑ 14.9 31.1 7.7 0.2
9 -14 Years 1052 46.5↑ 15.5 18.6 18.3↑ 0.2
15+ Years 297 37.0↑ 9.9↓ 2.8 46.8↑ 0.0
Not Specified 97 34.0↑ 4.1↓ 34.9 22.2↑ 0.0

6.9.1 Source of immunization services across states
In most of the states immunization services were accessed through government facilities.
Only in the states of Delhi and Kerala significantly higher percentage of children (over 20%)
were vaccinated at private health facilities compared to national average (10%).
The government hospitals were the main source of immunization (over 40%) in Tamil Nadu,
Rajasthan, Maharashtra, Madhya Pradesh, Kerala, Karnataka, Delhi and Andhra Pradesh,
while PHC was main source in West Bengal, Uttaranchal, Karnataka and Assam. In
Chattisgarh, exceptionally high proportion of children (73%) accessed outreach sessions for
immunization. Similarly, in Assam, Haryana, Jharkhand, Punjab and Rajasthan, significantly
higher proportion of children got vaccinated at out reach sessions.
Table 58 Source of immunization services across states

Base :All who received any vaccine
% across Base Mostly Govt Mostly PHC Mostly outreach Mostly Pvt. nursing
hospital/Municipal session including home/Pvt. Clinic
hospital SC
Andhra Pradesh 237 43.9 5.1 37.1 14.3
Assam 207 15.1 26.2 51.1 3.8
Bihar 122 27.9 18.9 30.9 18.7
Chhatisgarh 233 10.5 2.7 72.5 6.4
Delhi 216 44.6 14.1 17 21.4
Gujarat 226 30.0 15.5 32.9 9.9
Haryana 229 20.1 8.8 57.7 8.4
Jharkhand 166 17.0 20.1 40.9 13.7
Karnataka 230 53.9 28.9 6.4 10.5
Kerala 238 59.2 8.5 5.9 25.0
Madhya Pradesh 240 48.4 11.9 27.5 2.7
Maharashtra 239 51.1 14.1 24.9 9.4
Punjab 217 21.3 16.0 50.3 11.6
Rajasthan 167 42.1 11.6 38.1 2.6
Tamil Nadu 240 43.0 2.2 37.2 15.8
Uttar Pradesh 145 19.0 21.5 32.4 10.3
Uttranchal 188 22.6 34.5 28.6 12.6
West Bengal 230 35.6 28.9 29.1 6.3
All India 3770 36.5 15.9 32 10.4

6.10 REASONS FOR NON COMPLIANCE
By the age of 12 months, a child is expected to be completely immunised. Reasons were
elicited from the primary care taker of 12-23 months children for not getting their child all the
scheduled vaccines. Overall “lack of awareness” (71%) was the major reason behind non-
compliance, more so in Rural areas.. This includes reasons such as- “not aware of the need
of all vaccinations (58%)”, and “not aware of time /place of vaccination (28%).
About one tenth of the children were missed due to reasons pertaining to lack of motivation.
“Fear /rumour of side effects” (4%) and “ fear of getting diseases” (6%) were the two major
obstacles which were mentioned and this fears were higher amongst Muslims.
Table 59 Reasons for Non compliance


l
l
BASE 1467 897 570 1136 265 388 157 922 697 770
LACK OF AWARENESS 70.9 72.6↑ 61.9↓ 71.7 68.5 72.2 76.9 69.4 72.8 69.0
Not aware of the need of all 57.6 58.2 54.5 58.5 54.5 60.1 63.3 55.8 57.4 57.9
vaccination
Not aware of the place/time 27.5 29.0↑ 18.9↓ 29.0 21.6 27.2↓ 33.5↑ 26.6 30.3 24.7
OBSTACLES 9.7 8.8↓ 15.0↑ 8.2↓ 16.9↑ 7.4 4.8 11.5 10.3 9.2
Fear of getting disease 5.5 5.3 6.5 5.1 7.2 4.1 2.0 6.6 5.8 5.2
Fear /rumor of side effect 3.5 3.1 5.9 2.6 7.6 4.2 2.8 3.4 3.6 3.4
Doctor advised against it 1.2 0.9 2.4 0.8 3.0 0.5 0.0 1.6 1.0 1.3
LACK OF MOTIVATION 12.2 12.9 8.5 11.6 13.7 15.2 12.1 11.1 12.1 12.4
They don't come at home 7.8 8.8 2.2 7.7 7.7 10.4 8.6 6.8 7.6 8.1
Child was ill 2.6 2.3 4.2 2.4 3.0 2.3 2.4 2.8 2.8 2.4
Hospital too far 1.1 1.1 1.6 0.7 2.8 1.6 0.0 1.2 0.9 1.4
OTHERS 13.1 12.0↓ 19.2↑ 13.3 13.0 14.0↑ 4.6↓ 14.1 10.8 15.3
Looking across states, in Jharkhand (77%), Karnataka (77%), Madhya Pradesh (83%),
Rajasthan (85%) and Haryana (82%) more than 75% of the people whose children had
missed one or more vaccines were not aware of the need of all vaccinations. This proportion
was the lowest in Kerala (7%) followed by Maharashtra (11%), possibly because of the high
level of literacy in these state. In most other states the proportion varied between 50-60%.
Amongst those who mentioned lack of awareness of place/time a significantly higher
proportion of respondents were in Madhya Pradesh (43%) while the lowest were in
Karnataka (4%). More than 30% were unaware of place time of vaccination in states of
Andhra Pradesh, Bihar, Rajasthan, West Bengal and Madhya Pradesh.

Table 60 Reasons for Non compliance across states
% ACROSS Base Not aware of Not aware of No one said Child was ill They don't Hospital Fear/ Fear of getting Doctor advised
the need of all the place/time about that come at too far rumour of disease against it/Said it
vaccination home side effect was not required
Andhra Pradesh 58 39.7 30.3 0.0 0.0 0.0 0.0 0.0 10.5 0.8
Assam 89 57.0 14.0 0.0 7.4 0.0 0.0 16.4 4.3 1.9
Bihar 180 52.6 34.3 0.1 2.7 7.5 2.8 1.9 2.6 1.0
Chhatisgarh 62 46.0 13.1 2.3 2.2 11.7 2.3 2.8 9.5 2.2
Delhi 70 61.5 27.2 0.0 6.4 3.3 0.0 6.5 3.5 0.0
Gujarat 73 32.0 22.8 2.6 12.1 5.8 0.0 1.6 2.4 1.6
Haryana 102 81.9 8.1 1.3 2.5 0.5 0.0 1.1 6.3 0.0
Jharkhand 146 76.7 19.7 0.2 2.7 7.2 0.2 2.2 2.5 1.1
Karnataka 44 76.8 4.3 1.4 2.8 0.0 0.0 27.5 24.5 2.9
Kerala 22 7.0 9.3 0.0 5.0 0.0 0.0 7.3 17.1 0.0
Madhya Pradesh 45 83.4 43.4 0.0 0.0 0.0 0.0 4.5 0.9 0.0
Maharashtra 34 10.9 26.2 0.0 0.0 0.0 0.0 2.1 2.1 0.0
Punjab 63 55.1 17.6 6.6 6.4 0.0 10.7 3.9 5.4 0.0
Rajasthan 166 85.3 30.0 2.1 1.6 16.4 2.1 2.4 4.7 0.0
Tamil Nadu 20 42.2 16.9 0.0 13.6 4.0 4.2 0.0 0.0 11.4
Uttar Pradesh 161 58.1 28.8 0.0 1.8 11.8 0.0 2.0 7.5 1.6
Uttranchal 78 62.4 12.9 3.1 0.0 9.4 12.5 6.2 7.1 1.5
West Bengal 54 32.6 30.7 0.0 0.8 0.0 0.8 10.0 1.6 0.0
All India 1467 57.6 27.5 0.6 2.6 7.8 1.1 3.5 5.5 1.2

7 INJECTION SAFETY
7.1 INJECTIONS SAFETY
The national policy prescribes one sterilised syringe and one sterilised needle to be used per
injection. Normally sterilisation is to be done in a double deck steriliser/autoclave or an
electric steriliser or boiling for 20 minutes in a saucepan.
However, in field situations, different variants of `sterilisation’ had been practised, many of
which do not completely sterilise. In these times of HIV, it becomes extremely important that
proper injection safety procedures are followed.
In the survey we had asked respondents to recall the procedure of how syringes and needles
were prepared for the vaccination given to their child.
Overall, 42% mentioned the use of Disposable syringes. Use of disposable was significantly
higher among Urban respondents (60%) as compared to Rural (34%). 7% of the respondents
mentioned “Boiling in a saucepan for at least 20 minutes”. This practise is more common in
Rural areas compared to Urban areas. 5% mentioned use of Autoclave / double rack
steriliser while 6% mentioned electric steriliser, indicating under utilization of equipment
provided under immunization programme.
After disposable, the next most common response was cleaning the syringes and needles in
once boiled water (13%), is a matter of concern. This was significantly higher in Rural (15%)
compared to Urban areas (9%). In addition, 24% of people totally unaware of the process
followed, which could be unsafe by and large.
Table 61 Injection Safety
Base : Amongst all those who Location Caste Religion
received any vaccine
% down All Rural Urban SC ST Others Hindu Muslim Christian Sikh
BASE 3770 1809 1961 806 290 2674 3011 459 74 126
SAFE INJECTION PRACTICES
Disposable 41.5 33.5↓ 60.3↑ 37.4↑ 24.3↓ 45.4↑ 42.7↑ 28.2↓ 46.2 62.1
Boiling in a Saucepan for at 7.1 8.4↑ 4.0↓ 8.1 5.0 7.1 6.8 7.3 5.7 6.3
least 20 min
Autoclave/Double Deck 4.9 5.2 4.2 6.2 7.5 4.0 5.2 4.7 4.0 0.9
Steriliser
Boiling continuously in an 5.6 5.9 5.1 9.0 5.9 4.5 5.9 5.0 6.4 4.4
electric steriliser
UNSAFE INJECTION PRACTICES
Cleaning the needles/syringes 13.3 15.3↑ 8.5↓ 13.2 12.5 13.4 13.1 16.1 14.5 3.6
in once boiled water
DK/CS 24.2 27.1 17.3 24.7 39.5 21.8 23.6 30.4 23.2 22.6

7.2 INJECTION SAFETY ACROSS STATES
Analysis by state revealed that use of disposable syringes was more than 70% in Delhi and
Haryana, between 60-70% in Jharkhand, Punjab, Rajasthan and Uttaranchal, while it was
lowest in Madhya Pradesh (18%). Use of equipment supplied under immunization
programme (autoclave and double rack sterilizer) were reported by more than 10% of the
respondents only in Gujarat, Karnataka, Maharashtra and West Bengal. In Andhra Pradesh,
Assam, Karnataka and West Bengal, more than 15% of the children were vaccinated by
syringes and needles boiled in saucepan for 20 minutes.
Across states, Unsafe injection practises were known and reported by more than one fourth
of the respondents in Tamil Nadu (34%), Uttaranchal (27%) and Uttar Pradesh (30%) closely
followed by Bihar (24%). This proportion was the lowest for Gujarat and Punjab at 2%.
Table 62 Injection safety
Base: All who have received any injection
Base Autoclave Boiling Boiling in a Disposable Cleaning
/Double continuously Saucepan for syringe/needle in
Deck In an electric 20 min once boiled water
Sterilizer sterilizer
Andhra Pradesh 237 0.7 0.7 15.0 53.9 9.8
Assam 207 0.9 0.0 16.4 46.7 3.5
Bihar 122 0.2 0.0 0.2 47.1 23.7
Chhatisgarh 233 3.0 3.7 4.2 49.0 18.6
Delhi 216 1.0 1.9 2.7 72.9 3.0
Gujarat 226 14.1 14.7 3.6 26.2 2.1
Haryana 229 0.2 0.6 1.4 77.8 3.6
Jharkhand 166 0.0 0.3 3.3 64.3 12.9
Karnataka 230 13.4 8.5 16.8 48.6 2.6
Kerala 238 0.6 6.4 3.3 29.9 19.1
Madhya Pradesh 240 1.3 1.7 2.1 18.5 8.4
Maharashtra 239 10.4 12.7 6.4 46.0 5.5
Punjab 217 1.6 3.2 3.9 68.2 2.2
Rajasthan 167 0.0 0.6 2.3 66.4 9.2
Tamil Nadu 240 6.7 9.0 6.4 30.7 34.3
Uttar Pradesh 145 2.8 0.0 1.8 34.0 29.9
Uttranchal 188 0.3 1.4 0.8 63.6 27.4
West Bengal 230 7.9 14.6 20.7 22.6 20.7
All India 3770 4.9 5.6 7.1 41.5 14.3

8 MATERNAL CARE
8.1 AGE AT FIRST PREGNANCY
The National Population Policy advocates a delayed marriage after 18 years and pregnancy
after 19. By this age it is expected that the woman is physically and mentally mature to go
through the travails of a pregnancy. In this study women who had a pregnancy of at least 28
weeks completed between 27th Jan 2001 and 26th Jan 2002 were contacted. Details were
taken on their pregnancy history including the age at which they become pregnant for the first
time and the care provided during the pregnancy, which ended within the reference period.
Overall, proportion of women becoming pregnant for the first time before the age of 17 years
was 15%. This was observed to be higher in Rural areas (18%) compared to Urban areas
(9%). Proportion of the women becoming pregnant before the age of 19 years was 42%. A
significantly higher proportion of women from Rural areas (46%), Muslims (54%), SC (53%)
and women educated up to 8 years of schooling (46-55%), were pregnant before this age. The
mean age at first pregnancy in All India was found to be 20.1 years.
Table 63 Age at first pregnancy
Percent become pregnant before age :
Percent across All 15 years 17 years 19 years 21 years 21 and Mean Age at first
more pregnancy
ALL 4320 1.8 15.0 42.1 64.1 100.0 20.1
AGE OF THE WOMAN
Less than 20 years 652 3.4 32.2 86.5 99.8 100.0 17.0
21 – 25 years 1965 1.1 9.7 30.5 63.2 100.0 19.7
26 – 30 years 1240 0.9 6.6 20.7 42.6 100.0 21.5
More than 30 yrs 463 1.4 8.5 23.0 43.4 100.0 23.0
NO. OF CHILDREN BORN ALIVE
One 1503 1.0 11.8 47.4 65.2 100.0 20.2
Two- Four 2429 1.9 16.4 36.8 60.2 100.0 20.3
More than Four 382 3.1 17.8 47.5 75.1 100.0 19.2
LOCATION
Rural 2160 2.5↑ 17.7↑ 46.5↑ 67.8↑ 100.0 19.7
Urban 2160 0.1↓ 8.7↓ 31.9↓ 55.6↓ 100.0 21.1
RELIGION
Hindu 3480 1.8 14.9 40.2 62.5↓ 100.0 20.2
Muslim 583 2.0 17.0 53.9↑ 75.8↑ 100.0 19.1
Others 257 0.9 8.3↓ 32.1 46.9 100.0 22.1
CASTE
SC 932 2.0 18.4↑ 53.4↑ 73.9↑ 100.0 19.3
ST 354 1.6 14.5 41.5 66.5 100.0 20.0
Others 3034 1.7 13.8 38.1 60.2 100.0 20.4
EDUCATION OF THE WOMEN
Illiterate 1514 2.8 20.7↑ 48.3↑ 71.5↑ 100.0 19.4
1- 4 years 323 0.5 21.7 55.0 72.2 100.0 19.1
5-8 years 1007 2.0 12.1 46.2 68.3 100.0 19.7
9-14 years 1165 0.0 5.1 25.3↓ 48.9 100.0 21.7
15+ years 292 0.0 0.9 6.0↓ 16.4 100.0 24.7

8.1.1 Pregnancy wastage and children surviving
Pregnancy wastage is defined as ratio of pregnancies not resulting in live births (including still
birth & abortion) to the total number of pregnancies. In other words, of a total of 100
pregnancies how many did not result in a live birth.
Respondents were asked about the total number of pregnancies that the women had gone
through and the total number of children that were born alive and are currently alive. In All
India, the pregnancy wastage rate is 6%. It is observed that women with only one pregnancy
have a lower pregnancy wastage rate compared to those with more than four pregnancies.
Pregnancy wastage rate is significantly higher amongst respondents from other religions
(11%) compared to Hindus (5%).
Table 64 Survival rate and Pregnancy wastage
% across Base Mean No. of Mean No of Pregnancy

pregnancies children born wastage
alive
ALL 4320 2.8 2.6 5.6
AGE OF THE WOMAN
Less than 20 years 652 1.4 1.3 1.6
21 – 25 years 1965 2.1 2.1 3.4
26 – 30 years 1240 3.4 3.1 7.5
More than 30 yrs 463 4.5 4.2 6.7
NO. OF PREGNANCIES
One 1419 1.0 1.0 -2.1
Two- Four 2437 2.6 2.5 4.4
More than four 454 6.6 6.0 9.5
LOCATION
Rural 2160 3.0 2.8 5.2
Urban 2160 2.3 2.2 6.5
RELIGION
Hindu 3480 2.6 2.5 5.1↓
Muslim 583 3.5 3.3 6.6
Others 257 2.1 1.8 10.9↑
CASTE
SC 932 2.6 2.5 5.0
ST 354 2.8 2.6 5.7
Others 3034 2.8 2.6 5.7
Illiterate 1514 3.5 3.3 5.4
1- 4 years 323 2.9 2.8 5.6
5-8 years 1007 2.1 2.0 7.0
9-14 years 1165 1.9 1.8 4.7
15+ years 292 1.7 1.7 3.2
Not Specified 19* 2.1 2.0 4.4

8.1.2 Pregnancy details across states
Overall in All India more than one third (44%) of the women were pregnant before the age of
19 years. In Bihar, Jharkhand, Chhattisgarh and Uttar Pradesh more than 50% of the
respondents were pregnant before 19 years. The highest proportion was reported for Bihar
(59%) while Kerala and Maharashtra reported the lowest at 27%.
At an All India level the pregnancy wastage rate is reported to be 6%. However, the pregnancy
wastage rate was significantly higher in Assam (10%), Kerala (11%) and Tamil Nadu (12%). In
all these states the ratio was above 10%. The proportion was the lowest for the state of
Uttaranchal (0%) and Karnataka (1%).
Table 65 Pregnancy details across states
% across Base Pregnant before 19 years Pregnancy Wastage

Assam 240 42.9 9.6

Bihar 240 59.4 3.5
Delhi 240 38.9 3.8
Gujarat 240 35.1 8.0
Haryana 240 46.4 4.7
Kerala 240 27.0 10.5
Punjab 240 32.2 7.5
Tamil Nadu 240 31.2 11.5
Uttranchal 240 33.3 -
All India 4320 42.1 5.6

8.2 ANTENATAL CARE
Quality antenatal care contributes to the prevention of maternal morbidity and mortality by
detecting and helping to manage potential complications. Antenatal care also provides
opportunities for women to learn the danger signs of pregnancy and delivery, immunization, to
learn about infant care, and the ways of minimising Anaemia.
Overall in India, 77% of the women received one antenatal check up (ANC1). The ANC1
coverage was significantly higher in Urban areas (91%), among non-ST/ST (79%) and women
staying with their own parents (87%). Year of schooling showed strong correlation with the
ANC1 coverage. It increased from 61% among illiterate to 97% among women of 15+ years of
schooling.
Nationally, 42% of the pregnant women received check up in first trimester. Similar to ANC1,
place of residence (urban/rural), religion and education showed strong influence on ANC in 1st
trimester.
Another important component of Antenatal Care is the number of time a pregnant woman had
Antenatal Contact during her pregnancy. Though, 77% women received antenatal check-up,
only 55% received it al least thrice. Impact of different background characteristics was similar
to ANC1. Compared with the previous year’s data, ANC3 coverage remained more or less the
same.
Table 66 Ante Natal Care
Base ANC1 ANC1 in 1st ANC3+
trimester
ALL 4320 77.2 42.5 55.0
LOCATION
Rural 2160 71.1↓ 36.6↓ 45.7↓
Urban 2160 91.0↑ 56.0↑ 76.3↑
RELIGION
Hindu 3480 77.6 41.7 56.6
Muslim 583 71.4↓ 41.1 42.0↓
Others 257 91.7 66.4↑ 77.0
CASTE
SC 932 72.2 40.6 52.9
ST 354 74.3 34.8 44.1
Others 3034 79.3↑ 44.2 57.3↑
PLACE OF STAY
With In laws 2644 74.6 38.3 52.5
With own parents 1030 87.0↑ 58.6↑ 67.9↑
Nuclear family 639 70.2 31.6 42.8
Not Specified 7* 100.0 88.2 91.2
Illiterate 1514 61.5↓ 26.3↓ 33.5↓
1- 4 years 323 81.1↑ 42.2↑ 61.5↑
5-8 years 1007 88.1↑ 47.6↑ 66.4↑
9-14 years 1165 95.1↑ 65.8↑ 81.6↑
15+ years 292 97.1↑ 80.6↑ 90.4↑
Not Specified 19* 69.7↑ 67.7 57.6↑
* Base too low

Across the background characteristics of location it was observed that a significantly higher
proportion of women staying with own parents (83%) from Rural areas had an Antenatal
contact compared to women residing with in laws (68%). This trend was not discernible in
Urban areas.
Level of education too seems to have a positive effect on the consciousness towards health
during pregnancy both in Urban and Rural areas. While 59% of illiterate in rural areas had
antenatal contact, percentage of such women was 76 in urban. This proportion increased to
85% in rural while 100% in urban among women with schooling of 15+years.
Table 67 Ante Natal Care
All women Rural Urban
Base ANC1 Base ANC1 Base ANC1
ALL 4320 77.2 2160 71.1 2160 91.0

RELIGION
Hindu 3480 77.6↑ 1731 71.4↓ 1749 91.9↑
Muslim 583 71.4↓ 282 65.7 301 84.7↓
Others 257 91.7 147 88.5↑ 110 97.7
CASTE
SC 932 72.2↓ 542 68.2 390 86.2↓
ST 354 74.3 229 67.8 125 94.5
Others 3034 79.3↑ 1389 72.8 1645 91.8↑
PLACE OF STAY20
With In laws 2644 74.6↓ 1305 67.8↓ 1339 90.9
With own parents 1030 87.0↑ 543 83.4↑ 487 94.0
Nuclear family21 639 70.2 307 63.9 332 85.8
Not Specified 7* 100.0 5* 100.0 2* 100.0
EDUCATION OF THE
WOMEN
Illiterate 1514 61.5↓ 1013 58.9↓ 501 76.3↓
1- 4 years 323 81.1↑ 176 79.0↑ 147 85.6
5-8 years 1007 88.1↑ 506 85.2↑ 501 93.6↑
9-14 years 1165 95.1↑ 424 91.8↑ 741 98.4↑
15+ years 292 97.1↑ 36 84.8↑ 256 100.0↑
Not Specified 19* 69.7 5* 53.5 14* 81.6
* Base too low
20
Place of stay means where the woman stayed during last four months of her pregnancy
21
Nuclear family means staying with her husband
8.2.1 ANC across states
Overall, close to 77% of the respondents had at least one ANC and 55% had at least three.
States like Andhra Pradesh, Karnataka Tamil Nadu, Kerala and Punjab were observed to be
fairly good with more than 90% of respondents having received Antenatal check-up. However
in states like Rajasthan and Jharkhand only 60% mentioned to have received it. Bihar ranked
the lowest with only 34% mentioning this.
ANC3+ was over 80% in Andhra Pradesh, Karnataka, Kerala and Tamil Nadu. In addition,
percentage of women receiving at least three ANC was significantly higher than national
average in Chattisgarh, Delhi, Maharashtra, Punjab and West Bengal. Whereas, coverage for
ANC3+ was exceptionally low in Bihar, Rajasthan and Uttar Pradesh.
Table 68 ANC across states

% across Base Antenatal contact ANC3+
Assam 240 81.9 41.3

Bihar 240 34.2 17.9
Delhi 240 83.3 70.6
Gujarat 240 76.4 54.5
Haryana 240 62.4 38.6
Jharkhand 240 61.7 39.1
Karnataka 240 92.4 80.4
Kerala 240 99.9 94.0
Punjab 240 91.3 65.5
Rajasthan 240 60.6 26.9
Tamil Nadu 240 95.7 90.5
All India 4320 77.1 55.0
8.2.2 ANC Service Provider
As, we had seen from the previous section, 77% of the respondents had received antenatal
check-up. This table details the provider that they had met for the antenatal care.
Amongst the women who had an antenatal care, 44% accessed Private physicians. Govt.
doctors were accessed by 37% and ANM catered to 12% of the women while LHV catered to
11%.
As expected private doctor got a higher mention in Urban area (50%) compared to Rural areas
(40%), ANM was mentioned by a higher proportion of Rural respondents (17%) compared to
Urban respondents (2%).

Table 69 ANC service provider
Base :All women who received Location Caste Religion
ANC
% down All Rural Urban SC ST Others Hindu Muslim Others
BASE 3560 1630 1930 729 264 2567 2873 458 229
ANC SERVICE PROVIDER
Govt. Doctor 36.9 35.7 39.0 39.3↓ 49.4↑ 34.5 37.5↑ 37.9 21.9↓
LHV/Nurse at Govt. 10.9 10.7 11.3 13.4 10.2 10.2 10.9 10.5 12.4
hospital
ANM 11.8 17.2↑ 2.0↓ 12.6↓ 21.5↑ 10.2 11.8↑ 15.0 1.0↓
Trained Dai 0.9 1.3 0.3 0.7 1.2 1.0 0.9 0.8 1.8
Untrained Dai 1.5 1.6 1.4 1.9 3.7 1.1 1.5 1.4 1.5
Private doctor 43.7 40.0↓ 50.2↑ 36.0↑ 19.7↓ 49.4 43.6↓ 37.5 64.5↑
Private Nurse 0.8 0.4 1.5 0.4 1.5 0.8 0.8 0.2 1.8
* Total may add up to more than 100 % due to multi response
8.3 ANC SERVICE PROVIDER BY STATES
Comparing the data across states it is observed that in Delhi, Madhya Pradesh and West
Bengal more than half of the respondents mentioned to have received ANC services from
Doctor at Government Hospitals. However in states like Bihar (14%) and Uttar Pradesh (16%)
services from Government Hospitals was availed by very small proportion of population.
Table 70 ANC service provider across states

Base: All who met medical personnel
ANC Service provider
% across Base Untrained Trained ANM LHV/Nurse Govt Doctor Private
Dai Dai at Govt Doctor
hospital
Andhra Pradesh 232 1.1 0.0 2.7 3.0 40.9 66.5
Assam 205 0.5 0.2 6.2 17.1 47.5 31.2
Bihar 114 3.2 2.5 5.3 13.2 14.4 72.2
Chhatisgarh 218 0.0 0.0 46.6 11.7 35.8 30.5
Delhi 202 0.0 0.0 2.7 7.4 55.8 36.0
Gujarat 180 7.3 3.1 17.5 5.7 17.1 49.8
Haryana 168 0.7 0.6 17.6 8.8 23.8 48.5
Jharkhand 174 0.2 0.0 14.2 5.3 18.6 71.4
Karnataka 224 1.3 0.0 2.6 2.1 45.8 50.2
Kerala 239 0.3 0.0 0.0 0.0 47.1 54.5
Madhya Pradesh 210 2.3 6.0 17.5 19.8 62.8 7.0
Maharashtra 215 0.4 0.9 10.9 19.0 31.5 43.3
Punjab 215 5.0 1.5 5.1 23.6 19.5 50.5
Rajasthan 161 3.9 1.8 22.2 6.4 33.2 35.1
Tamil Nadu 235 0.4 0.3 3.0 8.1 40.0 50.1
Uttar Pradesh 152 1.4 0.0 29.4 20.4 15.6 37.2
Uttranchal 198 1.2 0.0 35.3 14.7 31.8 18.7
West Bengal 218 0.0 0.0 2.6 5.4 62.6 29.5
All India 3560 1.5 0.9 11.7 10.9 36.9 43.8
Largely the services were availed from private physicians. In Andhra Pradesh, Jharkhand,
Karnataka, Kerala, Punjab and Tamil Nadu more than 50% of the population accessed private
doctors. ANM services were availed by a significantly higher proportion of respondents in the
newly formed states of Uttaranchal and Chhattisgarh. Very few of those who had an antenatal
contact accessed Trained and Untrained Dai for ANC services.
8.3.1 Components of Antenatal Care
All respondents were asked if basic check-ups (namely fundal examination, BP checks, weight
monitoring) were done during ANC. Nearly 63% of the women confirmed that the fundal
examination was done during ANC visit. Amongst these 56% had this thrice or more.
Percentage of such women was higher in Urban (67%), among SC (51%) & other castes
(60%) and non-Hindu/Muslim (74%).
Overall, blood pressure of 58% of the pregnant women was checked. Among these, 56% had
at least three check-up. The weight of 51% of the respondents was taken and it was taken at
least thrice for 64% of them. Overall only 21% of the women had undergone the three check-
ups namely physical examination, BP checking and weight monitoring at least thrice. Data
revealed that location, caste and religion influenced quality and frequency of antenatal check-
ups. Proportion of women who received all these three check-ups at least thrice was
significantly higher in among urban respondents (38%), non-SC/ST (25%) and non-
Hindu/Muslim (37%).
Table 71 Components of ANC - Abdominal Check-up, BP and Weight Monitoring
Base :All women Location Caste Religion**
BASE 4320 2160 2160 932 354 3034 3480 583 257
PHYSICAL EXAMINATION OF
ABDOMEN
Yes 63.2 55.9↓ 80.0↑ 62.0 59.3 64.2 65.3↑ 47.5↓ 85.5
NO. OF TIMES THE
PHYSICAL EXAMINATION
DONE
Once 16.8 18.8 13.6 17.7 20.2 16.1 17.4 17.1 6.2
Twice 27.0 31.5↑ 19.9↓ 31.6 38.4 23.9 26.8 31.1 20.2
Thrice or more 56 49.4↓ 66.5↑ 50.7↓ 41.2↓ 59.7↑ 55.6 51.1 73.6
BLOOD PRESSURE
CHECKED
Yes 58.3 49.6↓ 78.2↑ 55.3 50.0 60.6 59.3↑ 47.7↓ 82.6
NO. OF TIMES THE BLOOD
PRESSURE WAS CHECKED*
Once 21.0 23.8↑ 17.0↓ 26.2 22.3 19.1 21.7 21.0 9.8
Twice 23.2 25.2↑ 20.2↓ 31.0 38.7 18.8 22.1↓ 31.5↑ 18.7
Thrice of more 55.9 51↓ 62.9↑ 42.8↓ 39↓ 62.1↑ 56.2 47.5 71.6
WEIGHT TAKEN
Yes 51.0 42.4↓ 70.5↑ 43.4 46.9 54.2 52.0↑ 42.3↓ 66.0
NO. OF TIMES WEIGHT
TAKEN *
Once 15.5 17.6↑ 12.5↓ 21.5 22.2 12.9 15.4 16.9 12.2
Twice 20.9 23.4↑ 17.4↓ 23.4↓ 33.4↑ 18.6 19.0↓ 34.1↑ 15.9
Thrice or more 63.7 58.9↓ 70↑ 55.1↓ 44.4↓ 68.4 65.5 49 71.7
ALL THREE COMPONENTS 20.8 14.7↓ 34.7↑ 13.9 10.1 24.8↑ 21.7↑ 12.6↓ 36.5
AT LEAST THRICE

8.3.2 Components of Antenatal Care by state
Overall, close to three fourth (69%) of the respondents had undergone any of the three check-
ups (abdominal, BP and weight) ranged between 33% in Bihar and 100% in Kerala. Only 44%
reported to have received all these three services. In Andhra Pradesh, Karnataka, Kerala and
Tamil Nadu more than 90% of the respondents underwent at least one check-up while more
than 70% of the women underwent all the three. In Bihar (33%) and Uttar Pradesh (34%), less
than 40% received any of the check-up and less than 10% received all the three services.
About 63% of the respondents had the physical examination of their abdomen. Less than one
third of the respondents in Bihar and Uttar Pradesh reported to have the physical examination
of their abdomen done.
Overall, more than 58% of the respondents had their blood pressure checked and only 56%
had their blood pressure checked at least thrice. Again in Bihar, Uttar Pradesh and Uttaranchal
a lesser proportion mentioned to have had their blood pressure checked.
About 51% of the respondents at an All India level reported to have their weight checked of
which 64% had checked at least three times.
Table 72 Components of ANC
Basic Check-ups during ANC
% across Base Any check- Undergone Physical Blood Had BP Weight Weight
up all three examination pressure checked taken taken
check-ups of abdomen checked thrice or thrice or
more more
Andhra Pradesh 240 94.9 72.7 86.2 86.9 64.2 84.6 76.3
Assam 240 57.9 31.6 54.6 53.4 38.8 34.3 39.8
Bihar 240 33.2 9.6 30.5 25.3 43.0 12.7 26.1
Chhatisgarh 240 73.6 24.2 65.0 45.1 43.8 39.4 42.9
Delhi 240 82.2 54.6 80.0 77.4 75.3 57.8 68.1
Gujarat 240 78.2 49.4 75.5 59.7 43.7 57.7 50.5
Haryana 240 53.3 31.9 49.8 46.2 43.4 36.1 43.1
Jharkhand 240 53.5 22.3 49.0 44.4 42.6 25.1 58.0
Karnataka 240 90.9 82.3 87.9 90.1 84.5 84.3 79.0
Kerala 240 99.6 77.6 91.8 98.6 84.9 85.7 90.5
Madhya Pradesh 240 65.2 51.9 60.8 57.2 35.4 58.7 30.1
Maharashtra 240 86.9 57.4 74.6 75.6 45.4 69.2 70.8
Punjab 240 88.3 47.0 83.0 78.3 67.7 53.5 61.4
Rajasthan 240 48.7 9.1 46.2 27.1 45.3 14.8 40.9
Tamil Nadu 240 96.4 79.8 96.1 86.3 60.7 82.4 67.7
Uttar Pradesh 240 34.0 7.2 27.8 18.3 34.4 11.7 42.9
Uttranchal 240 41.7 17.6 40.6 23.0 55.5 18.7 63.7
West Bengal 240 83.0 66.0 74.4 78.2 50.1 74.3 62.3
All India 4320 68.9 44.4 63.2 58.3 55.9 50.9 63.8

8.3.3 TT Immunization
Tetanus Toxoid injections are given to women during pregnancy to protect her and the new
born from tetanus. Two doses of Tetanus Toxoid during pregnancy offer protection for the
pregnancy. However, if a woman was vaccinated during the previous pregnancy within
3years, she may only need a booster to get adequate protection. Five doses are thought to
provide lifetime protection.
78% of the respondents received TT2/Booster, which was significantly higher in urban (87%)
compared to rural (75%). Religion and caste both shown it’s influence on TT2/booster
coverage. Data revealed that ST, Hindu and Muslim women were poorly covered.
Overall 49% of the women accessed the Govt. health services for TT Immunization while 29%
utilised Private health services. Both Govt. and Private facilities were equally accessed in
Urban areas.
Table 73 TT Immunization
Base :All women Location Caste Religion
BASE 4320 2160 2160 932 354 3034 3480 583 257
TT INJECTIONS GIVEN IN THE
LAST PREGNANCY (IP)
Yes 81.3 77.2↓ 90.6↑ 77.6↓ 75.3 83.4↑ 80.7↓ 82.3 88.1↑
TT2 /BOOSTER RECEIVED 78.3 74.6↓ 86.9↑ 75.9↑ 65.7↓ 81.0↑ 77.6↓ 79.9↓ 87.7↑
SERVICE DELIVERY POINT

Govt. Doctor/ PHC/Sub 49.4 51.1↓ 45.5↑ 54.3 61.5 46.0 50.3↑ 47.7 37.8↓
Center/ANM visit to village
Private Physician/ Pvt. 28.5 21.7↓ 44.1↑ 21.1↑ 11.1↓ 33.7 27.9↓ 26.8 50.4↑
Hosp./Pvt. Clinic
Not Specified 22.2 27.2 10.7 24.6 27.4 20.6 22.0 25.6 11.6

8.3.4 TT Coverage by State
Overall 78% of the women had received TT 2 Booster dose. Across the states, in West
Bengal, Tamil Nadu, and Kerala the proportion receiving TT2 booster was was more than
90%. Rajasthan, Uttar Pradesh, Jharkhand, Andhra Pradesh and Bihar, were able to protect
less than 70% of pregnant women in 2001-02.
Across states in West Bengal and Madhya Pradesh more than 70% of the respondents
mentioned Govt. Doctor/ PHC/Sub Centre/ANM visit to village as source of receiving TT
immunization. This proportion was extremely low in Bihar at 16%.
In states like Andhra Pradesh, Karnataka, Punjab and Kerala more than 40% of the
respondents reported to have received TT immunization service from private physicians.
Interestingly, in Bihar close to one fifth of the respondents mentioned Chemists. The proportion
was the highest in Kerala at 56% and the lowest in Madhya Pradesh at 10%. The proportion of
clients getting TT shots from private sector (29%) was much higher than children getting
vaccinated from private (11%)
Table 74 TT Coverage & Service delivery
TT immunization service delivery
% across Base: TT2/ Booster Govt. Health Pvt. Physician/Pvt. Not Specified
Received Facilities/Outreach Hosp./Pvt. Clinic
sessions
Andhra Pradesh 240 67.5 31.1 40.5 28.4
Assam 240 79.1 63.2 20.2 16.6
Bihar 240 68.7 15.9 17.6 66.5
Chhatisgarh 240 72.2 60.9 15.8 23.3
Delhi 240 89 65.4 24.2 10.4
Gujarat 240 88.7 57.0 31.9 11.2
Haryana 240 73.7 50.7 26.4 22.9
Jharkhand 240 65.2 25.1 34.7 41.0
Karnataka 240 87 45.8 43.8 10.7
Kerala 240 97.3↑ 42.4 55.7 1.6
Madhya Pradesh 240 85.5 75.5 10.2 15.1
Maharashtra 240 86.3 61.2 32.8 6.1
Punjab 240 83.1 40.7 44.2 15.2
Rajasthan 240 54.3 47.8 17.1 35.1
Tamil Nadu 240 95.3↑ 58.4 38.0 3.7
Uttar Pradesh 240 64.4 40.3 24.5 35.5
Uttranchal 240 79.2 63.3 17.3 19.4
West Bengal 240 91.5↑ 73.6 19.3 7.1
All India 4320 78.3 49.3 28.6 22.3
level.

8.4 IRON FOLIC ACID (IFA) SUPPLEMENT
IFA Tablets (or Iron) supplements form an important part of the antenatal care of a pregnant
woman. The Iron supplements are the most effective measure to prevent and treat anaemia.
Overall in All India, 65% of the pregnant women received IFA tablets. A significantly higher
proportion of women in Urban areas (76%), among Hindus (67%), those staying with own
parents (72%) and educated (64-91%) received IFA tablets.
Nationally, only 19% of the beneficiaries received the recommended number of 90-100 tablets
and only 14% consumed them. Consumption was highest among women (47%) with 15+
years of schooling. Data reflected the high dropout from initiation (65%) to completion (14%) of
service and indicated the need of ensuring proper follow-up and counselling.
Compared to last year, consumption of IFA 90 has not improved.
Table 75 IFA Tablets
% across Base Received IFA Received 90 or Consumed 90 or
more tablets more tablets
ALL 4320 65.0 19.2 13.7
LOCATION
Rural 2160 60.0↓ 16.5 11.2
Urban 2160 76.4↑ 25.4 19.3
RELIGION
Hindu 3480 67.1↑ 19.2 13.2
Muslim 583 53.4↓ 17.2 13.2
Others 257 70.5 28.7 24.8
CASTE
SC 932 63.8 16.0 9.2
ST 354 59.3 14.2 8.7
Others 3034 66.3 21.1 16.0
PLACE OF STAY
With In laws 2644 63.4↓ 17.1 11.4
With own parents 1030 71.6↑ 24.4 19.0
Nuclear family 639 60.1 18.8 13.2
EDUCATION OF THE
WOMEN
Illiterate 1514 51.2↓ 10.5 6.5
1- 4 years 323 63.7↑ 22.7 14.7
5-8 years 1007 72.1↑ 19.3 12.7
9-14 years 1165 84.2↑ 30.8 23.4
15+ years 292 91.0↑ 50.1 46.7
Not Specified 19* 68.1 46.3 46.3
* Base too low

8.4.1 IFA coverage by state
The following table details the IFA receipt across the states. In states of Assam, Karnataka,
Kerala, Madhya Pradesh and Tamil Nadu, more than 80% of the pregnant women received
IFA in 2001-02. Bihar was the worst performing state showing proportion lesser than 30%.
Jharkhand and Uttar Pradesh also have one of the lowest figures at 41-42%. Receipt of more
than 90 tablets was less than 20% countrywide. It was dismally low (under 10%) in Bihar,
Haryana, Rajasthan and Uttar Pradesh. Consumption of more than 90 tablets was high in
Kerala (59%) distantly followed by Delhi (34%) and Tamil Nadu (32%), while overall
consumption level was around 14%. The situation signifies the problem of distribution of
recommended number of tablets and consumption.
Further analysis revealed that proportion of women who consumed more than 90 tablets was
significantly lower than those received it in Bihar, Kerala and Uttaranchal.
Table 76 IFA coverage by state
% across Base: Received Received Consumed Consumed
IFA Tablets more than 90 less than 30 more than 90
tablets tablets tablets
Andhra Pradesh 240 67.6 10.2 52.1 9.8
Assam 240 83.0 10.3 19.0 8.6
Bihar 240 29.7 6.0 8.9 0.7
Chhatisgarh 240 71.8 21.2 26.6 12.3
Delhi 240 76.4 37.6 21.4 34.5
Gujarat 240 74.0 20.4 37.0 14.4
Haryana 240 64.0 8.4 29.7 5.5
Jharkhand 240 41.4 13.7 17.6 8.2
Karnataka 240 80.9 27.0 32.6 22.2
Kerala 240 95.9 72.7 16.6 59.0
Madhya Pradesh 240 83.0 28.7 37.4 18.0
Maharashtra 240 78.6 19.3 39.0 13.4
Punjab 240 59.2 12.0 26.5 10.7
Rajasthan 240 52.4 6.0 32.9 2.2
Tamil Nadu 240 89.6 39.8 25.9 32.4
Uttar Pradesh 240 41.7 8.3 26.6 3.4
Uttranchal 240 68.2 29.4 15.9 12.1
West Bengal 240 64.8 19.1 23.7 13.0
All India 4320 64.9 19.2 29.2 13.7

8.4.2 Source of receiving IFA
Amongst all those who received IFA Tablets, majority (70%) received it from Government
health/ICDS centres, while 30% from private sector, which included private hospital/clinic and
chemist shop. Among the various government health/ICDS centres, 35% received from
hospital followed by outreach sessions (21%) and PHC (10%). Around 6% of the pregnant
women received IFA tablets from AWCs.
The source of service delivery varied significantly with place of residence. While 47% in urban
got IFA supplementation from private sector, less than 21% from the rural areas accessed from
private. Government health facilities particularly hospital (33%) and outreach sessions (30%)
were accessed in much higher proportion in rural areas compared to urban. The source of IFA
remained similar among caste and religion.
Table 77 Service Delivery Point
BASE : AMONGST ALL WHO Location Caste Religion
RECEIVED IFA
BASE: 3085 1481 1604 637 243 2205 2525 362 198
Govt. hospital 34.8 33.1↓ 38.0↑ 41.6 51.1 30.4 35.0 37.3 24.0
Primary health center 9.7 12.4↑ 4.9↓ 11.5 13.2 8.6 9.4↓ 14.1↑ 2.4
Outreach Sessions 21.4 30.0↑ 6.0↓ 23.9↑ 23.6↓ 20.2 21.3 23.2 16.3
(including Sub center)
Anganwadi center 5.8 5.8 5.8 4.8 9.2 5.7 6.2 4.5 3.1
Pvt. Hospital/Pvt. Clinic 15.5 12.6↓ 20.8↑ 10.3↑ 1.6↓ 19.1 15.3 12.5 30.0
Chemist 14.8 8.3↓ 26.5↑ 9.1 3.6 18.2 15.2↑ 9.1↓ 25.2
• Base too low

8.4.3 Source of receiving IFA tablets by State
Among all those women who received more than 90 (recommended level) IFA tablets majority
(35%) reported to have received it from Government doctors/PHC/ANM visiting village. In
Delhi, Madhya Pradesh, Maharashtra and Tamil Nadu more than 40% of the respondents
reported to have received IFA from the Government hospitals/PHC/ANMs. This proportion
was the lowest in Jharkhand (7%) and the highest in Delhi (61%).
Close to 16% reported to have received it from private physicians/clinics whereas close to 15%
received it from chemists. In Kerala and Karnataka more than 30% received IFA from private
hospitals. In Punjab and Jharkhand chemists received high mention as source of receiving IFA
tablets. AWCs were important source of IFA tablets in Madhya Pradesh, Jharkhand and
Haryana.
Table 78 Source of receiving IFA tablets
Base: All who have received IFA
% across Base Govt PHC SC Pvt. Outreach AWC Chemist
hospital hospital/Pvt Services (Anganwadi
. clinic centre)
Andhra Pradesh 193 39.1 2.3 4.4 29.2 17.2 1.6 7.9
Assam 195 28.3 17.4 25.3 10.7 4.0 6.1 10.7
Bihar 76 26.4 3.6 22.0 5.8 13.1 2.2 25.7
Chhatisgarh 185 19.9 3.9 12.4 11.1 46.6 3.9 8.8
Delhi 183 60.8 4.0 2.2 6.0 0.0 6.3 23.3
Gujarat 176 24.7 12.5 23.1 21.3 4.7 2.6 11.4
Haryana 172 18.6 2.9 27.4 11.2 12.2 10.6 18.4
Jharkhand 118 7.3 4.2 13.0 8.1 26.3 11.2 29.8
Karnataka 194 38.2 19.2 0.0 39.0 1.2 1.2 2.7
Kerala 227 38.4 10.0 0.3 30.6 0.6 5.3 22.0
Madhya Pradesh 211 48.7 4.8 0.3 0.5 10.6 34.7 6.2
Maharashtra 195 39.7 9.1 6.6 11.3 11.1 5.4 18.2
Punjab 168 20.9 3.5 31.9 11.5 0.0 3.0 30.5
Rajasthan 123 23.9 1.2 15.1 6.6 38.0 3.1 20.0
Tamil Nadu 219 41.4 3.8 5.9 23.1 13.2 2.8 10.6
Uttar Pradesh 118 27.9 16.8 2.4 11.8 26.1 1.6 12.7
Uttranchal 172 26.8 22.2 22.7 1.2 13.7 1.2 12.3
West Bengal 160 39.1 20.8 10.3 2.1 0.2 2.0 27.0
All India 3085 34.9 9.7 8.9 15.5 12.4 5.8 14.9
level.

8.5 NIGHT BLINDNESS
Night blindness or poor adaptation to dark is an early functional manifestation of Vitamin A

deficiency (VAD). VAD is accentuated during pregnancy due to increased demand.
Overall 12% of the respondents confirmed to having difficulty in vision during the night during
the pregnancy that ended in the reference period. A significantly higher proportion of
respondents in Rural areas (15%) had night vision problems compared to Urban areas (6%).
Lower prevalence was also observed amongst women staying with their in laws (12%) in
comparison to women staying in nuclear families (17%). Higher proportion of illiterate women
also complained of this compared to literate women.
Table 79 Difficulty in vision at night
Base Yes No Don't Remember
ALL 4320 11.9 87.7 0.4
LOCATION
Rural 2160 14.5↓ 85.2 0.4
Urban 2160 6.0↓ 93.5 0.4
RELIGION
Hindu 3480 11.7 87.8 0.4
Muslim 583 12.6 87.1 0.3
Others 257 12.0 87.8 0.2
CASTE
SC 932 13.3 86.2 0.5
ST 354 15.4 84.6 0.0
Others 3034 10.9 88.7 0.4
PLACE OF STAY
With In laws 2644 11.5↓ 88.1 0.4
With own parents 1030 9.5 89.9 0.5
Nuclear family 639 17.2↑ 82.7 0.1
Illiterate 1514 15.7↑ 84.0 0.3
1- 4 years 323 12.9 85.9 1.1
5-8 years 1007 9.4↓ 90.1 0.4
9-14 years 1165 7.5↓ 92.1 0.3
15+ years 292 1.0↓ 98.5 0.5
Not Specified 19* 12.7 87.3 0.0
* Base too low

8.6 NIGHT BLINDNESS ACROSS STATES
Overall at an all India level, 12% of the pregnant women suffered from Night Blindness. This
proportion was close to 20% in states such as Bihar, Jharkhand, Uttraranchal and Madhya
Pradesh. It was lowest in Kerala where less than 1% reported it. In states of Delhi, Haryana,
Maharashtra, Tamil Nadu, less than 10% complained of VAD. Rest of the states were between
11-19%.
Table 80 Night Blindness by State

% across Base: Suffered from Night Blindness
Andhra Pradesh 240 16.4
Assam 240 12.0
Bihar 240 19.1
Chhatisgarh 240 15.8
Delhi 240 5.1
Gujarat 240 13.3
Haryana 240 7.1
Jharkhand 240 20.1
Karnataka 240 10.8
Kerala 240 0.8
Madhya Pradesh 240 17.8
Maharashtra 240 7.1
Punjab 240 9.4
Rajasthan 240 11.8
Tamil Nadu 240 3.7
Uttar Pradesh 240 11.9
Uttranchal 240 19.8
West Bengal 240 13.8
All India 4320 11.9
level.
8.7 KNOWLEDGE ABOUT COMPLICATIONS DURING PREGNANCY
During pregnancy a mother can suffer from several pregnancy related problems like night
blindness, blurred vision, convulsions, swelling (of the legs, body or face), excessive fatigue,
(anaemia) and vaginal bleeding. To assess the knowledge of the respondents regarding the
common problems and the complications that a woman can suffer during pregnancy the
respondents were specifically asked what all complications during pregnancy they are aware
of.
Good proportion of women (30%) were not aware of any pregnancy-related complications. The
complications which got higher mention were “Severe Weakness” (34%) followed by “Swelling
of face/feet” (32%), “Severe headache” (10%), “Bleeding/spotting” (7%) & “Very high fever
(7%). A significantly higher proportion of respondents from Urban areas (42%) reported
Swelling of face/feet compared to Rural areas (27%). Higher proportion of Hindus (34%) also
mentioned this complication compared to Muslims (24%) and other caste respondents (27%)
compared to SC women (33%).
A significantly higher proportion of Muslim respondents (39%) mentioned severe weakness
compared to Hindu respondents (33%). Awareness of all pregnancy complications was higher
among Urban women and literate women. Lack of knowledge was higher among women
belonging to Rural areas (33%), ST (36%), staying in nuclear family (39%) and among those

were illiterate (38%).

Table 81 Knowledge of pregnancy complication
Base : All
% across Base Swelling of Bleeding/s Not feeling the Severe Abnormal Very high Severe Vomiting DK/CS
face/feet potting movements of headache presentation fever weakness
the baby
ALL 4320 31.8 6.5 5.7 9.7 3.7 7.1 33.8 14.5 30.2
LOCATION
Rural 2160 27.4↓ 4.5↓ 3.8↓ 8.8↓ 3.7 7.0 32.5↓ 13.0↓ 33.4↑
Urban 2160 41.7↑ 11.1↑ 10.3↑ 11.5↑ 3.7 7.5 36.8↑ 17.9↑ 22.9↓
RELIGION
Hindu 3480 33.6↑ 6.8 6.7↑ 9.9 3.4 7.4 32.7↓ 14.2 30.1
Muslim 583 24.0↓ 4.9 0.7↓ 8.4 5.2 7.0 39.2↑ 13.9 31.9
Others 257 25.7 7.7 6.0 8.9 3.1 3.0 35.1 22.7 25.2
CASTE
SC 932 27.4↓ 3.7↓ 5.1 9.0 2.7 7.3 31.5 20.0↑ 30.9
ST 354 32.8 3.5 8.9 10.5 2.6 6.6 29.9 6.8 36.3↑
Others 3034 33.2↑ 7.9↑ 5.5 9.7 4.2 7.1 35.2 13.5↓ 29.1↓
PLACE OF STAY
With In laws 2644 30.9↓ 7.2 7.1 12.3↑ 3.3 8.6↑ 34.9 12.1↓ 30.4↓
With own parents 1030 36.0↑ 6.6 4.1 7.2↓ 5.4 5.1↓ 35.3 19.3↑ 24.5↓
Nuclear family 639 27.9 4.1 3.5 4.1 2.5 5.1 27.4 15.1 38.8↑
Not Specified 7* 29.4 0.0 9.5 0.0 0.0 0.0 34.0 33.7 22.7
Illiterate 1514 25.8↓ 3.4↓ 2.8 8.7 3.1 6.9↓ 32.4↓ 8.6↓ 38.1↑
1- 4 years 323 32.2 8.9 3.4 12.1 2.8 9.9 35.4 14.0 25.3↓
5-8 years 1007 30.1 6.5 8.6 9.9 4.7 6.5 32.1 19.9↑ 28.0↓
9-14 years 1165 44.0↑ 12.0↑ 9.8 10.9 3.8 6.2 36.3 19.9↑ 20.0↓
15+ years 292 51.1↑ 10.5↑ 7.5 9.6 5.8 13.4↑ 45.3↑ 18.4↑ 17.5↓
Not Specified 19* 21.4 2.8 2.8 0.6 3.4 7.4 31.4 42.0 10.0

8.7.1 Knowledge about Complications during Pregnancy by State
Awareness of pregnancy related complications were high in Tamil Nadu (97%) followed by Madhya Pradesh (88%) and Karnataka (87%) while it
was low in Uttaranchal (35%), Delhi (50%) and Uttar Pradesh (45%). Among the various complications, majority of the pregnant women (74%) in
Karnataka were aware of swelling of face/feet followed by sever weakness (60%). In Tamil Nadu, vomiting (60%) was most commonly known
complication during pregnancy.
Table 82 Knowledge of pregnancy complications by State
% across Base Swelling of Bleeding/ Severe Fits Not feeling the Severe Abnormal Very high Stomach Vomiting Vertigo DK/DS
face/feet spotting weakness movements of baby ead-ache presentation fever pain
Andhra Pradesh 240 29.1 2.0 18.8 1.5 1.2 8.9 2.8 6.7 1.2 1.6 0.0 43.2
Assam 240 17.5 2.4 39.4 3.7 1.0 13.6 8.7 8.6 0.6 12.0 1.3 30.2
Bihar 240 17.8 3.0 47.5 6.1 2.9 7.2 6.0 2.5 7.0 10.6 0.1 35.7
Chhatisgarh 240 28.6 1.4 14.3 4.8 0.6 4.2 0.9 3.7 5.2 20.0 8.4 34.6
Delhi 240 23.5 2.4 18.7 3.0 3.7 5.0 1.5 6.6 2.7 9.4 2.7 50.5
Gujarat 240 41.9 1.3 17.7 7.7 2.9 7.0 8.6 5.1 3.6 32.8 8.3 27.9
Haryana 240 34.4 1.1 38.2 1.3 2.5 19.5 4.0 7.0 0.0 9.3 1.6 22.2
Jharkhand 240 21.5 0.4 48.8 12.8 0.5 9.1 0.9 4.5 9.8 12.0 0.5 23.8
Karnataka 240 74.2 3.9 57.8 6.4 11.0 12.5 4.0 7.2 0.6 0.3 0.0 12.7
Kerala 240 35.5 14.3 42.2 3.1 5.2 9.8 2.9 5.0 1.3 25.2 0.0 13.6
Madhya Pradesh 240 33.0 9.2 57.9 6.1 9.4 35.4 10.9 43.6 1.2 0.4 0.1 12.0
Maharashtra 240 37.4 21.5 32.0 20.5 17.5 5.7 4.0 2.7 1.2 7.1 0.8 35.7
Punjab 240 25.0 2.0 43.3 0.5 1.2 12.2 1.5 6.0 0.4 2.9 1.3 40.7
Rajasthan 240 29.2 12.8 50.7 1.1 4.1 23.0 7.2 10.5 5.3 15.4 0.1 24.9
Tamil Nadu 240 41.8 3.9 11.9 0.2 4.4 0.7 1.4 0.6 1.9 60.0 20.5 2.7
Uttar Pradesh 240 27.5 1.7 33.0 0.4 0.2 0.9 0.3 3.1 0.6 1.4 3.1 54.6
Uttranchal 240 7.0 0.5 22.3 1.4 0.0 2.7 0.1 1.4 0.3 5.1 1.3 65.1
West Bengal 240 18.0 11.6 19.1 5.0 14.6 11.9 0.7 6.3 5.3 33.1 7.6 14.6
All India 4320 31.7 6.5 33.9 5.2 5.7 9.6 3.7 7.1 2.6 14.5 3.6 30.2

8.8 KNOWLEDGE ABOUT THE PLACE OF CONSULTATION FOR PREGNANCY COMPLICATIONS
In order to identify complication and avail the services on time, pregnant women / her family
member should know the danger sign and the right place for seeking care.
Government doctors were mentioned maximum (44%) followed by Private doctors (36%). A
distant third was ANM/LHV/Nurse (9%). More than 9% of women mentioned that they would
not consult anybody.
Higher proportion of the Urban women would access Private Doctors (46%) in comparison to
the Rural women (32%). In Rural areas (11%) a significantly higher proportion mentioned
ANM/ LHV Nurse compared to Urban areas (4%). A significantly higher proportion of ST
respondents (57%) said they would go to Govt. Hospital compared to SC (48%). Higher
proportion of Hindus (46%) also mentioned them compared to Muslims (35%).
Table 83 Knowledge about the place of consultation

Base : all LOCATION CASTE RELIGION
Base: 4320 2160 2160 932 354 3034 3480 583 257
Untrained Dai 0.8 0.6 1.3 0.6 0.5 0.9 0.7 1.5 0.0
Trained Dai 0.8 1.0 0.4 1.0 2.1 0.6 0.9 0.4 0.2
ANM/LHV/Nurse 9.1 11.3↑ 4.1↓ 9.4↓ 17.2↑ 7.8 9.5 8.4 4.2
Govt. Doctor 43.6 42.2 46.6 47.9↓ 57.4↑ 40.1 45.6↑ 35.2↓ 35.7
Private Doctor 36.1 31.9↓ 45.6↑ 24.6 18.6 42.6 34.7↓ 37.2 60.9↑
Friends /relatives/neighbors 2.8 2.6 3.1 2.2 8.9 2.1 2.9 2.6 0.2
No need/Nobody 8.6 10.2↑ 5.0↓ 9.4 11.3 7.9 8.4↑ 10.8 3.5↓
Not Specified 10.4 11.8 7 12.3 6.3 10.3 10.1 13.3 3.6

8.9 COMPLICATIONS EXPERIENCED DURING PREGNANCY
To have an idea about the proportion of pregnant women suffering from any complication during pregnancy,
the respondents were specifically asked what all complication did they experience during pregnancy. More
than half of the women had faced some problem. A significantly higher proportion of urban women (57%)
faced complications compared to rural women (50%). 17% reported that they had swelling of face/feet and
24% said they had severe weakness. High fever was experienced by 9% of the pregnant women and severe
headache by 9% of women. Abnormal representation was reported by 3% of the women .
A significantly higher proportion of Rural respondents (10%) reported to have experienced severe headache
in comparison to the Urban women (7%), which could be due to unrecognized pregnancy introduced
hypertension. Similarly, higher proportion of other caste respondents reported swelling of face feet (19%)
compared to SC respondents (15%). Severe headache was reported by a higher proportion of SC women
(11%) compared to ST women (6%).
It is interesting to note that a higher proportion of literate women mentioned that they had experienced
different complications in comparison to illiterate women. The reason can be not being aware of the
complications or accept it as a normal occurrence during their pregnancy.

Table 84 Experienced complications during pregnancy
Base : All
% across Base Swelling of Bleeding/s Not feeling the Severe Abnormal Very high Severe Did not face
face/feet potting movements of headache presentation fever weakness any problems
the baby
ALL 4320 17.4 2.1 1.8 9.2 3.2 8.5 24.2 47.6
LOCATION
Rural 2160 16.6 1.5 1.4 10.0↑ 3.0 7.4↓ 25.1 49.5↑
Urban 2160 19.2 3.3 2.6 7.2↓ 3.8 11.2↑ 22.1 43.1↓
RELIGION
Hindu 3480 16.8 1.8 1.7 9.1 3.2 8.7 22.1 48.8
Muslim 583 20.1 3.3 2.1 9.6 3.4 8.0 33.1 42.3
Others 257 18.9 1.6 1.0 7.8 2.9 7.9 32.2 43.6
CASTE
SC 932 14.6↓ 1.4 1.5 11.4↑ 1.6 9.1 23.3 48.3
ST 354 11.7 2.7 2.2 6.2↓ 3.6 9.0 19.8 56.5
Others 3034 19.3↑ 2.2 1.8 8.8 3.8 8.3 25.1 46.0
PLACE OF STAY
With In laws 2644 16.4 1.7 1.8 10.9 2.9 8.2 24.7 49.8
With own parents 1030 19.4 2.9 1.5 7.2 4.3 8.3 22.6 44.3
Nuclear family 639 17.6 2.0 2.0 6.1 2.8 10.3 25.0 45.0
Not Specified 7* 33.8 0.0 0.0 0.0 0.0 14.2 11.1 9.5
Illiterate 1514 15.8↓ 1.8 1.2 11.5↑ 3.1 8.9 26.3 51.2↑
1- 4 years 323 24.4↑ 3.1 2.9 8.2 6.2 10.2 30.9 38.7↓
5-8 years 1007 14.5 2.4 1.8 8.0 2.7 7.7 22.4 48.8
9-14 years 1165 20.0↑ 1.7 2.5 5.9↓ 2.7 7.4 20.9 43.7↓
15+ years 292 28.4↑ 3.5 2.4 7.9 4.4 13.4 16.5 33.9↓
Not Specified 19* 2.8 0.0 0.0 6.1 2.8 2.5 2.5 58.0
* Base too low
* Totals may exceed 100% because of Multi-coding

Higher percentage of the respondents (43%) have reported that they consulted a Private Doctor and 28%
mentioned that they consulted a Govt. doctor when they experienced complications. A significantly higher
proportion of respondents in Urban areas consulted Govt. and private doctors. ANM and LHV/ Nurse were
consulted by 4% each of the respondents.
Overall 18% said they did not feel the need to consult anybody when faced with minor complication during
pregnancy. A significantly higher proportion of these were in Rural areas (23%) compared to Urban areas
(10%). Almost a quarter of SC and Muslim respondents expressed that consultation was not required or did
not visit anybody, which is significantly higher than other caste and religious groups. May be the awareness
and urgency to consult or accessibility of medical facilities or medical personnel is an issue.
Table 85 People consulted while faced complications

Base :all who faced any LOCATION CASTE RELIGION
complication during
pregnancy
Base: 2264 1070 1194 458 183 1623 1816 322 126
Govt. Doctor 27.7 24.1↓ 35.0↑ 26.9 37.2 26.9 29.1 23.3 19.5
LHV/Nurse 3.5 3.6 3.2 5.9 3.7 2.6 3.8 1.9 3.0
ANM 3.9 5.1↑ 1.4↓ 4.8 5.8 3.3 3.6 5.9 0.0
Private Doctor 42.5 39.4↓ 48.9↑ 33.6↓ 26.6 47.5↑ 43.0↑ 33.8↓ 72.2
Untrained Dai 1.0 0.9 1.2 0.9 1.8 1.0 0.9 1.5 0.0
Trained Dai 1.1 1.3 0.6 1.2 2.1 0.9 1.3 0.3 0.4
Friends /relatives/neighbors 5.0 6.2 2.7 4.0 8.7 5.0 4.7 7.0 3.2
No need/Nobody 18.3 22.5↑ 9.8↓ 25.3↑ 18.5 15.8↓ 17.0↓ 27.3↑ 2.8
* Base too low
FINAL REPORT ALL INDIA

114
8.10 COMPLICATION EXPERIENCED DURING DELIVERY
These section details the different complications experienced by the respondents during delivery. 28% of the
women reported that they had complication during their delivery. 17% reported “prolonged labor (more than
16hrs for first delivery and more than 12hrs for other delivery)” followed by obstructed labour (5%).
Percentage of women reporting obstructed labour was significantly higher in urban (8%) areas compared to
rural (7%).
Table 86 Complication during delivery
Base : All
% across Base Prolonged labor Any bleeding Obstructed labor No complications
before delivery
ALL 4320 17.2 2.1 5.1 72.4
LOCATION
Rural 2160 16.6 2.0 4.0↓ 74.0↑
Urban 2160 18.5 2.3 7.8↑ 68.9↓
RELIGION
Hindu 3480 17.5 2.2 5.0 72.3
Muslim 583 16.3 2.0 5.4 73.7
Others 257 15.8 0.8 6.2 69.9
CASTE
SC 932 18.9 2.1 6.0 71.6
ST 354 15.5 2.9 3.6 75.4
Others 3034 16.9 2.0 5.0 72.3
PLACE OF STAY
With In laws 2644 15.8 1.4 3.8 75.5↑
With own parents 1030 19.2 3.4 9.3 65.3↓
Nuclear family 639 19.0 2.7 3.5 73.1
Not Specified 7* 45.6 0.0 0.0 54.4
Illiterate 1514 15.3↓ 1.5 2.1↓ 78.1↑
1- 4 years 323 23.7↑ 1.9 6.4↑ 64.0↓
5-8 years 1007 21.2↑ 2.9 6.2↑ 65.8↓
9-14 years 1165 15.2 2.9 9.8↑ 70.9↓
15+ years 292 12.6 0.5 6.8↑ 74.6
Not Specified 19* 13.6 6.1 7.4 61.2
* Base too low

115
8.11 PLACE OF DELIVERY AND ASSISTANCE AT DELIVERY
Institutional deliveries and delivery by skilled attendants can greatly reduce maternal and
newborn mortality by the use of technically appropriate procedures, and accurate and speedy
diagnosis and treatment of complications.
Institutional deliveries were accounted for 49% of the total deliveries, which remained
same as compared to previous year. Government and private hospitals contributed equally.
The proportion of institutional deliveries was more than double in urban (78%) compared to
rural (36%). This proportion increased significantly compared to previous year’s
proportion of 72% in urban. Analysis with other background characteristics revealed that
institutional deliveries were strongly correlated with educational status of women and utilization
of private sector also increased with the year of schooling (74% among 15+ years of
schooling). A significantly higher proportion of women living with own parents had an
institutional delivery compared to those living with in laws.
Rest 51% of the women delivered at home, which was significantly higher among rural (64%),
Muslims (60%), SC/ST (60%) and illiterate (25%). This could be because of low accessibility to
health institutions and ignorance regarding the importance of institutional delivery.
Table 87 Place of delivery

Base : All Place of Delivery
Base Govt. Private hospital Sub Home
Hospital(PHC/CHC) /Nursing Home center
ALL 4320 24.7 23.5 0.5 51.0
LOCATION
Rural 2160 18.4↓ 17.1↓ 0.5 63.7↑
Urban 2160 39.1↑ 38.1↑ 0.6 22.1↓
RELIGION
Hindu 3480 25.8↑ 23.2↓ 0.5 50.2↑
Muslim 583 19.7↓ 20.1 0.5 59.6↑
Others 257 21.6 45.8↑ 0.0 32.7↓
CASTE
SC 932 23.7 15.3↑ 0.6 60.3↑
ST 354 29.9 8.7↓ 0.0 61.4↑
Others 3034 24.3 28.6 0.6 46.2↓
PLACE OF STAY
With In laws 2644 24.3↓ 21.7↓ 0.6↓ 53.2↑
With own parents 1030 29.9↑ 30.9↑ 0.2 38.9↓
Nuclear family 639 17.8 18.2 0.8 63.2↑
Not Specified 7* 8.8 43.3 22.9↑ 25.0
Illiterate 1514 14.3↓ 9.4↓ 0.6 75.1↑
1- 4 years 323 25.7↑ 18.3↑ 0.8 54.9↓
5-8 years 1007 33.8↑ 27.1↑ 0.5 38.4↓
9-14 years 1165 38.8↑ 43.0↑ 0.2 18.0↓
15+ years 292 19.5 74.4↑ 0.2 6.0↓
Not Specified 19* 10.3 59.9 0.0 29.9
* Base too low
116
Among the total deliveries, around 23% were assisted by Private Doctors followed by
Untrained TBAs (22%) and Government doctors (21%). Friends/ Relatives (15%) and Trained
TBAs (6%). Pvt. Doctors were mentioned by a higher proportion of Urban women (36%)
compared to Rural women (18%) and those living with own parents (30%) compared to those
residing with in laws (22%).
Untrained TBAs got a higher mention in Rural areas (28%) compared to Urban areas (9%) and
women staying with in laws (24%) as compared women residing with own parents (17%). Less
literate women had their deliveries conducted by untrained TBAs compared to illiterate.
Among the institutional deliveries, doctors conducted 42% each in private and government
health facilities, followed by LHVs/nurses (12%) and ANMs (2%). The untrained TBAs were the
major birth attendants in domicile deliveries followed by friends and relatives (29%). Trained
TBAs conducted only 11% while skilled birth attendants (Doctors, LHV, Nurse and ANMs)
attended 14% of the home deliveries.
Table 88 Assistance during delivery

Unskilled Birth Attendant Skilled Birth Attendant
Base Friends/ Untrained Trained ANM LHV/Nurse Govt. Private
Relatives Dai Dai Doctor Doctor
ALL 4320 15.1 22.4 6.0 3.1 8.0 21.3 23.2
LOCATION
Rural 2160 19.0↑ 28.2↑ 7.4↑ 3.0 6.7↓ 16.8↓ 17.6↓
Urban 2160 6.4↓ 9.2↓ 2.8↓ 3.2 11.1↑ 31.5↑ 35.9↑
RELIGION
Hindu 3480 16.4↑ 20.5↓ 6.0 3.1 7.8↓ 22.3↑ 22.8
Muslim 583 11.8↓ 34.7↑ 6.7 3.1 6.4 16.2↓ 20.0
Others 257 1.4 11.1 3.7 2.0 18.7↑ 20.5 45.1
CASTE
SC 932 15.6 27.5↑ 6.9 2.3 8.6 20.8 15.9↓
St 354 18.8 27.9 8.9 6.9 5.8 24.4 7.6
Others 3034 14.4 19.8↓ 5.3 2.8 8.1 21.0 28.0↑
PLACE OF STAY
With In laws 2644 15.3↑ 24.2↑ 6.5 3.4 7.4 20.2↓ 21.5↓
With own parents 1030 8.8↓ 17.0↓ 5.2 1.8 10.0 27.0↑ 30.2↑
Nuclear family 639 25.0 24.5 5.7 3.9 7.2 15.9 17.6
Not Specified 7* 2.3 22.7 0.0 0.0 8.8 8.8 57.4
EDUCATION OF THE
WOMEN
Illiterate 1514 24.1↑ 33.5↑ 7.8 3.4 4.9↓ 12.8↓ 11.6↓
1- 4 years 323 9.0↓ 33.6 5.2 2.1 7.5 23.5↑ 19.6↑
5-8 years 1007 11.9↓ 15.1↓ 6.0 2.9 9.0↑ 28.3↑ 26.1↑
9-14 years 1165 3.7↓ 4.4↓ 3.6 3.4 15.6↑ 31.7↑ 38.1↑
15+ years 292 3.0↓ 1.2↓ 0.6 0.7 2.1 21.3↑ 69.9↑
Not Specified 19* 0.0 29.3 0.0 0.0 2.8 18.8 49.1
PLACE OF DELIVERY
Institutional Delivery 2426 0.0 0.0 0.0 2.0↓ 12.3↑ 42.2↑ 42.3↑
Home 1890 29.4↑ 43.2↑ 11.4↑ 4.1↑ 3.9↓ 1.0↓ 5.0↓
* Base too low
117
The following table shows the proportion of deliveries attended by skilled birth attendants.
Significant differences were observed across the background characteristic of location. The
proportion of literate women getting skilled assistance was higher. This was true across both
Rural and Urban areas. In Rural areas, a significantly higher proportion of women living with
own parents (59%) received skilled assistance compared to those residing with in laws (41%).
However, in Urban areas a higher proportion of women living with own parents (86%) or with in
laws (81%) received skilled assistance compared to those in a nuclear family (72%).
Table 89 Skilled delivery – Rural and Urban

Base : All women Skilled assistance
All Rural Urban
% across Base Base Base
ALL 4320 55.2 2160 43.9 2160 81.1
RELIGION
Hindu 3480 55.8↑ 1731 43.9↓ 1749 83.0↑
Muslim 583 45.6↓ 282 35.8 301 68.4↓
Others 257 84.0 147 79.1↑ 110 93.5
CASTE
SC 932 47.6↓ 542 40.4 390 72.4↓
ST 354 43.8 229 33.1 125 77.4
Others 3034 59.6↑ 1389 47.1 1645 83.6↑
PLACE OF STAY
With In laws 2644 52.4↓ 1305 40.5↓ 1339 80.8↑
With own parents 1030 68.2↑ 543 59.0↑ 487 86.3↑
Nuclear family 639 44.4 307 33.1 332 72.4↓
Not Specified 7* 75.0 5* 64.5 2* 93.6
EDUCATION OF THE
WOMEN
Illiterate 1514 32.6↓ 1013 28.6↓ 501 55.4↓
1- 4 years 323 52.0↑ 176 45.2↑ 147 66.4
5-8 years 1007 66.0↑ 506 55.9↑ 501 85.4↑
9-14 years 1165 88.0↑ 424 81.2↑ 741 94.8↑
15+ years 292 93.8↑ 36 81.7↑ 256 96.6↑
Not Specified 19* 70.7 5* 53.5 14* 83.4
PLACE OF DELIVERY
Institution Delivery 2426 98.8 874 98.5 1552 99.1
Home 1890 14.0 1282 13.2 608 20.2
*Base too low
118
Deliveries conducted by TBAs is predominantly a Rural phenomenon. In Rural areas,
trained TBAs conducted 7% of deliveries, while untrained 47% compared to 3% and 16%
respectively in urban areas. Untrained assistance during delivery in Rural areas was
significantly more amongst women staying at their in laws place (50%) as compared to the
parents’ place (33%).
Table 90 Trained assistance during delivery

Base : All women Trained assistance Untrained assistance
All Rural Urban All Rural Urban
% across Base % Base % Base % % Base % Base %
ALL 4320 6.0 2160 7.4 2160 2.8 37.5 2160 47.1 2160 15.5
RELIGION
Hindu 3480 6.0 1731 7.5 1749 2.6 36.9↓ 1731 46.9↑ 1749 13.8↓
Muslim 583 6.7 282 7.6 301 4.7 46.6↑ 282 55.0 301 26.7↑
Others 257 3.7 147 5.4 110 0.3 12.5 147 15.9↓ 110 6.2
CASTE
SC 932 6.9 542 7.5 390 4.9 43.1↑ 542 49.3 390 21.8↑
ST 354 8.9 229 11.4 125 0.8 46.7 229 54.6 125 21.8
Others 3034 5.3 1389 6.8 1645 2.5 34.2↓ 1389 45.0 1645 13.4↓
PLACE OF STAY
With In laws 2644 6.5 1305 7.9 1339 3.1 39.5↑ 1305 49.6↑ 1339 15.4↓
With own parents 1030 5.2 543 7.2 487 1.2 25.7↓ 543 32.7↓ 487 12.0
Nuclear family 639 5.7 307 6.1 332 4.6 49.4 307 60.1 332 23.1↑
Not Specified 7* 0.0 5* 0.0 2* 0.0 25.0 5* 35.5 2* 6.4
EDUCATION OF THE
WOMEN
Illiterate 1514 7.8↑ 1013 8.3 501 5.1↑ 57.6↑ 1013 60.9↑ 501 38.7↑
1- 4 years 323 5.2 176 5.3 147 4.8 42.5↓ 176 49.1↓ 147 28.8
5-8 years 1007 6.0 506 7.5 501 3.0 26.9↓ 506 35.2↓ 501 11.0↓
9-14 years 1165 3.6↓ 424 5.9 741 1.4↓ 8.1↓ 424 12.6↓ 741 3.7↓
15+ years 292 0.6↓ 36 2.3 256 0.3↓ 4.2↓ 36 16.0↓ 256 1.4↓
Not Specified 19* 0.0 5* 0.0 14* 0.0 29.3 5* 46.5 14* 16.6
PLACE OF
DELIVERY
Institution 2426 0.4 874 0.6 1552 0.1 0.9 874 1.0 1552 1.0
Delivery
Home 1890 11.4 1282 11.3 608 12.1 72.6 1282 73.4 608 67.1
* Base too low
119
8.11.1 Nature of delivery
Around 89% of the population confirm to having had a normal delivery, which is significantly
higher in the Rural areas (92%), amongst illiterate women (95%), Muslims (94%) and SC
women (92%). Overall 9% of the women had a caesarean done. This was significantly higher
in urban areas and among women with 9+ years of schooling, probably because of the
availability of institution.
Table 91 Nature of Delivery
Base : All Nature of Delivery
% across Base Normal Assisted Caesarian
Delivery delivery Section
ALL 4320 88.7 1.9 8.9
LOCATION
Rural 2160 91.8↑ 1.5 6.2↓

Urban 2160 81.8↓ 2.7 15.1↑
RELIGION
Hindu 3480 88.4↓ 1.6 9.4
Muslim 583 94.0↑ 2.6 3.4
Others 257 73.2 3.6 23.2↑
CASTE
SC 932 91.9↑ 1.5 6.2
ST 354 92.2 4.2 3.4
Others 3034 87.1↓ 1.7 10.7
PLACE OF STAY
With In laws 2644 90.3 2.0 7.4
With own parents 1030 85.4 2.0 12.0
Nuclear family 639 88.6 1.2 9.6
Illiterate 1514 95.0↑ 0.8 4.0↓
1- 4 years 323 90.7↓ 4.4 4.8
5-8 years 1007 88.7↓ 1.7 9.4
9-14 years 1165 79.0↓ 2.7 16.8↑
15+ years 292 64.1↓ 5.0 31.0↑
Not Specified 19* 66.8 8.6 24.6
120
8.11.2 Delivery Details across States
Overall 49% of the respondents had institutional deliveries, while in Kerala, 99% were
institutional deliveries. Tamil Nadu followed closely at 86% and then followed by Delhi,
Maharashtra, West Bengal, Karnataka, Gujarat and Andhra Pradesh in the range of 60-73%.
However in Bihar, Rajasthan, Jharkhand, Chattisgarh and Uttar Pradesh less than a quarter of
the deliveries were conducted in institutions.
About 55% of the respondents had received skilled assistance during delivery and 6%
received trained assistance while 38% received untrained assistance. In Andhra Pradesh
Delhi, Kerala, Madhya Pradesh, Maharashtra, Punjab and Tamil Nadu more than 70% of the
women received skilled assistance. Almost 100% of the women in Kerala received skilled
assistance while this proportion was the lowest for Bihar at 24%. The difference between
skilled attendance and institutional delivery was in the range of 2-8% indicating the poor
attendance at home deliveries by ANMs. This is a major concern and need to be addressed.
Only in the state of Punjab (25%), Chattisgarh (12%), Rajasthan (12%) did ANM’s bridged a
gap of more than 10% of home deliveries.
In Assam, Bihar, Jharkhand, Rajasthan, Uttar Pradesh and Uttaranchal more than 50%
received untrained assistance. This proportion was almost 0% in Kerala and the highest in
Bihar (73%).
Overall 89% of the deliveries were normal. The variation across states was not much and most
states reported more than 80% deliveries as normal except for Andhra Pradesh (68%) and
Kerala (76%).
Overall, less than one tenth of the deliveries were reported to be caesarean. However, in
Kerala and Punjab more than 15% had caesarean section done.
Table 92 Place/type of delivery and assistance during delivery
% across Base Institutional Skilled Trained Untrained Normal Caesarian
deliveries Assistance Assistance Assistance deliveries deliveries
Andhra Pradesh 240 63.1 69.9 5.3 25.1 68.2 27.7
Assam 240 36.4 39.1 7.7 50.4 94.4 4.9

Bihar 240 15.9 24.3 1.9 72.7 96.4 2.4
Chhatisgarh 240 20.9 33.1 19.8 46.6 92.4 3.4
Delhi 240 72.8 79.0 10.5 10.6 94.3 3.9
Gujarat 240 62.5 65.9 7.6 26.4 92.9 2.9
Haryana 240 40.2 48.5 19.3 28.2 90.2 9.8
Jharkhand 240 21.9 30.8 4.7 65.1 96.2 3.7
Karnataka 240 59.3 67.5 5.8 23.5 91.4 7.4
Kerala 240 99.0 99.6 0.0 0.0 76.1 23.5
Madhya Pradesh 240 35.6 37.7 19.5 42.1 97.6 1.9
Maharashtra 240 70.8 72.2 6.2 21.6 87.0 8.2
Punjab 240 44.9 69.9 12.3 17.8 83.9 15.5
Rajasthan 240 23.3 35.4 7.0 56.8 96.2 3.6
Tamil Nadu 240 86.2 91.3 0.5 6.5 80.5 14.3
Uttar Pradesh 240 19.6 29.7 1.5 68.8 94.4 2.5
Uttranchal 240 28.9 37.1 9.4 52.6 95.4 4.0
West Bengal 240 66.9 68.1 4.2 20.8 85.2 14.8
All India 4320 48.6 55.1 5.9 37.7 88.8 8.9
level.
121
8.11.3 Clean Delivery Practices at Home
For all women who delivered at home, details were taken to assess whether the Basic Cleans
of Delivery was practised. This Five Cleans were 1) Clean Hands 2) Clean Surface 3) Clean
Blade 4) Clean thread 5) Clean cord. In the survey, data for all cleans except clean hands
were collected.
DDK or Disposable Delivery Kit contains a new blade, sterile thread and soap such that these
all Cleans could be adhered to.
At the aggregate level, only 15% of the total respondents received DDK.
Surface used: Only 49% ensured a clean surface for their delivery, 24% used a cot with a
clean sheet for delivery and 25% delivered on the ground with a clean cloth or a plastic sheet.
Instrument used for cutting the cord: In majority of the home deliveries (52%) a new blade
was used to cut the cord while 36% reported that boiled scissors or blade was used.
Cord tying: About 42% of the population claims to have tied the cord with a boiled thread
while 48% said they tied the cord with a non-boiled thread and remaining 10% were not aware
of this. A significantly higher proportion of respondents in Rural areas (50%) used a non-boiled
thread compared to Urban respondents (38%).
Application on the cut cord: Over 29% said that they applied oil (a dangerous practise) on
the cut cord while 26% said they applied powder/ medicine on the cord. 26% kept the cord free
of any applications. A significantly higher proportion of respondents in Rural areas (30%) said
they applied oil compared to Urban areas (22%).
Only 6% of the deliveries at home were such deliveries where four cleans were followed.
122
Table 93 Clean Delivery Practices at Home
BASE : ALL Location Caste Religion
BASE: 1890 1282 608 494 226 1170 1508 301 81
WHETHER RECEIVED DDK
Yes 15.3 14.3↓ 21.8↑ 17.4 21.1 13.2 15.0↓ 13.3 41.6↑
No 77.6 79.2↑ 67.2↓ 76.2↑ 65.3↓ 80.6 77.5↑ 83.0 41.2↓
Don't know 6.3 5.7↓ 10.3↑ 4.9↓ 11.6↑ 6.0 7.0 3.7 5.7
SURFACE USED
cot with clean sheet 23.7 22.8↓ 29.4↑ 22.5 18.1 25.3 22.2 29.0 32.2
cot without clean sheet 6.1 5.6 9.7 6.9 5.9 5.8 6.1↓ 4.3 20.0↑
ground but clean sheet 25.4 24.8 29.2 23.7 29.2 25.5 25.9 23.3 24.0
ground without clean sheet 41.1 42.7↑ 30.3↓ 43.7 36.4 40.7 41.4↑ 43.1 12.6↓
Don't know 2.5 2.8 0.4 2.0↓ 9.0↑ 1.5 3.1 0.2 2.5
INSTRUMENT USED
Boiled Scissors/ Blade 36.0 35.5 39.5 38.9 30.9 35.6 35.3 37.5 46.5
New blade 52.3 53.1 47.1 53.4 58.1 50.6 54.4↑ 46.5 26.4↓
Don't remember 8.5 8.2 10.5 6.5 7.2 9.7 8.2 9.0 16.5
Not Specified 2.6 2.6 2.9 1.0 2.9 3.3 1.8 5.0 10.5
TYING OF THE CORD
boiled thread 41.6 41.1 44.9 44.6 38.2 40.9 42.3↓ 34.4 74.9↑
Thread without boiling 48.0 49.5↑ 37.8↓ 48.7 47.3 47.8 47.6↑ 53.5 17.4↓
DK/CS 10.3 9.3↓ 16.9↑ 6.7 14.1 11.2 10.0 12.0 7.6
APPLICATION ON THE CUT CORD
Nothing 26.2 26.2 25.9 24.9 17.9 28.4 24.1↓ 32.1 50.3↑
Powder/ Medicine 26.3 26.6 23.9 19.5 21.7 30.3 25.2 30.8 27.6
Oil 28.5 29.5↑ 22.1↓ 38.1 34.3 23.0 31.4↑ 19.0 8.2↓
Don't remember 11.4 10.7 15.7 9.0↓ 19.8↑ 10.9 11.1 12.5 10.9
All 4 cleans practiced 6.0 5.4↓ 10.1↑ 9.6↑ 2.1↓ 5.1 5.0↓ 6.6 34.7↑
123
8.11.4 Clean Delivery Practices at home by States
Overall, at an All India level only 49% of the respondents delivered on a clean surface. About
88% used a clean instrument to cut the cord and 41% used clean thread to tie the cut cord.
Close to 26% of the respondents did not apply anything on the cut cord.
In Andhra Pradesh, Chhattisgarh, Madhya Pradesh, Uttar Pradesh and Uttaranchal more than
95% of the respondents used clean instrument to cut the cord. In Punjab more than 80% of the
respondents used clean thread to tie the cord. This proportion was the lowest for Uttaranchal at
17%.
Less than 25% of the respondents in Bihar, Madhya Pradesh, Maharashtra and Uttar Pradesh
reported not applying anything on the cut cord. More than 50% in Uttaranchal and Chhattisgarh
said they kept the cord free of any application.
As also seen in the previous section, overall only 6% of the home deliveries were reported
where all four cleans were followed. In number of states the proportion of clean delivery was
even less than 5% (Jharkhand, Madhya Pradesh, Maharashtra and Uttar Pradesh). In Punjab
and Haryana more than 20% of the home deliveries met the four ‘cleans’ for which data was
collected.
Table 94 Clean deliveries
% across Base: home Clean Clean Clean thread Clean cord All four clean
deliveries surface instrument deliveries
Andhra Pradesh 73 71.0 94.9 66.3 28.5 6.0
Assam 128 76.0 75.3 58.3 39.6 12.2

Bihar 168 38.6 91.4 31.4 23.8 0.6
Chhatisgarh 157 53.5 98.4 41.8 51.7 13.2
Delhi 74 62.7 91.8 56.4 26.2 6.2
Gujarat 89 69.1 73.3 42.5 31.4 10.1
Haryana 126 80.4 92.1 63.9 48.0 23.5
Jharkhand 150 39.2 87.9 23.6 44.2 1.5
Karnataka 85 63.8 71.4 44.4 34.9 10.0
Kerala 2* 0.0 44.5 0.0 0.0 0.0
Madhya Pradesh 127 56.6 95.6 63.2 4.3 2.0
Maharashtra 68 60.7 87.7 50.7 7.5 1.2
Punjab 108 61.2 82.8 87.7 38.2 33.6
Rajasthan 156 31.4 79.4 56.9 43.8 7.2
Tamil Nadu 21* 18.1 87.4 56.1 42.3 0.0
Uttar Pradesh 165 37.0 94.8 21.2 15.2 2.4
Uttranchal 134 81.0 96.5 16.8 59.0 8.8
West Bengal 59 43.7 74.0 28.5 27.0 7.5
All India 1890 48.7 88.2 41.2 26.2 5.7
*Base too low

The figures in green colour refer to the states that have significantly higher coverage as compared to national level.
The figures in red colour refer to the states that have significantly lower coverage as compared to national level.
124
8.12 POSTNATAL CARE
Postnatal care, especially during the first week of delivery, is of critical importance to the
mother and her new born.
Nationally, only 19% of the women reported that they received at least three PNC, while 52%
had not received even a single check-up after delivery. Irrespective of number, 33% received
PNC within 24 hour of delivery. As expected, proportion of women who had at least 3 PNC
was significantly higher in urban area (28.5%), among non-Hindu/Muslims (42%) and among
non-SC/ST (21%) and literate women. Among women with 15+ years of schooling, 64% had at
least three PNC.
Table 95 Postnatal Check-ups
Postnatal Checkups Timing of PNC
% across Base No PNC PNC1 PNC2 PNC3+ Within 24 After 24
Hrs Hours
ALL 4320 51.8 16.7 13.0 18.6 32.9 15.2
LOCATION
Rural 2160 59.6↑ 15.4 10.9 14.1↓ 26.9↓ 13.5↓
Urban 2160 34.2↓ 19.7 17.6 28.5↑ 46.8↑ 19.1↑
RELIGION
Hindu 3480 52.2↑ 17.7 12.0 18.1 32.2 15.6↓
Muslim 583 56.2↑ 11.4 17.2 15.2 35.0 8.8
Others 257 25.2↓ 18.3 15.1 41.5 ↑ 40.2 34.6↑
CASTE
SC 932 57.5↑ 17.8 10.5 14.2 26.4↓ 16.1
ST 354 64.3 6.1 15.8 13.8 22.9 12.8
Others 3034 48.0↓ 17.8 13.5 20.8 ↑ 36.7↑ 15.2
PLACE OF STAY
With In laws 2644 55.2↑ 15.6 12.7 16.6 29.3↓ 15.5↑
With own parents 1030 39.5↓ 20.8 16.6 23.1↑ 42.7↑ 17.7
Nuclear family 639 59.9 13.9 8.0 18.2 30.0 10.1↓
Not Specified 7* 25 17.6 0.0 57.5 75.0 0.0
.0
EDUCATION OF THE
WOMEN
Illiterate 1514 67.9↑ 13.2 10.5 8.4 21.8↓ 10.3↓
1- 4 years 323 58.7↓ 15.5 13.3 12.5 27.5 13.8
5-8 years 1007 43.1↓ 21.3 12.4 23.2↑ 36.5↑ 20.3↑
9-14 years 1165 30.7↓ 19.2 15.8 34.3↑ 49.6↑ 19.6↑
15+ years 292 9.7↓ 23.3 31.2 35.7↑ 63.8↑ 26.5↑
Not Specified 19* 35.5 2.8 14.9 46.8 64.5 0.0
*Base too low,
125
7.13 POSTNATAL CARE BY STATES
Overall, less than half (48%) of the respondents reported to have received postnatal check
ups, while only 18.6% received it at least three times.
In Kerala and Tamil Nadu, more than 80% of the respondents had postnatal care, while in
Bihar less than 11% had postnatal check-up. In Kerala, Karnataka and Tamil Nadu more than
43-47% of the respondents received this check-up at least thrice.
Table 96 Postnatal check-ups
% across Base At least PNC3+
PNC1
Assam 237 44.8 17.7
Bihar 238 10.8 2.8
Delhi 239 34.4 11.7
Gujarat 239 62.3 13.6
Haryana 240 40.7 27.9
Karnataka 240 78.4 43.6
Kerala 240 91.6 43.3
Punjab 240 67.2 26.0
Tamil Nadu 239 85.8 46.8
All India 4307 48.2 18.6
level.
126
8.14 INITIATION OF BREAST FEEDING
Infant feeding practices have significant effects on child survival, maternal health and fertility.
Breastfeeding improves the nutritional status of infants and reduces morbidity and mortality.
Colostrum provides important nutrients and also protects the newborn against infections.
Only 29% of respondents initiated breast feeding within 2 hours of birth. An additional 26%
initiated within 2-24 hours However, there was a substantial segment comprising 16% that
initiated breastfeeding only 72 hours after delivery thereby denying the child of essential
colostrum. A significantly higher proportion of Rural women (19%) initiated breastfeeding after
72 hours compared to Urban women (11%). This proportion was also higher amongst SC
women compared to ST and Hindus compared to Muslims.
Overall, 60% of the women claimed to have fed colostrum and this proportion was higher
among Urban areas (67%) compared to Rural areas (57%) and Hindus (62%) compared to
Muslims (48%).
Table 97 Initiation of Breast feeding
% across Initiation of breast feeding
Base : All who had Base Less 2 Hours 25 Hrs – More than Didn't Colostrum
a live birth than 2 – 24 72 Hrs 72 Hours Breastfed feeding
hrs Hours
ALL 4307 29.0 26.0 27.1 16.2 1.4 60.2
LOCATION
Rural 2154 26.9↓ 23.7↓ 29.2↑ 18.5↑ 1.4 57.0↓
Urban 2153 33.9↑ 31.1↑ 22.1↓ 10.8↓ 1.4 67.4↑
RELIGION
Hindu 3472 29.5 25.9 25.6↓ 17.6↑ 1.0 61.9↑
Muslim 579 26.8 24.7 34.7↑ 11.1↓ 2.6 47.5↓
Others 256 28.5 33.2 26.4 8.3 3.6 78.6
CASTE
SC 930 28.4↓ 22.6 29.7↑ 18.6↑ 0.3 61.6
ST 353 41.1↑ 26.1 21.6↓ 8.7↓ 0.2 67.0
Others 3024 27.6 27.1 26.9 16.4 1.9 58.7
PLACE OF STAY
With In laws 2636 26.6↓ 27.9↑ 27.4↓ 16.9 0.7 61.3↑
With own parents 1026 37.3↑ 26.1 19.8 15.1 1.7 67.6
Nuclear family 638 24.0 18.8↓ 37.9↑ 15.6 3.4 43.8↓
Not Specified 7* 60.8 25.0 14.2 0.0 0.0 85.8
EDUCATION OF THE
WOMEN
Illiterate 1509 21.4↓ 20.0↓ 34.9↑ 22.1↑ 1.0↓ 48.8↓
1- 4 years 322 25.6 32.2↑ 22.2↓ 13.0↓ 7.0↑ 55.8
5-8 years 1004 32.8↑ 27.9↑ 24.4↓ 14.2↓ 0.4 64.4↑
9-14 years 1163 42.0↑ 32.0↑ 16.8↓ 7.9↓ 1.2 77.1↑
15+ years 291 32.0↑ 39.1↑ 18.6↓ 9.4↓ 0.5 88.2↑
Not Specified 18* 62.0 31.0 3.1 3.9 0.0 86.8
* Base too low
127
Lower proportion of Hindu women and women from SC households initiated breastfeeding
within 2 hours of delivery in Rural areas as compared to their counterparts in Urban areas.
Table 98 Initiation of Breast feeding

All Rural Urban
Base within 2 hrs Base within 2 hrs Base within 2 hrs
ALL 4307 29.0 2154 26.9 2153 33.9
RELIGION
Hindu 3472 29.5 1728 28.1 1744 32.7
Muslim 579 26.8 280 21.6 299 39.2
Others 256 28.5 146 24.0 110 36.9
CASTE
SC 930 28.4↓ 541 26.7↓ 1744 32.7
ST 353 41.1↑ 229 45.1↑ 299 39.2
Others 3024 27.6 1384 24.0 110 36.9
PLACE OF STAY
With In laws 2636 26.6↓ 1302 25.6↓ 1334 29.1↓
With own parents 1026 37.3↑ 540 37.1↑ 486 37.8↑
Nuclear family 638 24.0 307 16.2 331 43.7
Not Specified 7* 60.8 5* 42.4 2* 93.6
EDUCATION OF THE
WOMEN
Illiterate 1509 21.4↓ 1011 20.6↓ 498 26.1↓
1- 4 years 322 25.6 175 25.1 147 26.7
5-8 years 1004 32.8↑ 504 29.4↑ 500 39.4↑
9-14 years 1163 42.0↑ 424 47.1 739 37.0↑
15+ years 291 32.0↑ 36 38.2↑ 255 30.6
Not Specified 18* 62.0 4* 87.5 14* 51.9
The following table depicts the comparison figures of the current survey with the previous year.
It can be observed that overall the proportion of mothers who breastfed the child within 24
hours of birth declined significantly. Most of the decline seems to originate from Rural areas
only. The difference in Urban figures for the two years were only marginal.
2000-01 All Rural Urban Hindu Muslim SC ST Others
Base 8315 5854 2461 5108 1069 1169 1277 4677
Proportion who breastfed the child 62.4 60.8 66.2 60.7 60.4 60.4 75.0 59.6
within 24 hours
2001-02
Base 4307 2154 2153 3472 579 930 353 3024
Proportion who breastfed the child 55.0↓ 50.6↓ 65.0(=) 55.4 51.5 51.0 67.2 54.7
within 24 hours
128
8.14.1 Initiation of Breast feeding by state
A large majority in Tamil Nadu (87%) had initiated breastfeeding within 2 hours of birth. It is
surprising that despite 100% institutional deliveries in Kerala, only 62% initiated breastfeeding
within 2 hours.
Overall, close to 55% of the respondents initiated breastfeeding within 24 hours of delivery. In
states like Assam, Gujarat, Kerala, Karnataka, Maharashtra, Tamil Nadu and West Bengal
more than 70% of women initiated breastfeeding within 24 hours of their delivery. However in
Bihar (27%) and Uttar Pradesh the proportion was extremely low (20%).
Close to 43% initiated breastfeeding after a day at the All India level. In states like UP and
Bihar more than 70% of the respondents initiated breast-feeding after a day of delivery.
Table 101 Initiation of Breastfeeding by state
Base : All who had a live birth Base within 2 hours between 2- 24 hours
24 hours
Andhra Pradesh 239 15.4 22.7 56.7
Assam 237 34.1 36.4 29.5

Bihar 238 3.4 23.1 71.6
Chhatisgarh 240 23.9 26.5 48.7
Delhi 239 31.9 29.5 36.0
Gujarat 239 33.3 36.3 30.2
Haryana 240 7.1 37.0 55.8
Jharkhand 239 13.1 27.3 58.9
Karnataka 240 47.1 31.5 21.4
Kerala 240 61.8 36.7 1.3
Madhya Pradesh 240 37.7 29.4 31.2
Maharashtra 240 51.0 24.3 24.6
Punjab 240 5.2 38.9 52.3
Rajasthan 239 12.7 21.4 59.3
Tamil Nadu 239 86.7 3.8 7.3
Uttar Pradesh 239 6.2 13.9 78.2
Uttranchal 240 28.1 26.2 44.5
West Bengal 239 24.2 47.8 27.7
All India 4307 29.1 25.9 43.4
level.
129
8.15 IMMUNIZATION STATUS OF INFANTS
According to Govt. of India guidelines, a child should receive a BCG vaccination to protect
against tuberculosis, three doses of DPT to protect against Diphtheria, Pertussis, and Tetanus,
three doses of Polio vaccine, and a Measles vaccination by the age of 12 months. This section
details on the Immunization status of infants born in last one year.
56% of the infants vaccinated within one and half months of age. Percentage of such infants
were significantly higher in Urban (73%) and among Hindus (57%) compared to Rural (49%)
and Muslims (48%). In 19% of infants, vaccination was initiated after 1½ months (20% in Rural,
15% in Urban areas). Regarding the name of first vaccine given to infants, 63% mentioned
BCG and 2% mentioned OPV followed by Measles and DPT. Around 34% of the respondents
were not aware of the name of the first vaccine given to their infants.
Table 102 Knowledge and Practice of Routine Immunizations
Base :All women whose Location Caste Religion
children were alive
BASE 4299 2151 2148 928 349 3022 3463 580 256
AGE AT WHICH CHILD
RECEIVED FIRST VACCINE
Within one and half months 56.4 49.1↓ 73.3↑ 51.6 54.8 58.4 57.2↑ 48.4↓ 74.8
After one and half months 18.6 20.3↑ 14.5↓ 21.1 20.2 17.4 18.8 18.8 12.4
Not yet received 22.0 27.3↑ 9.8↓ 23.8 21.7 21.4 20.9↓ 29.8↑ 10.9
Don’t know 3.0 3.2 2.4 3.5 3.2 2.7 3.0 2.9 1.8
NAME OF THE FIRST VACCINE
BCG 63.0 57.0↓ 73.9↑ 57.6↑ 42.2↓ 67.6 62.5 66.9 59.6
OPV 2.3 3.3 0.5 6.0 0.5 1.3 2.5 1.7 1.2
DPT 0.4 0.5 0.2 0.4 0.7 0.3 0.4 0.0 0.7
Measles 0.6 0.6 0.6 0.4 1.2 0.6 0.6 0.6 1.1
Don't know 33.6 38.6↑ 24.6↓ 35.5↓ 55.4↑ 30.0 34.0 30.5 36.3
PLACE OF GETTING ROUTINE
IMMUNIZATION
Govt. hospital 45.6 38.1↓ 59.3↑ 45.5 48.7 45.3 47.0↑ 40.5↓ 37.2
Primary health care 9.3 11.6 5.1 8.2 11.4 9.4 9.3 11.4 2.1
Sub center 13.4 18.7↑ 3.7↓ 20.7↑ 11.6↓ 11.1 12.1↓ 21.3↑ 11.9
Out reach session(ANM 10.4 14.8↑ 2.4↓ 13.0 15.2 8.9 11.4↑ 6.3↓ 5.7
visit to village)
Anganwadi center 4.6 6.2 1.8 4.5↓ 10.6↑ 3.8 5.0 2.2 3.8
Pvt. Hospital/Pvt. Clinic 15.9 9.9↓ 26.8↑ 7.5 2.0 20.6 14.4 17.0 38.6
Chemist 0.1 0.1 0.2 0.1 0.2 0.1 0.1 0.0 0.4
NO OF TIMES VACCINATION/
DOSES NEEDED TO COMPLETE
22
IMMUNIZATION
Less than five 10.4 9.7 11.9 10.5 7.3 10.8 10.3 11.4 8.1
Five to six 14.5 12.6↓ 18.6↑ 12.1 9.5 16.0 14.6 13.7 14.7
More than six times 10.5 8.3↓ 15.5↑ 8.4 4.7 12.1 10.0 10.8 19.9
Would go whenever are 15.0 14.4 16.4 15.9↑ 7.6↓ 15.8 16.7↑ 3.9↓ 26.6
asked to
Don’t know 48.5 53.9↑ 36.1↓ 52.7 69.6 44.0 47.1 59.7 30.2
22
Base all Women 130
Slightly less than half (46%) reported government hospital as the place of vaccination, followed
by out reach sessions (24% - including sub-centres). Around 16% utilized private health
facilities. As expected, significantly higher proportion of urban respondents accessed
Government hospitals and private health facilitates compared to their rural counterparts.
One tenths of the respondents reported that less than 5 visit would required to complete
primary immunization, while 14.5% mentioned 5-6 visits. 15% reported that they would go
whenever asked by the health worker. However, almost 50% were not aware of the total
number of visits required. Percentage of such women was significantly higher (54%) in rural
areas compared to urban (36%)
8.15.1 Immunization Status of Infants by State
The Immunization status and knowledge among mothers showed extreme variations by
state. While almost 94% of the mothers in Kerala vaccinated her infant within one and half
month of age, this proportion was only 12% in Bihar. Jharkhand, Rajasthan and Uttranchal
were other states with below 40% immunization initiation within first 6 weeks.
Overall, in India almost two thirds knew that BCG was the first vaccine their child received.
Across states there was quite a bit of variation, proportions ranged from a miniumum of
38% (Chhatisgarh) to a maximum of 91% (Karnataka)
Most respondents were not aware of the number of visits required for completing
immunization schedule (Close to 50% mentioned they did not know). Noteworthy is the
fact that 15% of the respondents mentioned that they ‘would go whenever asked to’,
stressed the need for system people to keep reminding the clients for repeat visits.
Table 993 Knowledge and Practice of Routine Immunizations by State
Base : All women who had a live birth
% across Base Child received Name of the first Number of visits needed to complete immunization
first vaccine vaccine
Within 1½ BCG Don’t <5 5-6 >6 whenever Don’t
months know asked know
Andhra Pradesh 239 60.9 46.0 53.4 18.2 3.4 11.3 60 0
Assam 239 59.4 71.3 22.7 14.3 14.1 4.3 0.1 67.3
Bihar 240 11.8 51.4 43.9 9.8 9.5 2.4 1 77.3
Chhatisgarh 240 46.3 38.0 56.4 30 18.3 7.8 6.3 37.7
Delhi 236 78.6 47.0 49.3 7.4 8.7 11.6 4 68.3
Gujarat 240 63.5 60.2 33.6 12.7 23.1 12.8 1.1 50.3
Haryana 240 60.3 43.0 55.1 31.8 12.2 7 7.6 41.4
Jharkhand 239 33.0 68.3 27.6 6 5.7 8.9 3.1 74.7
Karnataka 240 77.4 90.8 5.7 5.4 22.3 39.7 3.7 28.9
Kerala 239 93.9 88.1 11.2 9.3 10.3 24.7 11.5 41.9
Madhya Pradesh 237 53.4 63.5 33.3 4.1 7.9 15.7 13.4 58.5
Maharashtra 240 70.2 72.8 24.5 7.6 39.9 9.1 1.6 39.6
Punjab 240 75.5 38.4 57.3 12.7 19.6 9.8 17 40.9
Rajasthan 236 31.9 45.6 52.2 12.1 8.5 2.1 0.7 75.1
Tamil Nadu 238 96.1 85.5 12.4 11.6 19.6 3.6 51.9 13
Uttar Pradesh 237 31.6 61.8 28.7 7.5 9.7 6.2 4.2 72.4
Uttranchal 240 38.8 56.1 43.8 3.9 8.4 4.9 5.9 76.9
West Bengal 239 69.5 47.3 51.7 5.3 5.6 11.9 32.4 44.3
All India 4299 56.3 63.1 33.5 10.2 14.4 10.5 15.0 48.7
131
9 HIGH-RISK DISTRICTS
Apart from the 18 states where confirmed Polio cases were reported in the last three years, 6
very high-risk districts and 4 group of high-risk districts from UP and Bihar were identified. For
these individual and cluster of districts, a separate independent sample was drawn so as to
have district level estimates. This chapter details some of the salient findings from these
districts and compares them to All India figures and the figures from their respective states23 of
Uttar Pradesh and Bihar.
9.1 PULSE POLIO IMMUNIZATION
9.1.1 PPI Coverage
The reach of the PPI campaign in the study districts was higher than All India figures indicating
that the extra efforts in these areas had been effective in reaching out to more number of
children.
Table 1004 Reach of PPI across study districts of Bihar and UP
Base: All children eligible for any dose
% across Base Overall Coverage in Coverage in
Reach January December
All India 10800 97.1 96.1 93.6
Uttar Pradesh 600 97.9 97.0 97.8
Bihar 600 97.9 95.2 93.5
Individual Districts of UP
Badaun 800 98.2 97.2 96.3
Bareilly 800 98.6 97.3 97.1
Moradabad 800 98.2 97.3 95.7
Rampur 800 96.7 93.9 95.2
Cluster of Districts of UP
Meerut , Muzzafar Nagar , Bulandshahr , JP Nagar (A) 600 97.8 97.2 97.2
Gonda, Basti, Faizabad, Sultanpur (B) 600 97.0 96.6 96.2
Individual Districts of Bihar

Bhagalpur 800 99.3 98.1 98.7
Muzaffarpur 800 98.2 96.9 97.4
Cluster of Districts of Bihar

Darbhanga,Madhubani,Sitamadhi (C) 600 98.6 95.2 96.7
Jamui,Banka,Lakhisarai,Munger (D) 600 99.5 98.3 96.5
The data indicated that the districts of Bihar had better coverage than those in Uttar Pradesh. It
was highest in the cluster D (99.5%) followed by Bhagalpur (99.3%), cluster C (98.6%) and
Bareilly (98.6%) and lowest in Rampur (96.7%).
23
The figures of Bihar and U.P. are based on an independent State level sample that was randomly selected. In the random
selection at the state level, the villages/towns from these High-Risk districts may or may not have got selected. 132
It is also seen that while the reach in the January round was higher than the December round
in districts of UP, the reverse trend was seen in districts of Bihar.
9.1.2 Dosage received
Polio drops were administered at the booths on the first day of the campaign. In addition,
house to house vaccination activities were taken up in the subsequent 5-6 days in UP. In Bihar
mainly house to house strategy was followed to reach the children.
The additional efforts put in these districts resulted in better coverage for at least two doses.
The proportion of children receiving at least two doses was highest in Bhagalpur (99.1%),
Cluster D (98.3%) and Bareilly (97.4%). This was lowest in Cluster B (96.2%) and Rampur
(95.7%).
The good work in these districts owe a lot to the House to House campaign as is evident from
extremely low proportions of children who received all doses at the booth. In most districts only
two fifth of children received all doses at the booth. Notable exceptions were cluster A (69.9%)
and cluster C (59.9%).
Table 1015 Coverage by number of doses across study districts of Bihar and UP
% across Base Received at Received all Received all
least two doses only at doses only at
doses booth home
All India 10532 95.6 81.8 10.5
Uttar Pradesh 579 97.3 64.3 23.9
Bihar 588 95.1 58.2 18.7
Badaun 779 97.0 20.5↓ 55.8
Bareilly 788 97.4 34.8 41.8
Moradabad 788 96.3 43.5 47.5
Rampur 781 95.7 38.6 47.4
Meerut , Muzzafar Nagar , Bulandshar , JP Nagar (A) 581 97.4 69.9↑ 20.4

Bhagalpur 775 99.1 35.0 36.2
Muzaffarpur 775 97.5 52.0↑ 26.9

Darbhanga, Madhubani, Sitamadhi (C) 585 96.8 59.9↑ 19.0
Jamui, Banka, Lakhisarai, Munger (D) 580 98.3 39.6 34.1
* Remaining received some doses at home and some doses at Booth.
133
9.1.3 Zero dose cases
The proportion of Zero dose cases in the districts, except Rampur and Cluster B was lower
compared to All India.
The proportion of Zero dose cases in UP districts was higher than that of Bihar, implying a
higher reach of the campaign in Bihar. The proportion of Zero dose case during the current
campaign was reported highest in Rampur (3.3%) and Gonda, Basti, Faizabad, Sultanpur
(3.0%). In Cluster D (0.5%), Bhagalpur (0.7%), Bareilly (1.4%) and cluster C (1.4%), it was
significantly lower than the national average.
The study revealed that during 2001-02 campaign, despite having four rounds in these two
states, half a million children were missed in Uttar Pradesh, while more than a quarter million in
Bihar. The 12 study districts of UP accounted for 23% of the campaign zero doser, while their
under 5 population accounted for 21%. In Bihar, study districts contributed 14% of the
campaign zero doses, while their population accounted for 25% of total state population.
Table 106 Zero dose cases across study districts of Bihar and UP
Campaign Lifetime
% across Base Zero Est. No. of zero Zero dose Est. No. of
dose dosers zero dosers
All India 10800 2.9 4350000 0.9 1125000
Uttar Pradesh 600 2.1 533036 1.1 279209
Bihar 600 2.1 284104 0.8 108230
Badaun 800 1.8 9396 0.1 522
Bareilly 800 1.4 8209 0.1 586
Moradabad 800 1.8 11277 0.3 1879
Rampur 800 3.3 10671 0.7 2264
Meerut , Muzzafar Nagar , Bulandshahr , 600 2.2 36179 0.3 4934
JP Nagar (A)
Gonda, Basti, Faizabad, Sultanpur (B) 600 3.0 46740 1.3 20254

Bhagalpur 800 0.7 2666 0.1 381
Muzaffarpur 800 1.8 10774 0.2 1197

Darbhanga,Madhubani,Sitamadhi (C) 600 1.4 21783 0.2 3112
Jamui,Banka,Lakhisarai,Munger (D) 600 0.5 3939 0.2 1576
134
9.1.4 Reasons for not receiving one or more IPPI doses
In the districts of Bihar, lack awareness of place and time was quoted as the reasons for missing one or more doses, while in the districts of Uttar
Pradesh, lack of motivation was the major constraint.
Table 107 Reasons for not receiving one or more IPPI doses
% ACROSS Base Not aware Not aware Child was We were Child was Nobody Service Inconvenie Not aware Fear/ Have no Fear of
of the of the need too young travelling sick there to provider nt of the rumour of faith in the getting
place/ time of all take child did day/timing time/day of side effect vaccine disease
vaccination to booth Not come home visit
home
All India 645 24.0 5.2 13.2 7.8 5.1 11.6 31.2 0.6 13.6 7.3 1.1 2.3
Uttar Pradesh 24 12.2 0.0 45.3 9.2 0.0 16.5 26.0 0.0 1.1 7.8 0.0 0.0
Bihar 69 36.9 1.0 8.1 9.2 0.9 5.0 43.2 0.3 22.6 3.6 0.2 3.5
Badaun 47 3.9 0.0 3.6 22.3 9.6 7.7 48.1 0.0 0.0 19.3 0.0 4.1
Bareilly 41 11.6 2.3 16.7 17.8 10.5 8.1 21.2 0.0 16.1 1.9 9.7 0.0
Moradabad 42 8.5 0.0 11.4 18.3 8.1 7.2 19.4 1.6 7.4 21.2 0.0 4.7
Rampur 63 1.2 0.0 0.0 13.4 0.7 7.7 46.1 0.0 7.6 9.9 0.0 0.0
Meerut , Muzzafar Nagar , Bulandshar , 31 9.2 0.0 17.4 0.0 3.0 4.9 11.1 4.9 5.6 22.5 0.0 0.0
JP Nagar (A)
Gonda, Basti, Faizabad, Sultanpur (B) 27 0.6 1.0 0.4 2.0 7.3 37.5 37.7 0.0 0.0 18.7 6.6 7.6
Bhagalpur 42 11.1 0.0 12.4 2.3 2.3 8.6 13.4 0.0 59.0 4.6 0.0 0.0
Muzaffarpur 62 44.9 2.7 9.1 4.1 9.7 0.6 42.2 0.4 18.3 11.7 1.9 4.1
Darbhanga,Madhubani,Sitamadhi (C) 50 40.9 3.6 15.4 16.0 0.2 22.4 55.9 0.0 9.1 3.4 2.9 0.3
Jamui,Banka,Lakhisarai,Munger (D) 41 40.0 0.4 9.0 6.5 6.3 0.9 42.8 0.7 34.3 5.6 0.0 0.0

9.1.5 Source of Knowledge
To assess the reach of the various communications methods and aids used, the respondents
were asked about the different ways they came to know about the PPI campaign.
Interpersonal Communication
Proportion of respondents mentioning any kind of interpersonal communication, as the
source of knowledge for PPI campaign was highest in cluster D with 87% respondents
reported followed by Badaun (78.6%) and Bareilly (78.3%). It was found to be lowest in
Rampur (37%) and cluster A (45%).
The health worker was most commonly mentioned as the source of interpersonal
communication except in districts of Moradabad, Rampur and cluster A. Teachers informed
nearly one fifth of the respondents in Moradabad, Bhagalpur and Cluster D. Religious /
community leader contributed significantly in communicating about the campaign in
Moradabad (15%).
Table 108 Source of Knowledge regarding IPPI across study districts of Bihar and UP
% across Base Any Source of Interpersonal Communication
interpersonal Health Anganwadi Govt/ Private Relative Teacher Religious /
worker worker Paediatrician / Friend community
leader
All India 10800 78.3 41.9 27.5 4.7 18.7 14.5 1.2
Uttar Pradesh 600 65.2 41.4 3.5 1.8 19.2 12.8 0.6
Bihar 600 78.9 38.4 5.8 2.7 31.6 18.6 1.7
Badaun 800 78.6 55.5↑ 1.5 1.4 22.2 15.1 0.0
Bareilly 800 78.3 53.1↑ 1.0 1.5 28.4 15.6 1.5
Moradabad 800 55.8↓ 6.7↓ 3.1 4.1 15.9 20.0 14.9
Rampur 800 36.6↓ 25.2 3.4 0.4 4.2 9.8 0.0
Meerut , Muzzafar Nagar , 600 45.0↓ 8.3↓ 2.9 1.6 20.1 9.6 7.2
Bulandshahr , JP Nagar (A)
Gonda, Basti, Faizabad, 600 62.3 51.4↑ 3.8 0.4 12.6 8.0 0.9
Sultanpur (B)

Bhagalpur 800 76.6 47.3 4.8 1.5 20.0 21.6 1.9
Muzaffarpur 800 74.5 39.7 11.0 1.6 24.7 13.3 0.0

Darbhanga,Madhubani,Sitamad 600 76.9 37.7 12.6 3.6 32.4 6.6 0.6
hi (C)
Jamui,Banka,Lakhisarai,Munger 600 86.9 35.6 3.7 1.5 44.3 21.5 0.0
(D)

Mass Media
The reach of mass media amongst the target population was highest in cluster A (67.2%)
followed by Moradabad (54.7%) and Rampur (53.1%). It was found to be lowest in cluster C
(24.4%) and Badayun (24.2%).
The reach of Mike/Drum beating was found to be the highest across all the districts
particularly in cluster A (55%), Moradabad (46%) and Rampur (42%) pointing to the
importance of local media and ‘on the day’ efforts that is understood by illiterate population as
well. It is noteworthy that the Mike/ Drum beating efforts in the study districts have been
significantly more active than the state (22% for U.P. and 9% for Bihar).
Table 109 Source of Knowledge regarding IPPI across study districts of Bihar and UP
Mass Media
% across Base Any mass TV Radio Newspapers / Wall/ Mike/
media Magazine paintings/ Drum-
posters beating
All India 10800 46.1 22.4 8.1 5.2 5.3 24.4
Uttar Pradesh 600 39.4 14.5 5.6 3.5 2.6 21.9
Bihar 600 19.3 7.1 5.8 1.4 1.4 9.4
Badaun 800 24.2↓ 4.8 1.8 1.0 1.2 18.4
Bareilly 800 41.0 15.4 5.2 3.8 3.4 24.3
Moradabad 800 54.7 14.5 3.6 3.8 4.2 46.1↑
Rampur 800 53.1 13.6 14.7 2.2 1.3 42.3↑
Meerut , Muzzafar Nagar , 600 67.2 16.7 3.0 5.0 7.0 55.1↑
Gonda, Basti, Faizabad, 600 25.9↓ 11.8 9.9 3.0 0.5 8.1↓
Sultanpur (B)

Bhagalpur 800 38.2 9.2 13.3 1.6 1.3 24.7
Muzaffarpur 800 23.6↓ 12.0 9.3 1.9 1.8 7.7↓

Darbhanga,Madhubani, 600 24.4↓ 6.2 6.6 0.6 0.5 16.4
Sitamadhi (C)
Jamui,Banka,Lakhisarai,Munger 600 34.6 14.5 15.1 2.5 1.2 15.2
(D)
CES- 02 INDIA - FINAL REPORT 137

9.1.6 Nutrients
Overall in India, 40% of children received Vitamin A doses. This proportion was 10% in U,P,
and 15% in Bihar. The performance of the districts was extremely poor compared to the All
India Figure. However compared to their respective state figures, their performance was
comparable except in Badayun (8%). Among those who received vitamin A, majority received
only one dose.
Table 110 Vitamin A and IFA coverage among Children

Vitamin A IFA
% across Base Vitamin A Vitamin A 1 IFA Received
Received
All India 8967 39.5 26 10.3
Uttar Pradesh 496 10.2 9 5.5
Bihar 500 15.6 12 7.5
Badayun 664 7.5 6 4.1
Bareilly 659 16.7 13 4.9
Moradabad 658 14.4 14 4.2
Rampur 654 11.0 8 5.4
Meerut , Muzzafar Nagar , Bulandshar , JP 491 18.9 18 7.7
Nagar (A)
Gonda, Basti, Faizabad, Sultanpur (B) 495 15.6 13 3.3
Bhagalpur 659 24.7 23 5.4
Muzaffarpur 658 22.0 18 6.3
Darbhanga, Madhubani, Sitamadhi (C) 497 13.7 12 5.9
Jamui, Banka, Lakhisarai, Munger (D) 494 17.4 15 4.6
Overall in India, 10% of children received IFA doses. This proportion was 6% in U,P, and 8%
in Bihar. Across the districts, the figures were more or less in the range of state average
except in cluster B (3.3%). Across the state and districts, consumption of IFA paediatric was
abysmally low.

9.2 ROUTINE IMMUNIZATION
This chapter details the performance of districts on key indicators of Routine Immunization, in
comparison to their respective states and national average.
9.2.1 Routine Immunization Sessions
Data revealed that the organization of regular immunization session was significantly lower in
Uttar (58%) and Bihar (32%) compared to national average of 76%. In Uttar Pradesh,
marginally lower proportion of respondents in Badayun, Rampur and clusters A and B
mentioned that regular immunization sessions were held within cluster, than state average.
This was however still significantly better than the performance of districts from Bihar, which
was abysmal in clusters C (16%) and D (11%), while the individual districts had better access
to services.
The holding of Immunization card by the family was highest in Bhagalpur (45.5%) followed by
Muzaffarpur (42.5%), Cluster A (36.6%). It was lowest in cluster ‘B’ (20.5%) and Badaun
(17.8%).
Table 111 Routine immunization and presence of immunization card across study
districts of Bihar and UP
% across Base RI session At least once in a month Card Present
held on a particular day
All India 4320 76.4 51.5 53.8
Uttar Pradesh 240 57.9↓ 42.7 26.9
Bihar 240 32.5↓ 19.1 32.8
Badaun 320 28.5↓ 20.4↓ 17.8↓
Bareilly 320 55.0 21.0 28.2
Moradabad 320 60.1 34.7 24.5
Rampur 320 49.2 31.3 21.6
Meerut , Muzzafar Nagar , 240 44.5 27.0 36.6
Gonda, Basti, Faizabad, 240 47.0 36.3 20.5
Sultanpur (B)

Bhagalpur 320 44.1 34.1 45.5
Muzaffarpur 320 37.4↓ 31.8 42.5

Darbhanga,Madhubani,Sitamadhi 240 15.8↓ 2.5↓ 30.0
(C)
Jamui,Banka,Lakhisarai,Munger 240 10.5↓ 1.8↓ 32.7
(D)

9.2.2 Routine Immunization Coverage
In Uttar Pradesh and Bihar, less than half – 43% and 39% of the children were reached under routine immunisation respectively, which was 74%
countrywide. The proportion of fully immunised children in Uttar Pradesh was 27% and in Bihar, 13%. In Badayun and Rampur, significantly lower
proportion of children received all primary vaccination. Among the study districts of Bihar, only Muzaffarpur had better coverage (26%) compared to
state.
Table 112 Routine Immunization coverage across study districts of Bihar and UP
% across Base BCG DPT1 DPT2 DPT3 OPV1 OPV2 OPV3 Measles Vit A Fully Fully Vaccinated
Vaccinated before 12 months
All India 4320 74.0 70.6 67.1 63.8 75.1 71.5 68.3 61.4 43.2 56.6 50.1
Uttar Pradesh 240 43.3 36.7 32.9 30.4 46.2 43.2 41.1 29.2 20.1 26.7↓ 22.3
Bihar 240 39.0 33.9 26.6 21.1 33.8 26.6 21.1 13.8 11.1 12.8↓ 11.6
Badaun 320 34.7 20.6 19.1 18.2 33.9 32.0 30.7 16.7 12.7 12.2↓ 10.0
Bareilly 320 43.0 36.4 31.0 28.2 37.3 31.6 28.8 27.1 19.5 24.8 22.2
Moradabad 320 43.3 40.1 32.5 26.3 99.1 97.1 94.5 23.6 17.7 19.3 14.5
Rampur 320 34.8 26.9 24.2 22.3 92.7 92.7 91.7 17.3 15.4 14.3 12.6
Meerut , Muzzafar Nagar , 240 49.1 44.5 37.3 33.4 79.2 78.7 76.1 31.0 22.7 24.8 21.3
Gonda, Basti, Faizabad, Sultanpur (B) 240 37.3 39.7 35.7 31.7 58.6 55.5 53.1 30.7 18.8 23.9 22.2

Bhagalpur 320 49.1 41.1 34.8 30.0 41.2 34.9 30.2 18.6 19.0 17.6 14.3
Muzaffarpur 320 59.6 54.4 44.5 37.0 53.4 44.4 37.5 27.3 25.2 26.0 21.5

Darbhanga,Madhubani,Sitamadhi (C) 240 44.6 33.4 27.8 25.2 30.3 25.4 22.9 14.3 13.3 12.6↓ 10.6
Jamui,Banka,Lakhisarai,Munger (D) 240 34.5 29.7 27.5 24.6 32.6 27.4 24.5 19.1 12.1 17.6 13.3

The proportion of dropout rate from BCG to measles was 17% nationally, which was 33% in
Uttar Pradesh and 65% in Bihar. Among the districts, dropout rate was 50% or more in
Badayun (62%), Rampur (50%), Bhagalpur (62%), Muzaffarpur (54%) and cluster C (68%).
State and district authorities need to tap these dropout children by strengthening tracking
system.
9.2.3 Source of Immunization
It was observed that Government health services were the most frequently accessed source
for immunization (82 to 90%). In Uttar Pradesh, 32% vaccinated in outreach sessions
followed by PHC (21%) and district/ municipal hospital (19%). In Bihar, community accessed
district/ municipal hospital (28%) more than PHC (19%). Among the districts, contribution of
PHC was high (>25%) in Badayun, Cluster B, Bhagalpur and Muzaffarpur. The share of
private sector was significantly higher in Bihar compared to the nation. Data revealed that in
Bareilly, and cluster C and D, more than 20% of the of children were vaccinated at private
health facilities.
Table 113 Source of immunization services across study districts of Bihar and UP
% across Base Mostly Govt Mostly Mostly Mostly Pvt.
Hospital/ PHC Outreach nursing
Municipal (including home/Pvt.
Hospital SC) Clinic
All India 3770 36.5 15.9 32 10.4
Uttar Pradesh 145 19.0 21.5 32.4 10.3
Bihar 122 27.9 18.9 30.9 18.7
Badaun 170 13.4 27.2 33.9 7.3
Bareilly 149 16.9 15.4 33.7 29.0↑
Moradabad 317 15.0 6.4 22.9 6.6
Rampur 300 8.6↓ 13.0 13.2 3.9
Meerut , Muzzafar Nagar , Bulandshahr , JP 207 13.7 20.7 17.5 13.4
Nagar (A)
Gonda, Basti, Faizabad, Sultanpur (B) 187 9.7↓ 31.8 31.7 6.6

Bhagalpur 157 17.1 27.4 40.4 11.8
Muzaffarpur 220 26.5 30.3 26.1 16.2

Darbhanga,Madhubani,Sitamadhi (C) 118 28.5 16.1 28.1 22.0
Jamui,Banka,Lakhisarai,Munger (D) 95 15.9 23.0 14.4 26.2

9.2.4 Reasons for Non Compliance
By the age of 12 months, a child is supposed to be fully immunised. Reasons were elicited from the primary caretaker for not getting their child all the
scheduled vaccines. The most commonly mentioned reason was lack of knowledge on the need for all the vaccines. This proportion was particularly
high in cluster D (82.7%) and Badaun (81.1%) and lowest in Moradabad (38.4%). In Bareilly the highest proportion (49%) was unaware of the
place/time of vaccination and it was lowest in Badaun (7.5%). This indicated that for routine immunziation, lack of awareness was the main constraint.
Table 114 Reasons for Non compliance across study districts of Bihar and UP
% ACROSS Base Not aware of Not aware of Child was ill They don't Hospital too far Fear/ rumour of Fear of getting Doctor advised against
the need of all the place/time come at home side effect disease it/Said it was not
vaccination required
All India 1467 57.6 27.5 2.6 7.8 1.1
Uttar Pradesh 161 58.1 28.8 1.8 11.8 0.0 2.0 7.5 1.6
Bihar 180 52.6 34.3 2.7 7.5 2.8 1.9 2.6 1.0
Badaun 266 81.1↑ 7.5 0.3 14.4 0.0 2.1 3.6 0.4
Bareilly 236 69.3 49.0 1.0 12.4 4.3 3.8 5.8 0.4
Moradabad 254 38.4↓ 21.3 3.4 10.7 5.3 3.6 6.4 0.3
Rampur 269 67.6 26.8 4.7 30.9 2.9 1.8 1.8 0.9
Meerut , Muzzafar Nagar , Bulandshahr , JP Nagar 170 49.8 24.2 4.8 11.2 7.4 1.6 3.9 1.1
(A)
Gonda, Basti, Faizabad, Sultanpur (B) 161 49.7 23.0 5.3 23.7 3.1 4.5 4.8 3.2

Bhagalpur 263 70.5↑ 7.9 2.5 1.2 0.9 1.7 1.7 0.0
Muzaffarpur 214 61.9 21.9 4.8 0.6 1.9 4.1 6.9 0.8

Darbhanga,Madhubani,Sitamadhi (C) 192 53.5 21.9 2.8 2.7 0.9 2.0 6.6 1.0
Jamui,Banka,Lakhisarai,Munger (D) 191 82.7↑ 32.7 1.0 2.3 0.1 0.3 1.0 1.0
Totals may exceed 100% because of multiple response. In Moradabad it does not add to 100% because of non response.

9.2.5 Injection safety
Among those who were vaccinated, assessment was done to check the quality of injection.
With respect to injection safety, Bareilly, Bhagalpur, Cluster C and D were at par with national
data, mainly because of the use of disposable syringes. Sterilisation done by service provider
was hardly reported.
Unsafe injection practices were reported highest in Muzaffarpur (32.1%) and cluster B
(25.2%), while it was lowest in Rampur (5.8%) and cluster A (9.6%).
Table 115 Injection safety

Base Safe Autoclave/ Electric Boiling for 20 Disposable Unsafe
injection Double Rack steriliser min injection
Steriliser
All India 3770 59.1 4.9 5.6 7.1 41.5 14.3
Uttar Pradesh 145 38.6 2.8 0.0 1.8 34.0 29.9
Bihar 122 47.5 0.2 0.0 0.2 47.1 23.7
Badaun 170 28.4 0.0 0.3 0.0 28.1 11.5
Bareilly 149 55.6↑ 3.4 1.1 0.6 50.5↑ 29.2
Moradabad 317 35.8 1.3 1.1 1.4 32.0 6.9
Rampur 300 24.4 0.4 0.0 2.2 21.8 5.8
Meerut , Muzzafarnagar , 207 48.5 0.0 0.0 2.7 45.8 9.6
Bulandshar , JP Nagar (A)
Gonda, Basti, Faizabad, Sultanpur 187 33.3 0.0 0.0 0.4 32.9 25.2
(B)

Bhagalpur 157 68.8↑ 0.0 0.0 3.6 65.2↑ 14.9
Muzaffarpur 220 48.4 0.0 0.0 0.1 48.3 32.1↑

Darbhanga, Madhubani, 118 62.1↑ 0.0 0.0 1.8 60.3↑ 18.1
Sitamadhi (C)
Jamui, Banka, Lakhisarai, Munger 95 64.5↑ 1.0 0.2 0.2 63.1↑ 19.4
(D)

9.3 MATERNAL CARE
In this study women who had a pregnancy of at least 28 weeks completed between 27th
January 2001 and 26th January 2002 were contacted. Details were taken on their pregnancy
history including the age at which they became pregnant for the first time and the care
provided during the pregnancy.
9.3.1 Pregnancy details
While comparing the data for the study districts with All India, we see that the proportion of
respondents who had their first pregnancy before the age of 19 years was significantly more in
the districts. However, the pregnancy wastage rate in these districts was lower than All India
figures.
The proportion of women pregnant before the age of 19 years was highest in cluster D
(69.5%) and Bhagalpur (68.7%). This proportion was lowest in Bareilly (53.8%) and cluster A
(43.9%) and was found to be directly linked with the pregnancy wastage rate.
Table 116 Pregnancy details
% across Base Pregnant before Pregnancy Wastage

19 years
All India 4320 42.1 5.6
Bihar 240 59.4 3.5
Badaun 320 58.1 4.7
Bareilly 320 53.8 2.3
Moradabad 320 54.2 4.2
Rampur 320 58.4 3.6
Meerut , Muzzafar Nagar , Bulandshahr , JP 240 43.9 5.5
Nagar (A)
Gonda, Basti, Faizabad, Sultanpur (B) 240 64.2 3.9

Bhagalpur 320 68.7 5.5
Muzaffarpur 320 61.6 3.7

Darbhanga,Madhubani,Sitamadhi (C) 240 64.6 0.8
Jamui,Banka,Lakhisarai,Munger (D) 240 69.5 7.0

9.3.2 ANC received
The study districts fared very poorly in terms of proportion of the respondents receiving ANC
in comparison to All India figures particularly in Bihar and its districts being the lowest
proportion of respondents receiving ANC.
Districts of cluster A (61%), Rampur (66.0%) and Bareilly (64.2%) were observed to be fairly
good with almost two thirds of respondents having received Antenatal Check-up. ANC3
coverage varied between 11% to 28%.
Table 117 ANC Coverage

% across Base ANC1 ANC3+
All India 4320 77.1 55.0
Bihar 240 34.2 17.9
Badaun 320 54.0 17.1
Bareilly 320 64.2 27.6
Moradabad 320 51.7 16.3
Rampur 320 66.0 17.6
Meerut , Muzzafar Nagar , Bulandshahr , JP Nagar 240 61.0 19.4
(A)
Gonda, Basti, Faizabad, Sultanpur (B) 240 48.5 12.1

Bhagalpur 320 36.2 13.9

Darbhanga,Madhubani,Sitamadhi (C) 240 27.1 14.6
Jamui,Banka,Lakhisarai,Munger (D) 240 43.9 23.0
9.3.3 ANC Service Provider
The ANC Service provision is more or less fairly distributed across the Private (44%) and
Public sources (56%) at All India level. In U.P., government input was significantly higher
(65%) than the private (35%). In Bihar, however, the balance of Public and Private is
completely reversed. There, the Private doctor were the ANC service providers in almost three
fourth of the cases.
Comparing data across the individual districts it is observed that in Muzzafarpur and
Bhagalpur, about 80% of the respondents mentioned to have sought ANC from Private
doctor. Amongst the reorganised districts, this proportion was highest in Darbhanga,
Madhubani, Sitamadhi (82.9%).
ANM was most commonly mentioned as the service provider in Badaun (41%) and was
almost not mentioned at all in the study districts of Bihar. Very few of those who had antenatal
contact accessed trained and untrained Dai for ANC services.

Table 118 ANC service provider
% across Base Untrained Trained ANM LHV/Nurse Govt Doctor Private
Dai Dai at Govt Doctor
hospital
All India 3560 1.5 0.9 11.7 10.9 36.9 43.8
Uttar Pradesh 152 1.4 0.0 29.4 20.4 15.6 37.2
Bihar 114 3.2 2.5 5.3 13.2 14.4 72.2↑
Badaun 190 0.7 0.0 40.8↑ 33.7 14.2 21.9
Bareilly 198 0.2 0.0 24.8 17.7 17.0 40.4
Moradabad 210 0.0 0.4 31.6 14.8 14.9 40.3
Rampur 216 0.6 0.0 21.1 33.8 13.0 31.9
Meerut , Muzzafar Nagar , 174 0.3 2.7 23.8 15.6 11.4 46.8
(B)

Bhagalpur 142 5.4 0.0 4.0↓ 3.8 11.6 79.7
Muzaffarpur 141 1.7 0.0 1.3↓ 3.8 11.2 83.1↑

Darbhanga,Madhubani,Sitamadhi 96 0.0 0.0 0.0↓ 0.9 16.2 82.9↑
(C)
Jamui,Banka,Lakhisarai,Munger 123 0.2 0.0 2.6↓ 4.0 20.7 73.4
(D)
* The totals may exceed 100% because of multiple responses.

9.3.4 Details of ANC
A more important aspect of an ANC is the quality of check-up and whether the key aspects
were included in it or not. Considering this, the respondents were asked about the details of
check-up (such as three ANC check-ups, abdominal examination, blood pressure check up
and weight monitoring).
On specific details, the performance of Bihar and U.P. as states and their study districts was
abysmal compared to All India. For most indicators, the performance was either half Physical
examination of abdomen) or one third (Blood Pressure Checked) or one fourth (Weight
Taken) or one fifth (received all three ANC services) of the overall India figures.
Among the districts, in cluster A, Bhagalpur and cluster D, more than 30% of the respondents
received atleast one of the minimum check-up required. Physical examination was reported
by 16-38% of the respondents, while BP checked by 8-32% and weight 5 to 17%. Nationally,
33% of the respondents reported that their BP was checked at least thrice, while 33%
reported that their weight was taken. The percentage of such women was less than 12% in
the different districts.
Table 119 Details of ANC

% across Base Any Received Physical Blood Had BP Weight Weight
ANC all the examination pressure checked taken taken
check- three of abdomen checked thrice or thrice or
up ANC more more
services
All India 4320 68.9 44.4 63.2 58.3 32.6 50.9 32.5
Uttar Pradesh 240 34.0 7.2 27.8 18.3 6.3 11.7 5.0
Bihar 240 33.2 9.6 30.5 25.3 10.9 12.7 3.3
Badaun 320 20.0 2.3 15.9 9.2 3.0 4.6 0.6
Bareilly 320 28.2 11.2 25.4 17.9 9.0 12.1 5.8
Moradabad 320 27.9 7.8 23.8 17.7 8.0 10.2 4.5
Rampur 320 29.0 5.9 25.8 12.0 5.7 10.0 4.9
Meerut , Muzzafar Nagar , 240 36.3 13.2 34.2 20.2 12.4 16.6 10.6
Gonda, Basti, Faizabad, Sultanpur 240 21.4 3.9 19.8 7.9 3.3 4.9 1.8
(B)

Bhagalpur 320 32.2 10.8 28.2 24.5 7.0 12.8 3.6
Muzaffarpur 320 26.8 11.0 24.9 20.7 7.6 12.5 3.4

Darbhanga,Madhubani,Sitamadhi (C) 240 23.0 9.7 22.0 17.6 7.8 10.7 2.0
Jamui,Banka,Lakhisarai,Munger (D) 240 39.3 13.9 37.7 32.2 9.2 15.3 4.9

9.3.5 TT Coverage
The proportion of respondents receiving TT2 Booster was in the range of 41 to 69% in study
districts. Large proportion of respondents were not able to specify the place of receiving the
services. According to data, 11% of the respondents from Uttar Pradesh received TT
vaccination from government health facilities, while 19% from private. In Bihar, only 4%
accounted government health facility as the place of immunization while 14% accounted
private facilities.
In Bareilly, Cluster A, Bhagalpur and Cluster D, significantly higher proportion of women
received TT vaccination from private sector compared to government.
Table 120 TT immunization service delivery

% across Base TT2 booster Received from Received
received Govt. health from private
facilities health
facilities
All India 4320 78.5 38.7 22.5
Uttar Pradesh 240 64,4 11.5 19.2
Bihar 240 68.7 4.5 13.8
Badaun 320 40.9 11.7 7.0
Bareilly 320 59.8 11.8 21.8
Moradabad 320 47.6 9.9 11.6
Rampur 320 58.9 14.0 12.6
Meerut , Muzzafar Nagar , Bulandshahr , 240 56.9 8.7 23.3
JP Nagar (A)

Bhagalpur 320 68.2 4.4 32.9
Muzaffarpur 320 58.9 5.9 9.7

Darbhanga,Madhubani,Sitamadhi (C) 240 67.8 3.7 14.8
Jamui,Banka,Lakhisarai,Munger (D) 240 69.0 2.6 26.6

9.3.6 IFA tablets
Overall, in India, close to two thirds had received IFA tablet. This figure was substantially lower
for Bihar (37%) and U.P. (42%). In the study districts of Bihar, coverage was significantly lower
(16 to 26%) than the state average. A pregnant woman expected to consume 90 tablets
during her entire gestation period. However, only 13% in UP and 5% in Bihar received
expected number of 90 tablets and consumption was 5% and 3% respectively. The
consumption of more than 90 tablets were in the range of 2-14% in the study districts. Further
analysis revealed that proportion of women who consumed more than 90 tablets were
significantly lower than those who received it in Moradabad and Cluster C.
Table 121 IFA tablets
% across Base Received Received Consumed Consumed
IFA tablets more than 90 less than 30 more than
tablets tablets 90 tablets
All India 4320 64.9 19.2 29.2 13.6
Uttar Pradesh 240 41.7 12.9 41.3 5.3
Bihar 240 36.6 5.2 34.1 3.2
Badaun 320 36.6 5.2 34.1 3.2
Bareilly 320 45.4 3.5 51.9 2.1
Moradabad 320 36.3 13.0 34.8 5.6
Rampur 320 45.2 7.0 40.2 3.6
Meerut , Muzzafar Nagar , 240 39.4 19.1 37.3 13.0
Gonda, Basti, Faizabad, 240 60.6 5.9 31.7 2.5
Sultanpur (B)

Bhagalpur 320 22.0 14.6 24.2 10.5
Muzaffarpur 320 26.2 10.5 35.1 5.3

Darbhanga,Madhubani,Sitamadhi 240 16.3 18.0 38.7 6.8
(C)
Jamui,Banka,Lakhisarai,Munger 240 27.2 22.2 34.0 14.0
(D)

9.3.7 Source of receiving IFA tablets
Across India, among women who received more than 90 IFA tablets, 35% received it from
Government hospitals. We observe that this proportion was much less in the study districts of
Bihar, where the majority of the respondents mentioned Chemists as the main source of IFA
tablets. The proportion receiving from Govt. sources was lowest in Muzzafarpur and Jamui,
Banka, Lakhisarai, Munger and highest in Badaun and Meerut, Muzzafar Nagar, Bulandshahr,
JP Nagar.
Table 122 Source of receiving IFA tablets

Base: All who have received more than 90 tablets
% across Base Govt Primary Sub Pvt. During Anganwadi Chemist
hospital health center hospital/ ANM visit centre
care Pvt. clinic to village
All India 3085 34.9 9.7 8.9 15.5 12.4 5.8 14.9
Uttar Pradesh 118 27.9 16.8 2.4 11.8 26.1 1.6 12.7
Bihar 76 26.4 3.6 22.0 5.8 13.1 2.2 25.7
Badaun 131 23.7 12.6 1.7 6.3 45.3 0.0 10.4
Bareilly 140 14.7 15.8 8.1 9.3 39.5 0.0 12.6
Moradabad 136 19.8 6.2 2.0 4.2 53.7 1.1 13.6
Rampur 153 24.2 29.9 3.4 12.0 24.1 0.6 13.1
Meerut , Muzzafar Nagar , 114 21.7 12.8 0.0 17.7 19.1 3.6 22.7
Gonda, Basti, Faizabad, Sultanpur 137 12.9 23.5 5.1 2.0 19.5 0.9 36.2
(B)

Bhagalpur 92 21.7 11.8 18.0 7.6 4.9 1.9 34.6
Muzaffarpur 91 4.7 24.3 15.7 6.0 15.2 1.3 31.7

Darbhanga,Madhubani,Sitamadhi 47 11.8 15.4 3.5 4.0 24.9 0.0 37.0
(C)
Jamui,Banka,Lakhisarai,Munger 82 17.5 6.4 0.0 0.0 17.8 1.9 53.1
(D)

9.3.8 Night Blindness
Overall, in India, 12% reported to suffer night blindness during their pregnancy. This proportion
was similar in U.P. (12%) but more in Bihar (19%).
Among the study districts, Badaun (22%) and cluster D (26%) reported a much greater
instance of night blindness.
Table 123 Night Blindness
% across Base Suffered from Night
Blindness
All India 4320 12.0
Uttar Pradesh 240 11.9
Bihar 240 19.1
Badaun 320 22.3
Bareilly 320 8.9
Moradabad 320 12.9
Rampur 320 15.7
Meerut , Muzzafar Nagar , Bulandshahr , JP Nagar (A) 240 12.6
Gonda, Basti, Faizabad, Sultanpur (B) 240 7.3

Bhagalpur 320 24.6
Muzaffarpur 320 9.4

Darbhanga, Madhubani, Sitamadhi (C) 240 11.6
Jamui, Banka, Lakhisarai, Munger (D) 240 25.6

9.3.9 Knowledge about pregnancy complication
Comparing the All India figures for knowledge about pregnancy related complications, the study districts of Bihar had much lower awareness.
Among the high Risk Districts, awareness of pregnancy related complications was highest in Rampur and Cluster A while it was lowest in Badaun
and cluster C.
Table 124 Knowledge of pregnancy complications
% across Base Swelling of Bleeding/ Severe Fits Not feeling Severe Abnormal Very Stomach Vomiting Vertigo Don't
face/feet spotting weakness the head- presentation high pain know Not
movements ache fever Specified
of baby
All India 4320 31.7 6.5 33.9 5.2 5.7 9.6 3.7 7.1 2.6 14.5 3.6 30.2
Uttar Pradesh 240 27.5 1.7 33.0 0.4 0.2 0.9 0.3 3.1 0.6 1.4 3.1 54.6
Bihar 240 17.8 3.0 47.5 6.1 2.9 7.2 6.0 2.5 7.0 10.6 0.1 35.7
Badaun 320 30.7 1.2 35.8 1.1 0.1 2.6 1.8 4.5 0.0 0.0 0.0 54.2
Bareilly 320 20.8 8.5 20.7↓ 1.2 0.8 8.5 1.9 10.4 0.0 1.1 0.5 50.9
Moradabad 320 37.9 4.2 46.6 2.3 3.4 9.0 14.5 14.7 3.6 9.5 12.4 22.5
Rampur 320 60.2↑ 2.4 41.9 0.2 0.7 4.1 6.7 5.9 0.6 12.4 8.0 10.0↓
Clusters of districts of UP
Meerut , Muzzafar Nagar , 240 51.0↑ 5.4 59.3↑ 2.1 3.8 13.8 6.2 12.7 4.0 6.0 24.4 10.9↓
Gonda, Basti, Faizabad, 240 44.8↑ 0.6 34.0 3.2 0.0 17.2 1.5 5.5 2.2 2.1 1.1 20.6
Sultanpur (B)

Bhagalpur 320 30.4 3.9 57.9 27.0 6.7 13.2 12.4 3.3 4.7 4.4 0.2 19.9↓
Muzaffarpur 320 15.2↓ 0.7 12.9↓ 0.5 1.4 1.3 2.2 4.0 4.1 1.5 0.3 61.6↑

Darbhanga,Madhubani,Sitamadhi 240 17.5↓ 0.0 13.0↓ 0.8 0.0 3.1 0.0 2.6 2.9 2.1 0.0 66.7↑
(C)
Jamui,Banka,Lakhisarai,Munger 240 30.7 4.9 48.5 11.1 9.8 19.2 4.3 6.9 2.1 7.9 1.3 40.6
(D)

9.3.10 Birth Attendance
Respondents were asked about the place of delivery and birth attendant. Information on nature
of delivery was also gathered. In districts of Bhagalpur (20.1%) and Jamui, Banka, Lakhisarai,
Munger (24.9%) more than one fifth had institutional deliveries. These figures though among
the better of the study districts were far poor compared to All India figures which was more than
double at 49%.
In the lower performing study districts such as Badaun (9.5%) and Darbhanga, Madhubani,
Sitamadhi (7.5%) less than 10% of the deliveries were institutional deliveries.
In Bhagalpur (29.3%) and Meerut, Muzzafar Nagar, Bulandshahr, JP Nagar (30.7%) the
highest proportion received skilled assistance. This proportion was lowest in Badaun (12.6%)
and Darbhanga, Madhubani, Sitamadhi (12.0%).
In Moradabad (3.8%) and Jamui, Banka, Lakhisarai, Munger (5.4%) highest proportion had
caesarean section done. The incidence of delivery through caesarian sections was also lesser
compared to All India figure (9%), indicating poor access to emergency obstetric care.
Table 125 Place/type of delivery and assistance during delivery

% across Base Institutional Skilled Trained Untrained Normal Caesarian
deliveries Assistance Assistance Assistance deliveries deliveries
All India 4320 48.6 55.1 5.9 37.7 88.8 8.9
Uttar Pradesh 240 19.6 29.7 1.5 68.8 94.4 2.5
Bihar 240 15.9 24.3 1.9 72.7 96.4 2.4
Badaun 320 9.5 12.6 2.4 84.2 97.3 1.6
Bareilly 320 15.8 19.2 18.2 62.1 94.8 2.3
Moradabad 320 15.7 20.1 25.5 54.1 93.5 3.8
Rampur 320 14.6 26.3 19.1 54.7 95.6 2.6
Meerut , Muzzafar Nagar , 240 24.8 30.7 13.8 55.9 94.4 4.5
(B)

Bhagalpur 320 20.1 29.3 2.6 67.2 97.2 1.7
Muzaffarpur 320 13.3 17.5 11.4 70.1 98.0 1.0

Darbhanga, Madhubani, Sitamadhi 240 7.5 12.0 11.8 75.6 96.5 2.9
(C)
Jamui, Banka, Lakhisarai, Munger 240 24.9 26.5 2.6 68.7 94.5 5.4
(D)

9.3.11 Clean Deliveries
The proportion of respondents having deliveries at home which followed all the basic hygiene
norms of ‘Four Cleans’ was less than 6% even for All India. This proportion was less than 3%
for U.P. and less than 1% for Bihar.
In Bhagalpur (98.5%) and Gonda, Basti, Faizabad, Sultanpur (96.9%) the highest proportion
used a clean instrument to cut the cord. In Moradabad (56.6%) and Meerut, Muzzafar Nagar,
Bulandshahr, JP Nagar (64.3%) the highest proportion of the respondents used clean thread to
cut the cord.
The proportion of clean deliveries was highest in Bareilly (10.6%) and Meerut, Muzzafar Nagar,
Bulandshahr JP Nagar (8.7%).
Table 126 Clean deliveries
% across Base who Clean Clean Clean thread Clean cord All four clean
had home surface instrument deliveries
deliveries
All India 1890 48.7 88.2 41.2 26.2 5.7
Uttar Pradesh 165 37.0 94.8 21.2 15.2 2.4
Bihar 168 38.6 91.4 31.4 23.8 0.6
Badaun 268 22.3↓ 95.0 25.0 11.2↓ 0.7
Bareilly 265 68.3 95.8 30.3 16.1↓ 10.6
Moradabad 248 46.2 93.7 36.1 56.6↑ 4.0
Rampur 262 57.5 90.2 13.8↓ 26.7 2.4
Meerut , Muzzafar Nagar , 153 55.9 94.4 22.4 64.3↑ 8.7
Gonda, Basti, Faizabad, 175 49.9 96.9 22.5 36.0 3.4
Sultanpur (B)
Individual Districts
Bhagalpur 244 36.3 98.5 25.5 6.9↓ 0.0
Muzaffarpur 247 45.8 95.8 24.3 36.1 2.8
Cluster of Districts
Darbhanga, Madhubani, Sitamadhi 193 38.7 91.9 20.1 28.5 2.8
(C )
Jamui, Banka, Lakhisarai, Munger 145 26.0↓ 93.3 23.5 36.2 3.0
(D)

9.3.12 Postnatal checkups
This proportion of PNC was much lower in all the study districts, except cluster B (Gonda,
Basti, Faizabad, Sultanpur), where 53% respondents reported that they had received PNC.
Here 35% of the women received at least 3 PNC followed by Rampur (19.5%). In all the study
districts of Bihar, less than 4% of the women received PNC3.
Table 127 Postnatal Care
% across Base Had postnatal PNC3+
checkups
All India 4307 48.2 18.6
Bihar 238 10.8 2.8
Badaun 320 9.8 2.7
Bareilly 320 8 4.5
Moradabad 318 15 7.4
Rampur 319 27.5 19.5↑
Meerut , Muzzafar Nagar , Bulandshahr , JP 240 34.6 16.4
Nagar (A)
Gonda, Basti, Faizabad, Sultanpur (B) 240 52.7↑ 35.4↑

Bhagalpur 320 21.2 1.4

Darbhanga,Madhubani,Sitamadhi ( C) 239 16.3 3.7
Jamui,Banka,Lakhisarai,Munger (D) 239 28 2.0

9.3.13 Breast Feeding practice
The proportion of women initiating breast-feeding within 24 hours of delivery for All India was
55.0%. The proportion reported from Bihar and U.P. was less than half of All India figure.
Among the study districts, in Moradabad and Muzaffarpur more than 45% of women initiated
breast feeding within 24 hours of delivery. This proportion was extremely poor in Badaun
(10.8%), Bareilly (14.0%) and Darbhanga, Madhubani, Sitamadhi (15.2%).
Very few mothers initiated breastfeeding to their child within two hours of birth. This proprtion
across the study districts was in range of 1% (Darbhanga, Madhubani, Sitamadhi) to 9%
(Bareilly)
Table 128 Breastfeeding practices across study districts of Bihar and UP

% across. Base : All who had a live Base Breast feeding Breast feeding Breast feeding
birth initiated within initiated within initiated after 24
2 hours 2-24 hours hours
All India 4307 29.1 25.9 43.4
Uttar Pradesh 239 6.2 13.9 45.8
Bihar 238 3.4 23.1 50.1
Badaun 320 3.2 7.6 48.5
Bareilly 320 3.6 10.4 48.2
Moradabad 318 6.6 41.1 47.2
Rampur 319 9.1 30.2 44.8
Meerut , Muzzafar Nagar , 240 1.4 31.9 45.5
Individual Districts
Bhagalpur 320 6.4 37.1 46.2
Muzaffarpur 319 6.3 39 40.9

Darbhanga, Madhubani, Sitamadhi (C 239 1.3 13.9 45.9
)
Jamui, Banka, Lakhisarai, Munger (D) 239 5.4 28.8 46.4

Coverage Evaluation Survey - 2002 - IPPI, Routine Immunization and Maternal Care - National Report

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Coverage Evaluation Survey - 2002

IPPI, Routine Immunization and Maternal Care

Department of Family Welfare, Organized by Unicef, India Country Office

CES-02 INDIA - FINAL REPORT

1 EXECUTIVE SUMMARY ......................................................................................................................................7

3 RESPONDENT PROFILE ....................................................................................................................................27

S.NO. INDICATORS COVERAGE (%)

1 IPPI Coverage by Rounds

INTENSIFIED PULSE POLIO IMMUNIZATION

REACH AND COVERAGE OF IPPI:

IPPI COVERAGE OF >5 YEARS:

ZERO DOSE CHILDREN:

PLACE WHERE DOSES WERE ADMINISTERED:

REASONS FOR NOT RECEIVING ONE OR MORE IPPI DOSES:

PERCEPTION REGARDING THE IMPORTANCE OF ROUTINE IMMUNIZATION:

AVAILABILITY OF IMMUNIZATION SERVICES:

AVAILABILITY OF IMMUNIZATION CARDS:

REASONS FOR NON COMPLIANCE:

SAFE INJECTION PRACTICES

COMPONENTS OF ANTE NATAL CARE:

KNOWLEDGE ABOUT COMPLICATIONS DURING PREGNANCY:

KNOWLEDGE ABOUT PLACE OF CONSULTATION FOR PREGNANCY COMPLICATION:

COMPLICATION EXPERIENCED DURING PREGNANCY

PLACE OF DELIVERY AND ASSISTANCE AT DELIVERY:

POST NATAL CHECKUPS:

HIGH-RISK DISTRICTS FINDINGS

Cluster A - Muzaffarnagar, Meerut, Bulandshar & J.P. Nagar

Cluster B - Sultanpur, Faizabad, Basti, Gonda

Cluster C - Jamui, Banka, Lakhisarai, Munger

Cluster D - Madhubani, Darbhanga, Sitamarhi

2.1 RESEARCH OBJECTIVES

The research objectives for the study were to assess:

2.2 RESEARCH DESIGN

Quantitative Sampling Design

The respondents’ definition for each of the modules was different.

2.2.3 Sampling Design

2.2.3.1 Sample sizes

Sample Size Urban Rural Grand Total

2.2.3.2 Rural Sampling

Qualitative Sampling Design

• Parents of under 5 children

• Polio afflicted families

2.2.6 Sample Distribution

2.2.8 Recruitment, Training and Fieldwork

3.1 PRIMARY CARE TAKER

* Base too low

Completed years of schooling

ALL 10800 49.4 9.6 19.9 17.7 3.4

*Base too low. The arrows indicate significant difference.

3.3 EDUCATION OF THE FATHER

Completed years of schooling

ALL 10800 26.8 10.2 22.2 30.2 9.6

3.4 BACKGROUND CHARACTERISTICS OF THE SAMPLE COVERED

ALL 10800 10800 Census

* Base too low

4.1 DISTANCE OF THE PPI BOOTH

*Base too low

Table 6 Distance of the PPI booth- Rural and Urban Comparison

*Base too low

Table 9 Coverage by number of doses across states

Table 10 Coverage across various rounds

Urban 5400 97.3↑ 5263 96.4↑

Hindu 8719 96.3↑ 8512 94.8↑