You are on page 1of 208

State of Health in

Bihar

POPULATION FOUNDATION OF INDIA

State of Health in Bihar

Almas Ali Sanjit Nayak Sudipta Mukhopadhyay

Population Foundation of India

© Population Foundation of India 2007
Design and Print Impression Communications 2/8 A Ansari Road, Darya Ganj, New Delhi-110 002 9811116841, 65749684

ii

State of Health in Bihar

Acknowledgements
The idea of a comprehensive document on the State of Health in Bihar germinated while developing the book India Socio-Demographic Development Index, 2007 for policymakers and planners. This book looks substantially into some of the important issues affecting the health status of the people in Bihar. It views ‘health’ from a broader development perspective rather than purely health indicators. It also explores the possibility of a more effective future direction for healthcare in the state. This book was made possible due to the effort of many people at various levels. We extend our thanks to all of them. We are grateful to Mr A R Nanda for giving us the opportunity to undertake this assignment and for providing continuous guidance and motivation. We are grateful to our colleagues Dr Kumudha Aruldas, Sona Sharma, Dr Sharmila Ghosh Neogi and Dr Lalitendu Jagatdeb. We also greatly appreciate the support of our colleagues Sanjay Kumar Singh, Matish Kumar, Amrit Kumar Rawat in Bihar and Nihar Ranjan Mishra in Delhi. Our special thanks to the Registrar General of India for providing the maps, the Government of Bihar and Population Foundation of India documentation centre for providing us with relevant information. We extend our sincere thanks to Shailender Singh Negi and Gajinder Pal Singh Seerah for providing valuable technical assistance in data management and Arthur Monteiro for editorial inputs. We are indebted to the David and Lucile Packard Foundation for providing financial support for publishing this book. Almas Ali Sanjit Nayak Sudipta Mukhopadhyay

State of Health in Bihar

iii

iv State of Health in Bihar .

PFI released the district profile for Bihar in 2002 based on data from the Census of 2001 and District Rapid Household Survey 1998-99. and district profiles. the current health delivery system. One of the features of this advocacy is to publish relevant information on states and districts in the country. It identifies areas of concern and explores policy options. which may expedite improvement of human development in the state. This publication is an endeavour to help policymakers. programme managers and NGOs with information for improving social conditions. This publication brings out the current reality of the health and population scenario of the state of Bihar based on reliable data. We hope that the insights gained from it will help and motivate governmental and non-governmental agencies to work towards creating a healthy population in Bihar. As part of its advocacy conference on Population. It advocates rights-based. It can happen only when all other corresponding improvements are seen in related areas in social. and includes the demographic and socio-economic status in the state. These efforts should also be based on evidence which reflects the reality and the need. The publication was well received and created a large-scale demand for similar publications. assessment of its health situation. health and social development. The linkage between health and development is an established concept. PFI State of Health in Bihar v . economic and environmental sectors. and the gaps and priorities which need to be addressed in a development-oriented approach. programmes. The need to integrate these two has become an important concern for us today. gender-sensitive policies. strategies and interventions for population stabilization. district administrations. Health and Social Development in 2002 in Bihar. the state government. October 2007 New Delhi A R Nanda Executive Director. It reflects the current context of the health status. This document provides a holistic overview of Bihar.Foreword The Population Foundation of India’s strategic focus is advocacy and action research on critical issues of population. planners. Trying to change and improve the health status of people in isolation is like chasing a mirage.

vi State of Health in Bihar .

IV. V. District Health Profile Ranking of Districts Composite Socio-Demographic Development Index 5 6 Health Service Delivery Concerns. III. II. 4 Fertility Mortality Morbidity Nutrition Reproductive and Child Health viii x xiii xv 1 5 19 19 25 38 46 51 67 68 143 165 167 175 189 District Health Profile and Ranking of Districts I.Contents List of Figures List of Tables List of Maps Glossary 1 2 3 Introduction Demographic and Socio-economic Scenario Status of Health I. III. II. Challenges and Strategies for Change References State of Health in Bihar vii .

9 3.16b 3. by residence TFR for Bihar and India as per NFHS data Life expectancy in Bihar and India. Census 2001 CBR for Bihar and India. SRS 1981–2005. Bihar and India. SRS 2005 ASDR for Bihar. Census Population density.16a 3. by residence Distribution of deaths by broad age groups.18 3.10 2.3 3.Figures 2.6 2.3 2. SRS 2005.11 3. Census 1951–2001 Literacy rates for Scheduled Castes and Scheduled Tribes.11 2. Census 1951–2001 Child sex ratio in Bihar. Bihar.13a 3. Bihar. SRS 1981–2005 Neo-natal mortality rate by residence. Bihar and India by residence.12 3.19 Absolute increase in the population of Bihar. SRS 1995–2005 Child mortality rate for Bihar.2 3. Bihar and India.15 3.8 3. SRS 2005 ASFR for rural and urban Bihar for SRS 2005 GRR for Bihar and India. Rural and Urban.12 3. SRS 1995–2005 Infant mortality rate by residence.10 3. 2006 Development indicators. 2001 Literacy rate in Bihar. SRS 1996–2005 GFR.5 2.9 2.5 3.1 2. Census 1901–2001 Decadal growth rate of Bihar Compared with that of India. SRS 1981–2005 CDR for Bihar. SRS 2005. Bihar and India. by gender and residence CDR for Bihar and India.13b 3.14 3. Bihar.4 3.8 2. Bihar.4 2.6 3. Census 2001 HDI according to social groups for Bihar and India. SRS 1995–2005. SRS 1981–2005 GRR for Bihar and India. Bihar. SRS 1995–2005 viii State of Health in Bihar .7 3. by residence ASDR for Bihar and India. RGI Scheduled Caste and Scheduled Tribe population of Bihar. SRS 1981–2005 CBR for Bihar. Census 2001 Age Pyramid (a) Bihar. 2000. SRS 2005 ASFR. SRS 1995–2005 Child mortality rate for Bihar and India.2 2. Census 2001 Projected population composition in Bihar by age groups.1 3. SRS 2005 Child mortality rate in Bihar and India.17 3. Census 1991 Child sex ratio in Bihar. SRS 1981–2005 GFR for Bihar and India.7 2. by residence Infant deaths as percentage of total deaths by residence. 2001 (b) India.

36 3.4 5.35 3. Follow-up Positioning family planning State of Health in Bihar ix . Government of Bihar Concentration curve of public spending on curative health care Visit to health facility for health or family planning services. NFHS III and NFHS II Anaemia prevalence in Bihar.22 3.34 3.31 3. NFHS Bihar and India Birth order 3 and above. NFHS and RCH Bihar and India Achievement in family planning.26 3. 2001–05 Any ANC.33 3. NFHS and RCH Bihar and India Unmet need of contraception.3 5.29 3. Bihar. rural Bihar Visit to health facilities. NFHS III and NFHS II Nutritional status of married adults in Bihar. (d) among SC/ST Organogram of Health and Family Welfare Department. rural areas Change in utilization of health facility: NFHS II vs.40 3. (b) India Women married by age 18. Bihar. NFHS and RCH Bihar and India Contraception prevalence rate. NFHS Bihar and India Spacing methods of contraception. 2006 Achivement in CPR all methods.27 3. NFHS Bihar Age at first birth for women.24a 3.38 3. PFI-PRB 2003–06 Nutrition levels in boys in rural Bihar. private.3.28 3.39 3.1 Share of neo-natal deaths to infant deaths by residence. NFHS and RCH data Immunization coverage in Bihar: (a) progress.5 6. NFHS and RCH Bihar and India Limiting methods of contraception. 1998 Nutritional status of children in Bihar. NFHS III and NFHS II Use of iodized and non-iodized salt in (a) Bihar. (b) compared with all-India level.23 3. Bihar and India .25 3.20 3.21 3.41 5. 1998 Severe under-nutrition levels in children 1–5 years in India. (c) by residence. 1998 Severe under-nutrition levels in boys and girls in Bihar.2 5.30 3. SRS 1995–2005 Causes of maternal death.24b 3. Bihar.37 3. 1998 Nutrition levels in girls in rural Bihar.32 3. public vs. 2003-04 Various estimates of MMR for Bihar HIV/AIDS prevalence in Bihar.1 5. Bihar.

SRS 1995–2005 Infant Deaths as Percentage of Total Deaths in Bihar and India.4 3.14 3. SRS 2005 Distribution of Deaths by Broad Age Groups.15 3. 2006 Social Development Index according to Residence for Bihar.4 2.11 3. SRS 2005 Child Mortality Rate. SRS 1981–2005 ASDR for Bihar and India by Residence. Census 1951–2001 Literacy Rates for Scheduled Castes and Scheduled Tribes.7 3.15 3.6 2.13 3. Census 1901–2001 Change in Child Sex Ratio in Bihar and India.12 2. SRS 2005 TFR for Bihar and India. SRS 1981–2005 GRR. Census 1901–2001 Population Density in Bihar Compared with that of India. SRS 1981–2005 GFR.8 2.3 3. Bihar and India. SRS 1971–2005 GRR.11 2.1 2.12 3. Bihar and India.16 Reorganization of Districts in Bihar Population Growth in Bihar Compared to that of India.7 2. Census 2001 Crop Yield and Yield Gap in Bihar Poverty Indices for Bihar and India. 1993-94 to 1999-2000 Selected Socio-economic Indicators of Bihar Selected Millennium Development Goals Indicators for Bihar CBR for Bihar and India Compared.8 3. 1991 and 2001 Literacy Rate in Bihar. Bihar and India.Tables 1. SRS 1995–2005 Proportion of under 5 Mortality to Total Deaths. SRS 1981–2005 GFR.13 2.1 2.5 2. SRS 1995–2005 x State of Health in Bihar . Bihar. Census 1951–2001 Age-wise Population Distribution in Bihar.9 2.6 3. Bihar and India.10 3. Census 2001 Projected Population Characteristics of Bihar.10 2. Census 1951–2001 Change in Sex Ratio in Bihar and India.9 3.5 3. Bihar and India.2 2. SRS 1990 and 2000 CDR for Bihar and India Compared. Census 2006–2026 Scheduled Caste and Scheduled Tribe Population of Bihar. Bihar and India. Bihar and India. Bihar and India.2 3.14 2. Census 2001 HDI according to Social Groups for Bihar and India. SRS 1981–2005 TFR Bihar and India as per NFHS data Life Expectancy Figures for Bihar and India. SRS 2005 ASFR. SRS 2005 ASFR for Bihar and India.3 2.1 3.

47 3.26 3. 2001–06 TB Incidence.39 3. Bihar 2001–05 Effective CPR due to all methods. 1998 Distribution of Severely Undernourished Children (1–5 years) in States/UTs. Gomez Classification. 2001–06 Malaria and Pf Cases in Bihar and India. 2005 Japanese Encephalitis Cases in Bihar and India.22 3. Bihar and India.41 3. Bihar and India.32 3. 2001–05 Status of Maternal Health Determinants in Bihar Ante-natal Care.29 3. Prevalence and Treatment Rates in Bihar and India. 2005 Nutritional Status of Children and Married Adults in Bihar Households Reporting Use of Salt Types in Bihar and India.30 3. Bihar and India.42 3.43 3.17 3.33 3.20 3. 1998 Child Feeding Practices in Bihar and India Breast-feeding and Colostrum Feeding Practices in Bihar and India.44 3. 2004-05 Knowledge of HIV/AIDS among Ever Married Adults (15–49 years) Bihar and India Prevalence of HIV infection in Bihar and India. 2006 Estimated population exposed to risk of filariais and microfilaria carriers and filaria cases. 2000-01 to 2005-06 Selected Family Planning Methods.24 3. SRS 1995–2005 Percentage Change in IMR.21 3. SRS 2006–2025 Kala-azar Occurrence in Bihar and India.49 Infant Mortality Rate for Bihar and India by Residence.18 3.35 3.37 3. SRS Disaggregated Neo-natal Mortality and Peri-natal Mortality Rates.25 3. Bihar and India Unmet Need for Family Planning.40 3. 2005 Healthcare Received in Child Delivery Immunization Coverage in Bihar Immunization Status by Residence and among SC/ST in Bihar and India.48 3. Bihar and India. in Percentage (Gomez Classification). Bihar. SRS 1995–2005 Status of Maternal Mortality Ratio in Bihar and India Projected Mortality and Fertility Characteristics of Bihar.34 3.36 3. Bihar and India State of Health in Bihar xi .45 3.46 3.28 3.38 3. SRS 1981–2005 Infant Mortality Rates by Sex. 2005 Marriage and Fertility Rates for Bihar and India Current Use of Family Planning Methods.27 3.3.19 3. 2005 Coverage of Type of Syringes used for Immunization and Method of Sterilization.23 3. 2003–06 Nutritional Status of Children under 3 years in Bihar and India Distribution of Nutritional Status of Children (1–5 years) According to Weight for Age. 2001–05 Leprosy Cases and Prevalence in Bihar.31 3. Bihar and India Achievements of the State of Bihar in Family Planning.

51 3.1 5. Bihar and India.53 3.7 4. Bihar.1 4.2 5. March 2006 Shortfall of Specialists and Technicians in Health Facilities in Bihar.3.9 4.4 5.4 4. RCH-2 Ranking of Districts According to Decadal Population Growth Rate Ranking of Districts According to Density of Population Ranking of Districts According to Sex Ratio Ranking of Districts According to Child Sex Ratio Ranking of Districts According to Female Literacy Ranking of Districts According to Girls Marrying Below the Age of 18 Years Ranking of Districts According to Birth Order 3 and Above Ranking of Districts According to Any Antenatal Care Ranking of Districts According to Institutional Delivery Ranking of Districts According to Full Immunization Ranking of Districts According to Contraceptive Prevalence Rate Ranking of Districts According to Socio-demographic Development Index Healthcare Infrastructure in Bihar as in March 2006 Availability of health personnel in Bihar.10 4. Bihar and India Achievement in Immunization Treatment of Childhood Diseases Knowledge of Diarrhoea Management and Treatment District-wise Key RCH Indicator.13 5. March 2006 Shortfall in Health Personnel in Bihar.11 4. March 2006 Health Staff Position at PHCs and Sub-centres Quality of Care Indicators for Bihar and India Projected Population and Fertility. 2001–2101 xii State of Health in Bihar .12 4.3 5.52 3.8 4.5 4.6 6.2 4.54 4.5 5.6 4. Bihar District-wise Key RCH Indicators.1 Child Immunization and Vitamin A Supplementation.3 4.50 3.

28 4.21 4.5 4.8 4.1 1.12 4.13 4.24 4.4 4.19 4.16 4.20 4.11 4.2 4.1 4.29 4. 2001 District Map of Araria District Map of Aurangabad District Map of Banka District Map of Begusari District Map of Bhagalpur District Map of Bhojpur District Map of Buxar District Map of Darbhanga District Map of Gaya District Map of Gopalganj District Map of Jamui District Map of Jehanabad District Map of Kaimur (Bhabua) District Map of Katihar District Map of Khagaria District Map of Kishanganj District Map of Lakhisarai District Map of Madhepura District Map of Madhubani District Map of Munger District Map of Muzaffarpur District Map of Nalanda District Map of Nawada District Map of Paschim Champaran District Map of Patna District Map of Purba Champaran District Map of Purnia District Map of Rohtas District Map of Saharsa District Map of Samastipur District Map of Saran State of Health in Bihar xiii .23 4.3 4.Maps 1.9 4. 2001 Bihar Administrative Divisions.15 4.17 4.14 4.6 4.2 4.22 4.27 4.26 4.31 Position of Bihar in India.18 4.10 4.7 4.30 4.25 4.

39 4. socio-demographic development index.37 4. child sex ration.35 4. 2001 Bihar.44 4. 2001 Bihar.45 4.46 4. sex ratio.4.33 4. CPR prevalence Bihar.34 4. immunization figures Bihar. 2001 Bihar. density of population.48 4. ANC Bihar. 2001 Bihar. girls marrying below age of 18 years Bihar. female literacy rate.40 4.42 4.38 4. birth order 3+ Bihar.46 4.41 4. institutional delivery Bihar. 2007 xiv State of Health in Bihar .32 4.36 4.1991-2001 Bihar.43 4.49 District Map of Sheikhpura District Map of Sheohar District Map of Sitamarhi District Map of Siwan District Map of Supaul District Map of Vaishali Bihar decadal growth of population.

Glossary AIDS ANC ANM ARI ASDR ASFR ASHA AWW BCC BMI BoD BPL BSACS BSS CBO CBHA CBR CDR CES CGHS CHC CHW CNA CPR CSR CVD DALYs DLHS DNP Acquired Immuno Deficiency Syndrome Ante Natal Care Auxiliary Nurse Midwife Acute Respiratory Infection Age Specific Death Rate Age-Specific Fertility Rate Accredited Social Health Activist Anganwadi Worker Behaviour Change Communication Body Mass Index Burden of Disease Below Poverty Line Bihar State AIDS Control Society Behaviour Sentinel Surveys Community Based Organization Central Bureau of Health Information Crude Birth Rate Crude Death Rate Coverage Evaluation Report Central Government Health Services Community Health Centre Community Health Worker Community Needs Assessment Contraceptive Prevalence Rate Child Sex Ratio Cardio Vascular Disease Disability Adjusted Life Years District Level Household Survey District Nutrition Profile State of Health in Bihar xv .

DOTS DPT DRHS EIP EMCP EMoC ESIS FRU FSW GBoD GDI GFR GRR HBNC HDI HIV HMIS ICDS ICMR ICPD IEC IFA IMNCI IMR IUD JE LBW LHV MDG MDT MIS MLA MMR MoHFW MTP NACO Directly Observed Treatment. Short-course Diptheria Pertusis Tetanus District Rapid Household Survey Expanded Immunization Programme Enhanced Malaria Control Project Emergency Obstetric Care Employment State Insurance Scheme First Referral Unit Female Sex Worker Global Burden of Disease Gender Disparity Index Gross Fertility Rate Gross Reproduction Rate Home Based Neo-natal Care Human Development Index Human Immuno-deficiency Virus Health Management Information System Integrated Child Development Scheme Indian Council of Medical Research International Conference on Population and Development Information Education Communication Iron and Folic Acid Integrated Management of Nutrition and Childhood Illnesses Infant Mortality Rate Intra-uterine Device Japanese Encephalitis Low Birth Weight Lady Health Visitor Millennium Development Goals Multi Drug Treatment Management Information System Member of Legislative Assembly Maternal Mortality Ratio Ministry of Health and Family Welfare Medical Termination of Pregnancy National AIDS Control Organization xvi State of Health in Bihar .

NAMP NCAER NCC NCD NHP NFHS NGO NLEP NPP NRHM NSSO NSV NTP NYK OPV PCPNDT Act PFI PHC PPP PRI QoC RCH RMP RNTCP RTI SDI SRS STD STI TB TBA TFR TT UIP UNFPA UNICEF WHO National Anti-Malaria Programme National Council of Applied Economic Research National Cadet Corps Non-Communicable Diseases National Health Policy National Family Health Survey Non Government Organization National Leprosy Eradication Programme National Population Policy National Rural Health Mission National Sample Survey Organization No Scalpel Vasectomy National TB Programme Nehru Yuva Kendra Oral Polio Vaccine Pre-Conception and Pre-Natal Diagnostic Techniques Act Population Foundation of India Primary Health Centre Public–Private Partnership Panchayati Raj Institution Quality of Care Reproductive and Child Health Rural Medical Practitioner Revised National TB Control Programme Reproductive Tract Infection Social Development Index Sample Registration System Sexually Transmitted Disease Sexually Transmitted Infection Tuberculosis Trained Birth Attendant Total Fertility Rate Tetanus Toxoid Universal Immunization Programme United Nations Population Fund United Nations Children’s Fund World Health Organization State of Health in Bihar xvii .

2001 xviii State of Health in Bihar .1 : Position of Bihar in India.Map 1.

which dominate the morbidity and mortality pattern in less developed regions. lack of protected water supply. sanitation.1 Introduction The health status of its population reflects the socio-economic development of a state. housing. The other aspects of deprivation. industrial output. It also has the lowest ratio of girls in schools. The relationship between health and poverty or health and development is complex and multifaceted. As much as 32. The state has the lowest per capita net domestic product among all the Indian states. and the coverage. accessibility. caste and sex. and efforts in social modernization.5% of the population of the state lives below the poverty line (as per the 61st Round NSSO survey 2004-05). non-polluting domestic fuels. Undernourishment in children in turn reinforces the consequences of such infections. even leading to higher mortality levels. water supply. faecally related and waterborne diseases. By any index to measure socio-economic development the state of Bihar lags far below the national average and remains well behind other states. The poor health status of states is a product of inadequate nutrition. In its most basic form — as a state of food deprivation and nutritional inadequacy — poverty has a direct bearing on the morbidity and longevity of people. to education and general awareness. Some of these parameters of backwardness are per hectare productivity in agriculture. dependence of people on the secondary and tertiary economic sectors. connectivity of life support services and. which is the second-highest rate after Orissa (39. High child mortality levels on account of supervening infections. The root cause of poor health status in the state of Bihar is poverty (both income and human poverty) and social deprivation. and overcrowded and insanitary housing conditions. The state also has the lowest literacy rate of 47. employment. are fairly widespread among people deprived of these basic amenities of life. acceptability and affordability of health services.9%). employment scenario. airborne diseases. availability. Health status is shaped by a variety of factors — level of income and standard of living.1% among Indian states and Union territories. These conditions are conducive to deficiency diseases. as revealed by the 2001 census. particularly diarrhoea and respiratory infections. most importantly. per capita income. Poverty in its various dimensions could be a manifestation as well as a determinant of an individual’s health. sanitation. health consciousness and personal hygiene. such as lack of access to critical amenities including safe water.0% and also the lowest female literacy rate of 33. State of Health in Bihar 1 . low literacy (especially female literacy) and structural inequalities in terms of class. contribute to reinforcing ill health and morbidity. These commonly seen childhood infections often exacerbate malnourishment. education.

2 State of Health in Bihar Map 1. 2001 .2 : Bihar Administrative Divisions.

The modern state of Bihar. The Ganges and its tributaries are the major source of water for the state. The region gave birth to great religious leaders such as Lord Buddha.015 are inhabited. West Bengal on the east. of which 12. 3 nagar panchayats. Total irrigated land is 4807.132 are rural and 1. the Sanskrit word for Buddhist monasteries. is located between 21°58′ to 27°31′ N latitude and 83°19′ to 88°17′ E longitude. The remaining 29 districts have been reorganized into 38 districts. bananas and jackfruit are the main fruits. rice and wheat are the other crops. Madhepura Sheohar Administratively.287. State of Health in Bihar 3 . Table 1. mangoes. out of which 39.92%). marked by the river Ganges which flows from west to east to join the Bay of Bengal. who ruled over the Indian subcontinent. The word Bihar derives from Viharas. Khagaria Araria. Other major rivers include Gandak. jute. The state has two distinct physiographic regions. Bihar has a land area of 94. Maize. There are 130 towns.000 hectares (1999-2000). Reorganization of Districts in Bihar Original District Bhojpur Gaya Jehanabad Munger Purnia Rohtas Saharsa Sitamarhi New Districts after Reorganization Buxar Jehanabad Arwal Lakhisarai. Ghagra.240 sq km).08%) and urban land area is 1804. 101 subdivisions and 533 community development blocks. Kosi and Baghmati. Table 1. The state gave the nation its first President Dr Rajendra Prasad and national leaders such as Jayaprakash Narayan. Bihar now has 9 divisions.744. It was witness to the Satyagraha movement of Mahatma Gandhi in Champaran. In November 2000 the state of Jharkhand was carved out of the state of Bihar by transfer of 13 districts to the new state. which came into existence in 1956. The state’s rural land area is 92.130. 42 municipalities.40 sq km (98. Uttar Pradesh in the west and Jharkhand on the south.1. oilseeds and tobacco. potato. viz. Litchis. hemp. There are 9032 gram panchayats. It is bounded by Nepal on the north.The poor socio-economic status of the state of Bihar is in ironic contrast to its illustrious history. Kishanganj Kaimur (Bhabua) Supaul. Sub-Himalayan area (North Bihar plains) and Gangetic plains (South Bihar plains). including 125 statutory towns and 5 census towns. The households number 13.163 sq km. Lord Mahavira and Guru Govind Singh. and 45. Patliputra (modern Patna) was home to great monarchs like Chandragupta Maurya and Ashoka. Sheikpura.358. and 853 police stations.60 sq km (1.998 are urban.1 presents details of the reorganization of districts.407.098 villages. which is 2. In ancient times it was the Magadh kingdom.336. The agricultural economy of the state is characterized predominantly by cash crops such as cotton. 7 municipal corporations.86% of the land area of India (3.

163 9 38 101 533 130 45.795 39.13 20 0.5 15.47 32 61 30.832.8 371 70 1641 8858 4 State of Health in Bihar . SRS-2005 Crude Death Rate (CDR).4 8. NFHS-III Life Expectancy at Birth.098 39.Bihar at a Glance Area (sq kms) Revenue Divisions Districts Sub-Divisions Community Development Blocks Towns Villages Inhabited Villages Gram Panchayats Municipal Corporations Municipalities Nagar Panchayats Police Stations Population Total (2001) Males Females Rural (percent) Urban (percent) Scheduled Castes (percent) Scheduled Tribes (percent) Decadal Growth Rate (percent) 1991-2001 Annual Exponential Growth Rate 1991-2001 (percent) Density of Population (per sq km).27 15 27.9 28.5 10.7 0. SRS-2005 Total Fertility Rate (TFR). 2001 Overall Sex-Ratio.509 43.998.243.7 18.1 4 60.10 19 16.0 33.2003 Community Health Centres (CHCs) Primary Health Centres (PHCs) Sub Centres 94.754. 2001 Sex-Ratio (0-6 years).714 89. 2000 Maternal Mortality Ratio.6 2.5 6719 0.5 881 919 942 47. SRS-2005 Crude Birth Rate (CBR).6 33. SRS 2001. 2001 Total Literacy (percent) Female Literacy Total Work Participation Rate Female Work Participation RatePeople living below Poverty Line (percent) Per Capita Income (in Rupees) Human Development Index (HDI)Value Human Development Index (HDI)Rank Social Development Index (SDI) Urban Value Social Development Index (SDI) Urban Rank Social Development Index (SDI) Rural Value Social Development Index (SDI) Rural Rank Gender Disparity Index (GDI)Value Gender Disparity Index (GDI)Rank Infant Mortality Rate (IMR).015 9032 7 42 73 853 82.

316.390 251.836 persons were living in institutional households.54 11.234.754. Population Growth in Bihar Compared to that of India.159.1 and 2.07 Population Proportion of Bihar in India State of Health in Bihar 5 .329.436 India Decadal growth rate — 5. Madhya Pradesh.421.8 24.465 82.737.028. The state accounts for 8.65 10.097 846.977.771 548.66 23.795 males and 39.52 –0. Andhra Pradesh.660.126.675 31.321.088.79 20. 42.1 and Figures 2. The state along with Uttar Pradesh. with 89. after Uttar Pradesh and Maharashtra.2 present details.86 21.311.64 24.1901–2001 Year Population 1901 1911 1921 1931 1941 1951 1961 1971 1981 1991 2001 27. the state ranked fifth in the country in terms of population. In the 2001 census it ranked third.090 436.238 318.093.396. consisting of 43.580 361.412 persons in 1991.447.554.75 –0.709 persons) residing in rural areas.374. 273. India’s population is estimated at 112 crore while that of Bihar is estimated at 9.734 86.213 278.28 10.840 38.46 11.1.2 Demographic and Socio-economic Scenario According to the 2001 census.20 8.353.2 crore.327 252.58 19.998. against 170.04 10.74 10.998.5% of the population (74.23 10.271 46.62 Population 238.97 9. the population of the state of Bihar is 82.243.436). Tamil Nadu.509 Bihar Decadal growth rate — 1. with a population of 64.298 persons were houseless in the 2001 census.028.457 56.347. Rajasthan and Karnataka constitutes almost 50% of the population of India.039 1.19 11. West Bengal. Census.281 28. According to the 2001 census.16 23.355 houseless persons in the 1991 census.782.652 683.22 13.31 11 14. Currently (2007).530. against 35. In 1991.170.314.91 24.22 10. Maharashtra. Table 2.31 21.38 28.23 11.369 69.714 females.737. The population of the state is predominantly rural.509 persons.24 11. Further.865 28.74 12.108 35.914. Table 2.07% of the country’s population (1.

54 whereas all other states had a drop in decadal growth rate. Table 2.3. Source: Census of India 2001.38 to 28. Daman and Diu and West Bengal. 1951–2001 Year 1951 1961 1971 1981 1991 2001 Bihar 223 267 324 402 685 881 India 117 142 177 216 267 325 Figure 2. Census 1901–2001 compared with that of India. which is higher than the national average of 21. The density of the population of the state is 4811 in urban areas as compared to 805 of rural areas. which was 2. Bihar and India. Absolute increase in the population of Figure 2.50 during 1991–2001. Census 1951–2001 Note: Figures for Bihar till 2001 include the present Jharkhand state.2.1.3 present details. Table 2. Annual average exponential growth rate. 6 State of Health in Bihar . Population density. In 1991 the corresponding figures were 685 and 267.62. New Delhi. Chandigarh. Population Density The state has a population density of 881 persons per sq km as compared to 325 persons per sq km at the national level. Pondicherry.Figure 2.10 during 1981–91. Lakshadweep.2. Bihar was the only state where the growth rate increased from 23. has also increased to 2. Population Density (per sq km) in Bihar Compared with that of India. Carving out of the state of Jharkhand has increased the population density of the state.2 and Figure 2. Decadal growth rate of Bihar Bihar. Registrar General of India. bringing its rank in the country in this respect to the 7th place in 2001 from the 8th rank in 1991 and comes only after Delhi. Census 1901-2001 Decadal Growth During the decade 1991–2001.

1%). Change in Child Sex Ratio in Bihar and India. There has.e. however. The sex ratio of the state since 1901 had always remained higher than that for the country as a whole till the 1981 census. Table 2.4. There has been a 12 point increase in sex ratio for the state. The percentage of women who desire the next child to be a son in Bihar is 55. The state ranks 20th in CSR in 2001 as compared to 21st rank in 1991 (see Table 2. However. number of females per thousand males in the state was favourable to females till 1961 except in 1931. the percentage of husbands who desire the next child to be a son is also high at 45.3. Child sex ratio in Bihar. Table 2. i. the sex ratio of 907 of Bihar in 1991 was much below the sex ratio of 927 at the national level.Sex Ratio The sex ratio.6%).2% (India 35. After 1961 the sex ratio in the state has been unfavourable to females. 1991 Figure 2.3). The corresponding figures in 1991 were 953 and 945.5). 1951–2001 Year 1971 1981 1991 2001 Bihar 964 962 964 981 Variance –12 –2 –24 +17 India 945 927 953 942 Variance –17 –18 –28 –11 Source: Census of India 2001. 2001 State of Health in Bihar 7 .5. Change in Sex Ratio in Bihar and India. The state ranked 22nd in 2001 as compared to 25th rank in 1991 (see Table 2. New Delhi.4 and Figures 2.5% (India 38. Figure 2.4. Registrar General of India.4 and 2. Child sex ratio in Bihar. Census 1901–2001 Year India Variance Bihar Variance 1061 1901 972 1911 964 –8 1051 –10 1921 955 –9 1020 –31 1931 950 –5 995 –25 1941 945 –5 1002 +7 1951 946 +1 1000 –2 1961 941 –5 1005 +5 1971 930 –11 957 –48 1981 934 +4 948 –9 1991 927 –7 907 –41 2001 933 +6 919 +12 The child sex ratio (CSR) for Bihar is 942 as compared to 927 for India in 2001. when it declined to 995. been some improvement in the 2001 census in this regard where the sex ratio of Bihar is 919 as compared to 933 at the national level for India.

1 4.6 8.2 13.5.8 11. Age-wise Population Distribution (%) in Bihar.3 10.8 7.3 1.1 crore young people (10 to 24 years) in India.1 8.4 2.3 1.3 13.2 7.1 7.3 7.8 15.1 40-44 5.4 20-24 7.2 4.6 10.3 2.4 0.4 4. representing a little less than one-third of the population. As per World Youth.5 1.6 5-9 15.6 13.9 Source: Census of India 2001.6b.6).1 2. New Delhi.5 60-64 2.6 1.Age Distribution The high fertility in the decades 1961–2001 is reflected in a young age structure for the country.1 50-54 3.9 3. The National Youth Policy of India (2003) recognizes people in the age group of 13 to 35 years as youth.3 10.5 0.7 4.6a. Age pyramid.7 35-39 6.6 65-69 1.2 2. with about 54% of the population being below the age of 24 years (Census 2001).0% below the age of 15 (see Table 2.8 10.7 8.2 3.5 6.9 9. 2001 The term ‘youth’ encompasses a diverse set of young people — urban.5 10. Of this 35% are in the age group 10–14 years and 19% in the age group 15–24 years. In Bihar as well.7 7.5 5.4 2.9 Figure 2. The population of the state is very young.4 0.3 6.0 1.5 and Figure 2. The United Nations Population Fund (UNFPA) defines adolescence as 10–19 years.9 0. 2006 Data Sheet.3 3.5 2.1 0.2 6.3 75-79 0.2 6.3 15-19 8. with 42. Bihar.6 10. produced by the Population Research Bureau.5 25-29 7. with 10–14 years being early adolescence and 15–19 years as late adolescence. rural youth.5 80+ 0.2 13.8 6. Age pyramid.5 1.9 10. 2001 Figure 2.4 11. Census 2001 Age Group Total Male Female Rural 0-4 13.1 1.5 3. In addition.0 45-49 4.6 3.7 3.0 5.2 55-59 2. schoolgoing.6 70-74 1.6 2.1 4.7 9. the age pyramid reflects the growing base of youth population in the state.6 7.1 30-34 6. married adolescents and out-of-school youth. 8 State of Health in Bihar . Table 2. there are about 33.7 10-14 13.1 0. India. Registrar General of India.5 8. one has to consider youth from marginalized sections of society who have faced historical discrimination. Urban 10.6 5.5 2.9 2.

14 695 114 810 2011 97720 50640 47080 930 1038 1. whereas the proportion of 0–14 years would decline to 24.5 49447 3461 50151 5740 38. with female population between 15–49 years being approximately 55%.11 577 122 698 2016 103908 53676 50231 936 1103 1.3% in 2006 to 11% in 2026.5 26.8 62.58 431 150 580 2026 113947 58409 55437 949 1209 79591 28347 73007 12493 24.8 and TFR of 2 by the year 2026.Population Projection The Registrar General of India’s population projection in 2006 suggests that the population of Bihar would swell to approximately 113 crore. marking a gradual ageing of the population (see Figure 2.9%.6 presents the quinquennial projected population characteristics of the state until 2026. RGI. with a growth rate of 0. The proportion of female population also shows an increase of 8%.1 54.2 63.0 29.0 65984 30944 64438 8525 29.22 480 132 613 2021 109431 56341 53091 942 1162 0.3 49.9 64. New Delhi 2006.7.3 54.6.2 57499 33191 57536 6993 34.0 6.05 388 171 559 Sex Ratio Population Density (per sq km) Population Growth Rate Population by Broad Age Groups (’000) Proportion (%) 18 years and above 0–14 15–59 60+ 0–14 15–59 15–49 (female) 60+ Young (0–14) Old (60+) Median Age (years) Dependency Ratio Total (Young and old) Source: Population Projection. 2006 Table 2.0 54.4 8. Figure 2.9 11.8 73538 29816 69250 10365 27. Projected population composition in Bihar by age groups.9 7.2 22. 2001–2026.7 9. State of Health in Bihar 9 . It is estimated that population above 60 years of age would double from 6. Registrar General of India.3 20.0 58.2 24. Table 2.9 51. Projected Population Characteristics of Bihar. 2006–2026 Indicator Population (’000) Total Male Female 2006 90752 47165 43586 924 964 1.7).4 55.

1% in 1991 (see Table 2. Kharia. 2001 Total Population Total Scheduled Castes 13048608 (15. Mochi. Birhor. Karmali. compared to 17% of Muslims (1. Sauria Paharia. Rajwar. Kora.7%) 758351 (0. as compared to 16.9% in 2001. Chamar.2% for India.8%) Female 6263932 (48%) 365237 (48.8. Bhangi. and others (52. Chero. The state ranked 16th in the Scheduled Caste population and 27th in the Scheduled Tribe population in 2001. Scheduled Castes and Scheduled Tribes The Scheduled Caste population of Bihar was 15.905). Pasi. The rest comprise Christians (53. Halalkhor. Scheduled Castes: Bantar. Bhumji. Savar.5% and 16.76. Mahli. Pahariya. The corresponding figures for 1991 were 15. Musahar. Munda. Dasadh. Banjara.37.4%) Female 406598 (46. Dhangad. Khond. Chaupal. Scheduled Tribes: Assure.137). Scheduled Caste and Scheduled Tribe population of Bihar. Sikhs (20.22. who are systematically disadvantaged because they are discriminated against in public institutions such as in education and in health services.818). Kharwar. Turi.4%) 717702 (1.2%) Total 12178555 (16. Kanjar.7%) 18544 (45. Binjhia.9%) Male 6784676 (52%) 393114 (51. Scheduled Caste and Scheduled Tribe Population of Bihar Census. Mal Paharia. Dabgar. Table 2. Santal. Census. Oraon. Kisan. Bhuiya.3%) Total 870053 (10. 10 State of Health in Bihar . Dom. Jains (16.5%) Urban Male 463455 (53. They are more likely to be poor and more likely to be denied access to income.048). Bhumij.90. Ho. Sawasi.8). Nat. It needs to be noted that some of the population groups now belong to the state of Jharkhand. Birjia. Bathudi.7. Gond.817). Chik Baraik. The Scheduled Tribe population was 0. The recently published Sachar Committee Report (2007) has drawn attention to the unequal opportunities for the Muslim population.5%. Hari. those who did not state religion (37. Pan. Bauri.6%) Scheduled Tribes Figure 2. Bedia. Mehtar. Gorait.0%) 40649 (0. Kurariar.3%) 22105 (54.919). Dhobi. Baiga. Ghasi. Buddhists (18.9%) 371009 (51.780).Religious Composition The population of Hindus in Bihar is about 83% (6. as compared to 8. assets and services.0%) Rural Male 6321221 (51. Korwa. Dharhi.7% in 2001.7%) Female 5857334 (48.7 and Figure 2. 2001 (%) Following are the notified Scheduled Castes and Scheduled Tribes in Bihar.1%) 346693 (48. Lohara.085). Lalbegi. Bhogta.2% for India in 2001 and 8.

undernourishment.13 2001 Rural Rank 20 Source: Social Development Index. 2006 Bihar All social groups Scheduled Castes Scheduled Tribes Other Castes 0. social and gender development. Table 2. The state ranks 15th in HDI.195 0. State of Health in Bihar 11 . illiteracy and social exclusion based on caste and gender. Under the prevalence of such backward societal conditions and inequalities in Bihar between people in urban and rural.270 0. nutritional status of women and children. HDI According to Social Groups for Bihar and India.03 Rural Rank 20 Value 27. Table 2. economic. The HDI among marginalized groups is a cause for concern as they are lagging behind on all fronts of development.Development and Social Exclusion The greatest challenge that Bihar faces today is development. 1991 and 2001 1991 Urban Value 22. per capita income. 2006 HDRC/UNDP India 2007 Bihar and India.8. This relates to income.9.301` India 0. poverty. etc.279 0. HDRC/UNDP India 2007. health and education.367 as compared to 0. development has to be viewed not just in terms of economic prosperity but in terms of human.9 show HDI among marginalized groups in Bihar and India.45 Rank 20 Value 16. Social Development Index According to Residence for Bihar. unemployment rate and incidence of poverty has been far from satisfactory.9 shows SDI by residence.393 Source: Human Poverty and Socially Disadvantaged Groups in India Delhi.201 0. Improvement in economic parameters such as gross domestic product (GDP). between the educated and the illiterate and between those who posses some form of entitlements and those who do not. This is mainly due to the inadequacy of social infrastructure and lack of access to basic amenities. Figure 2.8 and Figure 2.366 0.303 0. infant mortality rate. New Delhi. has been impressive in India but improvement in social indicators such as literacy. literacy rate and adjusted income. HDI according to social groups for Table 2.10 Urban Rank 19 Value 16. between rich and poor. 2006. especially for the socially and economically marginalized sections of society. The combined HDI of Bihar is 0.9. Table 2. Human Development Index (HDI) is a composite index representing three dimensions of human development. The indicators are life expectancy.472 for India. Council for Social Development. namely.

0 Male 22.676. Census 1951–2001 Source: Census of India.75.607. sexual orientation.11. namely demographic parameters. migrant status or where they live. educational attainments. caste. availability of basic amenities. age. health situation. Figure 2. SDI and GDI.469 for Bihar.11 9. Bihar ranks lowest in literacy rate in the country. Development Indicators. economy and political participation. the lowest in the country. 12 State of Health in Bihar . Figure 2. descent. religion. GDI value is 0.95 23.68 35.37 60.10 and Figure 2. gender.86 47. Mainly women and marginalized groups who are discriminated against often end up excluded from society. Literate males outnumber females 2 to 1 (see Table 2. 1951–2001 Year 1951 1961 1971 1981 1991 2001 Total 13.16. New Delhi. disability.32 37.61 21.2%.5% and 52.49 21. incidence of unemployment and poverty and extent of social deprivation as of 1991 and 2001. Gender Disparity Index (GDI) is estimated as proportion of female attainments to that of males for a common set of variables (National Human Development Report. The corresponding figures for 1991 were 37.In 2006 the Council for Social Development brought out a report on India’s Social Development. The variables used to capture economic attainments are worker population ratio.85 35. with literacy rate of 47. 2001 Social exclusion describes a process by which certain groups are systematically disadvantaged because they are discriminated against on the basis of their ethnicity.86 16. Table 2. Literacy Rate in Bihar.49 47. Registrar General of India. race. Literacy rate in Bihar.99 33. March 2001).0% as compared to 64.32 Female 4. which is different from the variable used to capture economic attainment in the HDI.17 32.11). Bihar.22 8. Literacy The number of literates in Bihar in 2001 was 3. the all-India figure being 0. Social Development Index is a composite index of six major dimensions of social development.8% for India (2001 census).10.10. HIV status.11 51.10 presents the development indicators for the state in terms of HDI.57 Figure 2.

respectively.0%) Scheduled Caste Scheduled Tribe 2880895 169895 Rural Urban Total 20644376 (59.5% and among the Scheduled Tribes. Bihar.4%. Scheduled Castes and Scheduled Tribes were 47.1%) 1900047 111086 Urban 3131366 (79.6%. Bihar is the only state where primary enrolment has fallen between 1993-94 and 1999-2000 by 2%.2% and 52.8% in 1991 to 18.6%.9%) 2536205 147420 (71. especially in those areas where it showed inordinately low rates in the 1991 census. The corresponding all-India figures were 39.6%) 636158 36334 Figure 2. Among the State of Health in Bihar 13 . Literacy rates for Scheduled Castes and Scheduled Tribes. work participation rate declined in 2001 in all the male categories of population. Table 2.5%. work participation rate in Bihar was 33. work participation rate among females increased appreciably from 11.4% and 18.12 illustrates the scenario graphically. Male work participation rate during the 2001 census for total population.6%) 115789 8513 25876919 5232658 (43. Special training modules and wider publicity were undertaken to capture female work participation. Literacy rates of these segments of population in the 1991 census were 18.7% as compared to 30. Women’s enrolment (34%) is considerably lower than that of men.1% and 37. During 2001 special efforts were made to cover female contribution in the economy in paid as well as unpaid work in family farm.6% in 1991.9%) 344690 22475 10465201 8363909 (33.95 respectively at the state level. Census 2001 According to the NSSO 55th round. Census 2001 Total Total Overall 31109577 (47. 50.6%. As a result. the net primary enrolment for Bihar in 1999-2000 was 52 compared to 77 for India. 49.3% and 33. with an enrolment gap of 14%. Table 2.11.3% and female literacy was 53.12. Occupational Status Work Participation.7%) 2128948 125048 Male Rural 17513010 (57. literacy rate among the Scheduled Castes was 28.2%.7%. Thus.4% and 53. Figure 2. The state has improved its rank in work participation to 30th place in 2001 as compared to 33rd place in 1991.1%) 751947 44847 (29. rice dehusking.9%) 228901 13962 Total Female Rural Urban 2101292 (62. Literacy Rates for Scheduled Castes and Scheduled Tribes. The corresponding figures for Bihar were 60.11 provides details. etc.9%. bidi rolling.Male literacy in India during the 2001 census was 75. According to the 2001 census. rearing of goats/sheep. in the 1991 census the corresponding figures were 47. Bihar. 28. According to the Census of 2001. collection of tendu leaves.8% in 2001.

9%. In view of the high incidence of leasing-in of land among the small and marginalized farmers and social groups. The state average agriculture yield is almost half of that of the potential yield in comparison to the yield at all-India levels.45% among the Scheduled Tribe workers were marginal workers in 2001. Further. Scheduled Castes and Scheduled Tribes has been recorded as 75.9% in 2001.12).8% recorded in 1991.4% among the Scheduled Caste workers and 60.7%. respectively. 14 State of Health in Bihar .7% against 4. leading to major gains in the category marginal workers and consequent decline in the proportion of main workers across the country. Cultivators. 75. The proportion of cultivators among Scheduled Castes was 8. with the result that majority of tenancy contracts continue to exploit the poor. 29% among the Scheduled Castes and 31. Land reforms have led to the acquisition of only 1. the percentage of marginal workers to total workers was 24.0% in 1991. horticulture crops account for less than 5% of cropped area and show strong promise for growth in several districts. Total number of household industry workers in Bihar was 1. Crop Yield.2% in 2001. Main Workers. Currently.Scheduled Castes female work participation rate increased from 23. Marginal Workers. The proportion of cultivators to total workers in Bihar decreased from 41.5% in 1991 and 3. Similarly.2% respectively in these categories in the 1991 census. Bihar has the highest number of agricultural labour in India. During 2001 the percentage of main workers to total workers in respect of total population. Litchi cultivation is one such success story. In marginal workers the state ranked 27th in 1991 and 12th in 2001. wheat yield shows a much lower gap (see Table 2. According to the 2001 census. The corresponding figures in the 1991 census were 4. The proportion of agricultural labour to total workers increased from 43. Land Ownership. with more than 75% of overall workers being either cultivators or agricultural labour.4% and 92. Further. a slight decline from the corresponding figures of 79.2% and 61. Efforts to provide legal protection to tenants (1963) through tenancy and land reforms have not met with much success. 95. The corresponding figures for the 1991 census were 95. As much as 75% of the rural poor in the state are landless or near landless. respectively.1% in 1991 to 32.3% in the 1991 census to 29. 71% and 68.2%.5% in 2001.1% and 31. The gap is particularly large in the case of rice and maize.9% among the Scheduled Tribe workers are engaged in agricultural labour.2%.8%.6% and 7. tenurial arrangements do have a significant impact on the livelihood of the poor.3%. This is a decline from 12. In main work participation the state was ranked 8th in 1991 and 23rd in 2001.7% in 1991 to 48.5% of cultivable land for distribution as compared to the requirement of 20% for redistribution. respectively.9%. One reason for this decline is attributed to the fact that during the 2001 census special emphasis was placed on netting of marginal workers.0% in 2001.7% while that of Scheduled Tribes was 23. among the Scheduled Tribes the percentage of female workers rose from 31% to 36.

there is very limited occupational opportunity outside the sector. more than 40% of household heads were self-employed and 30% had regular employment in 19992000. Over time.36 per capita per month. Per capita income in Bihar in 2005 was Rs 6719.9% of the population as compared to 21. Government of India.7%. According to the Director General of Employment and Training. respectively. The NSSO data show that wage employment in agricultural labour accounted for nearly 40% of the rural work force of Bihar in 1999-2000 as compared to 42% in 1993-94.30 and Rs 538.90 in the private sector. For the quarter ending 31 March 2003 total employment was 634. Casual non-farm labour is a last resort that households choose. New Delhi. respectively. leading to outmigration to other states. Bihar has the lowest per capita Net State Domestic Product (Rs 5772) among the states. Underemployment in rural Bihar is very high. the corresponding figures for urban areas are 28.9 percentage points between 1993-94 and 19992000. The head count indices declined in Bihar by 6. As per the latest NSSO 61st round based on Maximum Retail Price (MRP) consumption. The poor are far more likely to be agricultural wage workers or casual non-farm labourers.9% and 21.12.0 (in thousand). rather than cultivators or employed in a regular non-farm job. It is the lowest paid. compared to all-India figures of Rs 356.5 percentage points for rural Bihar. In urban areas. The total value of livestock per household among the richest is almost six times that of the poor. which again points to the continuing rural–urban gap.Table 2.5 in the public sector and 44. Thus. with 1360. and is usually unstable. with a 39. its urban equivalent was Rs 435. A majority of rural households own some livestock. Employment. Ministry of Labour and Employment. agricultural labour among the poorest has declined while casual non-farm labour and self-employed non-farm occupations have increased.00 per capita per month.87% of the population for India.60. Such a shift does not necessarily mean an improvement in occupational status.5% of the population in Bihar was below the poverty line in 2004-05 as compared to 21.9. with 590. Poverty The State Specific Poverty Line for rural Bihar in 2004-05 was Rs 354. 32.4 in the private sector. The only state worse than Bihar in this respect is Orissa. While the reduction in the head count levels was similar to the national average State of Health in Bihar 15 .8% for rural India. total employment in the organized sector in Bihar for the quarter ending 31 March 2002 was 1613. The decline was 7. The poor and socially disadvantaged household tends to own low quality livestock (goats rather than cows and buffaloes).9% figure. Crop Yield and Yield Gap in Bihar (kg per hectare) Rice Potential Yield Average Yield Gap All-India yield 3026 1218 1818 1994 Maize 4056 1844 2212 1810 Wheat 3052 1816 1236 2703 Sugarcane 62780 48856 13924 70578 Litchi 1850 1000 850 – Source: Export Potential of Indian Agriculture 2000. Agricultural labour and cultivation together accounted for around 80% of occupations in 1999-2000. People living below the poverty line in rural Bihar comprise 32. Livestock ownership.10 in the public sector and 252.

4 Source: India Development Report.6 79. Table 2.0 47 52 4. 1993-94 to 1999-2000 Headcount Index Urban Bihar India –7.1 61 29. Not surprisingly. NFHS-2 (1998-99) Human Development Index (HDI) Human Poverty Index (HPI) Health Indicator TFR NFHS-3 (2005-06) CPR IMR Safe Delivery (%) Anaemic Children 6–35 months NFHS-3 (2005-06) (%) Children Fully Immunized (%) Maternal Mortality Rate 12.3 58 47.4 –20. see Table 2. 2004-05.5 –32.7 –37.14). 2004-05) Female Literacy Rate (%) % of Girls in School (11-14 Yrs).8 53.8 371 15 16 16 16 16 15 15 11 14 14 16 12 Lowest Lowest Lowest Lowest 2nd lowest 2nd lowest 6th highest 3rd lowest 3rd lowest Lowest 5th highest 16 State of Health in Bihar .5 33.8 Poverty Gap Index Rural –20. For most dimensions of human development.of 6. Table 2.13.416 Bihar 6719 Ranking among 16 Major States 16 Ranking Status Lowest 2nd lowest 21. the state is also far below the national average on key health indicators (see Table 2.0 57 39 2.14.3% for rural and 21% for urban. the performance of the state during the 1990s fell well short of what is needed to achieve the Millennium Development Goals by 2015 (see Table 2.7 Overall –20.6 –25.5 percentage points.15).6 Rural –15.2 20.13).0 –22.18 301 32.5 87.7% were significantly higher than the national average (26.6 32.3 Urban –10.8 –27. The status of women in Bihar is low in terms of income and poverty.3 34.3 Overall –15.9 56.7 67. Selected Socio-economic Indicators of Bihar India Socio-economic Indicator Per capita income (Rs) 2005 Persons Below Poverty Line % (NSSO. both rural head count at 41% and urban head count at 24.1 53. Poverty Indices (% Change) for Bihar and India.

2 127.7 19 595 23.4 52 0.6 – 47.56* 72.4 16. 2007.10 62. State of Health in Bihar 17 . A World Bank Report.0 408 42.6 54 0.0 Achieve universal primary education Reduce child mortality Promote gender equality Literacy gap Infant mortality rate (per 1000 live births) Child mortality rate (per 1000 live births) Immunization (measles) (% children below 12 months of age) Improve maternal health Maternal mortality ratio (per 1 lakh live births) Delivery by skilled birth attendant (%) Combat HIV/AIDS.15.4 989 24.5 10.6 94.Table 2.2 77.1 11.5 75.9 42.9 0. Selected Millennium Development Goals Indicators for Bihar MDG Eradicate extreme poverty and hunger Poverty head count (%) Poverty gap Prevalence of child malnutrition/underweight children below 5 years (%) Net primary enrolment ratio (%) Bihar 1993 Bihar 1999 45.0 451 23.3 544 48.9 105. Source: Bihar: Towards a Development Strategy.71 67.08 54.5 39.44 89.9 36.0 0.0 77 0.1 63 16.8 India 1999 28. malaria and other diseases Access to safe drinking water and sanitation Incidence of tuberculosis (per 1 lakh) Contraceptive prevalence rate (%) Access to improved water sources (%) Access to improved sanitation (%) * Literacy gap figures for 2001 census.

information on fertility levels and trends consisted mainly of indirect estimates prepared by various demographers using age and sex distribution from census data. but negligible for Bihar.8. The decline in CBR is partly attributable to increase in women’s age at marriage and first pregnancy over the period.1 in 1981 to 30. Fertility Before the Sample Registration System (SRS) was introduced in India by the Registrar General of India in the late 1960s. at 0.97% from 30.3 Status of Health I.7 in 1991. Prior to the 1970s the only other source for such estimates was the National Sample Survey. The decline during 1991–2005 has been about 19% for India.4. CBR continues to be higher in rural areas (31. CBR for Bihar declined from 39. National Family Health Surveys. and is considered to be the most accurate and reliable. This is a problem common to data sources on population trends.2 present details. Making sense out of multiple and sometimes contradictory indicators available from diverse sources shows up not only the vulnerability of data sources but of various forms of errors and biases. a decline of about 21%. CBR at allIndia level declined from 33.8) in 2005. updating the trend often requires reconsideration of the estimates from the past.4 to 23. State of Health in Bihar 19 .9 in 1981 to 29.1 and Figures 3. Whenever new data emerge.1 and 3. Diverse sources such as censuses.7 to 30.2) than in urban areas (23. which also was inadequate to provide dependable estimates on birth and fertility rates. a decline of about 10%. The SRS has been providing data for estimating fertility measures. Crude Birth Rate (CBR) CBR is defined as the number of live births per 1000 population in a given year.5 in 1991. Table 3. Age Specific Fertility Rate (ASFR). General Fertility Rate (GFR). from 29. Gross Reproduction Rate (GRR). the SRS system. and Total Fertility Rate (TFR). The fertility indicators used for analysis here are Crude Birth Rate (CBR). and Reproductive and Child Health Surveys are not always in agreement and it requires caution in interpreting demographic trends in India.

2 24.8 19.1 27.4 25.2 28.2 30.0 27.9 30.7 32.8 20.3 34.6 26.5 25.4 23.2 31.4 25.6 35.4 26.8 31.1 33.5 21.1 31.4 23.9 33.2 Urban 33.1 32.9 28.0 19.0 31.6 24. CBR for Bihar and India Compared.2 31.5 26.9 37.3 23.2 29.3 34.0 25.4 32.6 23.6 23.9 30.6 37.4 24.1 Figure 3.6 Urban 27.3 37.0 29.3 35.4 27. Rural and Urban SRS 1981-2005 20 State of Health in Bihar .8 Total 33.1 20.0 24.5 30.7 33.8 24.1 23.0 25.8 31.1 32.1 32.2 26.9 25.3 35.1 33.5 33.2 25.6 31.1 37.2.5 30.6 30.9 32.6 23.1 23.5 27. SRS 1981–2005 Year 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Total 39.7 30.0 33.5 32.5 36.4 28.7 20.7 37.6 27.3 32.7 28.8 23.1 35.Table 3.7 40.3 33.8 36.3 38.5 27.9 30.6 28.1.1 26.1 27.1 30.3 27. SRS 1981–2005 Figure 3.3 31.0 19.6 25.3 34.1 23.9 32.9 30.1 33.8 India Rural 35.3 32.1.8 32.0 27.1 25.7 32.2 30.7 33.1 22.8 30.5 29.7 24.6 21.3 29.8 33.5 23.3 25.6 32.5 31.1 33.4 Bihar Rural 39.4 30.2 33.6 31.9 31.0 32.9 32. CBR for Bihar and India.8 37.7 23.5 32.1 31.2 39.3 23.1 32.6 38.7 21. CBR for Bihar.2 37.3 20.7 28.5 37.7 30.7 31.1 29.8 25.3 28.

Table 3. State of Health in Bihar 21 . Maharashtra and Andhra Pradesh) exhibits values below the national average. GFR for all-India is 95.5 97. Bihar and India.3. defined as the number of live births per thousand women in the reproductive age group (15–49) in a given year. Uttar Pradesh and Madhya Pradesh).5 167.9 136.1 137. The ASFR for Bihar also peaks in the age group 20–24 (0.1 95. SRS 1996-2005 Figure 3.9 106.4.3 and Figures 3. It is seen from Table 3.8. GFR for rural areas is again the highest among states at 144.3 98. Karnataka.0 in urban areas.8 132. Figure 3. GFR is high in northern India (Rajasthan.4 126.106). SRS 2005 Age Specific Fertility Rate (ASFR) ASFR is fertility rates calculated for specific age groups to see the differences in fertility behaviour at different ages or for comparison over time.2 and 3. Tables 3. while southern India (Kerala. This regional difference is attributed to the knowledge of fertility.2 102. Table 3.2 130. for Bihar and India.6 95.4 and Figure 3.9 140.6 compares ASFR for rural and urban Bihar for 2005.4 present details. The corresponding figure for Bihar.5 compares data for ASFR for Bihar and India over the last 25 years.5 109. SRS 1981–2005 Year Bihar India 1981 1986 1991 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 139. 70.5 119.2 in rural areas.4 142.4 99. GFR. and 101.6. is the highest among the states.2 138.8 136.5 147.0 134. The National Family Health Survey (NFHS) III has also estimated ASFR. which is low for all ages in urban areas of Bihar than rural areas.8 174. Bihar and India by residence.274) and gradually declines after the age 30–34 (0.2.5 that fertility peaks in the age group 20–24. is a more refined measure than CBR because it specifically relates to the reproductive age. in Bihar the decline occurs after 35.2 112.General Fertility Rate (GFR) GFR.3 and 3.6. In India fertility declines after the age of 30. Tamil Nadu. 139.9 137.9 in urban areas and 106. Haryana. GFR.6 Figure 3. GFR.5 103.

4 171.0 264.5 India 76.3 180.5 71.5 229.5 71.2 51.1 Urban 28.0 134.4 246.2 Source: Sample Registration System.3 9.5.4 56.9 54.9 223.8 216.3 54.5 2308.0 275. 1981–2005 Age Group 1981 Bihar 15–19 20–24 25–29 30–34 35–39 40–44 45–49 114.6 43.4 87.6 28.4 274.5 244.1 59.1 Figure 3.6 35.4 170.1 112.0 18.4 21.4 112.4 160.6 60.3 19.1 167.6 37.1 116.7 18.4 274.6.1 33.5 277.9 21.5 225.0 53.4 Total 45.9 165.9 253.9 104.9 223. Registrar General of India.4 246.6 30.3 98. Gross Reproduction Rate (GRR) GRR measures the average number of female children a woman is expected to give birth to during her entire reproductive span conforming to ASFR for a given year if there is no mortality.7 184.0 127.Table 3.0 India 45. ASFR for rural and urban Bihar for SRS 2005 Table 3.7 102.0 16.6 12.0 73.0 16.0 145.3 117 66. New Delhi.1 5.9 India 91.0 64.0 229.0 20.1 234 191.3 India 48.9 14.0 280.2 78.2 2001 Bihar 53.9 232.1 1996 Bihar 52. ASFR Bihar and India.6 113. ASFR.8 30.0 Bihar Rural 59.5.5 8.3 10. ASFR for Bihar and India.8 249.9 26.2 225.2 India Rural 52.4 139.3 34.7 6.1 165.2 171.1 252.6 233.5 49.3 2005 (current) Bihar 56.2 99.7 6.2 India 90.4 160.9 2.5 44 19. 22 State of Health in Bihar .5 225.4. Bihar and India.9 215.9 74.9 177.6 1986 Bihar 113.2 171.1 165.2 7.9 1991 Bihar 78.0 203.4 187.4 87. SRS 2005 Figure 3.0 18.5 28.3 India 55.4 214.1 41. SRS 2005 Age Group Total 15–19 20–24 25–29 30–34 35–39 40–44 45–49 56.6 15.2 51.3 229.1 188.2 Urban 38.

1 1. This overlaps with other structural factors such as links between economics. and to some extent in the East.9) reflect that there is a clear trend of decline in TFR for India whereas for Bihar TFR declined to 3. Table 3. which is the highest among the states.5 2. TFR is influenced by the social importance attached to marriage. and low economic value ascribed to women in a patriarchal society.7. GRR for Bihar and India.3 1981 2. are better off and have greater autonomy.5 1976 n.1 1.7 in NFHS-2 and again increased to 4 in NFHS-3.4 compared to 2.2 1986 2.8 compares TFR data for Bihar and India for 1981–2005.3 in 2005 is the highest among the states. The Hindi-speaking core region (including Bihar) is characterized by high fertility due to a patriarchal value system.a. 3.4 2004 2.4 2005 2. Rural and Urban.8. assuming that ASFR continues to be the same and there is no mortality.1 1. TFR for Bihar at 4. Figure 3. Data from NFHS (Table 3.9 1.7 illustrates the trend. This is further compounded by regional diversity of economy and social development and gender biases in kinship structure. New Delhi.7 and Figure 3. The link between high fertility and high female mortality in Bihar is statistically significant. child mortality.4 2003 1. Women in the South. active discrimination against women.9 illustrates the data of Table 3. pronounced economic underdevelopment. culture. SRS 1981– 2005 Figure 3.1 1.a. Figure 3.6.1 in Bihar.0 1. CBR for Bihar. 2. Table 3. and female child survival.7 1996 2. and female work force have the most significant effect on fertility.7 2. Table 3. Table 3.5 2002 2. 1971–2005 Year Bihar India 1971 n. Registrar General of India.6 2000 2.9 graphically. SRS 1981–2005 Total Fertility Rate (TFR) TFR indicates the average number of children expected to be born to a woman during her entire reproductive span. Fig. State of Health in Bihar 23 .8 provide the break-up by residence for 2005.6 compares GRR data for Bihar and India for 1971–2005. education.The estimated value for GRR in India in 2005 is 1. GRR. 2. Sex ratio.0 1.4 Source: Sample Registration System. and exclusion of women in education and development.0 1991 2. Bihar and India.

2 3.3 4.0 3 2.8 4.6 3.6 4.4 3.5 3.68 Figure 3.3 4.8 2.1 3.5 3.9 4.5 3.9 3.5 3.1 3.6 4.6 5.4 5.8 4.5 4.1 Table 3.5 5.1 2.2 5.3 3.5 4.3 4.5 3.7 4.7 4.9 4.9 3.4 3.2 4.4 Urban 4.3 2.3 3.3 3.4 2.5 4.5 5.3 2.1 4.3 5.6 4.3 4.5 4.9.6 6.4 4.4 3.2 3.4 5.5 4.85 2.1 2.1 4.1 3.5 4.9 3.Table 3.9 4.0 5.9 3.5 4.4 3.5 4.4 2.2 3.7 5.2 4.8 3.2 3.4 4.5 3.2 3.3 4.4 5.1 3.0 3.7 4.8.2 4.9.6 4. TFR for Bihar and India as per NFHS data 24 State of Health in Bihar .9 5.6 4.7 2.1 3.6 4.4 3.5 4.3 3.2 3.8 4.1 3.2 3.8 4.7 4. TFR Bihar and India as per NFHS Data Bihar NFHS-1 (1992-93) NFHS-2 (1998-99) NFHS-3 (2005-06) 4 3.8 3.7 4.2 4.3 2.9 2.39 2.6 2.1 3.4 3.8 4.2 2.5 4.6 3.3 3.3 3.6 5.4 4.8 3.4 3.4 4.5 4.2 4.7 3.6 3.5 4. SRS 1981–2005 Year Total 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 5.3 Bihar Rural 5.3 3.4 2.4 4.6 2.9 3.8 4.7 5.7 2.7 3.4 4.9 4.2 2.74 4 India 3.8 2.2 Total 4. TFR for Bihar and India.4 4.5 4.4 4.8 5.5 3.1 3.9 India Rural 4.5 3.2 Urban 3.3 5.5 3.2 4.8 2.4 3.

9 66.0 66. The challenge to still reduce CDR is going to be control of mortality due to non- State of Health in Bihar 25 .8 to 7.2%.10 Crude Death Rate (CDR) CDR is defined as the number of deaths per 1000 population in a given year. IIPS.5 66.3 59. Mortality Life Expectancy Life expectancy is the number of years a person would live.8 in 1991. It is seen from Table 3. Source : Table 3. access to modern system of medicine. a fall of about 1.8 58.2 67. Life expectancy in Bihar and India.7 57.10 in terms of gender and residence for 2000.9 61. Figure 3.11 that the declining trend in CDR has been fairly steady.8 to 8.8 Urban Male 62. Ram.1. CDR at all-India level declined from 12.6. for Bihar the decline has been negligible.5 60.4 61. with a disturbance in 1992 and thereafter for about six years.8 Total 64. that as of mid-2000 life expectancy at birth for Bihar is 60. 2000. It is seen from Figure 3.2 59. mid-1990 India.0 56.9 in 1981 to 9. Figure 3.10.10.8 64.4 56.9 Rural Male 57. improved basic infrastructure such as safe drinking water and development activities in Bihar. and again a minor spurt in 2004. CDR for Bihar declined from 13.11 compares data for India and Bihar over the period 1981–2005.9 Female 57.4%. by gender and residence population. The declining trend in CDR has been attributed to better health infrastructure.2 57.8 Male 58. calculated on the basis of current death rates at any given point of time. a fall of about 1.5 62.4 Female 59.1 Female 65.3 66. Figure 3.5 years) than men (61. Chander Shekhar and S K Mohanty. mid-2000 Bihar.4 years). The state also shows a trend of shorter life span for women (59.3 60.10.6 61. 1990 and 2000 Total Total India.II.4 55. Table 3.1 64. which presents life expectancy figures for Bihar and India for 1990 and 2000. 2005 Figure 3. from 9.10 illustrates the data of Table 3. Human Development: Strengthening District Level Vital Statistics in India.5 in 1981 to 9.12 presents the trend for Bihar in terms of residence.6 61.6 58.8 as compared to 62.11 illustrates the trend graphically.1 69. control of communicable diseases.5 for India. mid-2000 58.9 60.5 Total 57.8 67.5 Source: F. For India during 1991–2005 the decline has been about 0. which is against the national trend of higher life expectancy for women. from 9.4 63. mid-1990 Bihar.7%.8 in 1991. Life Expectancy Figures for Bihar and India. It gives the survival rate rather than the health status of the Table 3.

3 9.4 7.3 6.0 8.6 6.1 13.8 7.3 9.9 9. SRS 1981–2005 Figure 3.2 7.4 9.2 7.0 12.5 15.4 7.1 8.0 Figure 3.6 6.1 13. along with the emerging new diseases and re-emergence of old diseases.6 12.2 6.2 10.0 10.1 6.2 9.9 6.2 12.9 11.0 8.5 11.4 11.5 8.0 8.5 10.9 6.2 8.12.1 10.7 9.6 11.6 India Rural 13.1 6.0 5.3 8.1 8.0 7.9 10.0 8.8 6.0 13.3 6.1 8.5 8.7 9.0 14.6 7.4 13.1 10.6 9.1 9.3 Urban 8.5 10.0 11.4 10.1 8.9 5.4 8.4 9.8 6.0 12.6 10.2 8.5 1. SRS 1981–2005.7 6.1 Urban 7.3 6.7 8.8 10.0 7.3 6.communicable diseases such as cancer.4 8.8 8. CDR for Bihar and India. CDR for Bihar. Table 3.9 8.0 5.7 8.9 10.3 9.7 6.6 9.9 8.4 10.7 9.6 10.5 6.0 10.1 8.2 6.1 12.1 15.9 8.6 Total 12.7 8.9 12.8 7.1 7.0 9.0 7.8 13. by residence 26 State of Health in Bihar .8 10.0 2.9 6.1 7.8 13.3 9.9 10.11.6 10.8 10.11.2 11.7 13.9 14. CDR for Bihar and India Compared.6 13.0 5.8 9.8 11.5 6.7 9. SRS 1981–2005 Year 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Total 13. diabetes and other degenerative disorders.7 7.6 7.1 10.4 9.1 7.8 6.5 7.8 7.9 7.7 9.1 Bihar Rural 14.0 9.9 11.2 6.6 14.1 9.9 10.8 8.5 15.1 13.7 14.5 6.8 13.5 7.1 6.

9 4.7 5. ASDR provides a better and clearer understanding of mortality statistics.12.7 24.3 6. ASDR for Bihar and India. Because mortality varies by sex and race.2 60. Table 3.4 3.6 57.3 India Rural 70. Figure 3.0 2.13 (a) and (b) illustrates these data graphically.6 1.5 3.7 2.0 22.0 2.3 1.8 176.6 14.8 1.0 15.9 32.2 4.6 124.5 20.9 56.7 13.4 7.0 Bihar Rural 69.5 5.6 1.4 10.7 19.0 2. SRS 2005 Figure 3.0 106.6 5.6 2. ASDR is often given separately for males and females and by residence.9 Figure 3.2 2.1 3.13b.3 49. Figure 3.7 5. CDR is only a rough estimate of mortality.0 2.3 1.9 12.3 1.4 2.3 21.8 10.8 106.2 2.5 2.1 33.4 13.4 3.7 169.2 77.7 45.7 3. by residence State of Health in Bihar 27 .9 2.4 4.5 20.Age Specific Death Rate (ASDR) Age Specific Death Rate or Age Specific Mortality Rate (ASMR) is calculated for specific age groups in order to compare mortality at different ages or at the same age over time.1 2.7 Urban 45.5 22.0 6.8 9.9 17.1 1. SRS 2005.4 4.6 1.2 5.5 116.7 Urban 41.4 153.5 1.3 Total 63.3 3.3 2.8 7.5 1.0 72.4 8.7 1.2 7.1 13. Table 3.13 presents data by broad age groups for 2005.0 2. SRS 2005 Age Group Below 1 1–4 0–4 5–9 10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85+ Total 67.1 3.8 11.8 3.4 5.0 33.14 illustrates the data graphically.1 2.0 8.9 2.2 107.13a.3 156.6 52.2 58.1 2. Table 3.12 provides data for ASDR for Bihar and India by residence for 2005.3 7.2 2.6 24.4 54.2 32.3 31.3 1.5 152.9 0.0 30.0 2. ASDR for Bihar and India by Residence.2 2.0 68.9 115.3 0. ASDR for Bihar.7 19.7 2.4 166.3 2.8 74.6 0.8 1.

8 4.9 9.0 22.7 19.2 23. Table 3.8 15.14. Bihar and India.6 13.2 19.15 and Figure 3.Table 3.2 10.8 15.9 20.8 11.3 42.3 10.9 28. Distribution of deaths by broad age groups.5 20.6 19. with 22.9 23.0 15.14.5 13.2 21.9 22. SRS 1995–2005 28 State of Health in Bihar .0 India 18.14 that the record of the state in child mortality lags far below the national record. Table 3.5 32. Bihar and India.2 25. Bihar and India.1 16.5 19.9% infant deaths (0–1 year) against the all-India figure of 18.4 27.7 11.13.3 27.2 19 19 Urban 15.2 10 10 Figure 3. SRS 2005 Child Mortality It is seen from Table 3.5 17.0 12 15 Total 24. An important facet noted from the data is that mortality in this age bracket rose in Bihar in 2005 while the national trend has been of consistent decline.8 17.5 11.5 21.4%.4 17 20 Bihar Rural 28.0 14. Major causes of child mortality are pneumonia.0 23.16 (a) and (b) present the trend in <5 year mortality by residence for the country as a whole and for Bihar.8 17.4 14.1 29. Table 3.5 5.1 22. SRS 1995–2005 Year 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Total 28.5 19.4 23.2 13.5 26.5% for toddler deaths (1–4 years) against the all-India figure of 5. measles and malnutrition.8 Figure 3. Child mortality rate in Bihar and India.4 17 17 India Rural 26.9 21.5% and a figure of 9.2 17.9 25.7 19.4 17. Distribution of Deaths by Broad Age Groups.15 present figures for child mortality for Bihar and India for the decade 1995–2005.7 36.2 19.1 12.6 21.3 17.15.8 24.13 and Figure 3. diarrhoea.14 and Figure 3.9 17 21 Urban 21. SRS 2005 Age Group <1 1–4 0–4 5–14 15–59 60+ Bihar 22.4 19.5 6.7 21. Child Mortality Rate.

1 17.8 n.9 19. 23.3 30.9 11.2 17. n.6 19.7 25.5 25. 28.6 20.7 22.8 16.3 19.8 21.5 10.5 19.2 13.8 23.2 n.6 18.7 33.8 32.2 20.8 14.2 12.3 31.6 31.5 11.a.2 29.8 26.9 28.2 R 26.6 33.3 17.8 20.2 23.a.7 18.3 14.4 12.6 20.3 11.8 17 15. Child mortality rate for Bihar.8 < 5 death rates by residence Rural T 19.0 10.4 18.7 19.a.1 34.3 20.9 11.7 32.9 31.8 17.9 31.4 17.5 24.a.2 13 10.3 18.7 22. n. F 18.4 U 15.5 22.16.7 28.a.a.5 13.a.2 12.8 n.9 26 16.9 n.3 15.5 27.2 21.3 10.6 26. 24.6 F 20.9 n.1 18.2 28.6 19.3 35.1 17.8 n.7 19.4 20.a.4 29.5 17.8 11.8 32.5 24.7 34.a.5 18. 14.4 19.9 14.2 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 India Bihar India Bihar India Bihar India Bihar India Bihar India Bihar India Bihar India Bihar India Bihar India Bihar India Bihar T 17. n.8 16 n.1 F 11.6 15.15.9 31.2 18.7 9.2 28.5 27.4 27.7 25.9 19.a. SRS 1995–2005 % <5 mortality to total deaths by residence T 23.6 18.a.4 20.4 19.8 12 17.7 n.a.4 26.0 16.7 18.3 25.a.a.5 28. n.5 24.9 33.5 21.2 21.2 18.3 8.5 34.7 16.5 29.a.5 20.Table 3.3 17.8 17.2 19.7 26.9 18.6 25.8 25.5 T 10. n.3 13.0 15.2 23.5 23.9 Urban M 9.5 n.3 19.5 n.1 22.2 15.2 27. SRS 1995–2005.7 17.5 21.3 20.1 22.4 26. M 18. 30.1 18.1 16.8 31.2 17. Bihar and India.2 26. n.7 11. 21.7 31.3 10.1 10.8 11.3 18.a.5 19. 26.1 24.2 24.4 17.6 13.1 17.9 31. by residence State of Health in Bihar 29 . 32.8 11.2 21.1 17.8 15 21.9 25 24.a.5 14.9 11.4 16.8 18.4 30.6 22. 25.a.1 24.3 26 Note : Data not available for 1997 Figure 3.6 14. 14. n.7 18.8 21.2 26.5 19.a.4 15.a.2 n.7 16.9 21.5 11.1 25.9 32.a.7 n.5 32 <5 deaths rates by gender M 16.8 16. 13.0 26.1 21.1 20.8 31.6 19.9 21 21.1 18. n.7 15.a.8 15.7 26.2 21.9 29.3 34.2 13.2 23.a.6 11.7 23 20.1 33.8 19.8 17. n.a.4 23. n.2 21.1 12.9 22.1 20.7 28.9 23.5 12.2 n.1 26.1 10. n.3 32.1 35.7 15.6 19.5 17.4 19. Proportion of <5 Mortality to Total Deaths.

9 18.3 18.3 13.a.0 19.0 20.1 Total 23. SRS Bihar 1995–2005 30 State of Health in Bihar .0 12.17).3 n. 22.Infant Deaths The state also has a high rate of infant deaths to total deaths.3 22.6 13. It is a mater of particular concern that over the past ten years (1995–2005) the proportion of infant deaths have risen. 14.2 n.4 22.0 22.4 21.6 Figure 3. Infant Deaths as Percentage of Total Deaths in Bihar and India.a.7 13.1 20.5 20.9 n. 22. 21.4 22. and the rural areas solely account for this trend of increase (see Table 3.2 21.3 14. Within the state.16 and Figure 3.7 18.8 24.1 Urban 16. against the trend of decline at the national level.5 Urban 19.6 n.3 23.4 23.0 22. the rate of infant deaths has been declining in urban areas.5 22.0 21.4 n. 22.4 19.16.6 15. 18.5 14.a.17. Infant deaths as percentage of total deaths by residence.a.2 22.3 19.2 20.6 19.5 23.7 n.1 12.6 18.7 18.6 23.a.1 22.1 23.9 Bihar Rural 22. SRS 1995–2005 Year Total 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 22.a. Table 3.2 20.5 India Rural 24.4 18.6 23.7 23.5 22.9 23.4 23.7 20.1 19.7 17.

Figure 3. however. The decline in the decade of 1991–2001 has. been only 7 percentage points. from 118 in 1981 to 69 in 1991. In the period 2001–05 the figure fluctuated between 60 and 61. considered to be one of the most sensitive indicators of health and development.18 illustrates the trend for the state by residence.17 presents data for IMR for Bihar and India for 1981–2005.17.17 that IMR declined dramatically in the decade of 1981–91 by 49 percentage points. It is seen from Table 3.Infant Mortality Rate (IMR) IMR. Table 3. Table 3. from 69 to 62. is defined as number of infant (under age one) deaths per thousand live births in a given year. SRS 1981–2005 Year Total 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 118 112 99 95 106 101 101 97 91 75 69 73 70 67 73 71 71 67 63 62 62 61 60 61 61 Bihar Rural 124 116 102 97 109 104 104 99 93 77 71 74 73 68 74 73 73 68 64 63 63 62 62 63 62 Urban 60 60 65 79 62 68 72 70 63 46 46 49 41 61 57 54 53 51 55 53 52 50 49 47 47 Total 110 105 105 104 97 96 95 94 91 80 80 79 74 74 74 72 71 72 70 68 66 63 60 58 58 India Rural 119 114 114 113 107 105 104 102 98 86 87 85 82 80 80 77 77 77 75 74 72 69 66 64 64 Urban 62 65 66 66 59 62 61 62 58 50 53 53 45 52 48 46 45 45 44 44 42 40 38 40 40 State of Health in Bihar 31 . Infant Mortality Rate for Bihar and India by Residence.

18. Over the past ten years the gap in IMR between Table 3.Figure 3. i. It is seen from the table that IMR has declined in Bihar over the past ten years. Infant Mortality Rates by Sex. in urban area and rural area. SRS 1995–2005 T 58 61 58 61 60 60 63 61 66 62 68 62 70 63 72 67 71 71 72 71 74 73 Total M 56 60 58 60 57 59 62 56 64 57 67 62 70 63 70 67 70 72 71 68 73 75 F 61 62 58 63 64 62 65 66 68 68 69 61 71 62 73 66 72 71 73 75 76 71 T 64 62 64 63 66 62 69 62 72 63 74 63 75 64 77 68 77 73 77 73 80 74 Rural M 62 61 64 61 63 59 67 57 70 57 72 64 75 64 76 68 76 73 76 70 78 76 F 66 63 63 65 69 65 72 67 74 69 76 61 75 63 79 69 79 73 79 76 82 72 T 40 47 40 47 38 49 40 50 42 52 44 53 44 55 45 51 45 53 46 54 48 57 Urban M 37 45 39 44 33 59 40 47 41 49 45 42 47 53 42 65 46 61 48 50 49 60 F 43 50 40 50 34 37 39 53 44 56 42 64 40 58 49 37 44 45 44 59 47 54 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 India Bihar India Bihar India Bihar India Bihar India Bihar India Bihar India Bihar India Bihar India Bihar India Bihar India Bihar 32 State of Health in Bihar . Bihar SRS 1981–2005 Disaggregated data by sex for IMR are available only for the decade 1995–2005 (see Table 3. Bihar and India. more sharply in urban (17 points) than rural areas (10 points).18). Female IMR is higher in all categories.e.18. Infant mortality rate by residence. in total population.

early neo-natal mortality rate. Table 3.4 Urban –18. birth interval less than 24 months. including data for neo-natal mortality (early and late). neo-natal deaths to total infant deaths. Disaggregated data collection for infant mortality commenced from 1997.1 Urban –21. Table 3. Peri-natal mortality rate is defined as the number of stillbirths.2 India Rural –19. A majority of infant deaths are preventable by simple interventions provided through the healthcare delivery system. infection load in the community.6 –14.3 –11. SRS Period Total 1993–95 to 2003–05 1983–85 to 1993–95 –18. The desired impact has not been felt since the health of a child is dependent on the level of nutrition. are the age of the mother. Bihar and India. untrained birth attendants. The lower figures presented for the state as compared to the all-India figures for neo-natal mortality rate. Peri-natal mortality is a sensitive indicator of standards of healthcare prior to and during pregnancy and childbirth as well as the effectiveness of social support to the vulnerable segments of population. acute respiratory tract infection and diarrhoea.2 Total –20. post-neo-natal mortality. Table 3.3 whereas the estimate for the state is 20.19 illustrates the trend of neo-natal mortality rate for the state by residence for the decade 1995–2005. Figure 3. interventions that address the major post-neo-natal causes of death.1.19 presents data for average percentage change in the average of infant mortality between 1983–85 and 1993–95 and between 1993–95 and 2003–05.rural females and urban females has increased.7 –16. Neo-natal mortality rate is further considered in terms of early neonatal mortality rate (number of infant deaths of less than 7 days) and late neo-natal mortality rate (number of infant deaths of 7 days to less than 29 days). peri-natal mortality rate. previous stillbirth/pre-term birth. The main cause of infant deaths has been premature/low birth weight. Identified risk factors that have direct impact on peri-natal deaths.19. early neo-natal deaths to total infant deaths. State of Health in Bihar 33 .8 –15.20 presents disaggregated data for neo-natal mortality and peri-natal mortality for the state and for India for 1995–2005. Post-natal mortality has declined more than peri-natal and neo-natal mortality because programme interventions have focused on immunization and the management of diarrhoea and acute respiratory infection. and economic and environmental factors. as validated by ICMR.20 presents the trend in the share of neo-natal deaths to infant deaths. together with infant deaths of less than 7 days per 1000 live births and stillbirths in a given year. Peri-natal mortality rate has shown only a marginal decline during the last decade. and peri-natal mortality. Percentage Change in IMR.7 Neo-natal Mortality To have an idea about the various components/elements which make up infant mortality. Stillbirth rate is estimated as the ratio of the number of stillbirths per 1000 live births and stillbirths in a given year.4 –20. Figure 3.0 –20. and estimated stillbirth rate may be on account of underreporting in the state.2 Bihar Rural –18. low birth weight. The death rate of children below the age of five years by residence at the national level is estimated at 17. it is considered in terms of neo-natal mortality (up to 28 days) and post-neo-natal mortality (from 29 days through 11 months). and illiteracy.

a.3 50.9 1 2 40.1 61.0 63.3 42.7 2 0 53. n.1 54.4 32. 2 9 65.a. n.9 48.1 2 5 55.4 2 5 49.8 66. n.8 63. Disaggregated Neo-natal Mortality and Peri-natal Mortality Rates.3 1 9 47.4 62.2 62.8 1 4 44.a.3 36.6 2 4 62.4 58.1 38.9 59.1 41. Share of neo-natal deaths to infant deaths by residence.4 57.19.0 3 0 63.5 64.a.8 60.3 60.8 54.1 n.a.6 48.3 1 7 41.6 1 3 45.2 2 3 48.6 42.8 60. n.4 39.Table 3.0 2 9 64.3 69.0 55. n.a.8 3 7 63.a.1 51.5 55.a. SRS 1995–2005 34 State of Health in Bihar .9 27. n.8 46.5 60.1 2 8 64.2 41.9 16 4 2 42.9 42.9 50.6 2 2 61.4 1 8 32.3 2 2 48.7 37. n.0 2 9 68.5 2 2 47.5 2 4 64. Neo-natal mortality rate by residence.4 27.1 2 3 49.8 27 6 3 63.4 63. R 31 29 29 23 28 20 29 26 30 26 35 32 37 32 37 34 37 34 n. SRS 1995–2005 Neo-natal mortality % share of neo-natal deaths to infant deaths U T R U Early neo-natal mortality % share early neo-natal deaths to infant deaths by residence T R U Peri-natal mortality rate by residence T 37 30 35 24 33 22 35 29 36 30 40 34 44 35 42 37 44 39 45 39 R 40 31 39 25 36 22 38 31 39 29 44 35 47 36 45 38 46 39 48 39 U 24 14 23 14 20 22 23 16 25 32 26 22 30 28 29 24 32 36 31 37 Stillbirth rate by residence T 2005 India Bihar 2004 India Bihar 2003 India Bihar 2002 India Bihar 2001 India Bihar 2000 India Bihar 1999 India Bihar 1998 India Bihar 1996 India Bihar 1994 India Bihar 37 32 37 33 37 34 40 37 40 39 44 42 45 41 45 44 47 45 48 44 R 41 34 41 34 41 34 44 38 44 39 49 44 49 43 49 45 50 47 52 45 T 28 28 26 23 25 20 27 25 27 27 32 31 34 31 34 33 35 33 n.7 58.9 57.a.0 3 2 61.5 2 4 46.a.8 44.2 37.2 31.9 63.6 49.1 64. n.20.9 49.3 45.1 61.3 61.8 60.20.9 44. Bihar. SRS 1995–2005 Figure 3.a. Bihar and India.1 36.6 2 8 65.8 30 4 3 41.0 62. Figure 3.3 2 5 61.9 44.6 49.7 66. Bihar.7 69.0 45.8 51.7 46.1 1 6 47.8 2 7 65.1 2 9 65.9 52.5 65.4 47.9 57.1 65.9 65. n.6 3 4 60.5 1 3 36.3 1 4 41.1 Note: Data not available for 1997.0 39.7 2 0 51.6 65.6 54.4 47.2 1 8 53.3 27.a.4 48. U T 9 2 10 1 9 3 9 4 9 3 8 3 10 4 9 4 9 6 9 7 R 9 2 10 1 9 3 9 5 10 3 9 3 11 4 9 4 9 5 9 6 U 8 1 8 1 8 5 7 2 8 2 7 2 8 3 8 2 9 13 9 14 2 3 62.

Maternal mortality implies death of women in the prime period of their lives and has a major impact on their families. with a woman dying of childbirth and pregnancy-related complications every 12 hours. New Delhi. SRS 2003-04 overall socio-economic development. Even at the national level. and adequacy or inadequacy of healthcare system. Causes of maternal death.A leading cause of neo-natal mortality is low birth weight (LBW). Table 3. Maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy. Registrar General of India.21. About 80% of neo-natal deaths occur in LBW infants. but failed to confirm statistically the possible rise in the level of maternal mortality (IIPS and ORC Macro 2000). the pregnancy or its management but not from any accidental or incidental causes.21 and Figure 3. social status of women. Maternal deaths are now rare in developed countries but unfortunately remain common events in developing countries. 1995).000 households. the survey could not produce regional or state estimates because the sample was too small. Maternal mortality should also be viewed as the tip of the iceberg of maternal morbidity.000 live births. Bihar. NFHS-1 (1992-93) was the first to provide a national estimate of 424 maternal deaths per 1. The state has the fifth-highest maternal mortality in the country.22 present the various estimates State of Health in Bihar 35 . irrespective of the duration and site of the pregnancy.21 illustrates the main causes of maternal deaths in Bihar in 2003-04. Maternal mortality rate (annual number of maternal deaths per 1.000 women of reproductive age) is another measure. the sample inadequacies of the NFHS came into sharp focus when NFHS-2 (1998-99) produced a maternal mortality estimate of 540. a sensitive indicator of Figure 3. MMR for Bihar for the period 2001–03 was 371 as compared to 301 for India. Sample Registration System by the Registrar General of India (2007). MMR is a sensitive indicator of the status of women.00. Figure 3.00.00. is defined as the annual number of maternal deaths per 1. which reflects both the risk of deaths among pregnant or recently pregnant women and the proportion of all women who become pregnant in a given year.000 live births for the two-year period preceding the survey (IIPS. from any cause related to or aggravated by Source: Sample Registration System. Reduction in the occurrence of LBW babies and improvement in mean birth weight may be a key to improve neonatal and infant survival in the state. Although it surveyed nearly 90. MMR can be reduced either by making childbearing safer and/ or by reducing the number of unwanted pregnancies. Causes and Risk Factors. which may be directly/indirectly attributed to maternal origin (mostly due to maternal malnutrition and lack of antenatal care of expectant mothers). According to the latest MMR figures published in Maternal Mortality in India 1997–2003: Trends. Maternal Mortality Ratio (MMR) MMR.

Orissa. While fertility impacts strongly on mortality rates.8 per cent in these states. Maternal deaths can be reduced if all unwanted pregnancies are prevented. if childbearing is confined to the age group of 20–39. high fertility has several adverse consequences for economic and social development. 540 879 580 612 479 Note: Figures for Bihar include those for Jharkhand. infant and child mortality is also a major determinant of fertility rates. if age of marriage and first child is delayed and a minimum period of three years between births can be ensured. Uttar Pradesh. 453 451 408 452 407 n. There has been substantial decline in MMR during 1997–2003. High fertility rates also have a direct bearing on human capital formation. roughly equivalent to one death every five minutes. The pregnancy pattern in Bihar with too early. Table 3.22. Thus. Even going by the most conservative estimate of 400 maternal deaths per one lakh live births means that more than one lakh women die every year in India due to causes related to pregnancy and childbirth. Poor households facing a high rate of infant and child mortality tend to have a large number of children.a. Though the estimates vary with different methodology used this does not change the stark fact that MMR in India is still very high. Figure 3. Uttaranchal combined (the Empowered Action Group or EAG states) and in Assam. Madhya Pradesh. 424 n. High fertility rates and childbearing patterns also have a bearing on age structure and high youth dependency ratio. RGI 2007 MMRUnicef FOGSI 1995 1992–94 SRS 1997 SRS 1998 NFHS-1 1992-93 NFHS-2 1998-99 Mari Bhatt 1982–86 Mari Bhatt 1998-99 1997-1998 Retrospective MMR Surveys 531 398 1999–2001 SRS Prospective Household Reports 400 327 2001–2003 Special Survey of Deaths using RHIME 371 301 Bihar India 572 1668 n. too many and too close together enhances the risk of maternal mortality and complications. by 16 points per year. Status of Maternal Mortality Ratio in Bihar and India.21. Various estimates of MMR for Bihar About two-thirds of maternal deaths occur in the states of Bihar. This translates into 300 Indian women dying every day during childbirth or because of pregnancy-related causes. Chhattisgarh. Rajasthan. The lifetime risk of a woman dying of or in childbirth is 1. if third and higher order of births are reduced.a.for MMR for Bihar and India. with low investment by parents on each child’s education and health. Jharkhand.a. 36 State of Health in Bihar .

2 2021–25 17.5 3.7 68. CBR will reduce to 17.0 73.6 40. CDR to 6.0 70.6 44. State of Health in Bihar 37 . 2006. 2006–2025 Indicator Crude birth rate Crude death rate Infant mortality rate Under-5 mortality rate Total fertility rate Life expectancy of males Life expectancy of females 2006–10 24. Table 3.4 2. and under-five mortality to 54.7 6.6 68.2 6.4 Source: RGI.0 in 2025. projections for mortality and fertility indicators were made.1 54.22.6 2.22 provides projections for the next 25 years for the key mortality and fertility indicators for Bihar.4.6.7 2016–20 19. The projections show that by 2025.Projections for Mortality and Fertility Indicators In the document on population projections by the Registrar General of India. Projected Mortality and Fertility Characteristics of Bihar.7 37.4 6. Table 3.7 2011–15 21. 2006.7 50. Life expectancy for males will be 70.6 59.6 71.4.1 66.7 2. Population Projection for India and States 2001 to 2026.6 6.3 89.5 65.3 67. Report of the Technical Group on Population Projection constituted by the National Commission on Population 2006.6 70.7. The state will reach replacement level fertility of 2.6 and for females will be higher at 71.

38 State of Health in Bihar .77 95. Communicable Diseases Kala-azar The sand fly that transmits kala-azar (medical term Visceral leishmaniasis) multiplies in the cow dung villagers use to plaster their houses or as cow dung cakes for fuel.23.26 Bihar (5) 204 160 187 107 124 169 Deaths All India (6) 213 168 210 156 157 187 col. Bangladesh.23 presents the figures for occurrence of kala-azar both in Bihar and India since 2001. and leads to cardiovascular complications resulting in death. In 2000 the numbers were low but started rising from 2003. malaria. (5) as % of col. Mortality figures fail to reveal morbidity status or disease profile of the people. In the 1977 epidemic of kala-azar about one lakh people died.3% of kala-azar cases and 90. Around 90% of cases around the world are found in India.000.3% of deaths in the country.64 71.5 million children below the age of five and an equal number of young adults every year. Table 3.82 76.38 79. tuberculosis. Government of India. As a collateral benefit of malaria eradication programme. which remains high due to communicable diseases.77 76. Sudan and north-east Brazil. (2) as % of col.05 68. Nepal. It is a matter of concern that the incidence of the disease has increased in 2005 and further in 2006. Communicable diseases account for 50. Kala-azar has been occurring in India for more than a century and a half in various forms.III. The control measures put in place then were subsequently slackened from 1994 because DDT spray and surveillance were discontinued.3% of the disease burden and constitute a major cause of premature death in India. Japanese encephalitis and leprosy continue to be the major public health problems of the state. killing over 2. primarily in the developing world. Ministry of Health and Family Welfare. The disease is characterized by fever. According to the Annual Report of the Ministry of Health and Family Welfare. The flies survive on the sap in banana and bamboo groves and decomposed cow dung heaps. They make their home in the straw thatches of houses. weight loss. 32 districts Table 3. 2001–06 Year (1) 2001 2002 2003 2004 2005 2006 (P) Up to September Bihar (2) 10327 9684 13960 17324 21797 23001 Cases All India (3) 12239 12140 18214 24340 31217 30160 col. Kala-azar Occurrence in Bihar and India. The proportion of total deaths on account of communicable diseases. (3)(4) 84. Morbidity The distribution of the Burden of Diseases (BoD) between communicable and noncommunicable diseases highlights failure to control communicable diseases. Communicable diseases such as kala-azar. (6)(7) 95.98 90. maternal and peri-natal conditions and nutritional deficiencies continues to be unacceptably high at 42%.18 69.59 78. Government of India. The disease occurs in 62 countries. The epidemic recurred in 1992 due to lack of surveillance and harvested a death toll of almost 2. swelling of the spleen and liver.24 89. Kala-zar prevalence was almost zero in 1965.50. Currently Bihar accounts for more than 76.31 Source: Annual Report 2006-07.

State of Health in Bihar 39 . filarial. Malaria Malaria used to be the leading vector-borne disease of the country as well as Bihar at the time of independence. between 1995 and 1999.2 0. Purnia and East Champaran.4 million. But subsequently. Orissa. 2001–06 Year Bihar (1) 2001 2002 2003 2004 2005 2006 (P) Up to September (2) 4108 3683 2652 1872 2733 948 Malaria All India (3) 2085484 1841229 1869403 1915363 1817093 727952 col. Japanese encephalitis and kala-azar. Table 3.19 0. taking the caseload to 6. dengue. respectively. Initial efforts at malaria reduction brought down the caseload from an estimated 75 million to a record 1. Munger and Jamui. Efforts towards a further reduction were not successful due to vector and parasite resistance to conventional insecticides and drugs.13 0.05 0. Rohtas.000 cases in the 1960s. followed by Vaishali. anti-larval measures and enhancement of communitybased action. The malaria control programme today is known as National Vector Borne Disease Control Programme. technical and logistical constraints the momentum was slackened.12 0. This led to resurgence of malaria in 1976. Malaria and Pf Cases in Bihar and India.of Bihar are kala-azar endemic. (6) (7) 0. in some high endemic areas. This strategy is being implemented across the country along with the Enhanced Malaria Control Project (EMCP). Government of India. due to various financial. A modified plan of action helped reduce malaria cases by 1984. (2) as % of col.05 Source: Annual Report 2006-07. Bihar and Andhra Pradesh. The task force believes that continuous spraying of insecticides for at least five years in a phased manner and supervised administration of Amphotericin B could eliminate the disease. which includes malaria. Saharsa.04 0. Samastipur. Aurangabad.13 Bihar (5) 1027 1705 1080 333 427 182 Pf All India (6) 1005236 897446 857101 890152 805699 329686 col. as well as continuing financial and management constraints.14 0. Table 3. the most dangerous strain of malaria. Ministry of Health and Family Welfare. (3) (4) 0. A major concern is the resurgence of malaria in the flood-prone districts of the state every year.2 0. Rajasthan.15 0.00. The district of Muzaffarpur has the highest number of cases. which focuses on the high endemic districts in the high focus states. Some of the high endemic states are Madhya Pradesh. reduction in vector population through vector control measures. Malaria resurfaced in 1994. which also included increase in cases of Plasmodium falciparum malaria.24 presents the figures for the incidence of malaria in Bihar and India. Experts say that poor living standards and unhygienic conditions make members of the Mushahar community in Bihar an easy prey to the disease.10 0.24. In early 2007 the state government set up a task force on kala-azar to suggest measures to eradicate the disease by 2010. Chhattisgarh. (5) as % of col. Some of the high prevalence districts of malaria in the state are Gaya. The national programme focuses on reduction of the reservoir of infection in humans by early detection and prompt radical treatment.

Karnataka and West Bengal. and political will. 2005 Population Covered by RNTCP Bihar India 395 (43%) 10302 (93%) Patients Registered for Treatment 7809 346264 Smear Positive Patients Diagnosed 3705 209961 New smear Positive Patients Registered 2386 138718 Annual new Smear Positive Case Detection Rate 25 (34%) 55 New Sputum Positive Cases out of new pulmonary cases (%) 40 74 Source: State Health Society. The DOTS strategy is based on five principles: case detection. of which 58. TB clinics. covered 40% of the population and indicated an active prevalence level of 1. In spite of the huge amounts spent on NTP. conducted during 1955–59. the Revised National TB Control Programme (RNTCP) was formulated with the DOTS strategy as its cornerstone. administration of short course chemotherapy under direct supervision. Table 3. Some of the challenges to be overcome by the TB programme are weak coverage. The National TB Programme (NTP) was launched in 1962 and an impressive infrastructure of district TB centres. Bihar. Bihar ranks third in TB prevalence in the country (735 per 1.1% of men have heard about TB. weak involvement of civil society. the annual caseload is about 2500 cases and 500 deaths.2% of those surveyed still wanting the fact of a family member’s TB kept secret from neighbours.25. TB has re-emerged as a major public health problem in India and often as an associated illness of HIV/AIDS. Japanese Encephalitis This vector-borne disease is prevalent in about 65 districts in ten endemic states. TB Incidence. The number of New Sputum Positive cases for TB in Bihar for all four quarters in 2006 is 40. 2005. But this 40 State of Health in Bihar . For the first time.000 persons) after Arunachal Pradesh (9096) and Manipur (804). These estimates continue to be used. high illiteracy and poor sanitation. Such low coverage has implications for the number of patients registered for treatment and early diagnosis. The disease still carries a high level of stigma in the state. In India it continues to be a serious health threat even in the absence of HIV/AIDS due to poverty. mostly of children below the age of five. Uttar Pradesh.5%. Based on these reviews and the results of controlled pilot projects. Prevalence and Treatment Rates in Bihar and India. and the threat of a dual disease burden of HIV/AIDS and TB as opportunistic infection with a potential to increase the number of cases substantially.00. In Bihar 96. ensuring adequate drug supply. It is seen from the table that the coverage of the RNTCP programme is very low in the state. hospitals and beds was established. with 17. the outcome is unsatisfactory due to poor diagnosis. Table 3. unsupervised private practitioners following their own line of treatment. The DOTS strategy is implemented along with RNTCP across the country. 43% as compared to the country as a whole (93%).5% have misconceptions about its transmission. The WHO extended technical support to pilot test the DOTS strategy.25 presents data for Bihar and India for 2005. Nearly 90% of cases are reported from Andhra Pradesh. weak health system. inappropriate regimens and lack of patient evaluations or follow-up. systemic monitoring and accountability for every patient diagnosed.Tuberculosis (TB) The Indian Council of Medical Research (ICMR) nation-wide survey of TB. TB prevalence has been reported in NFHS-3.

Clofazimine and Dapsone. Table 3. Chhattisgarh. West Bengal.9 1.disease has spread to non-traditional areas as well such as in Kerala.6 leprosy cases per 10. There is no threat of disease transmission if the patient is taking treatment at home. Uttar Pradesh (23%). Government of India. Control strategies continue to focus on early diagnosis.3 0.3 1. respectively. 2001–05 Year Bihar (1) 2001 2002 2003 2004 2005 2006 (P) Up to September (2) 48 8 6 85 192 21 Cases All India (3) 2061 1765 2568 1714 6727 2069 col. Chhattisgarh (5%). However.3 7. vector control (two rounds of residual insecticidal spraying). Of the total 2. domiciliary treatment is advised. Ministry of Health and Family Welfare. case management. the number of cases rose from 85 in 2004 and reached a high of 195 in 2005. West Bengal (10%). Even a single dose of MDT kills 99. MDT is a combination of the drugs Rifampicin. Bihar (17%). Under the National Leprosy Eradication Programme (NLEP).000 population in 1981. and segregation of pigs and promotion of personal prophylaxis.0 Bihar (5) 11 1 2 28 64 3 Deaths All India (6) 479 466 707 367 1682 444 col. Jharkhand.8 0. While high costs limit the use of vaccination.9% leprosy bacilli under laboratory conditions.66 lakh recorded leprosy cases as on 31 March 2004. State of Health in Bihar 41 . Leprosy is endemic mainly in the states of Bihar.4 0. The number of deaths were the highest 64 in 2005 in Bihar. (2) as % of col. Maharashtra (11%). Jharkhand (4%). no curative drugs exist. It is seen from the table that the state had a low concentration of Japanese encephalitis cases till 2003 excepting for the year 2001. Patients seen with mutilated limbs are old burnt-out cases with no active disease and thus do not transmit disease.26 presents data for the incidence of the disease in Bihar and India for the period 2001–05. It takes only six months to one year of complete treatment with MDT to cure paucibacillary and multibacillary type of patients. The country as a whole also experienced more number of Japanese encephalitis cases in 2005.3 0. which morphologically resembles Mycobacterium tuberculosis. fogging by Malathion insecticide. Only less than 20% of leprosy patients are of infectious type and with MDT they become non-infectious rapidly. 75% cases have been contributed by seven states: Orissa (5%).6 Source: Annual Report 2006-07. (6) (7) 2.2 4. Uttar Pradesh. About 95% of people in the community are immune to the disease.6 3. Leprosy deformity is not associated with infectivity of the disease. Before the introduction of MDT in the early 1980s India recorded a prevalence of 57. Table 3. Leprosy Leprosy is caused by Mycobacterium leprae. (3) (4) 2. Orissa and Madhya Pradesh. Japanese Encephalitis Cases in Bihar and India. Leprosy bacilli have very weak potential of causing the disease and they multiply very slowly as compared to most other bacteria.2 0. (5) as % of col.26. The reservoirs of leprosy are infectious leprosy patient(s) who are not taking Multi Drug Therapy (MDT) and are in prolonged contact with healthy persons.

27).88 0.5% of the leprosy cases in the country as of 2006 (see Table 3. HIV/AIDS HIV/AIDS is a major health problem in India.81 1. 2006 Estimated Population. The National Filaria Control Programme provides assistance to all eighteen endemic states.00 472. Estimated population exposed to risk of filariais and microfilaria carriers and filaria cases. Orissa and Uttar Pradesh. but NFHS-3 shows that the level of awareness of AIDS among women is extremely low. This is for 2004-05. These show that the level of awareness of AIDS has increased among men and women. government dispensaries and hospitals across the country. This is a medical and social problem.81 2005 62. 2004-05 Population at Risk Total Bihar India 2004 72.81 Microfilaria Carriers Urban 2004 2005 2004 9.80 347. Four nation-wide Modified Leprosy Elimination Campaigns (MLECs) with intensified community IEC (information. Orissa. Ministry of Health and Family Welfare.64 0. Primary Health Centres. The Fifth MLEC was conducted in eight high-priority states during 2003-04. the most endemic being Andhra Pradesh.88 124. Uttar Pradesh. The hard-to-reach areas in rural/tribal/hilly terrain as well as urban slums are given special priority for continued surveillance and prompt MDT to leprosy patients.20 1. Lymphatic Filariasis Filariaris declined in the late 1980s in India. Kerala and Bihar. Table 3.49 124. The state had 15. communication) have been conducted as special efforts towards early detection of leprosy cases and their prompt MDT.20 9. March 2005 91482682 1109670816 New Cases Detected 40395 260063 Cases Discharged as Cured 68214 376934 Cases on Record under Treatment 16532 148910 Prevalence Rate (per 10. West Bengal. which is 18.32 Diseased Person 2004 3. Ministry of Health and Family Welfare. Chandigarh. Bihar has not yet achieved the level of leprosy eradication.69 Rural 2004 62. Number of females detected with leprosy are 15.80 347. Government of India. Currently about 5.2 million people are living with the virus.28.34 Bihar India Source: Annual Report 2006-07.000 population) 1. education.28.27. Government of India. Data are not available for RCH I. Leprosy Cases and Prevalence in Bihar.17 2005 2.38% of patients. Table 3.909.39% of patients.Bihar is a high prevalence state and ranks seventh-highest in India after Chhattisgarh. The number of child patients are 7430.13 Source: Annual Report 2006-07.69 2005 72. which is 39.66 2005 0. 42 State of Health in Bihar . Jharkhand. MDT is now available free-of-cost on all working days at all Sub Centres. a pattern seen in the RCH II data as well.72 1.20 0.00 472. Information on or awareness of HIV/AIDS is available only for NFHS-2 and 3. but increased from 1989 to 2000. The estimated population exposed to the risk of filariais and microfilaria carriers and filaria cases during 2004-05 is given in Table 3. Tamil Nadu.

n.9 n.3 n.4 58.0 22.8 Part of the vulnerability of the state lies in a population where illiteracy is still widespread despite improving educational levels. In 2006 BSACS greatly increased the number of sentinel sites to widen the scope of HIV surveillance.18%. Table 3. This is a danger sign. 2007.20 0. which is one way HIV is known to spread. PFI-PRB 2003–06 (%) Source: HIV/AIDS Chart book. As per NFHS-3 Bihar has HIV prevalence of 0.0 80.29.40 1.29). India ANC 0. Statewide.1 NFHS-2 Bihar 10. Prevalence of HIV Infection in Bihar and India. Figure 3.36 STD 5.6 n.a.6 75. Knowledge of HIV/AIDS among Ever Married Adults (15–49 years) Bihar and India (%) NFHS-3 Bihar Women who have heard of AIDS Men who have heard of AIDS Women who know that consistent condom use can reduce the chances of getting HIV/AIDS Men who know that consistent condom use can reduce the chances of getting HIV/AIDS 35.30. Population Foundation of India. Table 3. so that reaching people with essential HIV information is especially difficult.5 n.a.38 0. HIV/AIDS prevalence in Bihar.43 1.7 5.6 5.13%.09% and for men being 0.23.a. Bihar is India’s most rural state with 89% of its population living in rural areas.a. The opportunity to arrest its spread is here today. RCH IIDLHS 2002–04 Bihar 28. the percentage of positive cases rose from 0.76 in 2006.9 0. The state is also a major crossroads for commercial traffic. RTI/STI management and treatment remains one of the most neglected areas in maternal health. Keeping in mind the increasing vulnerability of married women to HIV/AIDS. India 40. 2003–06 (%) Year STD 2003 2004 2005 2006 0. there is need to bring in more women to treatment and counselling centres for reduced gynaecological problems and better maternal health.00 0.7 68.0 34. While HIV prevalence is low at present. n.30 presents the prevalence of HIV infection in Bihar and India in 2003–06 as per the STD and ANC sentinel surveillance sites.8 62. Data are also available for 2005 and 2006 of HIV prevalence among female sex State of Health in Bihar 43 .1 India 53.a.a.a.00 0. n. A low level of HIV prevalence presents both an opportunity and a danger. n.The RCH II awareness data for RTI (reproductive tract infection) and STI (sexually transmitted infection) throw light on interesting findings. the state is considered highly vulnerable by the National AIDS Control Organization (NACO). The danger is that its quiet nature will expand its devastation tomorrow.a.4 India 57. Significantly more number of women in Bihar are aware of RTI and STI than in India.67 in 2005 to 0. Figure 3.23 illustrates the data graphically for Bihar. Table 3.9 0.2 70.05 Bihar ANC 0. But the percentage of women seeking treatment is very low as compared to men (see Table 3. with the rate among women being 0.

As more individuals survive to middle age. neuro-psychiatric ailments and other chronic diseases are becoming major contributors to the BoD. The existing health system will need to be reoriented to deliver the expanded mandate of primary and secondary healthcare involving the prevention.40 in 2005 and 0.9% among men. the prevalence rate among MSM was 0. They account for significant morbidity. As a result.000 who reported as diabetic in Bihar were 1024 as compared to 881 in India. decreased physical activity and augmentation of psychosocial stress. The prevalence of major mental illness in the country has been estimated to be 1–2 per thousand.68 in 2006. is principally due to a combination of demographic and lifestyle changes resulting from socio-economic development. Demographic transition is characterized by changes in population age structure with a decline in fertility and an ageing population. India contributes substantially to the global burden of NCDs. 44 State of Health in Bihar . even though they are not major contributors to mortality. Simultaneously. Diabetes has a high prevalence in urban and migrant population.3% of deaths in India. Coverage data for HIV testing as per NFHS-3 show that in Bihar the coverage rate in the age group 15-49 is 88. Only 15% were aware of STD and of the fact that such diseases increase the likelihood of contracting HIV. This rate of diabetes among women in Bihar is on the higher side since it is above 1000. Knowledge of the existence of STD in Bihar is the lowest in India at only 18% and only 11% among women. given the fact that fertility decline is taking place in large segments of the country. surveillance and management of chronic diseases. other than self-inflicted. NCD epidemics are emerging or accelerating in most developing countries and cardiovascular diseases (CVD). It may appear that the problem of our ageing population is not yet relevant except for a few states in the South.00. The reduction is attributed to increase in sentinel sites.30 in 2006. As per NFHS-3 the number of women aged 15–49 per 1. contribute to 4. As the quality of dietary habits and physical activity decreases and obesity increases.24 in 2005 and 1.78% as compared to 0. However. The presence of a sexually transmitted disease (STD) increases the risk of HIV.56% for India. the years of exposure to the risk factors of chronic disease increase. urbanization. disability and economic loss.workers (FSW) and men having sex with men (MSM). as per various estimates.2% among women and 87. The 1998 Global Burden of Diseases (GBoDs) study estimates that injuries. diabetes becomes a greater contributor to NCD. industrialization and globalization are often accompanied by undesirable lifestyle alterations: changing diet. while minor mental illness occurs in 5–10% of the population. Disorders of mental health merit special attention because of the large burden of disability (DALY loss) resulting from them. The prevalence rate among FSW was 2. Non-communicable Diseases Health transition. whereby non-communicable diseases (NCDs) become the dominant contributor to Burden of Diseases (BoDs). National Survey of Blindness 2001-02 (visual acuity) reveals that less than 6/60 vision in Bihar is 0. it will not be long before this issue becomes important. knowledge of STD and the link between them and HIV is clearly essential. In Bihar 940 men suffer from diabetes as compared to 1051 for India. diabetes. Similarly. cancers.

Alcohol use among men in the state stands at 34. For men the corresponding figures are 981 (Bihar) and 1627 (India). the youth rather than the urban population.0% of women use tobacco in any form. which includes stroke and rheumatic heart disease.000 persons suffer from goitre or other thyroid disorders in Bihar as compared to 273 for men. About 30% of cancers are caused by tobacco use.000. oral cavity and gastrointestinal tract are rapidly advancing. These can be prevented with health. Consumption is particularly higher among the rural poor. which corresponds to the all-India figure. education and avoiding tobacco in all forms.0% of the tobacco using population in the state. the corresponding figure for women being 4. cocaine and marijuana.0% among women. As per NFHS-3. According to NFHS-3 in Bihar 66. cervix. including several types of cancers of the heart and lungs. khaini. it needs to be kept in mind that these are emerging problems of the future. Addiction to tobacco and other type of substances is high in Bihar. premature births. Tobacco use is associated with a wide range of diseases. Men who smoke cigarettes and bidis constitute 29. zarda and gutka. Therefore tobacco-related NCD could be higher in future in Bihar.Injury prevention and management has been limited to the provision of emergency care that functions with limited access and coverage. 1696 per 100. The Burden of Disease also includes the entire spectrum of cardiovascular diseases. These and other types of cancers such as of the breast. heroin. more so among women.00. no structured programme is available. low birth weight babies. In India the figures are slightly higher. 853 women per 1. The state needs to keep in view the increasing dense urban habitat and develop better city management.9% and 9. with 949 for women and 383 for men. Goitre or other thyroid disorders in Bihar have been moderate. stillbirths and infant deaths for those women who use tobacco. It also poses great health risks such as infertility. Chewing tobacco is an area of concern in the state along with alcoholism and substance abuse such as drugs. It is seen from NFHS-3 data that Bihar has a high number of people. There is need to develop an inter-sectoral-based programme addressing increasing injuries in the growing context of urbanization and infrastructure development.9%. particularly women suffering from asthma. Currently.6% of men and 8. pregnancy complications. The 50th round of NSSO and NFHS-2 reported use of tobacco by all household members in Bihar. While the precise dimensions of the diseases are not clear. State of Health in Bihar 45 .

7 23.8 24.31. India Nutrition Profile 1998 Table 3.7 Severe 26. 1998. The India Nutritional Profile Study (1998) found the maximum number of severely malnourished children (1–6 years) were from Bihar (26%). Nutrition Malnutrition continues to be a predominant problem of the state and its manifestation and consequences are diverse and alarming.5 Mild 27.5 Below –2SD Below –3SD 53.0 15.3 15.2 26. Table 3.0 Height for Age Below –3SD 33. Nutritional status of children (5–12 years) severely malnourished was the highest in Bihar (21.5 29. Nutritional deficiencies have been observed to affect physical and mental development of children adversely.1 28.9 30.7%) and Rajasthan (11. respectively. Nutrition levels in girls in rural Bihar.32.3 Boys Moderate 29. Malnutrition is seen to be a major contributing factor in over 50% of child mortality. states with high mortality are also generally those with high levels of malnutrition.31 and 3.1 26.2 26. followed by Tripura (19%) and Rajasthan (10%). in Bihar and India. India Nutrition Profile 1998 Figure 3.3 23.5 Moderate 29. Department of Women and Child Development.4 30. Food and Nutrition Board.5 2.32.8 Source: India Nutrition Profile (1998). Food and Nutrition Board.6 25.5 18.3 Girls Moderate Severe Normal 30.6 29. Of all segments of the population children and women appear to be more at risk than are others. followed by Dadra. Distribution of Nutritional Status of Children (1–5 years) According to Weight for Age.3 Mild 25.9 Severe 27. Ministry of Human Resource Development.0 Weight for height Below –2SD 21.32 present data for the levels of malnourishment in the under-3 and under-5 category.6 24.1 20. p.6 23. 18.24a and 3. Nagar Haveli and Daman and Diu (13. in Percentage (Gomez Classification).2 27.9 17. Ministry of Human Resource Development.25 presents the level of malnutrition in the state in 1998.2 26. Table 3.1 Source: India Nutrition Profile (1998). impairing health and productivity of work. Department of Women and Child Development.5 23. Figures 3. Figure 3.0 Below –2SD 54. Nutritional Status of Children under 3 Years in Bihar and India as per NFHS-2 (%) Weight for Age Below –3SD Bihar India 25. The level of malnourishment is quite high.7 17. Tables 3.5%). 18. p.8 18.4 47.7 Total Mild 26.0 25.33 and Figure 3. 46 State of Health in Bihar .24a.7%). Figure 3. Nutrition levels in boys in rural Bihar.26 present the distribution of severely undernourished children (1–5 years) in India in 1998.4 29. as per NFHS-2 Area Normal Total Rural Urban 16.7 27.24b.IV.3 18.3 Normal 19.24b illustrate the data from Table 3.7 45.5 5.3 25.

34).3%). states that every infection is a potentially fatal illness and the risk of death is doubled for the mildly undernourished children.9%) as compared to India (60%.33.35 presents data for breastfeeding and colostrum feeding practices in Bihar and India for 2005. Department of Women and Child Development. Nagalanad. Food and Nutrition Board. Tripura. Ministry of Human Resource Development. p. Manipur. 1998 Figure 3. 1998 Source: India Nutrition Profile (1998).9%) to NFHS-3 (42.Table 3. Sikkim Bihar (26%) Source: India Nutrition Profile (1998). It may be noted that most of the nutrition-related data are not comparable for NFHS-1. see Table 3. Table 3. Goa Rajasthan. 1998 Prevalence (%) <=5 6–10 >10 States Haryana. Severe under-nutrition levels in boys and girls in Bihar. the ‘period of perpetual hunger’ when the infants are dependent on another person for feeding. Assam. Mizoram. Meghalaya. Figure 3. Daman and Diu. It is seen from the table that the nutritional status of children in Bihar continues to be the worst in India. Arunachal Pradesh. Dadar and Nagar Haveli.36 presents data on the nutritional status of children and married adults in Bihar compared to India. Distribution of Severely Undernourished Children (1–5 years) in States/UTs (in %). Punjab. Ministry of Human Resource Development.27 and 3. Malnutrition generally sets in during the first two years of life. The most vulnerable age group has been identified as six months to two years. Source: Table 3. The proportion of children who are stunted decreased steadily with age from NFHS-2 (54. Gomez Classification (District Nutritional Profile Study). 18.33. Chandigarh. Sikkim. The nutritional status of children is strongly related to maternal nutritional status. tripled for the moderately undernourished children and maybe as many as eight times for severely undernourished children. Exclusive breast-feeding of infants less than five months old is also very low in Bihar (27.28 illustrate the data graphically. Delhi. Himachal Pradesh. NFHS-3 data indicate that only 4% of children under 3 years are exclusively breast-fed in Bihar as compared to 55% in India.25. Table 3. which reflects in infant birth weight. Figures 3. The Independent Commission of Health in India 1998. Food and Nutrition Board. Severe under-nutrition levels in children 1–5 years in India.26. whereas the proportion of under- State of Health in Bihar 47 . Department of Women and Child Development.

2 32.9%.4 46.5 India 40.9 45. n.a. weight for height – too thin for height Underweight i. n. Ministry of Health and Family Welfare.a. n.3 NFHS-2 NFHS-1 Bihar India Bihar India 54. n.4 43.e.6 n.0 77. Nutritional Status of children under 3 years Stunted i. India 9.3 India 50. n. It is a matter of concern that the overall level of malnutrition has increased among children in Bihar from NFHS-2 to NFHS-3.0 36.a.a. Girls and boys are equally undernourished but girls are slightly more likely than boys to be underweight and stunted. Table 3.3 39. Undernourishment generally increases with birth order.a.a.1 n. n.a. n.8 49.5 n.a. n. 3. NFHS-3) up to the age of 12–23 months and then declined significantly at age 24–35 months over the five years between the two surveys. height/age – too short for age Wasted i. NFHS-2 to 27.a. weight for age – too thin for age Nutritional Women whose Body Mass Index is below Status of Ever normal Married Adults Men whose Body Mass Index is below normal (age 15–49) Women who are overweight or obese Men who are overweight or obese Anaemia Children age 6–35 months who are anaemic Ever married women age 15–49 who are anaemic Pregnant women age 15–49 who are anaemic Ever married men age 15–49 who are anaemic State of Health in Bihar 48 . n. Child Feeding Practices in Bihar and India. n.3 8.a. 74. India 16.a.weight and wasted children increased (from 19.5 87.a.1 14. n.a.a.4 n.0 60.6 NFHS-2 (1998-99) Bihar 5.9 n. Breast-feeding and Colostrum Feeding Practices in Bihar and India.0 27.2 56.8 25.5 n. 21.a.a. New Delhi.a. n. n. 47.7%.0 28. n.34. n.9 57. n. n.9 61.4 45. 10. Table 3.3 38. whereas boys are slightly more likely to be wasted.a. 2005 (%) Bihar Breast feeding < 2 hours Breast feeding between 2–24 hours Exclusive breast feeding New-born given colostrum 17. 81.a. 51.a.a. n. Government of India.e. NFHS-1 (1992-93) Bihar n.e.a.6 68.a. 54.a.5 n.a. 19. n.36.1 79.a.4 27.a.5 n. Table 3. Nutritional Status of Children and Married Adults in Bihar (%) NFHS-3 Bihar India 42. n.7 5.a.a.0 n.8 n.4 n.7 n.1 Source: Annual Report 2006-2007.2 n.8 12.9 33.1 60.0 28.8 39.9 24.a.3 75.9 15. Young children in families with four or more children are nutritionally the most disadvantaged.a.9 27.1 58. n.a.2 57.35.3 60.7 19.4 41.a. NFHS data (%) Child Feeding Practices NFHS-3 (2005-06) Bihar Children under 3 years breast-fed within one hour of birth Children age 0–5 months exclusively breast-fed Children below 6–9 months receiving solid or semi-solid food and breast milk 4.a.a.2 51.

Figure 3.27. Nutritional status of children in Bihar under 3 years, NFHS-3 and NFHS-2

Figure 3.28. Nutritional status of married adults in Bihar, NFHS-3 and NFHS-2

Weight for height ratio is used to calculate several indicators of women’s nutritional status. An adult’s height is an outcome of several factors, including nutrition during childhood and adolescence. A woman’s height can be used to identify women at risk of having a difficult delivery, since small stature is often related to small pelvic size. The risk of having a baby with low birth weight is also higher for mothers who are short. Short stature is particularly strongly related to poverty. Body mass index (BMI) is defined as the weight in kilograms for height in square metres (kg/m2). It is an index that can be used to assess both thinness and obesity. BMI for women in Bihar who are below normal is 43%, which indicates high levels of nutritional deficiency. Women from households with low standard of living are more than two times likely to have a low BMI than women from households with a high standard of living. Anaemia is characterized by a low level Figure 3.29. Anaemia prevalence in Bihar, NFHS-3 of haemoglobin in the blood. Anaemia and NFHS-2 usually resolves from a nutritional deficiency of iron, folic acid, vitamin B12 and some other micro nutrients. This type of anaemia is commonly referred to as iron deficiency anaemia. Iron deficiency is the most widespread form of malnutrition in India and is estimated at 50% (Sheshadri 1998). Anaemia has a detrimental effect on the health of women and children and may become an underlying cause of maternal mortality and peri-natal mortality and results in increased risk of premature delivery and low birth weight babies. In Bihar anaemia level is 68.3% among women in NFHS-3 as compared to 60.4% in NFHS-2. Anaemia is relatively high for illiterate women and women belonging to religions other than Hindu or Muslim, Scheduled Tribe women and self-employed women. Pregnant women are more likely to have moderate to severe anaemia than non-pregnant women. Figure 3.29 presents data for anaemia prevalence in Bihar.
State of Health in Bihar
49

Iodine deficiency. Approximately twoTable 3.37. Households Reporting Use of Salt thirds of the population of Bihar is prone to Types in Bihar and India, 2005 (%) iodine deficiency. Only 37.7% of the population Bihar India uses fortified iodized salt as compared to 56.8% in India. A significant one-fourth of the Iodized (> 15 ppm) 37.7 56.8 population in the state use non-iodized salt. Iodized (1–15 ppm) 37.6 26.2 This increases the danger of higher incidence Not iodized 24.7 17.0 of goitre. Table 3.37 and Figure 3.30 (a) and Source: Coverage Evaluation Report 2005, Government of India. (b) present details.
Figure 3.30. Use of iodized and non-iodized salt in (a) Bihar, (b) India, Coverage evaluation Report 2005

To sum up, among adults the level of undernourishment is especially high among women, with less BMI and significantly high percentage of married women and pregnant women are anaemic. Another cause for concern is the increased level of anaemia among children, married women and pregnant women between NFHS-2 and NFHS-3, which raises issues related to the effectiveness and access to nutritional services and schemes for children and pregnant women. Special attention needs to be given to younger married women and younger women who are pregnant, many of whom are in their adolescent years and are often left out of healthcare services.

50

State of Health in Bihar

V. Reproductive and Child Health
Until 1994 thinking and policy orientation on population issues focused on the control of numbers and limiting the level of population. ICPD (Cairo 1994) brought about a paradigm shift in this thinking. Now there is recognition of the need for comprehensive reproductive health (RH) and reproductive rights. This new agenda is a holistic agenda which addresses reproductive health through a lifecycle approach. Reproductive health has been defined as:
State of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this condition are the rights of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods for the regulation of fertility which are not against the law, and the rights of access to appropriate healthcare services that will enable women to go safely through pregnancy and childbirth and provide couples the best chance of having a healthy infant.

In the context of India child mortality and infant mortality being critical, the reproductive health concept was broadened into Reproductive and Child Health (RCH) and the RCH programme was launched in 1997, which included child health as a component. Now the components of RCH programme include fertility regulation, safe motherhood, child health and child survival, and RTI/STI interventions, including HIV/AIDS. In the following paragraphs on the status of RCH in Bihar key data have been used from large-scale surveys such as the NFHS, District Rapid Household Survey (DRHS), and District Level Household Survey (DLHS) under the RCH programme.

Marriage and Fertility
TFR for Bihar at 4.0 as per NFHS-3 is higher than that of India (2.7) and also higher than 3.7 of NFHS-2. High TFR is associated with high percentage of women marrying before the age of 18 years (60.3% in Bihar). Almost one-fourth (25.0%) of married women in the age group of 15–19 years were pregnant at the time of the survey. Median age at first birth was 18.7 years. It is seen from Table 3.38, presenting marriage and fertility rates for Bihar and India, that a high percentage of women cohabit before 18 years of age. Figure 3.31 illustrates the data graphically.
Figure 3.31. Women married by age 18, NFHS Bihar (%)

Source: Table 3.38.

As per NFHS-3, the proportion of women aged 20–24 married by the age of 18 in rural Bihar (65.2%) is almost twice that of urban Bihar (37.3%). Percentage women marrying below the age of 18 has a positive correlation with education. Higher percentage of women with no education

State of Health in Bihar

51

Table 3.38. Marriage and Fertility Rates for Bihar and India
Marriage and Fertility NFHS-3 (2005-06) Bihar Women age 20–24 married by age 18 (%) Men age 25–29 married by age 21 (%) Total fertility rate Women age 15–19 who were already mothers or pregnant at the time of the survey (%) Median age at first birth for women age 25–49 Birth order 3+ Married women with 2 living children wanting no more children (%) Married women with 2 living children wanting two sons (%) Married women with 2 living children wanting one son, one daughter (%) Married women with 2 living children wanting two daughters (%) 60.3 43.3 4.0 25.0 18.7 n.a. 60.2 77.4 67.5 20.0 India 44.5 29.3 2.68 16.0 19.8 n.a. 83.2 89.9 88.1 62.1 NFHS-2 (1998-99) Bihar 71.9 n.a. 3.71 n.a. 18.9 54.6 41.8 58.8 43.7 10.8 India 50.0 n.a. 2.85 n.a. 19.3 45.2 72.4 82.7 76.4 47.0 NFHS-1 (1992-93) Bihar n.a. n.a. n.a. n.a. n.a. 56.4 n.a. n.a. n.a. n.a. India 52.4 n.a. 3.99 n.a. 19.4 48.6 59.7 71.5 66.0 36.9

(76.8%) were married below the age of 18 as compared to only 19.3% women who have completed 10 years of education. This implies that education is an important determinant in improving the age at marriage. NFHS-1 and 2 data show that across religion there is a differential in age at marriage. Higher percentages of Muslim girls marry below the age of 18 than Christian girls. The age of marriage also shows significant increase with standard of living. More number of girls from poor families with low standard of living marry early than girls from families with higher standard of living. The age at which a woman starts childbearing is an important determinant of reproductive health. The median age at first birth for women aged 25–49 has decreased from 18.9 in NFHS-2 to 18.7 in NFHS-3 (see Figure 3.32). The urban–rural divide in Bihar is by a year for women aged 25–49. The trend with women with no education is as low as 18.3% to 21.3% for those who have completed 10 years and above of education. The distribution of birth by birth order is yet another way to view fertility. It is seen from Figure 3.33, which presents data for birth order 3 and above, that birth order 3+ has decreased in
Figure 3.32. Age at first birth for women, Bihar and India, NFHS data Figure 3.33. Birth order 3 and above, Bihar and India, NFHS data

52

State of Health in Bihar

3% of MTPs were for the age group 15–19 (India 4%). 80.3% and 0. In addition to their relatively high level of pregnancy.7% for age 20–24 (India 28. This is in keeping with the all-India trend. The interval is 29 months for Bihar as compared to 31 months for India.the state across the various survey periods.6%). In terms of age group 19. The proportion of births of order 3+ is relatively large for births to illiterate women. This is consistent with the all-India trend. As per NFHS-3 25% women in the age group 15–19 in Bihar have begun childbearing as compared to 16. The significantly higher levels of fertility and childbearing have implications for access to and quality of family planning programmes and services. complications because of psychological immaturity and inexperience associated with child care practices also influence maternal and infant health. The primary reason for this desire is high mortality and morbidity in infants.1% were conducted during the first 12 weeks of pregnancy (India 86. and 27.0% in India. Young women who become pregnant experience a number of health. There is also a positive association between fertility and work status.6%).39) but continue to be lower than for India as a whole. The desire for additional children in rural Bihar is very high.2%). Family Planning Family planning services have improved in Bihar across the three NFHS surveys (see Table 3.3% in NFHS-3) with use of pills and IUDs being even lower (1.9% during 12–20 weeks of pregnancy (India 13. the level of condom use is very low (2. and women with a low standard of living.0%). The trend remains the same for RCH also (see Figure 3. NFHS-1 (56. State of Health in Bihar 53 .4%) to NFHS-2 (54. respectively). As per family welfare statistics 2006. The birth interval is shorter if the previous child was a girl than if it was a boy. Early start to childbearing reduces educational and employment opportunities of women and is associated with high levels of fertility. Marriage of girls at young age in India leads to teenage pregnancy and motherhood. 31.669 in Bihar. There is overwhelming focus on female sterilization as a family planning method in comparison to male sterilization and other temporary methods. social.6%.1% for age 25–29 (India 35.9%) and 19. unwanted pregnancies in India are extremely high due to high unmet need of contraception.6%) and from RCH I (45. especially neonates. The proportion who have begun childbearing is more than twice as high in rural areas (19%) than in urban areas (9%).34). Of these. The number of MTPs (medical termination of pregnancy) for 2004-05 was 29. Muslim women and Scheduled Caste and Scheduled Tribe women. Although resort to spacing methods has improved over the NFHS survey years. economic and emotional problems.8%) to RCH II (42. especially for two children and in favour of sons.

Contraceptive prevalence is also highest among women who do not belong to the marginalized communities.5 1.9 0.3 22. NFHS and RCH data Figure 3.9 3.3 1.3 21. The differences by education are also on account of the predominance of sterilization in the method mix and the fact that more educated women tend to be younger women who may not yet have reached their desired level of fertility.8 3.4%).35 presents contraceptive prevalence rate for Bihar and India.4 35 33.4 0.7 3.0 10.5 4. 18.3 21.1 3.3 NFHS-2 (1998-99) Bihar 23. Bihar and India.3 0.6%) than in rural (31.2 34.5 1.4 23.6 1.4 3. n.1 n. Spacing methods of contraception.9 1.7 36.9 2.a.8 1.3 37.a.4 8. Current use of contraceptive method is considerably high in urban areas in the state (50.6 4.39. 2.2 0.6 1.1 Figure 3.6 0.5 13.6 19.6 0. Current Use of Family Planning Methods. Current use of contraceptive method is much lower among illiterate women (29%) than women who have completed ten years and above of education.5 18.3 48.1 0. n. Bihar and India. The use of spacing methods generally rises with education.6 42.8 0. Contraceptive prevalence is the lowest among Muslims and approximately three times higher among Hindus and Christians.9 2.2 20.7 35. The use of traditional methods also rises with education.5 1.6 India 48.6 1.9 6.6 2.9 n. India 40.0 0.0 45.2 1.5 5.a.a.8 RCH-1 Bihar 24.6 n.34.0 27.0 2.5 21. NFHS data (%) Current Use NFHS-3 (2005-06) Bihar Any method Any modern method Total sterilization Female sterilization Male sterilization Total spacing methods IUD Pill Condom 34.3 India 56.1 5.6 India 48. This is true for each specific modern or traditional method.8 27.9 17.1 28.1 NFHS-1 (1992-93) Bihar 23.8 23. 54 State of Health in Bihar .1 1.2 2.0 India 53.5 0.a.8 36.4 RCH-2 Bihar 31.5 38.3 2.8 24.8 0.5 1.4 3.a.8 1.2 42. n.0 34.Table 3.5 30.

35. Contraception prevalence rate. Figure 3. respectively. Male sterilization in Bihar is less than 1% (0.7% for women and 86. needs. see Figure 3.4% among men of contraceptive use in Bihar (NFHS-3). their role. For both men and women awareness of spacing methods is very low for pills (95. and involvement.3% for RCH II.7% and 19. Although men constitute half of the reproductive equation.36).Figure 3. IUDs (79.9% and 91.4% for NFHS-3 and 22.8%.5% for men). the stereotype that most men do not care about family planning persists and family planning has been considered as women’s business.4% in RCH II) as compared to total sterilization (24.0% and 95.15% and 48. Awareness of limiting methods among women is 99. male condom (81. NFHS and RCH Bihar and India State of Health in Bihar 55 . Limiting methods of contraception.3%) and emergency contraception (4. NFHS and RCH Bihar and India The low use of contraceptive methods in Bihar is contradictory to the 100% awareness levels among women and 99. the corresponding figures for awareness among men are 98.36. Little attention has been paid to men.6% in NFHS-3 and 0.9% for female sterilization and 92. responsibilities.8%). In recent years the focus of the family planning programme has been on women and especially female sterilization.3% for male sterilization.2%).

7 RCH-1 Bihar 42.3 6. Unmet Need for Family Planning.2 6. Unmet need of contraception.40. If there could be intervention in regard to these unwanted births TFR would 56 State of Health in Bihar .3% of female sterilization as compared to 29. Total unmet need for family planning is very high in the state (23.3 7.7 13.8 8.4 as compared to 1.0% of education class ten and above.1 NA NA India 19. This is almost half the TFR of Bihar.1 12.Female sterilization constitutes approximately four-fifths of all modern methods. which is 4.6 Figure 3. Table 3.1%) as compared to 13. with male sterilization accounting for the least. which account for over half of the country’s population.5 11.5 India 15.9 for India. NFHS-2 indicates that the number of unwanted births account for one-fourth of TFR.0 8.1 8.3 10.2% for India in NFHS-3.7% in NFHS-2 to 23.1% in NFHS-3.7 14.5 12.4 India 13.6% in rural Bihar.0 18. This could be on account of increased access to family planning surveys in the state.5 NFHS-1 (1992-93) Bihar 25.1 10.2% of urban females are sterilized as compared to 22. though unmet need has marginally reduced from 25.7 14. Bihar and India NFHS data (%) Unmet need NFHS-3 (2005-06) Bihar Total For spacing For limiting 23. Total wanted fertility rate in Bihar as per NFHS-3 is 2.9 21. The demand for spacing and limiting has also decreased across the three NFHS surveys and RCH surveys (see Table 3. Uttar Pradesh.7 12. continue to have high fertility. 31. A similar pattern is seen where illiterate women constitute 21. Rajasthan and Madhya Pradesh.8 India 21.0.3 23.37.7 India 25.37).40 and Figure 3. Bihar and India (NFHS and RCH data) Achievements in Family Planning TFR in India has shown a consistent decline since independence but the states of Bihar.5 RCH-2 Bihar 36. Unmet Need The low levels of use of family planning methods are reflected in the high unmet need for family planning services in the state.8 NFHS-2 (1998-99) Bihar 25.

41. such as Non-Scalpel Vasectomy NSV and other spacing methods. 2000-01 to 2005-06 Sterilizations 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 130550 152219 111924 120899 88126 96341 IUD 110949 145310 158896 126882 108168 99847 Condom Users 36570 63065 63043 37329 241638 61965 Oral Pill Users 58997 84105 67938 51051 456853 49818 Other Methods 95567 147170 130981 88380 698491 111783 Source: Family Welfare Statistics in India. The achievements of the state in promoting various methods of family planning services over the past five years are presented in Table 3. State of Health in Bihar 57 .41. It is seen from the table that the number of tubectomy operations completely overshadow the number of vasectomy operations.42 presents data for selected family planning methods in Bihar for 2001-02 to 200405. Figure 3.39 present data on effective CPR methods in the state. 2006 Source: Table 3. Table 3. particularly in their early reproductive age. The high level of acceptance of methods in which the responsibility devolves entirely on women reflects the fact that the entire focus of the family planning and RH programme in the state places the responsibility of fertility reduction on women.43 and Figure 3. Ministry of Health and Family Welfare. Women in the age group of 25–29 years are among the maximum acceptors of the method (41. Achievement in family planning. 2006. This would also promote maternal and child survival. Table 3. Bihar. Achievements of the State of Bihar in Family Planning. Table 3.6%).38.fall to 3 for Bihar. The state has a long way to go towards building awareness and promoting other methods of family planning. Government of India.38.41 and Figure 3.

a. 32.3 48.1 Source: Family Welfare Statistics in India.a. 42.9 19.a.8 14.a.9 19.3 15.5 82 2004-05 n.3 44.a.3 n.0 26. 2002-03 599 n. Maternal Health Table 3.8 n. 50.4 2002 17.6 14.2 48.5 47.3 2004 15.0 8. Bihar. NFHS-1 (1992-93) Bihar 36. n.7 20. Bihar. 16. 15.44.9 22. RCH-II Bihar 37.a. Effective CPR due to All Methods. 2006. 30.4 RCH-I Bihar 29. 0 0 62.6 8.4 44.9 n. Selected Family Planning Methods.7 22.4 33.0 40.4 24.a.3 40.a.42. Status of Maternal Health Determinants in Bihar (%) Maternity care (for births in the last three years) Any ANC Mothers who has at least 3 ANC visits for their last birth Mothers who consumed IFA for 90 days or more when they were pregnant with their last child Birth assisted by doctor/nurse/ LHV/ANM/other health personnel Institutional births Safe delivery Mothers who received post-natal care from doctor/nurse/LHV/ANM/ other health personnel within 2 days of delivery for their last birth NFHS-3 (2005-06) Bihar n.6 2.7 India n. 2001 to 2005 Year Bihar 2001 17. Government of India.3 43.1 40.a.0 34. n.9 n.Table 3. n.3 NFHS-2 (1998-99) Bihar 36.43.2 58 State of Health in Bihar .a. India 65.a. Infertility In the last forty years India’s growing concern with population stabilization has unfortunately overlooked some other closely related problems of human reproduction. n. Table 3. Government of India.a.6 32. India 62.a. 8.2 n.5 23. Infertility has found no place in either our family welfare programme or in the reproductive and child health package.a.2 n.5 7.7 30. 36. n.3 53 41.a. Ministry of Health and Family Welfare.6 Source: Family Welfare Statistics in India.5 40. Ministry of Health and Family Welfare.a.a.a.9 9.a.7 2003-04 n.0 20.9 n.a. n.5 30.1 16.6 42.0 29. The following indicators may be noted from the data available.7 n.9 India 65. 2001–05 Total Vascetomy acceptors Acceptors of tubectomy 25–29years (%) Acceptors of tubectomy 30–34 years (%) Acceptors of IUD 25–29 years (%) Acceptors of IUD 30–35 years (%) MTP cases up to 12 weeks (%) 2001-02 482 41.a.8 23. which can in their own way seriously compromise the quality of life.a.4 50. Table 3. 80. n.3 2003 17.a.44 reflects the poor status of maternal health determinants in Bihar across the three NFHS surveys. 18.2 2005 16.0 n. n.3 n.a.1 34. 2006.1 India 73.2 n.7 17.

76.• • • • • • There has been a marginal increase in percentage of women with 3 ANCs for first birth in the state across the three surveys. This suggests the need for dissemination of information. Any ANC. One cause for the low ANC rate in Bihar is that most of the women concerned.40 presents ANC figures for the state and the country as a whole. The level of institutional delivery is low in the state at 22% (India to 40. A small significant number cited as reason that their families did not approve of such check-ups. To reduce the level of maternal deaths.3%) in NFHS-3.9% of women had 3 ANC visits for first birth (India 50.e. poor status of referral units. namely. did not consider having a check-up necessary or customary.3%) as compared to the country as a whole (36.7%) in NFHS-3. and poor levels of social mobilization and awareness generation by community health workers.3%) in NFHS-3. about two-thirds. Lowering the cost and making the service more accessible would also improve ANC in the state. ensuring safe delivery through skilled assistance. This falls far short of the NRHM goal of ensuring that every pregnant woman delivers in an institution. Coupled with very high levels of home delivery. The remaining one-third reported financial cost as the main reason. Figure 3.4%) in NFHS-3.7%) in NFHS-3.40. Only 16. NFHS and RCH data State of Health in Bihar 59 .8% of deliveries in the state are conducted at home. Only 30. Bihar and India. Completion of full ANC ensures that the woman is provided with adequate amount of iron and folic acid tablets and is regularly checked by skilled health personnel for the duration of her pregnancy. primarily by TBA. 5. ensuring services through the pregnancy period including emergency obstetric care. One indicator of good maternal health is to ensure reduced emergency risks in pregnancy and delivery. i. Very few cited lack of knowledge as the main reason. There is significantly low level of post-natal care in the state (15. The high levels of home delivery reflect the lack of functional first contact care. Figure 3. in RCH-II. Only 9. As per RCH-II data. this is a matter of concern. The state has the lowest levels of full ANC. which implies that most women lack access to regular institutional healthcare during the course of pregnancy.7% of women consumed IFA tablets in the state (India to 22. attention is required on three major components. and proper post-natal care.4%.9% of births were assisted by skilled personnel (including doctor) in the state (India to 48.

8 65.7 36. 39.6 24. 43.0 47.4 79.0 Source: Coverage Evaluation Report 2005. India 73.9 19. It may be noted from the data that ANC coverage in the state in rural areas is only half that of the urban.7 3.5%).5 21.8 10.4 6. India 62.5 0.1 15. Urban 60 State of Health in Bihar .1 31. 87. and IFA tablets (Bihar 17. Government of India. eye/ ear problems.8 61.8 20. Government of India.2 3.9 78.3 33. breathing problems and anaemia.7 58.4 24.6 6.45 presents disaggregated data for ANC for both Bihar and India.8 SC/ST n. This indicates the low health-seeking behaviour of rural Bihar and low levels of awareness. one or more TT (Bihar 42.Table 3. It is seen from the table that considerable work needs to be done in the state to increase the proportion of institutional deliveries and post-natal care for the rural and SC/ST segments of the population.0 Source: Coverage Evaluation Report 2005.4 92.46.0 93.9%).5 1.5 4.1 2.8 14.2 n.3 17. dizziness.a.4 Urban 59.6 62.5 30.6 5.1 Urban 67. diarrhoeal diseases.5 40.0 89.9 61.9 India Urban 89.0 5.2 62.3 41. Bihar and India.8%.0 n.a. Overall. respiratory infections. 5.9 2.2 Total 20.4 13.a.5 8.8 18.2 33. Ante-natal Care.6 81. A similar low level of coverage is seen for SC/ST.45.5 Total 53.2 17.9 64. serious communicable diseases such as TB and malaria.9%).8 2. 2005.0 Rural 66.2 79.6 3. the state lags far behind in the national average in coverage of services: awareness level of ANC services among mothers (Bihar 65.3 SC/ST 10.3 44.4%.6% women received IFA tablets but only 2.7 9.6 2.1% rural women received full ANC.2 11. weakness.3 11.5 34.2 SC/ST 43. Only 33. 7. Other Female Morbidity The leading causes of female morbidity in rural areas not linked to pregnancy are non-specific fever.1 Rural 39.8 Total 75.7 22.5 86.4 81. Table 3.8 67.a.1 n. Healthcare Received in Child Delivery Bihar Rural Institutional delivery Home Delivery Skilled delivery TBA Received PNC 16. which correlates with the high unmet need in the state.1 23. Table 3.1% consumed the tablets. 2005 Bihar Rural ANC One or more Three or more First check-up within 12 weeks TT 90+ IFA tablets Full ANC Received one or more TT Received Consumed 3 or more check-ups + one or more TT + received 90+ IFA tablets 3 or more check-ups + one or more TT + consumed 90+ IFA tablets 33. A dismal 2.a.6 2.0 59.3 11.7%. Table 3.4 66.7 75.6 SC/ST n.0 17. acidity.46 presents data for healthcare received in child delivery.a.7 India Urban 78. India 33.6 14. 74.1 33.0 9.1 24.8 n.5 Total 36.7 9.

However. Such attitude approving of force is the highest in the state. only 8. thereby limiting their access to the cash. Women also face various gynaecological morbidities such as menstrual problems. NFHS-3 reveals that most women in Bihar have access to cash.2% of women have a bank account or a savings account which they can operate themselves. 67. This lack of space for decision making in economic affairs of the household puts the woman at a disadvantage both in her house and in society despite her status of being employed.6% of women feel that it is all right for the wife to refuse sexual intercourse with the husband if she knows that he has a sexually transmitted disease.9% women age 15–49 in the state agree that husbands beating wives is justified. household needs.1% of the men approving of use of force to have sex with their wives. with 58. excessive discharge. A similar percentage of men (57. vaginitis. RTI. abortion. but experience it differently. Women’s autonomy in the state has a long way to go. heart ailments.4%) believe the same. NFHS-3 shows that in Bihar 84% of currently married women reported that they jointly make decisions related to her earnings. cervical erosion. HIV/AIDS and communicable diseases.2% of women take decisions regarding all four aspects. as reflected from the figures related to their access to money and cash. Health problems such as lack of nutrition.4% of men approve of the husband reprimanding the wife for refusing to have sex. Only 32. with 15. NFHS-3 statistics for the various forms of domestic violence experienced by women age 15–49 in State of Health in Bihar 61 . It is being increasingly recognized that women’s health issues go much beyond maternal morbidity and mortality to include nutrition. etc. Only 25. RTI/STI and HIV/AIDS prevalence have been discussed earlier.women face. in Bihar also women are affected by many of the same health conditions as men. STI. Only 41. contraception. reproductive health. In comparison. women’s low social status.6% of women having money that they can decide how to use.7% women take joint decisions regarding how their husband’s earnings are used. and paralysis. A little over 50% of the women in the state said that they take decisions alone or jointly with their husband regarding household purchases. role.2% of women in the state have mobility since most of the decisions regarding women stepping out of the house are taken by the men. As elsewhere. own healthcare and visits to family and relatives. This is because of multiple factors such as women’s low decision-making power. Only 6. function and behaviour within households. Women’s Empowerment It is important to note that women’s health-seeking behaviour and the determinants of their access to timely and quality healthcare are linked to their socio-cultural status such as status in society. Most women in the state (73%) are not aware of micro-credit programmes and only 1% of women have taken a loan from a micro-credit programme.6% of men responded that their wives should have joint decision making power. child bearing. whereas only 63.4% of men responded that they and their wives jointly take a decision about her earnings. knows that he has sex with other women or if she is tired and not in the mood. anaemia among married and pregnant women. low mobility. in addition. high blood pressure.1% of men agree that women have a right to refuse sex for these reasons and 28. experience of violence. In comparison. etc. As regards attitude towards wife beating and violence NFHS-3 shows that 56. only 73. and pelvic inflammatory diseases.

The present discussion is about immunization.1.000 deaths occurring annually.47). NFHS-2 1998-99 11 38 24 17 41 21 CES 2001 13 39 21 14 n. Bihar contributes about 9. The indirect indicator for reach of services.4 n.47.a. which additionally impact on women’s health.a.7 46.a. 13. 58 40 37 n.a.9% (the highest in the country). 38.8%.0 52. followed by the Universal Immunization Programme (UIP) in 1985. high drop-out rates and declining trend in some of the districts in Bihar are issues of major concern (see Table 3. knowledge of diarrhoea treatment. respectively. childhood disease treatment. 55.6 37.9% of infant deaths in the country. indicating poor access and utilization of immunization services.8.4 82. launched in the country in 1978.a.6 million non-immunized children to the pool of susceptible children. This drop needs to be addressed to improve routine immunization and subsequently child survival. the second largest in India (estimate from 2001 Coverage Survey by UNICEF/WHO and 2001 census). It should be clear from the preceding statistics that some of the social realities of women in Bihar are their economic dependence. 2. and child feeding practices.the state are as follows: physical violence only.4 n. The Expanded Immunization Programme (EIP). 25 CES 2005 19. measles and vitamin A were at 21. The stagnating routine immunization coverage rates. With 158. physical and sexual violence. showed that full immunization rates have decreased in 11 districts. Child Health Immunization The status of infant and child mortality in the state has been highlighted earlier. i. 19. and 11. Measles Source: Data for reported coverage 2004-05 from Bihar State Demographic Cell and Bihar State Immunization Cell.9%. and emotional violence. Strengthening routine immunization was seen as the cornerstone of the endeavour to reduce infant and child mortality. Bihar is among the few states where the performance of Routine Immunization Programme also continues to be significantly below the national average. OPV3. lack of food and inequitable distribution of food for girls and women in the household.4 n.5 28. BCG coverage level was at 39%. BCG and the acceptance of services (DPT) shows a drop of approximately 20%. 20 NFHS-3 Coverage 2005-06 32.8 36. The 2001-02 Coverage Evaluation Survey indicated that full immunization coverage level among children in Bihar was only 13%. their experience of violence and the negative attitude of men.8 64.8 34.a. lack of influence in decision making.a.a. 21 Fully vaccinated BCG DPT3 Measles Three Doses of Polio Drop-out: BCG. Table 3. sexual violence only. In 2001 the state contributed 2.3 18 Reported Coverage 2003-04* n.1%.1.6% (the highest in the country).a. 21. 62 State of Health in Bihar .7%. Immunization Coverage in Bihar (%) Antigen DRHS 1998-99 22.e.4 40. Reported Coverage 2004-05 n. sought to protect all infants and children in the country against preventable diseases and deaths. performed in 30 districts in Bihar in 1998-99 and again in 2002-03.1 40. Coverage levels for DPT3.9 25. District Level Rapid Household Survey (DRHS). DLHS 2002–04 23 44 33 26 34. Added to these are poverty. 13. physical or sexual violence. 50 44 30 n. These findings indicate a strong need for focusing greater efforts on strengthening immunization in the state. inadequate access to safe drinking water and sanitation facilities. n.

6 31. the state has achieved significant improvement in immunization coverage.0 66.6 73.3 14.8 47.50 and 3.48.7 56. Currently.8 India Urban 90.3 61. Bihar and India Bihar Total Glass Disposable AD Rural Glass Disposable AD Urban Glass Disposable AD Source: Coverage Evaluation Survey.5 54.0 99.6 1.4 70. Tables 3.4 61. Figure 3.9 95. Table 3.4 n.8 45.7 1.1 1.8%. Rural 79.4 19.0 25.0 31.0 Bihar Urban 66.8 58. 3.7 57. 2005 Antigen Rural BCG DPT 3 OPV 3 Measles Full Immunization Vitamin A Pulse Polio Source: Coverage Evaluation Survey.48 presents data for immunization status by residence and among the SC/ST segment of the population in Bihar and India for 2005.1 2. 51.51 graphically.9 21.4 51.9 n.7 26.a.2 35.6 99. The coverage of immunization and the method of sterilization by auto disabled (AD) syringes in Bihar is extremely low.1 60.a.5 Total 52.2 70. Polio3.1 54.49 presents data for syringe use in 2005.8 36. As against 2% coverage of type of syringes for immunization and sterilization for India.9 79.5 27. Table 3.1 28.0 SC/ST 83.5 9.7 4.4 17.2 31.48.7% in Bihar as per CES 2005.0 10.6 89. DPT3 and BCG.7 52.9 3.1 Total 83. 50% of syringes are reused in the country.51 present data on the achievement of the immunization programme in the state.7 State of Health in Bihar 63 .6 88. Table 3.7 0.5 49.6 54.8 4.8% more than the NFHS-1 coverage (11%). 2005. Coverage of Type of Syringes used for Immunization and Method of Sterilization.6 31. The coverage of full immunization has gone up to 32. India 9.49.4 94.0 99.7 79.3 68.4 67.4 67.9 70. Improvement is seen for the entire range of measles. Table 3. Although disposable syringe coverage rate is high in the state (88.5 30.41 presents the data of Tables 3.8 38. 2005.According to NFHS-3 data.0 19.50 and 3.8 88. Immunization Status by Residence and among SC/ST in Bihar and India.7 65. which is approximately 19. the coverage rate is only 1.1 SC/ST 47.0 28.6%) there needs to be increased coverage for AD syringes to check reuse.0 2.0 94.

47.9 31.2 64.4 NFHS-2 (1998-99) Bihar 11.2 43.8 India 28.50.8 48.2 111. (c) by residence.51.2 n.4 39.7 69 82.7 55.2 12.6 7.7 12.4 19. 2005.4 57.6 India 42.8 18.9 25.4 India 54.8 BCG (Below 1 year) 58.8 28.1 60 48.8 55. Child Immunization and Vitamin A Supplementation.7 n.0 India 45.2 48.2 24.7 43.1 48.0 49. (d) among SC/ST Table 3.1 28.4 19.5 58.6 75.9 16. Achievement in Immunization (%) Period TT DPT Polio (III dose) 44 65.7 82.8 RCH-I Bihar 22. Bihar and India (%) NFHS-3 (2005-06) Bihar Children 12-13 months fully immunized (BCG.2 58.4 29.0 RCH-II Bihar 23.2 33.4 13.3 33.1 23 33.8 Table 3.4 55. measles.0 6.4 35.1 50.8 45.0 68.4 46.4 12.4 77.7 63.6 60.9 9. 64 State of Health in Bihar .3 50.3 TT 16 years 45.1 40.3 70.0 57.4 14.4 36.9 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 26.5 12.7 DT TT 10 years 54. (b) compared with all-India level.7 27.8 26.0 31. and 3 doses each of polio/DPT Children 12–23 months who have received BCG Children 12–23 months who have received 3 doses of polio vaccine Children 12–23 months who have received 3 doses of DPT vaccine Children 12–23 months who have received measles vaccine Children 12–35 months who received a Vitamin A dose in last 6 months Children 12–13 months with no immunization 32.a.2 14.6 62.5 33.a.1 40.8 37.5 Measles (Below 1 year) 37.1 60.2 56.9 48.9 38.0 42.4 51.7 30.3 17.9 83.Figure 3.4 34.3 73.5 42.5 Source: Coverage Evaluation Survey. 71.8 39.1 15 15.8 51.41. Immunization coverage in Bihar: (a) progress.

5 37.52 and 3. and include low capacity to supervise.Immunization coverage in the state is very poor. India 17.a. NFHS-1 (1992-93) Bihar 12. low managerial and support capacity at the state and district immunization units. 70. n.1% of sub-centre and urban health posts in the state are within 2 km of residence from the nearest place for immunization (India 84.9 65. especially among the rural and SC/ST segments.a.9 43.8 58. which is a positive feature reflecting the high level of commitment of staff especially at the lower level.52. Instead of viewing immunization as a programme which has been imposed. There needs to be emphasis on problem solving at district and block level. Data for distance of the nearest place for immunization show that 68. have identified critical problems in the immunization system.2%). In terms of awareness about immunization the state lags far behind all-India levels. it needs to be recognized that the achievements have been under very difficult working conditions. Table 3. with services in poor condition. lack of adequately trained human resources.8 61.9 n. and weak management of fund flows. These are well known. Bihar as a high-focus state needs to give increased attention to the programme through decentralization in authority and decision making.3 n. monitor and implement micro-plans at district level. Tables 3. along with diarrhoea.8% for India.4 48.a.53 present data for treatment of childhood diseases and knowledge of diarrhoea management. State of Health in Bihar 65 . Various assessments performed by several agencies over the last few years. despite major constraints. Childhood Diseases and Treatment Acute respiratory infection (ARI) is a leading cause of childhood morbidity and mortality. Bihar has a prevalence of 6. in comparison to 5. India 26.a.6 NFHS-2 (1998-99) Bihar 13. including the UIP review done in Bihar.5% received antibiotics.9 n. Treatment of Childhood Diseases (Children under 3 years) (%) NFHS-3 (2005-06) Children with diarrhoea in the last 2 weeks who received ORS Children with diarrhoea in the last 2 years taken to a health facility Children with acute respiratory infection or fever in the last 2 weeks taken to a health facility Bihar 22.7 n. However.7 54.8% for ARI symptoms as per NFHS-3. ageing and poorly maintained cold chain.2% children under five years with symptoms of ARI sought treatment from a health facility or provider and 13.6 India 33. The state needs to effectively utilize the vast number of human resources available at the community level through other programmes such as ICDS. lack of effective vaccine distribution to immunization sites.a.

7 Bihar 64.53. Madhya Pradesh.2 Sexually Transmitted Infections Sexually transmitted infections (STIs) is a co-factor for HIV transmission.7 8.2 11. Early diagnosis and treatment of STIs is important in increasing awareness on HIV/AIDS awareness and prevention of HIV.Table 3.8% and 0.4 25. 66 State of Health in Bihar . Tripura and Rajasthan have STI prevalence of 15% and higher.6 14.6 RCH-I India 66.7 13.3 3.1 29.3 84. Knowledge of Diarrhoea Management and Treatment (%) RCH-II Women aware of diarrhoea management Women aware of ORS Women whose child suffered from diarrhoea and treatment was sought Children with diarrhoea who were treated with ORS Bihar 67.2 India 64.2 22. NFHS 3 shows that in India 11% of women and 5% of men who have ever had sex had an STI or STI symptom.7 27. Assam. The state-level figures reflect that Bihar.6 73. In Bihar STI prevalence among women is 2.4% among men.0 29.

the International Institute of Population Sciences (IIPS). NFHS and RCH survey. The integration of DRHS 1998-99 and Provisional Population Results of the Census of India. etc. 2.4 District Health Profile and Ranking of Districts State averages can be misleading because broad aggregates mask the disparities and variations which exist between districts. State of Health in Bihar 67 . thereby making the district the focus. 2001. the data base for district-level planning has been inadequate and limited. 2001. Health needs across the districts also vary. provided the basis for the first composite socio-demographic development index. At the national and state level there are a number of indicators available through census. Ranking of Districts by Demographic and key RCH indicators. Realizing the need for data at the district level. conducted the DRHS 1998-99 and DLHS in 2002-04 as part of the RCH Programme of the Ministry of Health and Family Welfare. and 3. The India Socio-demographic Development Index. is based on similar indices used by IIPS to compare and assess the overall development of 593 districts in India in the last five years. as do opportunities for overcoming these constraints. The 73rd and 74th amendments to the Constitution have brought about decentralized planning and programme implementation. Mumbai. published by Population Foundation of India. sample registration systems. Census of India. Constraints to effective service delivery also differ between districts. District Health Profile. The ensuing sections present 1. The computation by PFI is an integration of DLHS 2002-04 and the Final Population results. DRHS 1998-99 for the first time provided a set of key reproductive and child health indicators along with the Provisional Census 2001 for the district. Government of India. However. which was computed by IIPS in 2002. The district has now become the critical unit of planning and programme implementation. Composite Socio-Demographic Development Index.

2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.1 13.I.0% Towns: 3 Villages: 783 Demographic particulars (Census.4 33.6 1. District Health Profile ARARIA General information Area (sq km): 2830 Community Development Blocks: 9 As proportion of state’s area: 3. 1991–2001 (%) Population density (per sq km) 2158606 1128105 1030503 93.9 763 68 State of Health in Bihar .5 5.9 6.4 28.

3 36.2 4.5 56.2 0 0 91.6 5.0 4.4 39.2 38.3 31.0 46.9 71 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.8 74.2 3 39 200 State of Health in Bihar 69 .0 34.9 19.4 3. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 50.6 9.6 98.4 22.1 19.5 25.2 12.8 20.7 10.Sex Ratio (females per 1000 males) 1991 2001 907 913 986 963 35.

5 0.6 8.1 30.3 7.5% Towns: 5 Villages: 1828 Demographic particulars (Census. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.0 30. 1991–2001 (%) Population density (per sq km) 2013055 1040945 972110 91.7 609 70 State of Health in Bihar .AURANGABAD General information Area (sq km): 3305 Community Development Blocks: 11 As proportion of state’s area: 3.4 23.

7 25.0 71.3 32.6 0 2.2 14.5 0 93.3 37.1 3 69 207 State of Health in Bihar 71 . 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 45.9 4.1 41.8 19.7 21.6 53.2 83.0 20.8 32.5 7.7 34.3 59 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate Key RCH indicators from DLHS.3 4.3 28.5 0.Sex Ratio (females per 1000 males) 1991 2001 915 934 970 943 57.3 20.9 33.

5 12.5 533 72 State of Health in Bihar .BANKA General information Area (sq km): 3020. 1991–2001 (%) Population density (per sq km) 1608773 843293 765480 96.2% Towns: 2 Villages: 1737 Demographic particulars (Census.7 28. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.4 4.3 6.5 3.0 Community Development Blocks: 11 As proportion of state’s area: 3.8 24.

7 0.6 49.4 36.1 8.2 48.7 33.7 39.4 25.8 22.4 25.7 55.6 28.5 36.9 31.6 0. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 56.4 98.3 28.02 1.7 3 34 227 State of Health in Bihar 73 .8 4.Sex Ratio (females per 1000 males) 1991 2001 893 908 969 965 42.5 24.0 54.9 4.0 38.8 NA Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.1 0.

4 4.7 6.0% Towns: 2 Villages: 815 Demographic particulars (Census. 1991–2001 (%) Population density (per sq km) 2349366 1228874 1120492 95.BEGUSARAI General information Area (sq km): 1918 Community Development Blocks: 18 As proportion of state’s area: 2.5 1225 74 State of Health in Bihar .6 14.2 29.5 0. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.1 30.

8 26.3 4.7 21.6 31.Sex Ratio (females per 1000 males) 1991 2001 898 912 961 946 48.6 41.0 59.5 0 92.4 1.8 62 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.2 16.8 34.8 2 42 288 State of Health in Bihar 75 . 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 50.8 15.3 33.0 4.9 18.5 18.7 15.6 52.4 2.1 35.8 28.3 0.6 27.7 89.

5 2.9 943 76 State of Health in Bihar .7% Towns: 5 Villages: 1052 Demographic particulars (Census.3 30.BHAGALPUR General information Area (sq km): 2569 Community Development Blocks: 16 As proportion of state’s area: 2.7 10.3 18.7 26. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate. 1991–2001 (%) Population density (per sq km) 2423172 1291658 1131514 81.4 6.

6 29.8 0.4 0.7 69.9 38.9 7.Sex Ratio (females per 1000 males) 1991 2001 864 876 944 966 49.1 2 57 280 State of Health in Bihar 77 .7 3.7 41.2 0 98.5 62 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 42.1 35.6 33.9 39.6 51.2 38.3 21.4 28.9 4.1 31.2 42.1 48.5 59.6 19.5 27.

6% Towns: 6 Villages: 1129 Demographic particulars (Census.9 15. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.BHOJPUR General information Area (sq. 1991–2001 (%) Population density (per sq km) 2243144 1179611 1063533 86.5 25.3 0.1 907 78 State of Health in Bihar . km): 2474 Community Development Blocks: 14 As proportion of state’s area: 2.7 7.1 13.4 30.

6 91.1 4.Sex Ratio (females per 1000 males) 1991 2001 904 902 924 940 59.0 10.5 49.1 32.4 32.3 23.8 29.3 2 32 284 State of Health in Bihar 79 .0 37.3 54.3 0.6 6.9 30.5 97.5 14.0 74.3 2. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 55.3 41.1 12.2 54 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.0 30.0 36.8 51.1 0 0.

2 14.8 7. 1991–2001 (%) Population density (per sq km) 1402396 738354 664042 90.8 9. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.6 29.BUXAR General information Area (sq km): 1624 Community Development Blocks: 11 As proportion of state’s area: 1.7% Towns: 2 Villages: 882 Demographic particulars (Census.1 0.6 28.9 864 80 State of Health in Bihar .

2 23.7 4.0 87.8 11.9 39.1 1.9 9. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD clinics HIV + prevalence among ANC clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 59.9 30.0 0.4 97.4 76 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.2 55.0 0 27 158 State of Health in Bihar 81 .2 16.4 22.9 29.1 31.8 38.0 36.4 0 0.8 71.Sex Ratio (females per 1000 males) 1991 2001 884 899 905 925 56.5 31.1 11.6 4.6 40.

1 15.3 1446 82 State of Health in Bihar .0 30.4% Towns: 1 Villages: 1179 Demographic particulars (Census.1 6.9 8.DARBHANGA General information Area (sq km): 2279 Community Development Blocks: 18 As proportion of state’s area: 2. 1991–2001 (%) Population density (per sq km) 3295789 1722189 1573600 91.4 31.5 0. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.

5 16.5 74 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 49.1 0 0.1 4.Sex Ratio (females per 1000 males) 1991 2001 911 914 954 915 44.8 33.2 14.0 33.6 5.5 31.0 3.3 25.0 38.7 99.7 30.9 31.3 56.0 8.2 96.3 16.8 31.9 40.6 6.9 2 64 261 State of Health in Bihar 83 .8 56.9 22.

2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.GAYA General information Area (sq km): 4976 Community Development Blocks: 24 As proportion of state’s area: 5.6 0.3 13.7 30.1 30.3% Towns: 5 Villages: 2832 Demographic particulars (Census.7 29.3 698 84 State of Health in Bihar .7 6. 1991–2001 (%) Population density (per sq km) 3473428 1792163 1681265 86.

4 48 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.1 33.8 25.6 0.4 63.2 4.8 10.9 23.7 36. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 54.0 21.4 0 90.3 36.6 37.7 25.6 14.7 50.3 7.5 28.0 33.Sex Ratio (females per 1000 males) 1991 2001 922 938 983 968 50.4 0.2 2 68 439 State of Health in Bihar 85 .4 41.5 20.6 71.2 4.

3 1059 86 State of Health in Bihar .4 0.2% Towns: 4 Villages: 1475 Demographic particulars (Census. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.3 6.1 7.GOPALGANJ General information Area (sq km): 2033 Community Development Blocks: 14 As proportion of state’s area: 2. 1991–2001 (%) Population density (per sq km) 2152638 1075710 1076928 93.3 30.1 12.3 26.

4 12.6 54.5 35.6 1.0 39.0 4.3 28.1 35.7 3 32 186 State of Health in Bihar 87 . 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 34.3 1.3 97.5 63.Sex Ratio (females per 1000 males) 1991 2001 968 1001 966 964 47.8 53.3 6.0 32.2 29.4 63 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.6 0 97.2 24.9 4.0 31.6 29.2 30.8 15.1 34.

JAMUI General information Area (sq km): 3098 Community Development Blocks: 10 As proportion of state’s area: 3.8 30.1 33.6 7.3% Towns: 2 Villages: 1373 Demographic particulars (Census.3 6.4 4.4 17.0 452 88 State of Health in Bihar . 1991–2001 (%) Population density (per sq km) 1398796 729138 669658 92. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.

8 4.7 12.4 57.Sex Ratio (females per 1000 males) 1991 2001 903 918 967 963 42.8 9.1 0.1 26.4 23.2 43.7 49.9 38.1 1.8 28.0 32.5 NA Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.0 0 95.5 13.7 22. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 64.3 42.7 34.9 33.0 3 28 166 State of Health in Bihar 89 .1 2.3 7.0 27.3 20.

1 7.9 965 90 State of Health in Bihar .6 7.4 18.4 28.1 30.9 0.7% Towns: 2 Villages: 928 Demographic particulars (Census.JEHANABAD General information Area (sq km): 1569 Community Development Blocks: 12 As proportion of state’s area: 1. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate. 1991–2001 (%) Population density (per sq km) 1514315 784946 729369 92.

1 39. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 60.1 16.0 6.0 83.2 44.4 38.4 57.1 80 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.8 2 29 81 State of Health in Bihar 91 .6 35.0 4.4 4.Sex Ratio (females per 1000 males) 1991 2001 919 929 967 917 55.9 33.4 27.9 42.2 1.9 28.9 17.8 0 1.6 20.3 70.4 25.2 0 93.6 32.

5 7.6% Towns: 1 Villages: 1398 Demographic particulars (Census. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.8 28.4 31.2 2.2 22.KAIMUR (BHABUA) General information Area (sq km): 3362 Community Development Blocks: 11 As proportion of state’s area: 3.8 3. 1991–2001 (%) Population density (per sq km) 1289074 677623 611451 96.1 383 92 State of Health in Bihar .

4 28.1 17.1 69.6 7.1 36.1 21.3 34.4 4.Sex Ratio (females per 1000 males) 1991 2001 884 902 918 940 55.8 13.6 39. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 48.4 33.9 29.8 2 49 107 State of Health in Bihar 93 .8 NA Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.5 0.7 5.4 20.6 54.5 75.4 1.5 0 0 90.7 38.8 34.0 11.

2% Towns: 3 Villages: 1393 Demographic particulars (Census. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.KATIHAR General information Area (sq km): 3057 Community Development Blocks: 16 As proportion of state’s area: 3.9 29.9 9.5 31.7 5.1 783 94 State of Health in Bihar .1 5.1 8. 1991–2001 (%) Population density (per sq km) 2392638 1246872 1145766 90.

1 21.3 68 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.5 96.8 37.Sex Ratio (females per 1000 males) 1991 2001 909 919 975 966 35.0 38.1 17.4 33.4 28.1 5.5 2.5 23.1 36.1 48.2 56.4 28.6 39. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 46.8 13.5 0 95.2 5.1 2.1 45.9 3 43 257 State of Health in Bihar 95 .6 7.3 23.5 7.

0 14. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.6% Towns: 2 Villages: 298 Demographic particulars (Census.0 29.0 6.KHAGARIA General information Area (sq km): 1486 Community Development Blocks: 7 As proportion of state’s area: 1.7 862 96 State of Health in Bihar .7 6.0 29. 1991–2001 (%) Population density (per sq km) 1280354 679267 601087 94.5 0.

2 23.5 22.4 30.9 35.1 72 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.3 9.0 1 24 151 State of Health in Bihar 97 .1 21.8 8.8 0 0 89.8 35.3 51.Sex Ratio (females per 1000 males) 1991 2001 868 885 943 932 41.8 95.8 29.2 59.1 20.1 3.2 0.7 5.6 3.9 25.2 15. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 58.9 34.3 36.

KISHANGANJ
General information Area (sq km): 1884 Community Development Blocks: 7 As proportion of state’s area: 2.0% Towns: 3 Villages: 815

Demographic particulars (Census, 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate, 1991–2001 (%) Population density (per sq km) 1296348 669552 626796 90.0 10.0 6.6 3.6 29.5 4.9 31.7 688

98

State of Health in Bihar

Sex Ratio (females per 1000 males)

1991 2001

933 936 982 947 31.1 42.7 18.6 32.2 10.2 52.2 90.9 4.5 39.0 5.3 81

Child Sex Ratio (0–6 years) (girls per 1000 boys)

1991 2001

Literacy rate (7+)

Persons Males Females

Work participation rate

Total Female

Household amenities

Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%)

Vital rates

Crude Birth Rate Total Fertility Rate Infant Mortality Rate

RCH indicators from DLHS, 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 42.6 65.6 23.1 47.3 28.3 12.4 2.8 20.5 14.1 7.9 1.1 0.9 0 0 84.0 22.4 2 15 136

State of Health in Bihar

99

LAKHISARAI
General information Area (sq km): 1228 Community Development Blocks: 6 As proportion of state’s area: 1.3% Towns: 2 Villages: 410

Demographic particulars (Census, 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate, 1991–2001 (%) Population density (per sq km) 802225 417672 384553 85.3 14.7 15.8 0.7 29.5 6.6 24.1 653

100

State of Health in Bihar

Sex Ratio (females per 1000 males)

1991 2001

880 921 955 951 48.0 60.7 34.0 36.5 23.3 15.7 57.6 12.9 33.8 4.7 NA

Child Sex Ratio (0–6 years) (girls per 1000 boys)

1991 2001

Literacy rate (7+)

Persons Males Females

Work participation rate

Total Female

Household amenities

Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%)

Vital rates

Crude Birth Rate Total Fertility Rate Infant Mortality Rate

RCH indicators from DLHS, 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 57.4 50.0 32.6 31.6 40.4 21.9 13.4 30.9 25.4 23.2 0.2 0.3 0 1.0 96.7 24.3 1 17 102

State of Health in Bihar

101

1991–2001 (%) Population density (per sq km) 1526646 797180 729466 95.9% Towns: 2 Villages: 450 Demographic particulars (Census. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.5 17.3 5.MADHEPURA General information Area (sq km): 1788 Community Development Blocks: 13 As proportion of state’s area: 1.7 29.1 0.5 4.6 854 102 State of Health in Bihar .6 28.

9 21.3 72.9 27. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 54.7 8.8 37.8 0 0.5 1.8 22.1 44.8 36.5 89.3 50.Sex Ratio (females per 1000 males) 1991 2001 885 915 942 927 36.1 48.5 11.6 3.3 1 30 115 State of Health in Bihar 103 .2 17.1 96.5 37.7 4.4 31.7 3.8 67 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.8 21.7 11.

5 3.5 0.5 13.MADHUBANI General information Area (sq km): 3501 Community Development Blocks: 21 As proportion of state’s area: 3. 1991–2001 (%) Population density (per sq km) 3575281 1840997 1734284 96.0 28.2 1021 104 State of Health in Bihar .7% Towns: 4 Villages: 1150 Demographic particulars (Census.6 6. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.6 26.

6 15.3 4.1 33.0 15. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 60.Sex Ratio (females per 1000 males) 1991 2001 932 942 953 939 42.4 7.3 86 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.0 56.3 20.5 5.0 26.7 15.6 98.7 0 0 71.1 5.1 61.8 54.7 3.8 26.4 31.8 36.2 2 95 430 State of Health in Bihar 105 .5 1.7 30.2 34.

1991–2001 (%) Population density (per sq km) 1137797 607730 530067 72.5 Villages: 633 Demographic particulars (Census.1 27.2 6.5% Towns: 1.6 802 106 State of Health in Bihar .5 As proportion of state’s area: 1.9 13. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.8 20.6 31.3 1.MUNGER General information Area (sq km): 1419 Community Development Blocks: 1.

3 38.0 4.0 0 0 96.5 69.5 5.7 36.1 13.7 38.4 29.1 22.3 50.4 0 2.9 47.8 1 19 123 State of Health in Bihar 107 .Sex Ratio (females per 1000 males) 1991 2001 856 872 934 914 59.8 26.6 35.0 23.0 NA Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.4 48.7 29.5 51.5 47. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 48.4 23.

5 7. 1991–2001 (%) Population density (per sq km) 3746714 1951466 1795248 90.0 26.7 9.MUZAFFARPUR General information Area (sq km): 3172 Community Development Blocks: 16 As proportion of state’s area: 3.3 15.8 1181 108 State of Health in Bihar .9 0.4% Towns: 3 Villages: 1824 Demographic particulars (Census.1 29. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.

6 38.6 64 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.7 4.9 93.4 0.4 8.9 32.0 59.8 30.7 42.Sex Ratio (females per 1000 males) 1991 2001 904 920 943 928 48.1 12.8 40.4 20.4 35.4 0 66.5 32.1 35. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 44.5 37.0 19.4 12.8 31.5 51.4 1 61 473 State of Health in Bihar 109 .8 7.9 12.

9 20.0 30.1 14. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.NALANDA General information Area (sq km): 2355 Community Development Blocks: 20 As proportion of state’s area: 2.1 18.0 7.5% Towns: 5 Villages: 1140 Demographic particulars (Census.0 0.7 1007 110 State of Health in Bihar . 1991–2001 (%) Population density (per sq km) 2370528 1238599 1131929 85.

2 66.9 63.Sex Ratio (females per 1000 males) 1991 2001 898 914 962 942 53.8 0.2 96. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 59.1 4.1 27.9 33.0 3 48 302 State of Health in Bihar 111 .4 37.3 0.2 4.2 NA Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.3 10.4 38.4 31.6 1.8 27.5 38.6 38.1 26.8 21.2 15.6 59.0 30.0 12.0 5.

1 0.3 7.1 30.NAWADA General information Area (sq km): 2494 Community Development Blocks: 14 As proportion of state’s area: 2.6% Towns: 3 Villages: 1051 Demographic particulars (Census.1 726 112 State of Health in Bihar .4 6.7 24.8 33. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate. 1991–2001 (%) Population density (per sq km) 1809696 929960 879736 92.

4 5.9 35.6 74.3 2 37 129 State of Health in Bihar 113 .7 0 0.1 25.0 6.6 32.8 45.3 48 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.3 25.1 28.3 4.7 33.9 27.1 15.Sex Ratio (females per 1000 males) 1991 2001 936 946 974 978 46.8 34.8 60.6 55. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 58.2 37.4 0 1.8 13.2 90.1 26.

2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate. 1991–2001 (%) Population density (per sq km) 3043466 1600839 1442627 89.1 6.2 14.8 10.1 30.6% Towns: 5 Villages: 1484 Demographic particulars (Census.3 1.4 582 114 State of Health in Bihar .PASCHIM CHAMPARAN General information Area (sq km): 5228 Community Development Blocks: 18 As proportion of state’s area: 5.5 28.

0 24.9 57.Sex Ratio (females per 1000 males) 1991 2001 877 901 963 953 38.2 0 51.2 35.2 1.6 7.6 1.0 73 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.6 37.8 6.7 5.1 28.6 52.1 25.5 37.9 23.9 51.9 5.1 17. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 63.3 96.2 35.2 37.5 4.7 2 41 389 State of Health in Bihar 115 .6 7.

2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.2 31.4 41.5 0. 1991–2001 (%) Population density (per sq km) 4718592 2519942 2198650 58.7 30.4 1474 116 State of Health in Bihar .7 6.4% Towns: 12 Villages: 1565 Demographic particulars (Census.PATNA General information Area (sq km): 3202 Community Development Blocks: 24 As proportion of state’s area: 3.6 15.

2 45.Sex Ratio (females per 1000 males) 1991 2001 867 873 937 923 62.9 73.4 31.0 15.7 96.7 48.9 1.3 9. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 44.8 28.5 4 86 418 State of Health in Bihar 117 .4 49.2 13.5 42.8 34.3 50.5 3.2 0.4 8.0 47.8 30.3 39.4 3.4 77.0 52.1 36.9 52 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.

4 6.2 Towns: 7 Villages: 2835 Demographic particulars (Census.0 0.2 29.1 28.4 13.6 6.5 993 118 State of Health in Bihar .PURBA CHAMPARAN General information Area (sq km): 3968 Community Development Blocks: 27 As proportion of state’s area: 4. 1991–2001 (%) Population density (per sq km) 3939773 2077047 1862726 93. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.

0 27.0 3.7 14.5 26.0 93.4 42.3 24.3 32.7 45.5 11.6 6.0 54. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 59.8 4.9 81 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.2 1.8 38.9 27.5 49.3 34.6 0.5 80.0 6.6 14.2 18.6 23.Sex Ratio (females per 1000 males) 1991 2001 883 897 944 937 37.0 3 66 315 State of Health in Bihar 119 .

4 28.PURNIA General information Area (sq km): 3229 Community Development Blocks: 14 As proportion of state’s area: 3.4 788 120 State of Health in Bihar . 1991–2001 (%) Population density (per sq km) 2543942 1328417 1215525 91.4% Towns: 3 Villages: 1197 Demographic particulars (Census. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.7 12.8 5.4 35.3 8.3 4.

6 98.3 12.2 7.2 26.0 31.6 30.0 NA Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.4 37.4 0 96.6 23.0 3.2 59.5 27.Sex Ratio (females per 1000 males) 1991 2001 903 915 965 967 35.6 5.5 3.3 72.5 6.1 37.0 28.1 2 45 278 State of Health in Bihar 121 .0 13.8 23.1 45.1 19.4 0. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 42.

3 18.1% Towns: 5 Villages: 1855 Demographic particulars (Census.8 636 122 State of Health in Bihar . 1991–2001 (%) Population density (per sq km) 2450748 1283485 1167263 86.1 1.7 13.9 27. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.ROHTAS General information Area (sq km): 3851 Community Development Blocks: 18 As proportion of state’s area: 4.0 6.0 30.

7 1 30 186 State of Health in Bihar 123 .Sex Ratio (females per 1000 males) 1991 2001 894 909 965 951 61.5 39.3 2.8 46.6 16.6 0 0.5 32.8 8.7 30.5 2.5 86.6 30.5 35.5 41 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.3 45.4 25.1 4.5 52.7 50.4 92.6 1.4 13.0 30.7 24. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 46.3 75.

1 0.8 33.2 886 124 State of Health in Bihar .8 Towns: 1 Villages: 504 Demographic particulars (Census. 1991–2001 (%) Population density (per sq km) 1508182 789432 718750 91. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.3 16.SAHARSA General information Area (sq km): 1702 Community Development Blocks: 10 As proportion of state’s area: 1.7 8.3 29.4 5.

1 28.4 22.5 4.6 NA Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.5 21.4 57.9 35.1 28.7 3.5 6.5 96.1 0 40 152 State of Health in Bihar 125 .Sex Ratio (females per 1000 males) 1991 2001 884 910 920 912 39.7 25.5 16.3 39.1 51.9 8.2 2.6 0 1.9 14. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 47.6 37.5 30.1 99.9 62.7 34.

1 29.1% Towns: 4 Villages: 1230 Demographic particulars (Census.4 3. 1991–2001 (%) Population density (per sq km) 3394793 1760692 1634101 96.7 24.SAMASTIPUR General information Area (sq km): 2904 Community Development Blocks: 20 As proportion of state’s area: 3.9 1169 126 State of Health in Bihar .5 0. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.5 6.9 18.

Sex Ratio (females per 1000 males) 1991 2001 926 928 942 938 45.6 23.7 7.7 58.8 1 73 354 State of Health in Bihar 127 .0 17.2 0 0.6 31.4 8.7 87.1 57.7 42.6 15.7 31.8 8.7 86.1 11.4 34.8 4. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 67.9 78 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.0 6.7 4.1 16.1 25.6 22.5 19.

2 8.0 0.SARAN General information Area (sq km): 2641 Community Development Blocks: 20 As proportion of state’s area: 2. 1991–2001 (%) Population density (per sq km) 3248701 1652661 1596040 90.0 26.8% Towns: 5 Villages: 1708 Demographic particulars (Census.3 1230 128 State of Health in Bihar . 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.8 9.2 12.2 30.

7 NA Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.8 26.5 10.3 35.9 58.5 36.8 67.6 4.8 35.0 22.4 12.3 4.6 32.2 10.6 30.6 86.Sex Ratio (females per 1000 males) 1991 2001 963 966 960 949 81.9 2. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 28.1 3 60 413 State of Health in Bihar 129 .1 32.3 15.9 35.7 18.9 7.7 0 0 95.

7% Towns: 2 Villages: 315 Demographic particulars (Census.5 15.9 6.7 0.5 19.SHEIKHPURA General information Area (sq.0 29.7 25.0 793 130 State of Health in Bihar . 1991–2001 (%) Population density (per sq km) 525502 273992 251510 84. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate. km): 689 Community Development Blocks: 6 As proportion of state’s area: 0.

0 11.7 44.3 4.0 25.0 56.1 34.0 23.6 61.0 5.9 23.4 0 0 62.5 0 0.1 37.Sex Ratio (females per 1000 males) 1991 2001 896 918 965 955 48. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 85.9 43.9 33.7 NA Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.2 1 21 74 State of Health in Bihar 131 .7 23.7 26.9 37.5 55.4 10.1 18.

9 36.9 4.1 14.0 28.2 6.5% Towns: 1 Villages: 213 Demographic particulars (Census.SHEOHAR General information Area (sq km): 443 Community Development Blocks: 5 As proportion of state’s area: 0.4 0. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.6 1165 132 State of Health in Bihar . 1991–2001 (%) Population density (per sq km) 515961 273680 242281 95.

Sex Ratio (females per 1000 males) 1991 2001 876 885 946 916 35.2 58.5 21.1 NA Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.3 45.1 35.4 19. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 59.3 0 0.3 5.8 5.4 0 0 97.3 23.8 23.7 45.5 16.2 9.4 18.7 10.9 31.5 1 10 34 State of Health in Bihar 133 .8 60.1 8.9 98.1 3.

7 11.3% Towns: 5 Villages: 945 Demographic particulars (Census.4 6. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.3 5.SITAMARHI General information Area (sq km): 2200 Community Development Blocks: 17 As proportion of state’s area: 2.8 0.1 28.2 1219 134 State of Health in Bihar . 1991–2001 (%) Population density (per sq km) 2682720 1417611 1265109 94.5 33.

5 95.Sex Ratio (females per 1000 males) 1991 2001 884 892 921 924 38. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 56.1 98.9 11.6 25.2 21.5 3.3 27.0 59.5 16.0 5.4 26.1 27.3 5.1 31.0 0.9 38.1 42 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.5 49.2 2.6 6.4 36.1 11.5 3.4 1 51 213 State of Health in Bihar 135 .9 13.2 34.

0 1223 136 State of Health in Bihar . km) 2714349 1336283 1378066 94.4% Towns: 3 Villages: 1545 Demographic particulars (Census.0 25.5 11. 1991–2001 (%) Population density (per sq. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.6 8.5 5.4 0.SIWAN General information Area (sq km): 2219 Community Development Blocks: 19 As proportion of state’s area: 2.5 30.

3 36.8 16.6 41 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.9 3.7 45.9 6. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 39.7 4.7 43.9 26.7 0 82.4 1.6 24.3 22.2 2 49 370 State of Health in Bihar 137 .9 4.3 27.1 38.5 54.9 12.3 96.2 32.6 67.8 33.4 5.Sex Ratio (females per 1000 males) 1991 2001 1017 1031 963 934 51.0 23.

8 29.8 0.SUPAUL General information Area (sq km): 2410 Community Development Blocks: 11 As proportion of state’s area: 2.0 719 138 State of Health in Bihar .3 28.9 5.5 5. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate. 1991–2001 (%) Population density (per sq km) 1732578 902207 830371 94.6% Towns: 3 Villages: 591 Demographic particulars (Census.1 14.

0 24.7 3.3 97.8 12.4 20.Sex Ratio (females per 1000 males) 1991 2001 904 920 941 925 37.7 NA Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.9 9.1 51.3 52.3 1.8 42.4 0 85.4 15.4 4.4 25.7 36.5 15.0 78.3 27.7 2.0 33.6 36. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 61.2 4.4 1 37 178 State of Health in Bihar 139 .1 0.

2% Towns: 3 Villages: 1889 Demographic particulars (Census.9 20.1 29. 1991–2001 (%) Population density (per sq km) 2718421 1415603 1302818 93.1 6.3 26.VAISHALI General information Area (sq km): 2036 Community Development Blocks: 16 As proportion of state’s area: 2. 2001) Population Persons Males Females Rural (%) Urban (%) Scheduled Castes (%) Scheduled Tribes (%) Young people (10–24 years) (%) Elderly population (60+ years) (%) Decadal growth rate.6 7.7 0.7 1335 140 State of Health in Bihar .

1 11.0 46.7 37.4 25. 2002–04 Key RCH indicators Girls marrying below 18 years (%) Birth order 3 + (%) Current use of any FP Method (%) Total unmet need (%) Pregnant women with any ANC (%) Pregnant women with 3+ ANCs (%) Pregnant women received IFA tablets (%) Safe delivery (%) Institutional delivery (%) Children with full immunization (%) Communicable Diseases Kala-azar prevalence (%) TB incidence (%) HIV + prevalence among STD Clinics HIV + prevalence among ANC Clinics Women’s Health Awareness Aware of RTI/ STI (%) Aware of HIV/ AIDS (%) Health Infrastructure CHCs PHCs Sub-Centres 61.6 50.8 10.0 31.9 26.7 9.1 26.4 4.3 0 0.4 31.6 61 Child Sex Ratio (0–6 years) (girls per 1000 boys) 1991 2001 Literacy rate (7+) Persons Males Females Work participation rate Total Female Household amenities Households with kutchha houses (%) Households with safe drinking water (%) Households with electricity connection (%) Vital rates Crude Birth Rate Total Fertility Rate Infant Mortality Rate RCH indicators from DLHS.3 6.9 4.5 93.8 77.8 2 47 336 State of Health in Bihar 141 .0 33.6 28.0 37.2 36.5 63.8 23.Sex Ratio (females per 1000 males) 1991 2001 921 920 946 937 50.

9 28.2 20. District-wise Key RCH Indicators.6 31.0 51.5 26.0 13.8 18.4 35.5 50.2 42.9 54.0 55.4 42.6 58.9 21.8 38.0 35.5 26.9 25.3 60.8 26.7 50.9 27.9 52.3 31.5 31.1 16.8 38.4 52.6 34.5 20.4 42.5 23.9 20.6 56.8 25.5 61.5 17.7 28.1 30.5 37.6 37.9 28.8 47.4 33.3 30.8 32.7 22.4 % of Safe Delivery % of Children with Complete Immunization 19.6 21.6 22.2 19.9 46.2 25.7 25.0 50. RCH-2 (DLHS: 2002–04) District Sex ratio Population Density % Decadal Growth rate Female Literacy Girls Marrying below 18 (%) 50.8 23.7 33.7 32.0 40.4 33.9 85.2 33.1 36.3 25.4 31.8 33.6 64.6 50.5 30.4 934 908 912 876 902 899 897 901 914 938 1001 918 929 902 919 885 936 921 915 942 872 920 914 946 873 915 909 910 928 966 918 885 892 1031 920 920 609 533 1225 943 907 864 993 582 1446 698 1059 452 965 383 783 862 688 653 854 1021 802 1181 1007 726 1474 788 636 886 1169 1230 763 1165 1219 1223 719 1335 30.8 54.6 3.6 42.7 36.0 22.4 30.3 18.8 23.5 30.7 31.5 21.4 28.1 44.1 28.2 49.7 54.6 45.7 60.4 27.3 22.5 24.8 142 State of Health in Bihar .6 49.6 36.4 27.9 16.4 28.3 26.0 48.7 35.1 29.3 52.0 36.4 39.7 36.1 61.5 29.9 43.1 33.4 45.9 16.4 59.3 33.3 24.5 21.7 51.0 34.6 42.8 29. 26.5 62.1 52.8 39.7 34.9 23.8 12.9 26.6 16.9 29.6 31.1 54.2 58.2 30.4 35.8 36.7 36.9 19.7 41.9 23.4 54.1 40.0 14.0 53.1 55.2 50.6 50.7 42.4 32.6 27.4 39.9 23.6 44. Bihar.9 67.3 59.0 38.2 47.7 15.8 30. 4.5 36.2 33.6 51.0 29.6 32.0 23.6 22.9 57.4 28.4 38.5 30.1 36.0 20.8 20.3 44.9 28.6 30.5 26.6 40.8 36.2 25.9 23.9 59.1 16.1 59.1.9 24.2 59.4 59.1 23.1 28.5 19.4 35.5 18.8 23.9 22.1 Araria Arwal Aurangabad Banka Begusarai Bhagalpur Bhojpur Buxar Champaran East Champaran West Darbhanga Gaya Gopalganj Jamui Jehanabad Kaimur Katihar Khagaria Kishanganj Lakhisarai Madhepura Madhubani Munger Muzaffarpur Nalanda Nawada Patna Purnia Rohtas Saharsa Samatipur Saran Sheikhpura Sheohar Sitamarhi Siwan Supaul Vaishali 913 763 33.0 28.0 CPR % of women with any ANC 34.7 24.2 29.3 39.4 47.4 48.3 38.9 54.7 41.7 15.7 35.6 57.0 59.1 31.9 35.0 63.6 46.3 18.5 56.1 29.2 56.9 49.6 32.0 50.1 26.1 54.1 28.8 48.7 33.6 25.6 56.0 50.7 30.5 38.0 35.6 26.9 26.9 28.3 28.1 33.1 41.6 33.4 38.0 56.0 37.6 % of Births of Order 3 and above 56.1 48.6 39.7 27.3 25.6 55.3 40.9 31.7 27.2 21.1 7.2 24.2 26.3 25.2 27.8 36.5 59.3 44.0 14.Table.3 43.4 31.2 35.8 37.4 26.5 33.9 53.2 28.6 28.0 27.9 27.9 31.1 25.4 65.3 31.7 24.5 60.6 46.7 37.7 58.8 55.1 49.1 22.8 33.2 42.0 39.6 58.2 37.4 54.8 24.2 46.8 32.6 35.5 48.9 21.3 33.6 38.1 32.6 7.3 57.5 54.6 58.

Ranking of District State of Health in Bihar Map 4.II. decadal growth of population. 1991-2001 143 .38 : Bihar.

64 20.41 30.64 19.30 29.69 29.95 24.58) and Lakhisarai (24. Ranking of Districts According to Decadal Population Growth Rate (%) Rank in 2001 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 District Sheohar Purnia Araria Sitamarhi Saharsa Nawada Jamui Kishanganj Darbhanga Kaimur (Bhabua) Katihar Aurangabad Pashchim Champaran Patna Gaya Khagaria Madhepura Purba Champaran Begusarai Supaul Buxar Jehanabad Rohtas Bhagalpur Muzaffarpur Vaishali Gopalganj Saran Madhubani Bhojpur Sheikhpura Siwan Samastipur Banka Lakhisarai Munger Nalanda Bihar 1991–2001 36.73 31.34 29.14% as compared to 23.76 26.94 33.11 20.08 30.24 25. followed by Purnia (35.63 29. Nalanda (18.49 18. the growth rate of population during 1991–2001 for the state was 31.84 23.61 24.75 31.04 25.77 23.16 25.61) has the highest decadal growth rate.35 22.10 33.03 31.20 25.2.15 22. State of Health in Bihar 144 .40) and Araria (33.11).70 20.22 33.26 26.08 25.42 30.58 18.47 24.03 24.26 31.44 21.89 27.43 22.44 22.31 26.12 25. Sheohar (36.02 28.40 19.69 23.40 23.Table 4.76 19.73 23.77 24.94 28.77 24.94).15 20.47 29.17 20.15 22.15 21.58 22.10 31.87 26.18 33.58 27.54% for 1981–1991.84 26.04 28.30 19. followed by Munger (20.04 22.40 33.75) has the lowest decadal growth rate.54 Rank in 1991 15 17 5 16 12 18 29 22 9 20 4 11 37 33 14 2 25 6 10 13 34 36 21 23 7 1 8 19 27 35 30 26 3 24 31 32 28 Note: According to the 2001 census.46 29.17 25.72 30.46 24.82 26. Among the districts.67 26.92 28.12 23.14 1981–1991 23.61 35.

State of Health in Bihar
Map 4.39 : Bihar, density of population, 2001

145

Table 4.3. Ranking of Districts According to Density of Population (per sq km)
Rank in 2001 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 District Kaimur (Bhabua) Jamui Banka Pashchim Champaran Aurangabad Rohtas Lakhisarai Kishanganj Gaya Supaul Nawada Sheikhpura Araria Katihar Purnia Munger Madhepura Khagaria Buxar Saharsa Bhojpur Bhagalpur Jehanabad Purba Champaran Nalanda Madhubani Gopalganj Sheohar Samastipur Muzaffarpur Sitamarhi Siwan Begusarai Saran Vaishali Darbhanga Patna Bihar Census 2001 383 452 533 582 609 636 653 688 698 719 726 763 763 783 788 802 854 862 864 886 907 943 965 993 1007 1021 1059 1165 1169 1181 1219 1223 1225 1230 1335 1446 1474 665 Census 1991 402 476 573 446 466 402 476 522 536 602 545 476 569 597 582 476 659 664 703 602 703 573 749 767 844 809 838 905 936 931 905 978 946 974 1054 1102 1130 497 Rank in 1991 1 7 14 3 4 2 6 9 10 17 11 5 12 16 15 8 19 20 22 18 21 13 23 24 27 25 26 28 31 30 29 34 32 33 35 36 37

Note: According to the 2001 census, Bihar has a high density of population, with 665 persons per sq km, as compared to 497 during the 1991 census. Among the districts, Kaimur (Bhabua) has the lowest density of population (383), followed by Jamui (452) and Banka (533). Patna (1474) has the highest density of population, followed by Darbhanga (1446) and Vaishali (1335).
146

State of Health in Bihar

State of Health in Bihar
Map 4.40 : Bihar, sex ratio, 2001

147

Table 4.4. Ranking of Districts According to Sex Ratio
Rank in 2001 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 District Siwan Gopalganj Saran Nawada Madhubani Gaya Kishanganj Aurangabad Jehanabad Samastipur Lakhisarai Muzaffarpur Supaul Vaishali Katihar Jamui Sheikhpura Madhepura Purnia Darbhanga Nalanda Araria Begusarai Saharsa Rohtas Banka Bhojpur Kaimur (Bhabua) Pashchim Champaran Buxar Purba Champaran Sitamarhi Khagaria Sheohar Bhagalpur Patna Munger Bihar Census 2001 1031 1001 966 946 942 938 936 934 929 928 921 920 920 920 919 918 918 915 915 914 914 913 912 910 909 908 902 902 901 899 897 892 885 885 876 873 872 919 Census 1991 1017 968 963 936 932 922 933 915 919 926 882 904 895 921 909 882 882 885 903 911 898 907 898 895 891 876 896 891 877 896 883 882 868 882 876 867 882 911 Rank in 1991 1 2 3 4 6 8 5 11 10 7 28 15 21 9 13 27 29 25 16 12 18 14 17 22 24 34 20 23 33 19 26 32 36 31 35 37 30

Note:

According to the 2001 census Bihar has shown a decline in sex ratio, with 942 girls per 1000 boys as compared to 953 the previous decade. The district with the highest sex ratio is Nawada (987), followed by Gaya (968) and Purnia (967). The district with the lowest sex ratio is Munger (872), followed by Patna (873) and Bhagalpur (872). State of Health in Bihar

148

child sex ratio.41 : Bihar. 0-6 year.State of Health in Bihar GIRLS PER 1000 BOY IN THE AGE GROUP 0-6 YEAR 149 Map 4. 2001 .

The district with the most unfavourable child sex ratio is Saharsa (912). followed by Gaya (968) and Purnia (967). followed by Munger (914) and Darbhanga (915). Ranking of Districts According to Child Sex Ratio Rank in 2001 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 District Nawada Gaya Purnia Bhagalpur Katihar Banka Gopalganj Araria Jamui Sheikhpura Pashchim Champaran Lakhisarai Rohtas Saran Kishanganj Begusarai Aurangabad Nalanda Bhojpur Kaimur (Bhabua) Madhubani Samastipur Sitamarhi Purba Champaran Vaishali Siwan Khagaria Muzaffarpur Madhepura Buxar Supaul Patna Jehanabad Sheohar Darbhanga Munger Saharsa Bihar Census 2001 978 968 967 966 966 965 964 963 963 955 953 951 951 949 947 946 943 942 940 940 939 938 938 937 937 934 932 928 927 925 925 923 917 916 915 914 912 942 Census 1991 Rank in 1991 974 5 983 2 965 11 944 24 975 4 969 7 966 10 986 1 967 8 964 13 963 14 956 19 965 12 960 18 982 3 961 17 970 6 962 16 924 33 918 36 953 21 942 28 921 34 944 25 946 22 963 15 943 26 943 27 942 29 905 37 941 30 937 31 967 9 946 23 954 20 934 32 920 35 953 Note: According to the 2001 census Bihar has shown a decline in child sex ratio. as compared to 953 the previous decade.Table 4. The district with the highest child sex ratio is Nawada (987). with 942 girls per 1000 boys.5. State of Health in Bihar 150 .

State of Health in Bihar Map 4.42 : Bihar. female literacy rate. 2001 151 .

4 22.Table 4.1 25.7 41. followed by Munger (47.9 23.7 27.1).7 27.3 42.7 37 40.8 35.9 Rank in 1991 1 13 4 2 8 7 6 3 5 20 17 15 9 14 22 18 10 11 23 16 25 21 24 19 12 26 28 35 29 31 27 30 32 36 33 34 37 Note: According to the 2001 census female literacy in the state was 39.8) and Madhepura (22.4 Census 1991 60.7 25.3 28.6 28.1 25.3 37.7 26.2 51.1 36.8 38. The districts with low female literacy were Kishanganj (18.9 36. Supaul (20.3 25.2 31.8 47.8 18.8 35.8 47.8 47.7 17.1 45.1 20.4 50.3 26.2 28.8).4 38. Ranking of Districts According to Female Literacy Rank in 2001 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 District Patna Munger Rohtas Aurangabad Bhojpur Buxar Jehanabad Kaimur (Bhabua) Nalanda Bhagalpur Siwan Gaya Vaishali Saran Muzaffarpur Begusarai Lakhisarai Sheikhpura Darbhanga Nawada Gopalganj Samastipur Khagaria Banka Jamui Madhubani Sitamarhi Saharsa Pashchim Champaran Purba Champaran Sheohar Katihar Purnia Araria Madhepura Supaul Kishanganj Bihar Census 2001 50.8 36.0 33.4 39.5 42.8 42.6 34.6 38.4 45.5 40.8 31.9 39.3 27.8 23.3 33.2 41.9 41.7 29.3 23.6).2 24.6 38.9 in the 1991 census.7 33.6 32.4 as compared to 39.8 42.4 22.4 38.7).6 35. The district with the highest female literacy was Patna (50.5 27.6 39.2 23.8 49.2 32.9 33.4) and Rohtas (45.8 25.2 26. 152 State of Health in Bihar .4 51.6.7 36.3 42.8 39.2 42.8 51.

43 : Bihar.State of Health in Bihar Map 4. girls marrying below the age of 18 years (%) 153 .

5 DRHS 1998-99 51.6 44.8 47.7 55.6 39.4 60.1 56.2 54.6 66.6 56. State of Health in Bihar 154 .5 63.1 60. girls married below the age of 18 years in Bihar is 51.2 58.6 48.2 53.6 59. The district of Sheikhpura (85.4 59. At the lower end of the scale are Saran (28. Gopalganj (34.5 60.4 43.6 58.3 54.8 64.4 62.4 60.5 42.7 60.Table 4.2 46.2 58.7 45.5%.1 61.0) has the highest percentage followed by Samastipur (67.6 46.6 49. Ranking of Districts According to Girls Marrying Below the Age of 18 Years (%) Rank in 2002–04 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 District Saran Gopalganj Siwan Purnia Bhagalpur Kishanganj Muzaffarpur Patna Aurangabad Katihar Rohtas Saharsa Munger Kaimur (Bhabua) Darbhanga Araria Begusarai Madhepura Gaya Bhojpur Banka Sitamarhi Lakhisarai Khagaria Nawada Purba Champaran Sheohar Buxar Nalanda Jehanabad Madhubani Supaul Vaishali Pashchim Champaran Jamui Samastipur Sheikhpura Bihar DLHS 2002–04 28.7) and Jamui (64.6 51.5).8 50.0 56. and Siwan (39.4 58.0 51.0 64.6 69.5 47.8 61.6 63.7.9).3 51.9 64.3 58.6 42.0 57.0 56.6 63.7).8 63.7 65.6 54.4 79.6 64.4 40.0 59.9 72.2 59.5 44.3 56.6).7 67.5 69.7 85.6 58.2 59.8 48.9 34.5 50.7 58.2 Rank in 1998-99 8 14 2 5 17 4 9 1 26 3 35 11 21 34 7 6 15 33 23 13 16 31 20 27 36 24 30 32 18 10 28 12 25 37 19 29 22 Note: According to RCH-DLHS 2002–04.9 63.2 42.9 48.3 48.6 60.5 64.

State of Health in Bihar Map 4. birth order three plus 155 .44 : Bihar.

1 59.8 50.9 59.7 57.4 56.6) has the highest percentage followed by Saharsa (62.0 57.4 54.7 58.7 Rank in 1998-99 25 34 28 4 29 19 10 30 3 32 7 14 18 20 9 13 6 24 11 15 35 12 21 36 33 31 1 5 16 27 26 17 8 23 22 2 37 Note: According to RCH-DLHS 2002–04.5). Ranking of Districts According to Birth Order 3 and Above (%) Rank in 2002–04 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 District Rohtas Patna Jamui Vaishali Lakhisarai Madhepura Gaya Munger Supaul Muzaffarpur Bhagalpur Begusarai Aurangabad Siwan Bhojpur Gopalganj Banka Kaimur (Bhabua) Madhubani Purba Champaran Buxar Nawada Araria Katihar Darbhanga Sheikhpura Pashchim Champaran Jehanabad Sheohar Saran Samastipur Sitamarhi Nalanda Khagaria Purnia Saharsa Kishanganj Bihar DLHS 2002–04 46.1 55.9 51.6 51. At the lower end of the scale are Rohtas (46.1 62.8 58.6 65.7 54.4.1 56. State of Health in Bihar 156 .6 52.6 54.3 64.9 52.0 54.5 56.7 57.6 53.0 54.0 50. the birth order 3 and above for Bihar is 54.6 53.5 50.5 58.0 50. Patna (48.7 56.7 55.7 54.9 61.6 56.9 59.1) and Jamui (49.7 51.1 59.4 59.3 59.4 DRHS 1998-99 58.6 56.2 56.9 55.8).5 59.7 60.8 56.8 59.4 58.6). The district of Kishanganj (65.7 53.6 58.5 48.9 53.6 59.6 62.7 56.2 54.Table 4.7 56.5 54.4 58.3 59.2 56.6 57.4 50.3 59.0 57.1 53.0 55.4 58.6) and Purnia (59.6 53.8.8 53.1 49.6 53.3 56.9 58.

45 : Bihar.State of Health in Bihar Map 4. ante-natal care 157 .

7 43.5 26.4 51.Table 4.4 43.7 21. the percentage of women who received any antenatal care (ANC) is 37.9 28. At the lower end of the scale were Khagaria (23.3 42.3).1 24.7).7 26.7 31.9 33.9 17.0 29.8 38.5 33.9 23.7 41.7 28. Leading in this respect were the districts of Gopalganj (53.4).7 23.4 27.1 38.9 16.3 27.5 32.8 23.4) and Patna (52.9 36.2 26. an increase from 29.5 19.7 19.5 22.3).4 22.3 48.6 Rank in 1998-99 5 7 23 2 10 14 19 12 8 18 13 26 6 9 17 24 15 30 36 16 3 22 28 4 20 1 27 11 31 33 35 29 25 32 34 37 21 According to RCH-DLHS 2002–04.4) and Sheohar (23. Samastipur (23.9 28.2 33.8 37. Rohtas (52.4 23.6 40.4 40.0 32.3 33.2 37.0 35.4 29.7 17.2 33.1 46.0 36.6 in RCH-DRHS 1998-99.7 33.6 37.8 16.3 37.1 35. Ranking of Districts According to Any Antenatal Care (%) Rank in 2002–04 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Note: District Gopalganj Rohtas Patna Bhojpur Bhagalpur Munger Vaishali Jamui Siwan Purba Champaran Lakhisarai Muzaffarpur Kaimur (Bhabua) Banka Buxar Aurangabad Sheikhpura Katihar Madhubani Nawada Pashchim Champaran Araria Jehanabad Begusarai Darbhanga Nalanda Gaya Saran Saharsa Kishanganj Sitamarhi Madhepura Purnia Supaul Sheohar Samastipur Khagaria Bihar DLHS 2002–04 53.4 52.5 48.1 36. State of Health in Bihar 158 .9 DRHS 1998-99 33.9 22.9.3 29.2 17.4 40.6 33.5 13.3 52.5 38.0 19.1 34.8 29.9 27.3 24.0 29.5 20.0 27.7 32.8 15.9 for the state of Bihar.7 32.

institutional delivery 159 .State of Health in Bihar Map 4.46 : Bihar.

6 9.3 39.1 5.4 21.3 9.8 15.8 37.9 14.6 16.1 21.1 43.5 11.1 14.9 17.4 7.Table 4.0 12.9 18.0 DRHS 1998-99 12.8 11.4 35.7 38.0 12.1 24.7 17.2 6.6 11.1 14.7 10.7 23.0 8.4 17.1 23.8 30.6 12.3). Ranking of Districts According to Institutional Delivery (%) Rank in 2002–04 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 District Patna Rohtas Munger Bhojpur Jehanabad Kaimur (Bhabua) Nalanda Buxar Bhagalpur Pashchim Champaran Nawada Lakhisarai Banka Siwan Gopalganj Gaya Jamui Sheikhpura Vaishali Aurangabad Muzaffarpur Purba Champaran Darbhanga Saharsa Saran Begusarai Khagaria Kishanganj Katihar Purnia Supaul Madhepura Sitamarhi Samastipur Araria Sheohar Madhubani Bihar DLHS 2002–04 45. At the lower end of the scale are Madhubani (7.7).6 6. Sheohar (8.9% in RCH-DRHS 1998-99.9 26.7 15.8).3 14.1 33.9 16.9 13.4 14.1 13.9 Rank in 1998-99 21 7 11 2 4 6 5 3 19 1 13 10 18 17 14 22 9 12 20 8 24 26 23 27 16 15 25 34 36 37 28 29 31 35 33 30 32 Note: According to RCH-DLHS 2002–04.7 6. Rohtas (39.5 23.0 23.6 30.8 17.4 15.1 25.2 28.4 6.4 29.6 23.1 17.7) and Munger (38.10.4) and Araria (9.2 7.4 25.1 8. 23% of women in Bihar had institutional delivery as compared to 14. Leading in this respect are the districts of Patna (45.1).2 28.8 8.3 19.4 24.6 26.9 15.8 10.0 21.4 14.1 9.1 17. State of Health in Bihar 160 .9 31.4 9.1 13.0 9.1 23.4 18.

State of Health in Bihar Map 4. immunization figures 161 .47 : Bihar.

4 21.9 7.0 17.1 19.9) and Gopalganj (39.2 22.1 20.8 16.4 Rank in 1998-99 9 28 14 2 3 15 22 30 24 34 12 8 21 4 37 33 17 13 11 29 26 25 6 16 35 20 7 5 19 18 23 27 10 32 36 31 1 According to RCH-DLHS 2002–04.4 11.3 11 8.3 12.7 27.8 21.5 7.5).0 22.0 22 25.4 24.9 18.6 32. Kishanganj (7.0 21.5 26.4 11.0 15.2 21.3 11.6 14.5 25.4% in RCH-DRHS 1998-99.7 8.2 14.1 25.6 25.5 14.0 DRHS 1998-99 25.1 19.2 15.8 39.0 20.4 26.0).1 21.1 12. At the lower end of the scale were Pashchim Champaran (7.Table 4.9) and Kaimur (12.4 13.5 18.8 16.8 24.3 17.1 13.3 28. 23% of children in the age group of 12–35 months in Bihar received full immunization as compared to 22.6 23.9 39.6 18.9 22.6 20.7 21.0 18.4 36. Leading in this respect were the districts of Bhagalpur (42.8 22.2 30. Patna (39.3 20. Ranking of Districts According to Full Immunization (%) Rank in 2002–04 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Note: District Bhagalpur Patna Gopalganj Siwan Muzaffarpur Saran Aurangabad Bhojpur Purnia Munger Vaishali Banka Sitamarhi Nawada Rohtas Lakhisarai Saharsa Darbhanga Buxar Nalanda Madhepura Begusarai Khagaria Araria Sheikhpura Sheohar Katihar Jehanabad Samastipur Supaul Madhubani Purba Champaran Gaya Jamui Kaimur (Bhabua) Kishanganj Pashchim Champaran Bihar DLHS 2002–04 42.9 35.5 16.11.8 30.6 25.3 32.9 15.4 26.6 23.7 15.4 11.9 35.6).1 17.2 18.6 28.8).4 24.0 38. State of Health in Bihar 162 .

contraceptive prevalence rate 163 .State of Health in Bihar Map 4.48 : Bihar.

0 32.6 23. State of Health in Bihar 164 . At the lower end of the scale are Sheohar (19.7).7).3 21. Munger (38.6 37.6 33.9 31.6 19.0 20.5 30.8 17.7 20.2 23.2 28.8 27.5 22.0 29.7 21.6) and Saharsa (37.9 24.8 27.0 16.5 19.9 19.7 25.8 36.4 25.4 26.6 38.5 21.8 14. Ranking of Districts According to Contraceptive Prevalence Rate (%) Rank in 2002–04 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Note: District Bhagalpur Munger Saharsa Bhojpur Banka Patna Supaul Rohtas Katihar Vaishali Lakhisarai Muzaffarpur Darbhanga Madhepura Araria Buxar Khagaria Saran Madhubani Gopalganj Purnia Kaimur (Bhabua) Jamui Nawada Gaya Jehanabad Sitamarhi Purba Champaran Begusarai Nalanda Aurangabad Pashchim Champaran Sheikhpura Siwan Kishanganj Samastipur Sheohar Bihar DLHS 2002–04 39.2 24.6 23.2 27.9 27.9 23.1 35.6 26.3 21.7 23.4 35.4 15.9 36.0 33.5 31.7 31.9 27.9 28.7 20.4 30.7 21.Table 4.2 31.7 22.7 19.7) and Kishanganj (23.3 Rank in 1998-99 8 19 2 13 7 24 3 28 33 12 18 9 6 10 5 30 4 32 21 37 14 27 17 29 23 25 35 31 16 11 22 1 20 26 36 15 34 According to RCH-DLHS 2002–2004.5 22.6 20.7 36.1 30.1 21.9 24.9 23.9 36.8 28.1 22.3 in RCH-DRHS 1998-99. Samastipur (22.9 20.4 26.6).6 32.0 17.4 28.0 21.5 31.1).0 DRHS 1998-99 24. the percentage of women currently using any family planning methods is 31.12. Leading in this respect are the districts of Bhagalpur (39.9 21.7 24.0 30.8 30.6 16.0 as compared to 23.

56 9.11 68.67 24.70 66.26 46.40 7.46 42.39 38.44 40.55 31.54 39.92 7.41 1.72 31.71 21.87 28.98 63.46 33.63 30.95 22.35 27.58 40.41 13. i.47 46.14 41.68 31.71 6.2 26.68 65.02 43. Samastipur.38 55.85 13.87 58.80 0.40 31.57 75.24 6.11 17.86 21. Composite Socio-Demographic Development Index Table 4.76 29.03 62.88 20.41 61. Purba Champaran.93 25.06 5.72 26.02 58. published by Population Foundation of India.06 53.13 3.94 18.67 36.59 21.54 28.58 27.30 27.23 59.99 23.65 28.92 2.38 79.29 63.89 22.02 22.17 55.96 40.63 42.45 12.80 26.28 32.84 50.84 1.22 24.49 34.73 3.35 58.75 57.52 30.73 19.21 62.31 37.64 34.55 34.27 40.72 23.30 20.92 49.e.52 2.75 3.68 30.39 24.08 42.35 12.94 61.48 21.37 47.05 24.13 sums up the findings of the India Socio-Demographic Development Index.81 20.66 21.10 29.22 7.01 7.51 24. Mumbai.84 5.08 37.88 4 7 10 11 16 2 22 37 –12 5 –12 –26 27.26 58.22 57.94 23.40 21.66 29.56 24.12 31.61 41.10 30. etc. Ranking of Districts According to Socio-Demographic Development Indicators District Birth Order 3+ Full ANC Full Safe Girls Immu.99 24.31 59.27 34.56 26.85 46.49 5.42 13 14 15 16 17 18 21 22 24 34 35 36 44 51 53 55 59 63 67 71 72 73 83 85 93 119 123 126 129 148 150 156 193 4 6 10 13 14 25 33 28 3 30 34 29 32 72 56 27 77 46 35 45 44 52 50 48 67 62 69 109 66 40 53 97 228 9 8 5 3 3 –7 –12 –6 21 4 1 7 12 –21 –3 28 –18 17 32 26 28 21 33 37 26 57 54 17 63 108 97 59 –35 Table 4.12 41.32 9.30 30.70 6.01 41.80 26.25 51.77 78.65 14.58 35.87 31.17 4. Khagaria.81 34.43 23.54 25.49 69.23 9. It may be noted that in both documents all districts of Bihar figure as vulnerable/sociodemographically backward.02 20. respectively.25 44.36 32.31 24.68 55.18 28.55 3.90 47.60 Child Female Sex Literacy Ratio GDI Population Proportion RCH Index SDI Index SocioDemographic Development Index 23.60 25.86 45.50 34.71 31.26 26.02 4.75 23.16 2.46 32.28 30.58 39.28 70.86 25.51 27.11 34.09 20.22 68.56 33.60 14.24 24.02 73.74 63.08 24.06 40.78 13.47 45.21 32.81 43.80 26.83 37.73 15.55 16.89 37.49 12.12 17.34 9.87 2.95 60.23 24.65 37. 2001.31 44.64 19. New Delhi in 2007 and The Ranking of Districts in India for Area-specific Planning and Programme Interventions.07 16.74 4.61 68.86 37.15 31.91 64.91 16.26 2.06 24.39 0.63 46.93 25.Delivery Marrying nization under 18 Years of Age 18.98 16.90 28.16 16.28 63.23 74.83 38.26 73. West Champaran.82 12. The variables/indicators were chosen to reflect overall socio-demographic development.83 18.44 41.06 25.19 14.35 25.52 9.20 59.98 63.13.02 33. Kishanganj.78 57.72 7.61 35.46 30. Districts such as Sheohar.66 3.81 28.12 12.66 37.61 7.94 59.91 20.16 35.43 59.86 52.30 23.98 58.43 58.94 32.43 25.81 36.III.63 25.50 17.64 32.32 30. socially and demographically weak/backward.14 30.26 38.10 17.12 3.45 64.25 5.36 2.43 50.12 23.07 31.37 18.99 9.97 20.87 8.23 31.35 56.97 67.95 42.71 46.29 31.11 16.69 31.68 36. Madhubani.11 59.54 23.92 14.09 39.42 19.94 32.96 19.77 74.13 66.20 24.90 62.25 58.85 55.95 42.72 0.13 55.68 29.62 34.97 16.57 37.76 41.24 4. 2002.17 37.34 31.34 23.99 31.15 1.10 26.62 36.57 64.70 29.75 27.09 8.84 41.34 24.41 23.61 52.92 28.93 21.76 21.22 38.85 7.80 17.38 39.67 55.56 29.79 45.42 49.26 2.17 23.58 6.02 28.62 30.21 23.16 23.48 30. These computations identified districts as ‘vulnerable’.19 33.63 46.95 14.13 28.17 25.95 25.60 11.26 33.10 25.89 40.96 26.24 50.29 45.75 19.77 36.17 41.15 35.76 11.51 42.49 27.81 73.15 12.55 73.16 26.52 58.01 35.19 54.54 15.55 34.32 19. published by the International Institute of Population Sciences (IIPS).63 13.82 23.10 10.88 4.58 35.13 29.78 39.17 24.63 11.76 67.52 15.34 37. State of Health in Bihar 165 .56 26.74 8.56 36.86 36.22 31.64 15.52 55.62 45.07 34.43 24.96 21.03 34.43 59.41 24.96 32.65 59.82 21.80 57.22 17.80 60.37 21.53 31.00 40.25 14.39 74.84 35.16 46.05 60.97 30.30 47.04 28.61 19.94 22. Sitamarhi.65 7.73 22.67 27.34 2.83 56.76 54.33 6.84 30.09 65.53 34.38 24.53 25.59 26.09 21.99 33.48 27.72 73. These two publications attempted to compute composite indices based on ten key variables/indicators (using six indicators of DLHS and DRHS under the RCH programme and four indicators of the Census of India.36 8.90 35.17 27.01 1.96 6.83 44.03 27.14 43.96 43.00 4.65 31.74 13.06 18.11 15.38 44.23 27.11 Rank 2007 Rank 2002 Change in Rank Sheohar Kishanganj Samastipur Khagaria Pashchim Champaran Sitamarhi Purba Champaran Madhubani Supaul Saharsa Sheikhpura Araria Madhepura Darbhanga Purnia Jamui Kaimur (Bhabua) Jehanabad Begusarai Katihar Nalanda Buxar Lakhisarai Nawada Banka Vaishali Gaya Aurangabad Muzaffarpur Saran Siwan Bhojpur Munger Gopalganj Rohtas Bhagalpur Patna Note: 25.58 26.98 6.60 9.76 16.50 20.06 35.46 36.44 36.21 27.09 22.14 67.11 54. are perpetually at the bottom.52 2.28 36.

e. i. 2007 Note: It is seen from Table 4. socio-demographic development index. socially and demographically backward/weak. Bihar.Map 4.13 and Map 4. identifying them as ‘vulnerable’. The message is clear that all districts of Bihar need focused attention.12 that all districts in Bihar have a composite index of ‘value’ less than 50.12. State of Health in Bihar 166 .

1 presents the administrative structure of the health delivery system in the state. community health centre (CHC) and sub-centre (SC). Primary health care or first contact care is provided at the PHC.1 provides details of population coverage by the three-tier healthcare system. preventive and promotive services.5 Health Service Delivery The establishment of health service delivery through this approach started as early as 1952 on the basis of the recommendations of the Bhore Committee Report 1946 with the setting up of a three-tier delivery system. At the block level the block medical officer (BMO) heads the health administration.2 presents details. physician.e. State of Health in Bihar 167 . surgeon. A PHC is expected to have a medical officer (MO) and 14 para-medical and other staff. It is manned by one male multipurpose worker (MPW/M) and one female multipurpose worker (MPW/F) or ANM. Activities of the PHC involve curative. Table 5. At the district level the Civil Surgeon is the chief health and medical officer. The healthcare delivery system comprises the primary health centre (PHC). The staff strength of a CHC includes 4 medical specialists. It is also the most peripheral contact point between the primary health care system and the community. i. It acts as a referral unit for five to six sub-centres. gynaecologist and paediatrician. Figure 5. Table 5. CHCs are basically referral centres for PHCs approximately in the ratio of 1:4. A PHC on the other hand is the first contact point between the village community and the medical officer. the secondary care at the CHC and tertiary care at medical colleges and district hospitals. The sub-centre is the most peripheral health institution catering for the health care needs of the rural population. supported by 21 para-medical and other staff.

March 2006 Required Sub Centres PHC CHC 14959 2489 622 In Position 8858 1641 70 Shortfall 6101 848 552 Source: Bulletin on Rural Health Statistics in India. Particulars Community Health Centres (CHCs) (No.23 27 5 8390 10.28 4. 2006.96 644 23 45287 56. Availability of Health Personnel in Bihar.Table 5.) Primary Health Centres (PHCs) (No.82 5 94 21 21 27 25 Table 5. Special Revised Edition 168 State of Health in Bihar . Health Care Infrastructure in Bihar.) PHCs Average Rural Population served by a PHC Average Rural Area (sq km) Covered by a PHC Average Radial Distance (km) covered by a PHC Average Number of Villages covered by a PHC Sub Centres per PHC (No.) CHCs Average Rural Population Served by a CHC Average Rural Area (sq km) Covered by a CHC Average Radial Distance (km) Covered by a CHC Average Number of Villages Covered by a CHC PHCs per CHC (No. 2006.2. March 2006.) Sub Centres Average Rural Population Served by a Sub Centre Average Rural Area (sq km) Covered by a Sub Centre Average Radial Distance (km) covered by a Sub Centre Average Number of Villages covered by a Sub Centre FRUs At PHC At CHC At Sub District Level At District Level Source: Bulletin on Rural Health Statistics in India.41 18.43 1.1. Special Revised Edition Bihar 70 1641 8858 1061667 1319.) Sub Centres (No.

and 18% are without all-weather motorable road. 2006). only 5% have a lady doctor. and 26 urban family welfare centres. also showed that spending on public sector health services in Bihar was predominantly in favour of wealthier or richer groups (see Figure 5. It is seen from the data presented that while the healthcare delivery system in the state has expanded significantly over the last 15 years. State of Health in Bihar 169 . 8% have three doctors. no urban health posts.1. 48% with 4–6 beds. Table 5. 5. NSSO 52nd round. and only 14% with 24-hour delivery facility. 3% with operation theatre. 5. Urban health infrastructure under Family Welfare Programme shows that there are 28 districtlevel post-partum centres. In terms of basic amenities 33% of PHCs are without electricity supply. of the 8858 sub-centres 72% have ANM quarters but only 105 have ANMs living in the quarters.5 present data about the shortfall of health personnel in the state as on March 2006.2). Among additional reasons for people not accessing these services are that they do not believe in the relevance of these facilities or are put off by the service providers’ unhelpful interface with them. Government of Bihar As per the Bulletin on Rural Health Statistics (MoHFW. 34 sub-district-level post-partum centres. 29% are without regular supply of water and 37% are without all-weather motorable road. 9% have four doctors. 56% of the PHCs have only one doctor. Of the 1641 PHCs only 13% are equipped with labour room. A study conducted by NCAER in 1995-96. 19% have two doctors.4 and 5. In terms of personnel. most people still do not get the benefits of the existing health services. Tables 5. Many sub-centres are without ANM and most of them are without any male health worker. Services are often not accessible either geographically or financially. 42% are without regular water supply.Fig.6 presents data on staff position at PHCs and sub-centres. In terms of communication facility only 11% are equipped with telephone and 1% with computers.3. Organogram of Health and Family Welfare Department.

5. 2006. Special Revised Edition. 2006. 170 State of Health in Bihar .Table 5. 5. Health Staff Position at PHCs and Sub Spending on Curative Health Care Centre PHCs With 4 and more doctors With 3 doctors With 2 doctors With 1 doctors With no doctors With lady doctor Without pharmacists Without lab technicians Sub Centre Without HW (F)/ANM Without HW (M) Without both Number 141 137 317 925 121 74 686 810 854 3564 854 Source: Bulletin on Rural Health Statistics in India. Shortfall of Specialists and Techinicians in Health Facilities in Bihar. Midwife at PHCs and CHCs 1641 70 70 70 70 280 70 1711 1711 2131 Sanctioned 2078 70 70 70 70 280 89 989 82 1482 In Position 1606 28 19 29 12 88 15 291 16 1163 Vacant 472 42 51 41 58 192 74 698 66 320 Shortfall 35 42 51 41 58 192 55 1420 1695 968 Source: Bulletin on Rural Health Statistics in India. 2006. March 2006 Required Doctors at PHCs Surgeons at CHCs Gyne Obs Physicians Paediatricians Total Specialists Radiographers at CHCs Pharmacists at CHCs Lab technicians at PHCs and CHCs Nurse. March 2006 Personnel MHW/ANM Female at CHC MHW/ANM female at PHC Health worker male at Sub Centre Health worker female/LHV at PHC Health worker male/LHV at PHC Required 8858 10499 8858 1641 1641 Sanctioned 8858 10499 2135 850 649 In Position 7672 8904 1035 491 323 Vacant Shortfall 1186 1186 1595 1595 1100 7823 359 1150 326 1318 Source: Bulletin on Rural Health Statistics in India.4.3.2 : Concentration Curve of Public Table 5. Special Revised Edition Table 5. Shortfall in Health Personnel in Bihar.2. Special Revised Edition Fig.

facility timing not convenient (8.2%). the National Health Policy (NHP 2002 and the recent National Rural Health Mission (NRHM.3 : Visit to health facility for health sector health services provided among the major or family planning services : Rural states. 5.2%) said that he/she talked appropriately with them and 96. Poor health outcomes in the state justify focusing on National Population Policy (NPP 2000). This is the highest in the country. health personnel often absent (21. Fig. Change in utilization of health facility NFHS-II vs. The 1995-96 NSSO survey also points out that the public sector provided only a fraction of outpatient care (8% overall). Figures 5. a very high percentage (98. 5. But the Government has done little to regulate the private sector to ensure that it provides safe.7%) in the state do not use government health facilities due to poor quality of care.2% said that he/she made sure that the client understood the information given. with the wealthier/richer quintiles consuming higher rates of services in both public and private sectors. 5. Among those who had access to a health worker. Coupled with health personnel often not available.3% visit private healthcare facilities. community health workers have better client provider relationship and provide adequate information. The reasons cited are: lack of access to a facility (44. Only 19.3% in NFHS-3. The study also found that outpatient services are largely provided by rural medical practitioners (RMPs).2% of the women had any contact with a health worker. But the majority of households (83.5. RCH II data also disclose that only 8.9%).3. follow-up An increasing number of households are not using government facilities.5 provide data about people’s preponderant preference for private health facilities. these figures are the highest in India. effective and accountable health services. 5.6% of the population visit government health facility whereas 90. from 89% in NFHS-2 to 93. However.4%). access to a government health facility and regular visits by health worker are extremely poor in the state. The people of Bihar mostly depend on the private sector for their curative care. and waiting time too long (14. Visit to health facilities-public vs. It is thus seen that wherever present. State of Health in Bihar 171 .4 and 5. private rural area Fig.3. and the most inequitable distribution of its public services. 2005) efforts.The state also had the lowest levels of public Fig. as reflected in the rise in percentage of households not using government facilities.4.4%).

as shown in the dismal figures on home visits by ANM. (ii) information given to users.1 India 28.1 10. Referral exists more in theory than in practice and is the weakest link in the system. Table 5.3 23. Other issues are access.3 1. the urban population accesses the services. or the actual process of care giving. and integration.6 provides comparative data for quality of care in family planning services for Bihar and India.6. Key issues in quality of care and client satisfaction and reproductive choice are neglected. among which those in need of priority corrective action are: effectiveness.0 7. with low levels of information provided by the healthcare provider on type of contraceptive use. inadequate counselling. and by the focus on the client’s or user’s perspective of services.6 The health service delivery system is plagued with certain inherent weaknesses.5 16. decentralization.2 13.3 18. efficiency. Mumbai Bihar 20. Almost all district hospital services are localized and stationary.8 2.Quality of Care Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (Institute of Medicine. Efficiency. with few personnel going out and providing ambulatory care in the villages. Effectiveness. Mostly. It is estimated that healthcare delivery reaches barely 10–15% of the population. Earlier. (iv) interpersonal relations. It is seen from the table that there is a large gap in quality of care provided in Bihar in this respect. Such lacunae in health service delivery are evident across different levels of facilities and service providers in the state.8 4. policies related to primary healthcare were adequate and appropriate while the management of the various 172 State of Health in Bihar . training and infrastructure. The infrastructure remains poor. Outreach care is virtually absent. 1990). The framework of quality of care as enunciated by Judith Bruce (1990) incorporates six elements: (i) choice of methods. and (vi) appropriate constellations of services. Quality of care is also defined as the way by which clients are treated by the system. Table 5. client’s satisfaction and perspective. RCH-II.3 31.0 15. (v) mechanisms to encourage continuity.1 11.7 34.2 9. Quality of Care Indicators for Bihar and India Contraceptive Use % informed about other methods before sterilization % told about side-effects of sterilization % told about side-effects of other methods % received follow-up to sterilization % received follow-up to other methods % non users advised on use of contraceptive method Maternal Care % married women advised to have delivery by doctors/health worker % of women visited within 2 weeks of delivery by ANM % of women visited at least one within 6 weeks of delivery by ANM Source: DLHS.3 2.9 29. Providers’ attitude towards client. The UNFPA definition particularly emphasizes client’s participation in management decisions which goes beyond the concept of client provider interactions. IIPS. technical appropriateness and desired health outcomes are important components of quality. (iii) technical competence. and extremely low levels of community level monitoring of maternal health. The underlying reason for ineffectiveness is deficient management.

More immediately. who need services the State of Health in Bihar 173 . • A major shortcoming in the managerial health process is the fact that once a policy has been set it is translated directly into targets and numbers with little attention to planning. locality and poverty dominate access to employment. however. the vertical programmes remain largely independent in their own budgets. there is no accountability. Bureaucratic constraints: The rigid hierarchical system fits the patron-client relationship by which access to services is often gained. rather than being made more realistic they are made even more ambitious in order to demonstrate political support. supplies. Integration. For example. The NRHM has now accelerated the process of integration with some success but a number of issues still remain to be resolved. the danger that the effectiveness of the established vertical programmes might be diluted by integration and the dedicated human resource will be unprepared to deliver the amalgamation of services expected of them. Decentralization. When it becomes obvious that the targets will not be met. connection of class. Although there is little disincentive for poor performance individual action is carefully accessed in terms of accepted norms and stepping out is perceived as risky. Although integration of services has supposedly been completed. Since budgeting remains highly centralized there is little incentive to planning and decisionmaking responsibilities. They see the planning process as irrelevant to their work or become chronically disillusioned or indifferent. effective decentralization would not ensue as the mechanism for district health officials to exercise such control remains hazy. People do not expect much from public service and demands for better performance are constrained by such social factors as mentioned above. supervision and proper implementation of programmes. Architectural correction and the process of integration of vertical programmes remain unresolved under the NRHM. staff and bureaucratic imperatives. Even if financial control were to be delegated. Bihar has the lowest levels of child immunization in India and amongst the lowest levels of contraception prevalence and safe deliveries. how these targets and numbers will be met or can be met at all. This led to an extremely weak system in terms of motivation. Social cultural factors: The power of patronage. A prerequisite for making decentralized planning a reality is a sound decentralized health management information system. movement of trained human resources and frequency of supervision. promotions and transfers of individuals and to resources for the community.health programmes and projects did not reflect these policies. as envisaged in the NRHM. training. The policy of integration assumes that efficiency gains can be achieved by combining the service activities of vertical programmes. integration is often perceived as a threat to long-term programme staff who may face unemployment due to their contractual status. caste. given the low number of human resources and poor infrastructure. Some key determinants of efficiency or lack of efficiency are: • • • Access to care: This affects cost of services. Accountability: The government was regarded mainly as an instrument of revenue collection and law and order. Delivery of services is most problematic for the poor. As a result. Health services in Bihar also show relatively low levels of performance. This leads to frustration among those responsible for implementation. The effect of decentralization down to the district level has been limited. There is.

Health Insurance Health insurance coverage in Bihar is far from satisfactory despite the fact that a large proportion of the population lives below the poverty line and is illiterate. Bihar also had the lowest levels of public sector health services provided among the major states. i. Private providers of health insurance have only currently emerged as a big player in the Indian health insurance market after opening of the economy. Women from the richest and poorest quintiles are less likely to use the public sector if they deliver in a hospital. effective and accountable health services. Community health insurance scheme has been an emerging scheme introduced recently in some states.e. but the Government has done little to regulate the private sector to ensure that it provides safe. i. Existing insurance is largely limited to a small proportion of people in the organized sector. and the most inequitable distribution of its public services. insurance through employers and medical reimbursement through employers rather than voluntary health insurance schemes. 174 State of Health in Bihar .most. Currently. 28% and 49% respectively. The people of the state depend mostly on the private sector for their curative care. Hospitalization rates are also lower in Bihar than any other major state in India and are dependent largely on the private sector.e. This segment of the population lives under higher health risks. It is yet to take off in Bihar. less than 5%. Overall the private sector provides 28% of hospitalization in the state. Currently. Women from the poorest quintile have extremely low rates of institutional deliveries. with the rich 20% of the population consuming 15 times the number of public sector hospitalization as the poorest quintile. Central Government Health Scheme (CGHS). the various health insurance schemes by the government are Employment State Insurance Scheme (ESIS). knowledge about such schemes is low in the state.

This replacement level for the state will occur when its population will be 24. namely. USA. The Population Foundation of India and the Population Reference Bureau. State of Health in Bihar 175 .57. The British parliamentarians’ report on ‘Return of the Growth Factor: Its Impact on Millennium Development Goals’ is all the more relevant in the context of Bihar. malnutrition is rampant among children under 5 years of age. especially women. housing. the morbidity has its roots in communicable diseases for the whole population. underdevelopment and social deprivation.1 reflects the comparative scenarios for Bihar and India for the next 100 years (2001–2101).1 in 2061 while Bihar will reach that level in 2081. Population Stabilization A major challenge for the state is to achieve population stabilization. Therefore. The state is experiencing the classical health problems of underdevelopment and social deprivation. such as Bihar. nutritional deficiencies and communicable diseases. To sum up. Challenges and Strategies for Change It should be evident from the discussion in the preceding chapters that the health scenario in the state of Bihar remains dismal. The health scenario in the state. It may be noted from the projections that India’s population will reach replacement levels of TFR 2. Table 6. the female population is at great risk from complications of pregnancy and childbirth. but in states with high population. also opens up windows of opportunities. while presenting daunting challenges.000. The overarching challenge is to improve the health and nutrition status of the poor. much needs to be done to address the unmet need and stabilize the population to earn benefits from the demographic dividend. sanitation. have made projections with consistency for all the states of India. and effective utilization of health services by addressing the issues of access. disease and health in Bihar should be looked at in the context of social needs and related to health and social inequalities. Providing basic human needs and entailments — food. The most important recommendations for maximizing the gains from investment in health and improving the existing health status of the people are possible by ensuring food security. shelter and safe water — is the biggest challenge. safe drinking water. Following are the key strategies for the future.6 Concerns. quality and financing.82. but a broad horizontal problem of poverty. The problem in the state is not necessarily and primarily one of specific diseases calling for specific medical interventions along vertical lines. The country has made tremendous strides in slowing population growth.

3 3. etc. often limited to achieving numbers. 176 State of Health in Bihar .8 2. important to reduce population growth and ultimately stabilize population. Interventions for improving child survival are well known. The issue of population stabilization is not a technical issue with a technical quickfix solution.1. safe drinking water. Projected Population and Fertility. the same interventions are also required for empowering women. therefore. Reducing IMR and child mortality is.1 2.3 2.1 2. Bihar and India.1 2. Such narrow vertical programmes. to quality health care.2 2. and through greater gender equality. with focus on fertility reduction. It is well known that wherever infant mortality reduces.2 2. There exists a linkage between social development indicators. improved access to quality health care.5 2. particularly women’s access. improving the quality of life. higher earnings. are not the answer for India’s population stabilization. 2001–2101 Year Bihar 2001 2011 2021 2031 2041 2051 2061 2071 2081 2091 2101 82997 101024 122406 145305 168131 190521 211557 230275 245782 258417 267939 Population (’000) India 1028591 1203711 1380214 1546158 1695051 1823538 1930839 2018513 2087232 2141172 2181133 Bihar 4. better sanitation. health status and population stabilization. The answer does not lie in pushing sterilizations and chasing targets in the conventional mode.Table 6.1 TFR India 3. there exists a direct relationship between infant mortality and fertility.7 2.1 Historically.6 2. Interestingly enough.1 2. TFR falls.1 2. These are: better education. better employment opportunities.2 2.2 2. Thus. and ultimately for stabilizing population. better nutrition.4 2. The contraceptive mix needs to be enlarged and expanded. For population stabilization it is important to improve people’s access.1 2.3 2.0 2. This is related to the insecurity regarding child survival. through women’s empowerment. We are now discovering that the obvious route to population stabilization is through social development. India’s population stabilization efforts have centred around family planning.7 3.

Unless the mindset of people who manage things changes. (iv) focus on prevention. Given the situation in Bihar it is a matter of concern and it is becoming increasingly clear that it can be addressed effectively only through a social development approach. equal utilization of health care. hunger and poor health. This is. (ii) multi-sectoral development approach. it has to be placed and positioned in the broader context of comprehensive primary health care (see Figure 6. If development can help in stabilizing population. food security. Therefore.1). State of Health in Bihar 177 . The policy framework is based on the belief that people are the most valuable and precious resource of our country and the common agenda of both population and development is the well-being of the people. Surely. and equal care according to felt needs. The most important aspect of primary health care Figure 6.1. The paradigm shift from ‘number’ to ‘people’ has still a long way to go and it is being recognized that the shift to a reproductive health and rights agenda has not been fully internalized. These issues need to be widely disseminated in a correct perspective among various sections of society. Therefore family planning has to be positioned in the broader context of reproductive health and reproductive rights. (iii) utilization of appropriate technology. Primary health care Broader context of was and still is a potentially revolutionary concept reproductive health and which looks beyond the customary. Overall socioeconomic namely. preventive and promotive practices along with the assurance of high-quality curative services that are equitably acceptable. discrimination. a holistic concept and is guided by five principles. there is a need to address deep-rooted mindsets on critical issues relating to population and development. and (v) community participation and involvement. This has been accepted in principle in the National Population Policy (NPP) 2000. In fact. Delivery of primary health care requires an amalgamation of good. The health care component of equity is defined as equal access to Positioning family planning health care.Repositioning Family Planning in Primary Health Care We need to tackle the issue of population stabilization in a holistic way. The context of holistic is its ‘all-inclusive equity-oriented approach’. the NPP will remain on paper and cannot be implemented in its true spirit. It is only a means to development. Improvement of health and nutrition on the other hand can be an end in itself and will lead to population stabilization. this is a better approach. (i) equitable distribution. conventional and rights traditional boundaries of curative and preventive Comprehensive medicine and tries to address up-front the underlying primary healthcare social causes of poverty. Family planning programmes cannot be addressed in isolation. Population Stablization through Social Development Approach Curbing population growth cannot be a goal in itself. truly that is a much better and superior solution to one where population growth is curbed in the hope that development will automatically follow. in fact.

strengthening of public health system. child health and contraceptive services. and allround upgradation of health facilities. wider socio-economic development. there will also be emphasis on complete registration of births. It should distinguish community and epidemiological priorities. CNA should also assess the community perception of quality of care and practical indicators for quality of care should be developed. The need is for greater social investment. (iii) ensuring greater enrolment and retention of girls in schools. and providing comprehensive and safe abortion care. reducing infant mortality and MMR through better health care and immunization. Against this backdrop. marriages.Community Needs Assessment For making comprehensive primary health care programmes effective the starting point should be Community Needs Assessment (CNA). (ii) provision of health education. Social investments help reach the goal of slower population growth. At the village level the outcome of CNA should be a health improvement plan. and (iv) options for vocational engagement and livelihood. guidance and counselling services to adolescents. (c) ensuring institutional delivery. and deaths. There is need for women-centred preventive and promotive family planning services. which ideally needs to be aggregated and included in the district action plan. In this exercise it is vital to install a good Health Management Information System (HMIS) for improving the effectiveness of the programme. This decentralized and participatory process of health planning provides space for involvement of Panchayati Raj Institutions. effective IEC strategy. Micro-planning with CNA can help identify and address the local problems through more acceptable strategies. Specifically for increasing spacing in family planning there needs to be a shift in approach from sterilization to non-sterilization spacing options. addresses gender concerns. ensuring a minimum age at marriage of girls. CNA should assess the health needs and demands so that a realistic workload estimate can be made. increased IUDs and NSVs. CNA should be viewed as an important health sector reform initiative and not merely a reporting system. education of girls. A multi-pronged approach is required for population stabilization. ownership and accountability in health programme implementation. 178 State of Health in Bihar . pregnancies. Improvement in socio-economic indicators for population stabilization should be supported adequately and effectively with strong political commitment. and improved governance in order to achieve population stabilization. (b) delaying age of first pregnancy. and (d) meeting the unmet demand for contraception. information. increased interface and interaction between the community and the state. Delaying Age at Marriage and Spacing Some of the key approaches in delaying age at marriage and spacing are: (i) empowering women for increased decision making in family life. such as (a) strong campaign for delaying age at marriage after 18 years. nutrition support to women and children. Strategies for achieving population stabilization should include improving socio-economic indicators such as addressing the needs for maternal care.

child and maternal mortality. reduction of childhood diseases with focus on acute respiratory diseases and diarrhoea. In order to achieve these. reduce the burden of communicable diseases. Current pilot efforts in community monitoring being undertaken in selected districts in nine states of the country by Population Foundation of India in collaboration with the Ministry of Health and Family Welfare and NGOs attempt to provide lessons in good practices in community monitoring. Secondly. This will lead to greater accountability and transparency in programme implementation. There is wide consensus on the broad determinants of quality: adequate access and availability. involvement of the community should not be limited to monitoring. It should include community action. fully utilizing existing health care centres rather than increasing infrastructure further. there should be emphasis on complete registration of births and deaths. The aim should be to improve quality and increase coverage of services to reduce infant. Along with accessibility and availability of services. The latter includes the infrastructure and service environment — privacy and confidentiality. However. provision of quality care is recognized as a priority area in RCH Programme.e. who in turn return for services. Such process will ensure that the programme addresses people’s needs and reaches the underserved and unserved areas. implementation and monitoring where CBOs are to play a proactive. While the client perspective focuses State of Health in Bihar 179 . one needs to ensure effective functioning of public primary health care system.Community monitoring of health services The NRHM Implementation Framework outlines the need for inclusion of community monitoring or communitization of health services under NRHM. In addition. malaria and TB. establish gender-sensitive quality reproductive and maternal health services especially among the poor and vulnerable. The process includes direct involvement of self-help groups. and routine and reliable information on the scope of services and what is available at which level. The purpose is to increase efficiency in delivery of the entitlements under NRHM and to build people’s participation and direct involvement in monitoring of health services. PRIs and CBOs. which can then be replicated on a large scale across the country. neo-natal mortality and child mortality through Home Based Neo-natal Care (HBNC) and Integrated Management of New Born and Childhood Illness (IMNCI). Strengthening Health Service Delivery A second pillar in improving health care is strengthening health service delivery to be effective and responsive. especially kala-azar. and implementing universal immunization. A gender-sensitive quality reproductive and maternal health care services also need to be ensured. The focus is on decentralized district level planning. a comprehensive child health strategy needs to be developed wherein the focus should be on reduction of infant. planning and monitoring. Good quality of care creates demand from clients and ensures satisfied clients. A special strategy needs to be adopted to reduce the incidence of low birth weight babies. reduction of malnutrition. effective and meaningful role. Quality services are those that are commonly accepted by clients and which meet their needs. It is imperative that efforts are made for building the capacity of the community and the health service providers to jointly undertake planning and monitoring of heath services in Bihar. i.

the provider and managerial perspectives are equally important. Currently. special 180 State of Health in Bihar . the entire health delivery system has to gear itself to quality. including ASHA. and training ASHAs and retraining Dais and Skilled Birth Attendants in a phased manner. Better quality of services ensures increased use of the public health system as providing a higher standard of care leads to client satisfaction. The problem of quality cannot be addressed at a micro-level of a project. The bottom line is that there are no shortcuts and no quick-fix formulae. Strengthening Health Sector Management System A key approach to strengthening health sector management would include capacity building of staff and decentralized planning. providing necessary support systems for PRIs and ensuring devolution of financial and administrative powers to PRIs. orientation and training of PRIs (elected women representatives of the Panchayats in Bihar constituting more than 50% of the elected representatives) so that they play an effective role. Quality of care is a pillar of public health care which ensures a people-oriented and client-centred approach to public health. short-term courses for staff. The focus would be to develop disease-specific plans with emphasis on strengthening district-level implementation. Good quality family welfare services and reproductive technologies that are safe and effective should be promoted. It is equally important to ensure that quality of care at all levels is addressed. Pilot attempts are being made to ensure quality of care in reproductive health services and in other areas of NRHM. adopting innovative and effective models like IMNCI and HBNC model with community participation. It will also include developing an effective epidemiological information system to identify the magnitude and distribution of communicable diseases. there is little or no focus to put into practice processes for providing quality care in the public health system. Trained Birth Attendants and Skilled Birth Attendants. integrating all communicable disease control programmes at the primary health care and grassroots level. This will entail district-level orientation programmes for all health workers. Other important aspects would be to improve staff availability at the field level by human resource planning through the formation of district cadres. rather.on individuals. especially malaria and kala-azar in different population groups. It included not only the aspect of building quality assurance in the system but also including community perception of the quality of services. The two approaches are to promote institutional deliveries and to provide good and adequate referral support. This includes upgrading FRUs providing 24-hour emergency obstetric and basic obstetric care and strategy for strengthening enforcement of PCPNDT Act along with monitoring of ultrasound clinics. Quality of care It is not enough to provide basic health services. Population Foundation of India undertook such a pilot programme in two districts (Gaya and Vaishali) of Bihar in building capacity of the community to access better quality of care. The third objective is to reduce the burden of communicable diseases.

There needs to be increased coordination between various departments such as health. There is need for training of PRIs on their role and responsibilities. especially reproductive health and rights. Non-availability of skilled medical personnel. education.and postnatal check-up of pregnant women). contraception motivation and distribution. panchayati raj. so that they take greater interest in issues of the health of the people in their constituencies. Advocacy with elected representatives The Panchayati Raj elections held recently in Bihar led to a record number of almost 60% women elected as representatives in the panchayat system. rural development. Such initiatives need to be undertaken by donors. including nurse midwives. The Population Foundation of India as part of its advocacy efforts with elected representatives in Bihar helped form the Legislative Forum on Population. ensuring programme quality improvement through external reviews. NGOs. One of the first efforts of the forum was to undertake district-level advocacy efforts on health. The district-level advocacy brought together local MLAs. Intersectoral coordination has to be ensured by establishing an effective and meaningful institutional mechanism for convergence. and form and activate village health and sanitation committees to ensure greater grassroot involvement and monitoring of health services. leads to increasing unmet need. the state Health Department and people of the district on a common platform to discuss and identify key areas for action on health. and increased gender gap in access to services. State of Health in Bihar 181 . Enhancing demand and utilization of services and bringing equity and gender into the mainstream The low utilization of government health services in the state. etc. PRIs. women and child development. Another aspect of intersectoral coordination includes intra-departmental coordination.initiatives for remote areas. block and district level. institutions and the State Government more frequently at the district level so that the district realities and the regional disparities are addressed. and maintenance of CPR registers. beginning with Kishanganj which has the poorest health and social development indicators. Health and Development with the participation of almost 133 MLAs of Bihar. Her responsibilities include immunization. and evidence-based policy changes. increased regional disparities within the state such as between the districts of the north and the south. activate the health subcommittees of panchayats. community needs assessment. remains the major bottleneck to universal access to primary health care. survey of eligible couples. improving the effectiveness of asset management through review of guidelines. health service providers. safe delivery (pre. The Auxiliary Nurse Midwife (ANM) continues to be the primary service provider. client surveys. The other important aspect is to involve the state legislators cutting across party lines and build their perspective on health issues. A major bottleneck in access to services are the recurrent floods. The time has come to involve and harness this group of elected representatives to act as the voices of the community in ensuring better health service delivery at the village. especially by the poor due to lack of access to primary health care services.

This would require evaluation of existing information. In order to increase demand and utilization of services the following will have to be ensured. The issues in focus are reproductive 182 State of Health in Bihar . especially for referral and diagnostic health services. Scaling up innovative projects in the state on health. dignity and rights. (v) bringing in private capital to contribute to health sector goals and not transfer public assets or resources to private hands. particularly adolescents. In other words. BCC is a major component of RCH II and AIDS prevention programme. ensuring entitlements to people with disability. There is need to use different media methods and tools with principles of community involvement such as community radio and village wall newspapers. (ii) framework to ensure that costs and quality remain within reasonable limits and the poor have access especially in emergency situations. Addressing the Needs of Young People Bihar along with the rest of India has the maximum number of young people in its population. In some areas this would mean raising awareness about service needs. for example. There needs to be special focus on the married adolescent so as to influence them and make them capable of decision making for a better family life based on the principles of choice. (iv) ensuring cost and quality regulation to supplement and not substitute existing public health care in such partnerships. it also means changing health practices such as breast-feeding practices. especially in unserved and underserved areas. A third strategy would be to develop public-private partnership (PPP) in health service delivery. (vi) better access for the poor to tertiary services through risk pooling mechanisms and social insurance linkages. education and communications activities on their impact on the poor and marginalized through external agencies. The process of increasing PPP would include: (i) developing a basic minimum regulatory framework to register and accredit private health care providers. etc. It is the poorest people who are the most vulnerable during floods and suffer from outbreaks of epidemics. A second strategy would be to develop Behaviour Change and Communication (BCC) strategy. (vii) promoting a partnership with dedicated not-for-profit voluntary sector in health care service provision. including the increasingly important goal of ensuring that health care provision does not adversely impact the poor. and orientation of service providers and field workers on gender equity issues in all training. attitude or numbers must understand the need for addressing this demographic dividend by including and involving young people in the process. and (viii) acting as centres of innovation and excellence in reaching health care to the poor. This will need gender and equity strategy with specific focus on enhancing utilization of services.particularly in north Bihar districts. A major part of curative health care provision in the state is by the private and corporate sector. First would be to remove barriers to utilization of services by poor and marginalized groups. Any programme aimed at bringing about a change in behaviour. efficiency and accountability of private health service providers are badly wanting in the private health sector. Behaviour change is the key to an effective service delivery. (iii) encouraging linkages to public health system. the Pathfinder model of delaying age at marriage and first pregnancy in Bihar. high-risk sexual behaviour. There is need to involve this sector in contributing to the public health goals. Quality. the Janani model of social franchising for reproductive child health services. is also required.

emphasizing youth skills development beyond traditional schooling to include life skills. NGOs of national repute were identified as Regional Resource Centres (RRCs) to provide technical support to MNGOs. It is synergizing all its programmes in Bihar and Chhattisgarh with the RRC to address RCH issues. the Ministry identified and approved grants to MNGOs in allotted districts. and economic needs.NGO initiative The key challenges mentioned in this chapter can only be achieved by a partnership between government and non-government organizations. An important aspect in focusing on young people is to improve the health and welfare of young mothers and their children by changing traditional customs of early childbearing. In keeping with the philosophy of capacity building. strategy and plan and setting up youth resource centres at the state and district level. retaining and vocationalizing formal and non-formal education as part of the strategy to empower adolescent groups. developing an integrated youth policy. updating database on Reproductive and Child Health and development of Management Information Systems (MIS) in these two states. the Ministry of Health and Family Welfare introduced the Mother NGO (MNGO) Scheme under the Reproductive and Child Health Programme in the Ninth Five Year Plan. liaison with state governments. The common components are: • • • • • • ensuring access to reproductive health services and information. social. To supplement the efforts of the government. The broad objectives were: • • • to address the gaps in information on RCH services in the project areas. youth-friendly services. documentation of promising practices. health information and counselling. PFI has been playing an important role in providing technical support for NGO capacity enhancement. In order State of Health in Bihar 183 . from policy advocacy to service delivery. These MNGOs then disbursed grants to smaller NGOs called Field NGOs (FNGOs) in the allotted areas. Under this scheme. forming self-help groups of adolescents for micro-finance/Prime Minister’s Rozgar Yojana. to build strong institutional capacity at the state. and community norms and attitudes. district and field level. economic and personal development issues. continuing education and livelihood. induction and inservice training. The basic philosophy of this scheme has been nurturing and capacity building. fostering change in family and community norms and attitudes to increase acceptance of solutions that genuinely address youth reproductive health. advocacy and awareness generation. It was found that involving the NGOs in service delivery and addressing cross-cutting issues in the RCH service areas would be needed to make the programme more effective. enrolling. PFI is the RRC for Bihar and Chhattisgarh.

providing them better and suitable livelihood opportunities so that they develop as better human beings and committed and skilled assets for the state and the country. Population Foundation of India undertook a pilot advocacy programme on adolescent reproductive and sexual health issues in Bihar. Currently. by working with young married couples. Advocacy on youth issues The Government of Bihar has drafted the youth policy of Bihar. National Cadet Corps (NCC). The draft policy places emphasis on building the capacity of the young people of the state. there is low dependency ratio where there are a large number of working adults and fewer children to care for. nutrition. and space subsequent children by three to five years. Intervention research projects on delaying age at marriage. undertaking advocacy on youth issues at block. The consequences of this age structure are twofold. Secondly. demography. newlywed couples who have not yet had a child. when birth rates begin to fall. security. and families of young couples. The programme adopted a bottom-up approach where youth were directly involved in advocating for themselves along with local government officials. The challenge is to convert young people into an asset. or delay the age at first pregnancy. This is referred to as a demographic dividend or bonus. health system. such individuals could theoretically contribute to a country’s economic growth and prosperity. skill. various pilot efforts are being undertaken in the state to address the health needs of young people. and providing technical assistance to the state government on policies and programmes for young people. harnessing their talent. The need is to engage the youth directly at village. as is happening in some states and sub-regions in India. building leadership capabilities among youth in Bihar. block and district levels in developing the implementation plans based on the policy. The state can reap the demographic dividend as it stabilizes the population over the next fifty years. India is one of the youngest countries in the world. Demographically. 184 State of Health in Bihar . building awareness on issues. district and state level. The contribution of population momentum will be to increase the number of births. economy and development. in Bihar small pilot efforts are being undertaken to delay age at marriage and first pregnancy by mobilizing youth through groups at the village level. parents. behaviour change communication-focused programme involving married adolescent couples and capacity building of youth-based organizations such as Nehru Yuva Kendra (NYK).to bring about a reduction in maternal and infant mortality rates and improve the survival and general health of mothers and children. Projections by economists indicate that in India roughly eight million young people will look for employment each year. Some of the target population is adolescent girls and boys between 15 and 19 years of age. teachers. employment and health assumes urgency and importance. young couples with only one child. The recommendations from this effort complemented the draft youth policy and helped form the task group on youth issues in Bihar. there should be delay in the first pregnancy until the woman is 21 years of age. Failure to do so will have long-term repercussions on individual lives. delay cohabitation. Currently. because it is assumed that through an investment in employability through skill training. Therefore investing in young people’s education. The keys to slowing population momentum are to affect the age at marriage. youth organizations and elected representatives.

Nutrition
Morbidity and mortality are related to high prevalence of malnutrition. The stakeholders recognized young children, adolescents, pregnant and lactating women and elderly as the most vulnerable. The single greatest cause of malnutrition is poverty and the single greatest remedy is equitable development. • • • The state should ensure food security to all by strengthening and universalizing the Public Distribution System and promote employment generation schemes. Supplementary feeding system should reach all children through the Anganwadi and School Mid Day Meal Programmes. Integrated Child Development Scheme (ICDS) should remain the key strategy. The current ICDS Scheme should be strengthened into a comprehensive early childhood care programme with improvements in quality and outreach. Reduce malnutrition and under-nutrition by 50% by 2010 and 100% in 2012. Every pre-school child should be assured of nutrition, pre-school education and health care and every working mother should be assured of day care support for young children. Implement preventive measures against epidemics and recurrent infections such as diarrhoea, cholera, etc. in young children through school health programme. Children with special needs such as the physically challenged should be provided special nutrition with a flexible partnership approach. Among all these food security measures, public understanding of good dietary habits as suitable to different cultural and economic contexts should be promoted through appropriate nutrition and education programmes.

• • • • •

Addressing Emerging Health Problems
Health problems in Bihar will show a complex epidemiology in future. While we shall continue to have problems of poverty, poor hygiene, poor nutrition, poor sanitation and poor environment, we shall also increasingly experience the problems of development, affluence and modernization. New diseases will come up along with the resurfacing of older diseases with newer trends and patterns. Thus, there will be this ‘Double Burden of Disease’. Following are some of the health problems to be tackled in the years ahead. • • • • malnutrition complicated by increasing chemicalization and adulteration of food; waterborne diseases, including diarrhoea, dysentery, gastroenteritis, typhoid, cholera, hepatitis B and parasite infection; communicable diseases such as malaria, tuberculosis, leprosy, acute respiratory infection (ARI), and preventable childhood diseases; non-communicable diseases, including heart disease, hypertension, diabetes and cancer;

State of Health in Bihar

185

• • • • • • •

problems of mental ill health; increased addictions and substance abuse problems; pollution-related diseases, including allergies, asthma and other hazards; problems of the physically challenged; health problems of the aged; iatrogenic diseases; accidents and injuries.

Issues which would further complicate the health problems are increasing environmental pollution and deterioration of ecology, increasing challenge of providing basic environmental sanitation, urbanization, increasing malpractice in medicine and medical care and irrational therapeutics in medicine and medical care.

Conclusion
The slow pace of health sector reforms in Bihar poses a major challenge. Also poverty, social justice and gender issues have not been brought centre stage in health sector reforms. Linking health programmes to poverty alleviation is critical in the context of Bihar because the burden of health services falls disproportionately on the poor. Poverty remains one of the main reasons for untreated illness, thereby resulting in a sharp increase in morbidity. This burden is compounded further in a situation of unequal gender relations on the one hand and unequal social status on the other. In reality, the health delivery system as it exists today is based on loosely integrated vertical programmes of reproductive and child health, control of communicable diseases, and a stand alone HIV/AIDS prevention/control programme. However, now that NRHM is in place, one can take the opportunity of this programme platform. The NRHM appears to have brought back the primacy of primary health care. It has given prominence of place to what is called ‘communitization’. In fact, it is the hallmark of NRHM. Communitization means community ownership in terms of community-based planning, implementation, management and, of course, monitoring. NRHM fosters a platform for inter-sectoral coordination and collaboration. It also provides and creates a space for decentralized planning. People say that primary health care was tried in our country and failed. In fact, it has never been tried in its true spirit and the concept is as valid and relevant today as it was 29 years ago. The challenges of development in Bihar are enormous due to persistent poverty, complex social stratification, poor infrastructure and poor governance. Corruption is endemic in all spheres of life in the state. The development challenges must be considered in the light of India’s overall development. The state’s performance lags seriously behind the national trends and is a significant

186

State of Health in Bihar

contributing factor to the growing gap across states. In Bihar greater transparency and accountability is badly needed in public affairs. Transparency in the functioning of public health services and their accountability to communities goes hand in hand with improving access and availability of services. Communities need to know their right to health care, so that they make appropriate demands on health care systems. People’s demand for services can be improved as part of the provisions of the 73rd and 74th Amendments and the Right to Information Act. Health relates to everything that goes to constitute human lifestyle and life system. Therefore, the concept of health and health care has to transcend the present narrow technocentric understanding and unethical top-down prescriptive care system. Health is to be holistic and health care is to be for health development of all and actively participatory. Like any right, health has to be asserted rather than given or taken. Responsibility for health policy development, management and advocacy should not be limited to health professionals. All stakeholders and those contributing to human development and services, including the people, should participate in the process of development. Quality of life cannot be improved without people’s participation, involvement and initiative. Preparing the young people of the state to be healthy and productive is crucial for utilizing the available window of opportunity. This is an opportunity to convert 92 million people into a productive asset of society to make Bihar into a developed state, a vibrant economy and society. It is our social responsibility to make health a people’s agenda and take it beyond advocacy to the common concern of all in Bihar.

State of Health in Bihar

187

References
Government of Bihar. ‘Population Policy – 2002’ (draft), Department of Health. Government of India, 2004. Bihar – Universal Immunization Programme Review, 2004. IIPS (Indian Institute of Population Sciences), 2007. National Family Health Survey 3, India – 2005-06, IIPS, Mumbai. IIPS, 2005. Reproductive and Child Health District Level Household Survey (RCH-DLHS), 20032004, IIPS, Mumbai. IIPS, 1999. National Family Health Survey 2, Bihar – 1998-1999, IIPS, Mumbai. IIPS, 1999. Reproductive and Child Health District Rapid Household Survey (RCH-DRHS), 19981999, IIPS, Mumbai. IIPS, 1995. National Family Health Survey 1, Bihar – 1993-1994, IIPS, Mumbai. Kundu, Amitabh, 2006. India Social Development Report, Council for Social Development, Oxford. Misra, Rajiv, Rachel Chatterjee and S. Rao, 2003. India Health Report, Oxford University Press. MoHFW (Ministry of Health and Family Welfare), 2007. Annual Report 2006-2007, Ministry of Health and Family Welfare, Government of India, New Delhi. MoHFW, 2007. Family Welfare Statistics in India 2006, Ministry of Health and Family Welfare, Government of India. MoHFW, 2006. Bulletin of Rural Health Statistics in India, Special Revised Edition, Infrastructure Division, Ministry of Health and Family Welfare, Government of India. MoHFW, 2005. Health Information of India, Central Bureau of Health Intelligence, Ministry of Health and Family Welfare, Government of India. MoHFW, 2005. Mission Document on National Rural Health Mission – 2005, Ministry of Health and Family Welfare, Government of India, New Delhi. MoHFW, 2000. National Population Policy – 2000, Ministry of Health and Family Welfare, Government of India. Nayak, S. 2007. India’s Population in the Emerging Global Order, Xavier Institute of Management, Bhubaneswar. NIHFW and NACO, 2007. Annual Sentinel Surveillance for HIV Infection in India, Country Report 2005. NIHFW and NACO, 2005. Annual Sentinel Surveillance for HIV/AIDS Infection in India, Country Report 2005. Parekh, Kirit S. and R. Radhakrishna (eds.). India Development Report, 2004-05, Indira Gandhi Institute of Development Research, Oxford University Press. Park, K., 2002. Park’s Textbook of Preventive and Social Medicine, 19th edn, Banarsidas Bhanot, Jabalpur.
State of Health in Bihar
189

2007. Census of India. 2001. New Delhi. 1 of 2004. Ram. PFI.org www. 2007 Maternal Mortality in India 1997-2003. Government of India. Population Reference Bureau. RGI. Mumbai. The Future Population of India: A long range demographic view.rchindia. causes and risk factors.net www. Return of the Population Growth Factor – Its impact on the Millennium Development Goals. The World’s Youth 2006 Data Sheet. 2006. Registrar General of India. Census of India.K. Nayak.org www. Rao. 2006.. 2001. Registrar General of India 1999-2003. RGI (Registrar General of India). Mohanty.nhfsindia. SRS Bulletin 2003. RGI. Facts.C. RGI.whosea. National Human Development Report 2001.in www. Primary Census Abstract. 2005. SRS based abridged life tables. 1997. Losing Count. Registrar General of India. PFI and Population Reference Bureau. Compendium of India’s Fertility and Mortality Indicators 1971-1997. Statistical Report No. 2005. Population Foundation of India. New Delhi. RGI. New Delhi. Joint United Nations Program on HIV/AIDS. 1999. Report of the hearings by the All Party Parliamentary Group on Population. RGI. New Delhi. Sample Registration System. 2007.iipsindia. Population Foundation of India. PRB. Bihar State AIDS Control Society and Population Reference Bureau. Registrar General of India. New Delhi. New Delhi. New Delhi.mohfw. Planning Commission 2002.org www. Registrar General of India. www. 2007. Sample Registration System. F. Population Projection for India and States 2001 to 2026 (Revised in 2006). Voluntary Health Association of India.org 190 State of Health in Bihar . Chander Shekhar and S.PFI (Population Foundation of India). Sample Registration System. Development and reproductive health. Report of the Technical Group on Population Projection constituted by the National Commission on Population 2006. Training Module on Reproductive and Child Health. International Institute Population Science. RGI 2006. New Delhi. 2005. Sample Registration System. The World Bank. C-14. Washington D. Registrar General of India. VHAI. 2007. 1999. 2006. New Delhi. Registrar General of India.L. Report and Tables on Age. New Delhi. Independent Commission on Health in India. Bihar – Towards a Development Strategy. Total population: Table A-5. Human Development: Strengthening district level vital statistics in India. and S.nic. Trends. Figures and Response to HIV/AIDS in Bihar. K. series-I. A World Bank Report.censusindia. Registrar General of India. Mapping India’s Child Sex Ratio. RGI.

org. No : 42899770. E-mail : popfound@sify. . Tara Crescent. State of Health in Bihar State of Health in Bihar B-28.popfound. Fax : 42899795 Website : www.Ali Nayak Mukhopadhyay . Qutab Institutional Area. New Delhi 110 016 Tel.com PFI POPULATION FOUNDATION OF INDIA PF .