ANNUAL HEALTH SURVEY

FACT SHEET

KEY FINDINGS

Dr. C. Chandramouli
Registrar General & Census Commissioner,
India
 “ Reproductive health and rights are integral to
sustainable development and poverty reduction.
Investing in universal access to reproductive health is
crucial investment in healthy societies and a more
sustainable future”.

– Ban Ki-moon, Secretary-General, UN on World

Population Day, 2012
 “ Working for the survival and the well being of women and
girls is a human right imperative. And in order to take
advantage of women’s full potential in the development of
their nations, they must be able to plan their lives and
families.”

– Babatunde Osotimehin, Executive Director, UNFPA on World

Population Day, 2012
AHS provides key indicators on Reproductive
and Child Health at District level
in 8 EAG States and
Assam

Vital inputs for evidence based intervention and monitoring

“ There should be an Annual Health Survey of all
districts which could be published/monitored and
compared against benchmarks”

-Dr. Manmohan Singh, Prime Minister of India – In the meeting

of National Commission of Population, 2005
 OBJECTIVE OF AHS

 AHS yields a comprehensive, representative and reliable

dataset on core vital indicators including composite ones
like IMR, MMR and TFR along with their co-variates
(process and outcome indicators) at the district level and
maps changes therein on an annual basis.

 These benchmarks would help in better and holistic

understanding and timely monitoring of various
determinants on well-being and health of population
particularly Reproductive and Child Health.
Coverage : Annual Health Survey

Uttarakhand

Uttar Pradesh
Rajasthan
Assam
Bihar

Madhya Pradesh Jharkhand

Chhattisgarh
Odisha
 WHY AHS?
o
AHS States constitute:
• 48 percent of country’s Population
• 59 percent of Births
• 70 percent of Infant Deaths
• 75 percent of Under 5 Deaths
• 62 percent of Maternal Deaths

o
Enable direct monitoring of UN Millennium Development Goals on
Child Mortality and Maternal Health at the district(s) level.

o
Help in identifying high focus districts meriting special attention in
view of stark inter-district variations in these States.

o
Provide critical inputs to assess the milestones of various
interventions including NRHM and pave the way for evidence
based planning.
 KEY FEATURES
Coverage- All the 284 districts of 8 EAG States and Assam.

Sample Units- 20,694 statistically selected sample unit (Census Enumeration

Blocks in urban areas and Villages or a part thereof in rural areas)

Sample Identification Work- to uniquely identify the sample units on

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

Sample Units per district- 73.

Sample Population- About 20.1 million

The Largest Sample Survey in the World

 KEY FEATURES Contd…

 Sample Population per district - About 71 thousand.

 Sample Households - 4.1 million households.

 Sample households per district - About 14.5 thousand.

 Conduct of Field Work - hybrid approach wherein fieldwork has

been outsourced and supervision is being done by the ORGI.

 Primary Level of Aggregation – District

 Periodicity- Annual
 Indicators under AHS

•In all, 161 indicators are available from AHS baseline:

 Fertility- 13  Sex Ratio- 3

 Marriage- 5  Mortality- 7
 Mother & Child Care- 63
 Ante Natal Care: 11  Delivery Care: 8
 Post Natal Care: 5  Janani Suraksha Yojana (JSY): 3
 Immunization: 8  Vitamin A & Iron Supplements: 2
 Birth Weight: 2  Childhood Disease: 6
 Birth Registration: 2  Breastfeeding & Supplementation: 12
 Awareness in Mothers: 4

 Abortion- 6  Family Planning Practices- 15

 Disability- 1  Morbidity- 19
 Personal Habits:adults-4  Housing & HH Characteristics- 13
 Others- 12
 Indicators under AHS Contd…
 Under 1st phase of AHS following 9 indicators have already been
released:

 Crude Birth Rate (CBR)  Crude Death Rate (CDR)

 Infant Mortality Rate (IMR)  Neo-Natal Mortality Rate (NNMR)

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

 Sex Ratio at Birth (SRB)  Sex Ratio (0-4 years) and

 Sex Ratio (All ages)

 Remaining 152 indicators are being released under present phase of

dissemination.
 Five Core Themes Covered
• The presentation focuses on results pertaining to 5 core themes:

 Total Fertility Rate

 Family Planning: Current Usage & Total Unmet Need

 Ante Natal Care

 Delivery & Post Natal Care

 Immunization and Breast Feeding Practices

 Total Fertility Rate (TFR)
• TFR is the average number of children born to a woman during her entire
reproductive span.

Total Fertility Rate

4.0 Total Rural Urban

3.5

3.0

2.5

3.9
3.9

3.7
3.6
3.5

3.4
3.3

3.2
3.1
3.1
3.1

2.0
2.9

2.8
2.7

2.7
2.6

2.5
2.4

2.4
2.4

2.4
2.3

2.3
2.3

1.5
2.0

1.9

1.9

1.0
Uttarakhand Odisha Assam Chhattisgarh Jharkhand Madhya Pradesh Rajasthan Uttar Pradesh Bihar

• Uttarakhand & Odisha and UP & Bihar reflects the two extremes.

• Significant Rural-Urban variation across all 9 AHS States, the max. in Uttar Pradesh.
 Total Fertility Rate (TFR) Contd…

Total Fertility Rate (TFR)

State State value Minimum Maximum Range
Assam 2.6 Kamrup (2) Hailakandi (4.2) 2.2
Bihar 3.7 Patna (2.8) Sheohar (4.7) 1.9
Jharkhand 3.1 Purbi Singhbhum (2.4) Lohardagga (4) 1.6
Madhya Pradesh 3.1 Indore (2.2) Shivpuri (4.5) 2.3
Chhattisgarh 2.9 Koriya (2.4) Kawardha (3.7) 1.3
Odisha 2.3 Jharsuguda (2) Boudh (3.7) 1.7
Rajasthan 3.2 Kota (2.6) Barmer (4.7) 2.1
Uttar Pradesh 3.6 Kanpur Nagar (2.3) Shrawasti (5.9) 3.6
Uttarakhand 2.3 Pithoragarh (1.7) Haridwar (3.1) 1.4

 Within a State, the minimum variability of 1.3 reported in Chhattisgarh and the
maximum, 3.6 in Uttar Pradesh.

 Across 284 districts in 9 AHS States, it ranges from 1.7 in Pitthoragarh

(Uttarakhand) to 5.9 in Shrawasti (UP)- a variability of more than 4 children.
 Total Fertility Rate (TFR) Contd…
Frequency distribution of districts by level of Total Fertility Rate
State 0-2.1 2.2-3.0 3.1-4.0 4.1 & above Total Districts
Assam 3 16 3 1 23
Bihar 0 1 26 10 37
Chhattisgarh 0 12 4 0 16
Jharkhand 0 8 10 0 18
Madhya Pradesh 0 15 25 5 45
Odisha 10 18 2 0 30
Rajasthan 0 16 13 3 32
Uttar Pradesh 0 9 48 13 70
Uttarakhand 7 5 1 0 13
All States 20 100 132 32 284

• 20 districts namely Kamrup, NC Hills, Nalbari (Assam); Puri, Khordha, Angul, Jajpur,
Jagatsinghpur, Baleshwar, Sundargarh, Doegarh, Jharsugdha, Bargarh (Odisha);
Nainital, Almora, Bageshwar, Pitthoragarh, Rudraprayag, Chamoli, Uttarkashi
(Uttarakhand) have already achieved the replacement level of 2.1.

• 46 districts have TFR below the current National average of 2.5 (SRS 2010).

• 164 districts have recorded TFR of 3.1 and above, the National level TFR of 2001
(SRS).
Total Fertility Rate (TFR) Contd…
 Family Planning: Current Usage

 Contraceptive Prevalence Rate (CPR) is the percentage of currently married women

aged 15-49 yrs who are using any method of contraception (modern/traditional).

Current Usage- any method (%)

Total Rural Urban
70

60

50

68.6
66.0

64.5
64.1

63.1
62.7

62.7
62.4

61.4
61.2

59.9
58.4

58.4
58.2

57.9
40

56.9
56.2

54.9
53.9

52.7
49.9
49.7

47.8

47.6
44.1

30
37.6

35.8

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

 Current usage of any method varies from 37.6 in Bihar to 64.5 per cent in Rajasthan.

 Rural – Urban divide is significant in Jharkhand and Bihar.

 Family Planning: Current Usage Contd…

Current Usage of Family Planning- any Method (%)

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

 Within a State, the least variation is reported in Uttarakhand whereas the most,
in Uttar Pradesh.

 At district level, current usage of family planning ranges from 21.9 in Sitapur
(UP) to 79.2 in Ganganagar (Rajasthan) exhibiting a variability of 4 times.
 Family Planning: Current Usage Contd…
Frequency distribution of districts by current usage of family planning- any method (%)
State 0-30 30-50 50-70 70 & above Total Districts
Assam 0 3 20 0 23
Bihar 4 31 2 0 37
Chhattisgarh 0 7 9 0 16
Jharkhand 0 13 5 0 18
Madhya Pradesh 0 2 40 3 45
Odisha 1 9 19 1 30
Rajasthan 0 1 24 7 32
Uttar Pradesh 3 24 42 1 70
Uttarakhand 0 0 13 0 13
All States 8 90 174 12 284

 As high as 98 districts are reporting less than 50% current usage of any method
of family planning.

 Only 12 districts namely Damoh, Betul, Jabalpur (MP), Baleshwar (Odisha),

Ganganagar, Hanumangarh, Jhunjhunu, Alwar, Udaipur, Dungarpur, Banswara
(Rajasthan) and Jhansi (UP) feature in 70% & above category.

 35 out of 37 districts of Bihar have reported less than 50% usage of any method
of family planning.
Family Planning: Current Usage Contd…
 Family Planning: Current Usage Contd…

Share of sterilization in any modern method of family planning (%)

Assam Uttar Pradesh Jharkhand Bihar Odisha Uttarakhand Rajasthan Chhattisgarh Madhya Pradesh
Female 35.3 55.0 76.3 86.7 68.4 58.7 76.7 92.3 83.6
Male 0.6 0.6 1.2 0.9 0.7 2.8 0.7 2.0 1.7
 Unmet Need for Family Planning
 Currently Married Women who are not using any method of contraception but
who do not want any more children or want after a period of 2 years are defined as
having an unmet need.

45.0
Unmet Need for Family Planning (%)
Total Rural Urban
40.0

35.0

30.0

40.6
39.2
25.0

33.6
31.5

30.5

30.0
29.7
20.0

27.1
26.4
25.0
24.7

24.0

23.7
23.5
23.3

23.2

23.2

23.2
22.4

21.7

21.5
20.6
20.5
19.6

19.6
19.5

15.0
16.9

10.0
Rajasthan Madhya Pradesh Uttarakhand Odisha Assam Chhattisgarh Uttar Pradesh Jharkhand Bihar

 Total unmet need varies from a minimum of 19.6% in Rajasthan to 39.2% in

Bihar.

 Rural- Urban gap is prominent in Jharkhand, Bihar and Uttar Pradesh.

 Unmet need for Family Planning is a crucial indicator for assessing the future
demand for Family Planning services / supplies.
 Unmet Need for Family Planning Contd…

Total unmet need for Family Planning(%)

State State value Minimum Maximum value Range
Assam 24.0 Sibsagar (15.3) Dhubri (42.9) 27.6
Bihar 39.2 Patna (24.6) Kishanganj (52.5) 27.9
Jharkhand 30.5 Bokaro (18.2) Godda (42.8) 24.6
Madhya Pradesh 22.4 Jabalpur (14.3) Rewa (34.2) 19.9
Chhattisgarh 26.4 Dhamtari (14.5) Bastar (36) 21.5
Odisha 23.2 Baleshwar (6.1) Boudh (48.3) 42.3
Rajasthan 19.6 Ganganagar (10.0) Dhaulpur (32.4) 22.3
Uttar Pradesh 29.7 Mahoba (15.1) Sitapur (61.3) 46.3
Uttarakhand 23.2 Dehradun (16.8) Haridwar (29.2) 12.4

 The minimum variability within a State is in Uttarakhand whereas the maximum

in Uttar Pradesh.

 Baleshwar (6.1%) in Odisha and Sitapur (61.3%) in Uttar Pradesh are

the two extremes across 284 districts.
 Unmet Need for Family Planning Contd…

Frequency distribution of districts by total unmet need for family planning (%)
State 0-20 20-40 40-60 60 & above Total Districts
Assam 6 16 1 0 23
Bihar 0 20 17 0 37
Chhattisgarh 4 12 0 0 16
Jharkhand 2 13 3 0 18
Madhya Pradesh 18 27 0 0 45
Odisha 12 15 3 0 30
Rajasthan 16 16 0 0 32
Uttar Pradesh 9 52 8 1 70
Uttarakhand 2 11 0 0 13
All States 69 182 32 1 284

 Only in 69 out of 284 districts, the total unmet need for family planning is below
20%.

 Bihar and Uttar Pradesh dominate in 40% & above category.

 Mean Age at Marriage- Female
 Mean Age at Marriage is based on the marriages taken place during 2007-2009.

25 Mean Age at Marriage- Female

23.4

23.2
Total Rural Urban

22.9
22.4
22.1

22.0

22.0
21.8
21.7
21.6

21.5

21.5
21.4

21.4
21.1

21.0
20.9

20.6
20.6

20.5
20.2

19.8
19.7

19.7

19.7
19.5

20
19.1

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

 Mean age at marriage of females varies from 19.7 in Rajasthan to 22.0 years in
Uttarakhand.

 Rural – Urban differential is of at least 1.4 years in all AHS States. This is quite
prominent (2.3 years) in Madhya Pradesh & Rajasthan.
Marriages among Females below Legal Age (18 yrs)

 Based on marriages taken place during 2007-2009.

Marriages among Females below legal age (%)

Total Rural Urban

30

26.8
21.9
21.7
21.0

20.2
17.6
17.2
20

12.5
11.4

11.1
10.7

10.2

9.0
8.9

8.4
10
6.8
6.5

6.0
5.9

5.1

4.1
3.7
3.7

3.2

3.0
3.0

1.3

0
Uttarakhand Odisha Chhattisgarh Uttar Pradesh Assam Madhya Pradesh Jharkhand Bihar Rajasthan

 Varies from 3.0% in Uttarakhand to 21.9% in Rajasthan.

 In rural areas, every 4th marriage among females in Rajasthan and every 5th in
Bihar & Jharkhand take place below the legal age.

 Rural- Urban differential is quite significant across all AHS State.

 Ante Natal Care (ANC)

 Any ANC exceeds 80% in all AHS States.

 ANC in 1st trimester: 40% in UP & Bihar to 65% in Chhattisgarh

and Madhya Pradesh.

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

 Mothers who consumed IFA 100 days or more: 6.5% in UP to

23.8% in Chhattisgarh.

 Low performance in IFA consumption is the main reason for

sluggish full ANC: 3.9% in UP to 19.5% in Chhattisgarh.
 Full Ante Natal Check-up
 Full ANC comprise 3 or more ANC, at least one TT injection and consumption of
IFA for 100 or more days.

35
Full Ante Natal Check-up (%)

28.9

26.5
30 Total Rural Urban

22.3
25

20.0

19.5
19.0

18.6
18.5

18.0
17.4
17.2

16.9
20

13.3
13.1
11.9
15

11.1

10.9
10.5

10.4
9.1

8.5

8.3
10
6.1
5.9
4.7
3.9
2.8

0
Uttar Pradesh Bihar Rajasthan Uttarakhand Assam Jharkhand Madhya Pradesh Odisha Chhattisgarh

 Uttar Pradesh reports the minimum coverage of 3.9%; Chhattisgarh, the

maximum 19.5%.

 Full ANC coverage in urban areas is remarkably better than the rural areas.

 In 5 States, namely Bihar, UP, Rajasthan, Uttarakhand and Jharkhand urban

coverage is more than double that of Rural.
 Full Ante Natal Check-up Contd…

Mothers who had full antenatal check-up (%)

State State value Minimum Maximum Range
Assam 11.9 Dhubri (2.1) Jorhat (18.2) 16.1
Bihar 5.9 Madhepura (2.4) Patna (16.4) 14.0
Jharkhand 13.1 Garhwa (3.6) Purbi Singhbhum (31.6) 28.1
Madhya Pradesh 13.3 Sheopur (1.8) Balaghat (30.8) 28.9
Chhattisgarh 19.5 Korba (10.9) Dhamtari (34.5) 23.6
Odisha 18.6 Jajpur (5.4) Jagatsinghpur (36.0) 30.6
Rajasthan 8.5 Karauli (1.7) Jaipur (19.5) 17.8
Uttar Pradesh 3.9 Balrampur (0.6) Kanpur Nagar (14.8) 14.3
Uttarakhand 11.1 Rudra Prayag (3.7) Dehradun (22.7) 19.0

 Bihar has reported the minimum variability among the districts compared to
Odisha reporting the maximum.

 Less than 1% coverage of full ANC has been reported in Balrampur of Uttar
Pradesh; on the other hand Jagatsinghpur of Odisha has reported the maximum
36%.
 Full Ante Natal Check-up Contd…
Frequency distribution of the districts by level of full antenatal check up (%)
State <5 5-10 10-15 15-20 20-25 25 & above Total Districts
Assam 6 7 6 4 0 0 23
Bihar 17 17 2 1 0 0 37
Chhattisgarh 0 0 4 4 5 3 16
Jharkhand 3 7 4 3 0 1 18
Madhya Pradesh 7 11 10 7 6 4 45
Odisha 0 3 7 10 3 7 30
Rajasthan 7 16 7 2 0 0 32
Uttar Pradesh 52 15 3 0 0 0 70
Uttarakhand 2 7 2 1 1 0 13
All States 94 83 45 32 15 15 284

 As high as 94 out of 284 districts report less than 5% coverage of full ANC.

 Only 15 districts namely Raigarh, Mahasamund, Dhamtari (Chhattisgarh),

Purbi Singhbhum (Jharkhand), Indore, Bhopal, Narsimhapur, Balaghat (MP)
and Jharsuguda, Mayurbhanj, Jagatsinghpur, Cuttack, Ganjam, Kandhamal,
Naupada (Odisha) have reported 25% & above coverage of full ANC.
Ante Natal
Check-up
 Institutional Delivery
Institutional Delivery (%) Share of Govt. & Private Hospitals in Total Instritutional Delivery
100
80 13.8 12.9
76.1
90 22.6 20.7
71.3 30.5 30.9
70.2 80 40.2 38.9
70
70 55.5

60 57.7 60

50
50.5 86.0 86.4 Private
50 47.7 40 77.1 78.6
45.6 68.5 69.0 Govt.
30 59.1 60.8
40 37.6 20 42.5
34.9
10
30
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 Institutional Delivery: Ranges from 34.9% in Chhattisgarh to 76.1% in MP.

 More than 85% of total births have taken place in Govt. Institutions in Madhya Pradesh
& Odisha and it is more than 60% in remaining States except Jharkhand & Uttarakhand.

 Jharkhand is the only State where more than 50% of the births are taking place in
Private Hospitals.
 Balrampur, UP

Indore, MP

 Institutional delivery is below 60% in 170 districts.

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

 Safe delivery comprise institutional deliveries and domiciliary deliveries assisted

by doctor/nurse/ANM/LHV.

Safe Delivery (%)

100
92.8
90 86.9 88.6
81.9 82.2
80 77.6 78.4
75.1 75.2 76.2
73.4 73.0 73.3 72.8
70.1
70 67.7
64.7

60 56.9
53.5
51.3 51.4
49.5 48.4 49.4
50 47.1
44.3
39.0
40

30
Jharkhand Chhattisgarh Uttar Pradesh Bihar Uttarakhand Assam Odisha Rajasthan Madhya Pradesh

 Safe Delivery: 47.1 % in Jharkhand to 82.2% in Madhya Pradesh.

 Rural- Urban differential is quite prominent in Jharkhand, Chhattisgarh and

Uttarakhand.
 Safe Delivery Contd…

Safe delivery (%)

State State value Minimum Maximum Range
Assam 70.1 Karimganj, Hailakandi (34.8) Sibsagar (88.2) 53.4
Bihar 53.5 Sheohar (30.2) Munger (80.4) 50.2
Jharkhand 47.1 Pakaur (24.8) Purbi Singhbhum (69.0) 44.2
Madhya Pradesh 82.2 Dindori (45.5) Indore (96.3) 50.9
Chhattisgarh 49.5 Surguja (32.6) Kanker (69.4) 36.8
Orissa 75.2 Nabarangpur (35.6) Puri (92.7) 57.1
Rajasthan 76.2 Jaisalmer (48.6) Jaipur (92.2) 43.6
Uttar Pradesh 51.3 Balrampur (22.0) Jhansi (89.4) 67.4
Uttarakhand 56.9 Tehri Garhwal (43.1) Nainital (79.5) 36.4

 Uttarakhand has exhibited the least variability among districts whereas Uttar
Pradesh, the most.

 Balrampur (UP) has reported the minimum against Indore (MP) reporting the
maximum.
 Safe Delivery Contd…

Frequency distribution of districts by safe delivery (%)

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

 About 1/4th of the districts have reported less than 50% of the safe deliveries.

 Out of 14 districts reporting 90% & above safe deliveries, 10 belongs to Madhya
Pradesh.
 Janani Suraksha Yojana

70
Mothers who availed Financial Assistance under JSY (%)
60

50 Total Rural Urban

40

68.7

63.4
61.6
61.1
30

54.1
54.1
53.9

53.1

50.5
45.8
44.8

40.1
20

30.6
30.4

28.7
27.3
26.9
26.7
21.7
21.8
21.6
18.2

10
17.8
15.8
14.6

13.5
9.3

0
Jharkhand Uttar Pradesh Chhattisgarh Uttarakhand Bihar Assam Rajasthan Madhya Pradesh Odisha

 Mothers availing JSY: 14.6% in Jharkhand to 61.6% in Odisha.

 Rural- Urban differential is acute in the States of Madhya Pradesh, Odisha and
Jharkhand.
 Post Natal Care
90 Mothers who received Post-natal Check up within 48 hrs of delivery (%)
Total Rural Urban
80

70

87.5

85.9
85.4
82.6
81.5

79.1
60
76.6

74.9

74.9

74.5
74.2
73.3

72.6
70.0

69.3
68.4

67.0
64.8

60.9
60.8

59.3
59.1

59.1
50
57.0

53.3
53.1

51.0

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

 Mothers receiving PNC within 48 hrs of delivery varies from 57% in Assam to 74.5% in Odisha.
50 Mothers who did not receive any Post-natal Check up (%)
45
40
35 Total Rural Urban
30
25

42.9

40.5
39.6
20

36.9
35.8
34.4
30.9
30.4
29.5
28.1

15
26.3

26.0

26.0

25.2
23.2
23.0
22.1

21.4
21.1
19.6

19.3
10

16.5

16.1
12.1
10.5
10.4

10.3

5
0
Odisha Madhya Pradesh Rajasthan Chhattisgarh Uttar Pradesh Bihar Jharkhand Uttarakhand Assam

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

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

Total Rural Urban
80

70

86.1

85.8
83.4
81.3

79.0
60

75.3

74.9
74.7
74.7

73.1
73.1
70.0

68.4
68.2
66.8

66.1
65.0

60.6
59.3
50

56.6
55.9
55.3
52.6

51.4
51.4
51.2

50.6

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

 New born checked up within 24 hrs of birth exceeds 50% in all AHS States.

 It varies from 52.6% in Bihar to 74.9% in Odisha.

 Significant Rural- Urban divide is noticed in Uttarakhand, Jharkhand, Assam

and Chhattisgarh.
 Full Immunization
 Children are considered fully immunized when they have received vaccination
against Tuberculosis, 3 doses of DPT & Polio and 1 dose of measles.
Children aged 12-23 months fully immunized (%)
80
Total Rural Urban
70

60

79.9
78.7
77.3

75.4

73.8
74.1

73.0
71.4

70.8

69.0
50

66.1
64.9

64.5

64.3
63.7
63.7

61.1
59.5

59.0

58.2
54.9

55.0

54.3
51.1

40
48.1
45.3

44.7

30
Uttar Pradesh Madhya Pradesh Odisha Assam Jharkhand Bihar Rajasthan Chhattisgarh Uttarakhand

 All States except Uttar Pradesh have at least half of their children aged 12-23
months fully immunized.

 Uttar Pradesh reports the minimum percentage of children fully immunized

whereas Uttarakhand, the maximum.

 Rural-Urban gap exceeds 10% in Madhya Pradesh & Jharkhand.

 Full Immunization Contd…

Children age 12-23 months Fully Immunized (%)

State State value Minimum Maximum Range
Assam 59.0 Dhubri (29.9) Dibrugarh (83.8) 53.9
Bihar 64.5 Kishanganj (26.6) Samastipur (83.9) 57.3
Jharkhand 63.7 Giridih (28.0) Purbi Singhbhum (82.7) 54.8
Madhya Pradesh 54.9 Jhabua (23.8) Indore (77.6) 53.9
Chhattisgarh 74.1 Surguja (55.3) Kanker (93.2) 37.9
Odisha 55.0 Rayagada (11.9) Kendrapara (82) 70.0
Rajasthan 70.8 Dhaulpur (37.4) Hanumangarh (91.4) 54.0
Uttar Pradesh 45.3 Etah (13.5) Basti (73.8) 60.3
Uttarakhand 75.4 Haridwar (55.3) Pithoragarh (87.5) 32.2

 The variability among the districts within a State ranges from 32.2% in
Uttarakhand to 70.0% in Odisha.

 Across all 284 districts, the minimum has been observed in Rayagada of Odisha
and the maximum in Kanker of Chhattisgarh.
 Full Immunization Contd…

Frequency distribution of districts by children age 12-23 months Fully immunized (%)
State 0-30 30-50 50-70 70-90 90 & above Total Districts
Assam 1 4 14 4 0 23
Bihar 1 2 23 11 0 37
Chhattisgarh 0 0 6 9 1 16
Jharkhand 1 4 7 6 0 18
Madhya Pradesh 2 14 24 5 0 45
Odisha 8 7 6 9 0 30
Rajasthan 0 4 10 17 1 32
Uttar Pradesh 11 31 20 8 0 70
Uttarakhand 0 0 2 11 0 13
All States 24 66 112 80 2 284

 90 districts are below 50% level of full immunization.

 Only 2 districts 1 each from Chhattisgarh & Rajasthan feature in 90% & above
category.
 Children age 12-23 months who have received BCG(%) Children age 12-23 months who have received 3 doses of Polio vaccine(%)
100
97.5 90
96.8

95 94.2 85 82.3 83.2

93.3 93.9
79.9
91.8 91.9 80 77.5 78.1
90.6 75.5
74.7
90 75
69.4
70
85
83.4 65

60 58.5
80
55

50
75
sh a d an r rh d
UP ss am an ha ga an
UP an nd nd m ar es
h rh sa de i s th Bi
th ha ha sa ih ga is
Pr
a Or As k h
ja
s it s ak
h
ja
s k k As B rad t is Or ar Ra at ar
Ra ar ra aP at ya Jh h t
Jh t ta hy hh ad
h Ch Ut
U ad C M
M

Constituents
of full
immunization

Children age 12-23 months who have received 3 doses of DPT vaccine(%) Children age 12-23 months who have received Measles vaccine (%)
90 86.7 87.9
90
83.0 81.8 82.6
81.6 80.7
78.7 80 79.0
80 77.0 77.3
75.7
71.8 72.2 72.9
70 66.6 70

60 60.5
55.9 60

50
a r 50
UP es
h
an
d
sa
m sh ha
n
ha ga
rh an
d
ad kh As Od
i st Bi is kh UP
r m d h n d a rh
r ar ja tt ra ha sa an es ha an ss ga
aP Jh Ra ha t a Bi As kh ad st kh Or
i
is
hy Ch Ut ar r ja ra tt
ad Jh aP Ra ta ha
M d hy Ut Ch
a
M
 FULL
IMMUNIZATION
Full Immunization Contd…
 Vitamin A Supplementation to Children
Children aged 6-35 months who received a Vitamin A dose during last six months (%)
80
71.7 72.0
70
61.9 63.4
59.4 60.1
60
54.5 55.0

50

40 37.2

30

 At least every 2nd child aged 6-35 months

has received Vitamin A supplement in all
AHS States except Uttar Pradesh where it is
every 3rd child.
 IFA Supplement to Children
Children aged 6-35 months who received IFA tablet/syrup during last 3 months (%)
40 37.7

27.7 29.0
30
24.8
23.3

20
14.2 14.3
9.4 10.6
10

0
n h d d a h m r rh
ha es an an i sh es sa ha ga
st ad kh kh Od ad As Bi is
ja r ar ra r tt
Ra rP Jh ta aP ha
ta Ut hy h
Ut ad C
M

 IFA supplement to children aged 6-35

months during last 3 months ranges from 9.4
in Rajasthan to 37.7% in Chhattisgarh.

 Situation merit attention across all AHS

States however it is quite alarming in
Rajasthan & Uttar Pradesh.
 Breast Feeding Practices
Children under 3 Years breastfed within one hour of birth (%)
80

71.5
69.6
70
63.2 63.9
61.5
60

50 48.6

40 37.9

32.9
30.3
30

20
r h d n h d rh m a
ha es an ha es an ga sa sh
Bi rad kh st ad kh is As Od
i
ar ja r ra tt
rP Jh Ra aP ta ha
ta hy Ut Ch
Ut ad
M

 Bihar & UP and Assam & Odisha constitute 2

extremes.
 Breast Feeding Practices
Children age 6-35 months exclusively breastfed for at least six months (%)
50 47.5
45.6

40 39.2
38.2
36.8

30 28.5
24.7 24.8

20 17.7

10
a r
e sh a n
sh ha es
h
a nd sa
m nd ga
rh
ad th di Bi ad ha
as kh As rk tt is
Pr j O Pr ar
a
ha
r Ra a t J ha
ta hy Ut Ch
Ut ad
M

 Children exclusively breastfed for at least 6

months ranges from 17.7 in UP to 47.5 % in
Chhattisgarh.
 KEY FINDINGS
 Replacement level of TFR 2.1 has been achieved in only 20 out of
284 AHS districts.

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

 More than half of currently married woman aged 15-49 years are
not using any method of family planning in UP, Jharkhand and Bihar.

 Female Sterilization constitutes the most dominant method of

family planning among the modern methods across all AHS States
except Assam.

 Male Sterilization is the least preferred modern method across all

AHS States.

 At least 1/5th of currently married women are yet to meet their

family planning requirement (Unmet Need) across all AHS States.
 KEY FINDINGS Contd…

 Marriages among female taking place below legal age (18 years) is
rampant in rural areas as compared to urban areas.

 Despite wider penetration of `Any ANC’, the coverage under `first

trimester ANC’ as well as `3 or more ANCs’ needs further
improvement.

 Poor performance of full ANC is primarily due to low IFA

consumption.

 Universal coverage of JSY remains a concern even in better

performing States like Odisha, MP & Rajasthan; the situation in
Jharkhand & UP needs immediate attention.

 Seven out of every 10 deliveries are `safe’ in Madhya Pradesh,

Rajasthan, Odisha and Assam whereas it is less than 5 in Jharkhand
and Chhattisgarh.
 KEY FINDINGS Contd…
• In spite of better reach of Post Natal Care to Mothers and New-borns in
Odisha, MP & Rajasthan, every fifth mother has not received any PNC.

• In full immunization, even the better performing States like

Uttarakhand, Chhattisgarh and Rajasthan fall short by 25-30
percentage points in achieving universal coverage.

• Improvement has been noticed in most of the indicators as compared

to NFHS-3 as well as DLHS-3.

• Availability of 63 indicators (co-variates) on various facets of Mother &

Child Care at the district level will help in understanding the dynamics
of composite indicators like IMR, U5MR and MMR.

• For the first time, the data on TFR, Injury, Morbidity, Personal Habits
are available at the district level. This would provide new insight in
evidence-based planning and facilitate appropriate interventional
strategies.
 WAY FORWARD

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

• A Component of Clinical-Anthropometric & Bio-chemical (CAB)

Test on a sub-sample basis is scheduled to be introduced in
October.
THANK YOU