ANNUAL HEALTH SURVEY FACT SHEET First Updation round(2011-12) 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 “ 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 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 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 help in better and holistic understanding and timely monitoring of various determinants on well-being and health of population particularly Reproductive and Child Health. Coverage : Annual Health Survey Uttarakhand Rajasthan Uttar Pradesh Assam Bihar Madhya Pradesh Jharkhand Chhattisgarh Odisha Indicators under AHS • In all, 161 indicators are available from AHS : Fertility- 13 Sex Ratio- 3 Marriage- 5 Mortality- 7 Mother & Child Care- 63 Ante Natal Care: 11 Post Natal Care: 5 Immunization: 8 Birth Weight: 2 Birth Registration: 2 Awareness in Mothers: 4 Delivery Care: 8 Janani Suraksha Yojana (JSY): 3 Vitamin A & Iron Supplements: 2 Childhood Disease: 6 Breastfeeding & Supplementation: 12 Abortion- 6 Family Planning Practices- 15 Disability- 1 Morbidity- 19 Personal Habits:adults-4 Housing & HH Characteristics- 13 Others- 12 Indicators under AHS Contd… Under 1st phase of release, following 9 indicators have already been released in the Bulletin 2011-12: 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 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 KEY FINDINGS Improvement has been noticed in most of the indicators as compared to Baseline. Replacement level of TFR 2.1 has been achieved in only 29 out of 284 AHS districts whereas in Baseline it was 20 districts. In 145 districts, on an average a woman bears more than 3 children. More than half of currently married women aged 15-49 years are not using any method of family planning in Bihar. KEY FINDINGS Female Sterilization continues to remain the most dominant method of family planning among the modern methods across all AHS States except Assam. At least 12.6% currently married women are yet to meet their family planning requirement (Unmet Need) across all AHS States. This was 20.0% in Baseline. Despite wider penetration of `Any ANC’, the coverage under ‘first trimester ANC’ as well as ‘3 or more ANCs’ needs further improvement. KEY FINDINGS 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. Seven out of every 10 deliveries are ‘safe’ in Madhya Pradesh, Rajasthan, Odisha and Assam. KEY FINDINGS • At least 1 in 7 mothers has not received any PNC among all the AHS States, in Assam it is 1 in 3 mothers. • In full immunization, even the better performing States like Uttarakhand, Chhattisgarh and Rajasthan fall short by 22-30 percentage points in achieving universal coverage. • Percent of traditional method in any method of family planning is more than 20% in 4 States namely, Uttar Pradesh, Assam, Jharkhand & Odisha. Performance of Hot Spot Districts 55 districts are hotspots (57 in baseline) i.e. common in top 100 districts in IMR and top 25 Administrative Divisions (111 districts) in MMR. DISTRICTS FALLING IN BOTH TOP 100 IMR AND DISTRICTS OF TOP 25 MMR Assam- 6 UP - 31 Bihar -1 MP -16 Odisha -1 State wiseTFR of Hot Spot Districts Uttar Pradesh 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 Madhya Pradesh 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Assam 3.0 2.5 2.0 1.5 1.0 0.5 0.0 State wise Full ANC of Hot Spot Districts 12.0 Uttar Pradesh 10.0 8.0 6.0 4.0 2.0 0.0 Madhya Pradesh 30.0 25.0 20.0 Assam 16.0 14.0 12.0 10.0 15.0 10.0 5.0 8.0 6.0 4.0 2.0 0.0 0.0 State wise Immunization in Hot Spot Districts Uttar Pradesh 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 Madhya Pradesh 80.0 70.0 60.0 50.0 Assam 70.0 60.0 50.0 40.0 40.0 30.0 30.0 20.0 20.0 10.0 10.0 0.0 0.0 State wise Institutional Delivery in Hot Spot Districts 80.0 Uttar Pradesh 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 Madhya Pradesh Assam 70.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 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 Updation 3.6 Baseline 3.6 3.7 3.4 3.5 3.1 3.0 2.8 2.9 3.1 3.1 3.1 3.2 2.9 2.6 2.5 2.3 2.3 2.3 2.4 2.1 2.0 1.5 1.0 Uttarakhand Odisha Assam Chhattisgarh Jharkhand Madhya Pradesh Rajasthan Uttar Pradesh Bihar • Uttarakhand & Odisha and UP & Bihar continue to remain two extremes of the spectrum. TOTAL FERTILITY RATE (TFR) Total Fertility Rate State value State District with Minimum TFR District with Maximum TFR First updation Baseline First Updation Assam 2.4 2.6 Kamrup (2.0), Nalbari (2.0) Kamrup (2.0), Nalbari(2.0) Hailakandi (3.9) Bihar 3.6 3.7 Patna (2.7) Patna (2.8) Chhattisgarh 2.8 2.9 Koriya (2.4), Kanker (2.4), Durg (2.4) Jharkhand 2.9 3.1 Madhya Pradesh 3.1 Odisha Range First Updation Baseline Hailakandi (4.2) 1.9 2.2 Sheohar (4.6) Sheohar (4.7) 1.9 1.9 Koriya (2.4) Kawardha (3.7) Kawardha (3.7) 1.3 1.3 Purbi Singhbhum (2.2) Purbi Singhbhum (2.4) Pakaur (3.9) Lohardagga (4.0) 1.7 1.6 3.1 Bhopal (2.1) Indore (2.2) Shivpuri(4.4) Shivpuri (4.5) 2.3 2.3 2.3 2.3 Anugul (1.9), Bargarh (1.9), Jharsuguda (1.9) Jharsuguda (2.0) Baudh (3.5) Boudh (3.7) 1.6 1.7 Rajasthan 3.1 3.2 Kota (2.5) Kota (2.6) Barmer (4.5) Barmer (4.7) 2.0 2.1 Uttar Pradesh 3.4 3.6 Kanpur Nagar (2.2) Kanpur Nagar (2.3) Shrawasti (5.8) Shrawasti (5.9) 3.6 3.6 Uttarakhand 2.1 2.3 Pithoragarh (1.7), Bageshwar (1.7) Pithoragarh (1.7) 1.2 1.4 Baseline First Updation Haridwar (2.9) Baseline Haridwar (3.1) Within a State, the minimum variability of 1.2 is reported in Uttarakhand and the maximum of 3.6 in Uttar Pradesh whereas in Baseline it was 1.3 in Chhattisgarh and 3.6 in Uttar Pradesh respectively . Across 284 districts in 9 AHS States, it ranges from 1.7 in Pithoragarh and Bageshwar to 5.8 in Shrawasti. In Baseline this varied from 1.7 in Pithoragarh (Uttarakhand) to 5.9 in Shrawasti (UP)- a variability of more than 4 children. TOTAL FERTILITY RATE (TFR) Frequency distribution of TFR in terms of No. of Districts in each State State 0 - 2.1 2.2 - 3.0 3.1 - 4.0 4.1 and above Grand Total Assam 7 (3) 14 (16) 2 (3) 0 (1) 23 Bihar 0 (0) 1 (1) 28 (26) 8 (10) 37 Chhattisgarh 0 (0) 14 (12) 2 (4) 0 (0) 16 Jharkhand 0 (0) 9 (8) 9 (10) 0 (0) 18 Madhya Pradesh 1 (0) 19 (15) 22 (25) 3 (5) 45 12 (10) 17 (18) 1 (2) 0 (0) 30 0 (0) 18 (16) 12 (13) 2 (3) 32 0 (0) 14 (9) 45(48) 11 (13) 70 9 (7) 4 (5) 0 (1) 0 (0) 13 29 (20) 110 (100) 121 (132) 24 (32) 284 Odisha Rajasthan Uttar Pradesh Uttarakhand All States 29 districts have already achieved the replacement level of 2.1 whereas it was 20 in baseline. TOTAL FERTILITY RATE (TFR) Frequency Distribution of change in TFR in Terms of No. Districts in Each State State Decreased Decreased Decreased Decreased by 0.1 by 0.2 by 0.3 by 0.4 Decreased by 0.5 or more Increased Remained Total Same Uttarakhand 6 2 2 0 0 0 3 13 Rajasthan 13 14 0 0 0 0 5 32 Uttar Pradesh 25 14 3 7 0 7 14 70 Bihar 16 13 3 0 0 0 5 37 Assam 12 5 2 0 0 0 4 23 Jharkhand 11 5 1 0 0 0 1 18 Odisha 20 4 0 0 0 0 6 30 Chhattisgarh 8 2 0 0 0 0 6 16 Madhya Pradesh 30 9 1 1 0 1 3 45 Total 141 68 12 8 0 8 47 284 TOTAL FERTILITY RATE (TFR) •229 districts have recorded less TFR than the baseline estimates and 47 districts remained same. •8 Districts have recorded increase in TFR viz. Indore (M.P.), Baghpat, Budaun, Bulandshahar, Gonda, Lalitpur, Pilibhit and Rampur (U.P.) •8 Districts have recorded maximum decrease in TFR viz. Sehore(M.P.), Basti, Deoria, Gorakhpur, Kaushambi, Kushinagar, Maharajganj, Siddharthnagar (U.P.) TOTAL FERTILITY RATE (TFR) First Updation Replacement level of TFR Baseline Family Planning: Current Usage Contraceptive Prevalence Rate (CPR) is the percentage of currently married women aged 15-49 yrs who are using any method of contraception (modern/traditional). Current Usage- any method (%) 70 Updation 60 Baseline 64.5 66.4 57.9 65.1 61.2 63.4 62.7 61.7 56.2 59.4 49.9 58.6 53.9 47.8 37.6 43.0 30 56.5 40 58.6 50 20 Bihar Current Jharkhand Chhattisgarh Uttar Pradesh Odisha Uttarakhand Madhya Pradesh Assam Rajasthan usage of any method varies from 43.0 in Bihar to 66.4 in Rajasthan whereas it was 37.6 in Bihar to 64.5 per cent in Rajasthan in Baseline. Family Planning: Current Usage Any Method of Family Planning (%) State State Value District with Minimum FP District with Maximum FP First Updation baseline First Updation First Updation baseline Assam 65.1 57.9 Dhubri (45.1) Dhubri (33.2) Kamrup (76.0) Lakhimpur (67.6) 30.9 34.4 Bihar 43.0 37.6 Nawada (31.5) Siwan (26.0) Supaul (60.8) Muzaffarpur (52.2) 29.3 26.2 Jharkhand 56.5 47.8 Gumla (39.0) Paschimi Singhbhum (32.7) Hazaribagh (69.8) Dhanbad (61.9) 30.8 29.2 Madhya Pradesh 63.4 61.2 Sidhi (44.6) Sidhi (45.9) Damoh (75.7) Damoh (74.9) 31.1 29.0 Chhattisgarh 58.6 53.9 Dantewada (33.4) Dantewada (33.4) Kawardha (68.2) Dhamtari (68.7) 34.8 35.3 Odisha 59.4 56.2 Baudh (29.8) Kandhamal (28.6) Baleshwar (78.1) Baleshwar (73.4) 48.3 44.8 Rajasthan 66.4 64.5 Jaisalmer (53.3) Dhaulpur (49.0) Hanumangarh (89.1) Ganganagar (79.2) 35.8 30.2 Uttar Pradesh 58.6 49.9 Sitapur (33.8) Sitapur (21.9) Jhansi (74.4) Jhansi (74.1) 40.6 52.2 Uttarakhand 61.7 62.7 Haridwar (56.2) Haridwar (53.7) Pithoragarh (78.2) Dehradun (67.1) 22.0 13.4 baseline First Updation Range baseline Within a State, the least variation is reported in Uttarakhand and the most, in Odisha whereas in Baseline it was Uttarakhand and Uttar Pradesh respectively. At district level, current usage of family planning ranges from 29.8 in Baudh (Odisha) to 89.1 in Hanumangarh (Rajasthan)- a variability of 3 times-whereas in Baseline it varied from 21.9 in Sitapur (UP) to 79.2 in Ganganagar (Rajasthan) exhibiting a variability of 4 times. Family Planning: Current Usage Frequency distribution of current usage in terms of number of districts in each State State 0-30 30-50 50-70 70 & above Total Districts Assam 0 (0) 2 (3) 15 (20) 6 (0) 23 Bihar 0 (4) 29 (31) 8 (2) 0 (0) 37 Chhattisgarh 0 (0) 3 (7) 13 (9) 0 (0) 16 Jharkhand 0 (0) 7 (13) 11 (5) 0 (0) 18 Madhya Pradesh 0 (0) 1 (2) 40 (40) 4 (3) 45 Odisha 1 (1) 8 (9) 16 (19) 5 (1) 30 Rajasthan 0 (0) 0 (1) 21 (24) 11 (7) 32 Uttar Pradesh 0 (3) 20 (24) 44 (42) 6 (1) 70 Uttarakhand 0 (0) 0 (0) 6 (13) 7 (0) 13 All States 1 (8) 70 (90) 174 (174) 39 (12) 284 As high as 71 districts are reporting less than 50% current usage of any method of family planning whereas in Baseline it was 98. 39 districts feature in 70% & above category whereas in Baseline it was only 12 districts. 29 out of 37 districts of Bihar have reported less than 50% usage of any method of family planning. In Baseline it was 35 districts. Family Planning: Current Usage First Updation CURRENT USAGE OF ANY METHOD OF FAMILY PLANNING (%) Dist. with > 60% Usage Baseline CURRENT USAGE OF ANY METHOD OF FAMILY PLANNING (%) Family Planning: Current Usage FEMALE STERILIZATION (%) Share of sterilization in any modern method of family planning (%) Assam Uttar Pradesh Jharkhand Bihar Odisha Uttarakhand Female 35.1 (35.3) 50.4 (55.0) 74.3 (76.3) 81.2 (86.7) 69.7 (68.4) 51.9 (58.7) Male 0.8 (0.6) 0.5 (0.6) 1.4 (1.2) 0.8 (0.9) 0.4 (0.7) 3.0 (2.8) Rajasthan Chhattisgarh Madhya Pradesh 77.1 (76.7) 87.4 (92.3) 81.8 (83.6) 0.7 (0.7) 1.8 (2.0) 1.5 (1.7) Unmet Need for Family Planning Unmet need of Family Planning broadly means requirement of Family Planning methods among Currently Married Women but not using any method of Family Planning . Unmet Need for Family Planning (%) 45.0 40.0 35.0 33.5 26.4 24.8 29.7 22.6 22.4 21.6 23.2 19.1 23.2 18.1 24.0 15.9 19.6 15.0 12.6 20.0 24.1 30.5 25.0 39.2 30.0 10.0 Rajasthan Assam Uttarakhand Odisha Madhya Pradesh Updation Jharkhand Uttar Pradesh Chhattisgarh Bihar Baseline Total unmet need varies from a minimum of 12.6% in Rajasthan to 33.5% in Bihar. In Baseline it varied from 19.6% in Rajasthan to 39.2% in Bihar. Unmet need for Family Planning is a crucial indicator for assessing the future demand for Family Planning services / supplies. Unmet Need for Family Planning Total Unmet need (%) State State Value District with Minimum unmet need District with Maximum unmet need First Updation First Updation baseline First Updation Assam 15.9 24.0 Kamrup (8.4) Sibsagar (15.3) Karimganj (33.6) Bihar 33.5 39.2 Patna (20.2) Patna (24.6) Jharkhand 22.6 30.5 Hazaribagh (13.2) Madhya Pradesh 21.6 22.4 Chhattisgarh 24.8 Odisha Range First Updation baseline Dhubri (42.9) 25.2 27.6 Katihar (46.5) Kishanganj (52.5) 26.3 27.9 Bokaro (18.2) Gumla (33.2) Godda (42.8) 20.0 24.6 Datia(14.4) Dewas(14.4) Jabalpur (14.3) Sidhi(38.3) Rewa (34.2) 23.9 19.9 26.4 Dhamtari (13.9) Dhamtari (14.5) Dantewada (48.7) Bastar (36.0) 34.8 21.5 19.1 23.2 Kendujhar (9.7) Baleshwar (6.1) Baudh (45.3) Boudh (48.3) 35.6 42.2 Rajasthan 12.6 19.6 Jhunjhunun (3.1) Ganganagar (10.0) Jaisalmer (28.1) Dhaulpur (32.4) 25.0 22.4 Uttar Pradesh 24.1 29.7 Jhansi (12.7) Mahoba (15.1) Sultanpur (48.1) Sitapur (61.3) 35.4 46.2 Uttarakhand 18.1 23.2 Dehradun (12.8) Dehradun (16.8) Almora (27.4) Haridwar (29.2) 14.6 12.4 baseline baseline The minimum variability within a State is in Uttarakhand and the maximum in Odisha whereas in Baseline it was in Uttarakhand and in Uttar Pradesh respectively. Jhunjhunun (3.1) in Rajasthan and Dantewada (48.7) in Chhattisgarh are the two extremes across 284 districts. In Baseline it was Baleshwar (6.1) in Odisha and Sitapur (61.3) in Uttar Pradesh. Unmet Need for Family Planning Frequency distribution of unmet need in terms of number of districts in each State State 0-20 20-40 40-60 60 & above Total Districts Assam 16 (6) 7 (16) 0 (1) 0 (0) 23 Bihar 0 (0) 29 (20) 8 (17) 0 (0) 37 Chhattisgarh 3 (4) 12 (12) 1 (0) 0 (0) 16 Jharkhand 5 (2) 13 (13) 0 (3) 0 (0) 18 Madhya Pradesh 12 (18) 33 (27) 0 (0) 0 (0) 45 Odisha 14 (12) 13 (15) 3 (3) 0 (0) 30 Rajasthan 26 (16) 6 (16) 0 (0) 0 (0) 32 23 (9) 42 (52) 5 (8) 0 (1) 70 6 (2) 7 (11) 0 (0) 0 (0) 13 105 (69) 162 (182) 17 (32) 0 (1) 284 Uttar Pradesh Uttarakhand All States In 105 out of 284 districts, the total unmet need for family planning is below 20%. It was 69 in Baseline. Bihar and Uttar Pradesh continue to dominate in 40% & above category. Unmet Need for Family Planning First Updation TOTAL UNMET NEED FOR FAMILY PLANNING (%) Unmet need of <=20 Baseline TOTAL UNMET NEED FOR FAMILY PLANNING (%) Mean Age at Marriage- Female Mean Age at Marriage is based on the marriages taken place during 2008-2010. Mean Age at Marriage- Female 25 Updation Baseline 21.7 22.4 22.0 22.2 21.8 22.0 21.0 21.5 20.9 21.1 20.6 20.9 20.2 20.6 19.7 20.4 19.7 20.1 20 15 Bihar Rajasthan Jharkhand Madhya Pradesh Chhattisgarh Uttar Pradesh Assam Uttarakhand Odisha Mean age at marriage of females varies from 20.1 in Bihar to 22.4 years in Odisha whereas in Baseline it was 19.7 in Bihar & Rajasthan to 22.0 years in Uttarakhand. Marriages among Females below Legal Age (18 yrs) Based on marriages taken place during 2008-2010. Marriages among Females below legal age (%) 30 Updation Baseline 20.2 16.5 21.9 16.3 12.6 12.5 10.4 10.2 8.0 8.9 6.3 6.0 4.7 5.9 4.6 3.0 2.3 10 17.6 20 0 Uttarakhand Odisha Chhattisgarh Uttar Pradesh Assam Madhya Pradesh Jharkhand Rajasthan Bihar Varies from 2.3% in Uttarakhand to 16.5% in Bihar whereas in Baseline it was 3.0% in Uttarakhand to 21.9% in Rajasthan. Marriages among Females below Legal Age (18 yrs) MARRIAGES AMONG FEMALES BELOW LEGAL AGE (BELOW 18 YEARS) % Ante Natal Care (ANC) Any ANC exceeds 80% in all AHS States. ANC in 1st trimester: 46.5% in UP & Bihar to 70% in Chhattisgarh & Madhya Pradesh. In Baseline, this was 40% in UP & Bihar to 65% in Chhattisgarh & Madhya Pradesh. Mothers receiving 3 or more ANCs: UP-32.5% to Odisha-78.5%. This was UP-29.6% to Odisha-76.0 % in Baseline. Mothers who consumed IFA 100 days or more: 8.1% in UP to 26.0% in Odisha. It was 6.5% in UP to 23.8% in Chhattisgarh in Baseline. Low performance in IFA consumption is the main reason for sluggish full ANC: 5% in UP to 22.7% in Odisha. In Baseline, 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. 5 16.0 13.3 15.3 13.1 14.4 5.9 6.1 3.9 5.0 10 8.5 9.2 15 11.9 13.3 20 19.5 Baseline 11.1 Updation 20.2 25 18.6 22.7 Full Ante Natal Check-up (%) 0 Uttar Pradesh Bihar Rajasthan Assam Jharkhand Madhya Pradesh Uttarakhand Chhattisgarh Odisha Uttar Pradesh reports the minimum coverage of 5.0 % and Odisha, the maximum 22.7 whereas in Baseline it was 3.9% in Uttar Pradesh & 19.5% in Chhattisgarh. Full Ante Natal Check-up Mothers who had Full Antenatal Check-up (%) State State Value District with Minimum value District with Maximum value First Updation Baseline First Updation Assam 13.3 11.9 Dhubri (4.0) Dhubri (2.1) Dibrugarh (25.2) Bihar 6.1 5.9 Samastipur (2.0) Madhepura (2.4) Jharkhand 14.4 13.1 Garhwa (5.0) Madhya Pradesh 15.3 13.3 Chhattisgarh 20.2 Odisha Range First Updation Baseline Jorhat (18.2) 21.2 16.1 Patna (13.8) Patna (16.4) 11.8 14.0 Garhwa (3.6) Purbi Singhbhum (32.1) Purbi Singhbhum (31.6) 27.1 28.0 Sheopur (1.9) Sheopur (1.8) Indore (32.1) Balaghat (30.8) 30.2 29.0 19.5 Kawardha (11.5) Korba (10.9) Dhamtari (42.6) Dhamtari (34.5) 31.1 23.6 22.7 18.6 Jajapur (13.4) Jajapur (5.4) Jagatsinghapur (43.5) Jagatsinghapur (36.0) 30.1 30.6 Rajasthan 9.2 8.5 Karauli (3.0) Karauli (1.7) Jaipur (19.7) Jaipur (19.5) 16.7 17.8 Uttar Pradesh 5.0 3.9 Balrampur (0.9) Balrampur (0.6) Jhansi (17.9) Kanpur Nagar (14.8) 17.0 14.2 Uttarakhand 16.0 11.1 Rudraprayag (3.8) Dehradun (22.7) 25.9 19.0 Baseline First Updation Rudraprayag (3.7) Dehradun (29.7) Baseline Bihar has reported the minimum variability among the districts in a State compared to Chhattisgarh reporting the maximum. It was Bihar and Odisha in Baseline. Balrampur (0.9), less than 1% coverage and Jagatsinghapur (43.5), the maximum coverage of full ANC. In Baseline also the position was same with values 0.6 and 36.0 respectively. Full Ante Natal Check-up Frequency distribution of full ANC in terms of number of districts in each State <5 5 - 10 10 - 15 15-20 20-25 25 & above Total Districts 1 (6) 9 (7) 7 (6) 3 (4) 2 (0) 1 (0) 23 15 (17) 18 (17) 4 (2) 0 (1) 0 (0) 0 (0) 37 Chhattisgarh 0 (0) 0 (0) 6 (4) 2 (4) 3 (5) 5 (3) 16 Jharkhand 0 (3) 7 (7) 6 (4) 3 (3) 1 (0) 1 (1) 18 Madhya Pradesh 5 (7) 10 (11) 11 (10) 7 (7) 6 (6) 6 (4) 45 Odisha 0 (0) 0 (3) 4 (7) 7 (10) 9 (3) 10 (7) 30 Rajasthan 6 (7) 16 (16) 8 (7) 2 (2) 0 (0) 0 (0) 32 45 (52) 17 (15) 6 (3) 2 (0) 0 (0) 0 (0) 70 1 (2) 2 (7) 5 (2) 3 (1) 1 (1) 1 (0) 13 73 (94) 79 (83) 57 (45) 29 (32) 22 (15) 24 (15) 284 State Assam Bihar Uttar Pradesh Uttarakhand All States 73 out of 284 districts report less than 5% coverage of full ANC whereas in Baseline it was 94. 24 districts reported 25% & above coverage of full ANC . In Baseline it was only 15 districts. Full Ante Natal Check-up First Updation MOTHERS WHO HAD FULL ANTENATAL CHECK UP (%) Baseline MOTHERS WHO HAD FULL ANTENATAL CHECK UP (%) Ante Natal Check-up First Updation MOTHERS WHO RECEIVED ANY ANTENATAL CHECK-UP (%) 90% and above coverage Baseline MOTHERS WHO RECEIVED ANY ANTENATAL CHECK-UP (%) Ante Natal Check-up First Updation Baseline MOTHERS WHO HAD ANTENATAL CHECK UP IN FIRST TRIMESTER (%) MOTHERS WHO HAD ANTENATAL CHECK UP IN FIRST TRIMESTER (%) Above 50 % coverage Ante Natal Check-up First Updation MOTHERS WHO RECEIVED 3 OR MORE ANTENATAL CARE (%) Baseline MOTHERS WHO RECEIVED 3 OR MORE ANTENATAL CARE (%) Institutional Delivery Institutional Delivery (%) 76.1 71.3 77.7 50.5 54.6 47.7 45.6 37.6 40.0 34.9 40.4 50.0 41.2 51.7 60.0 51.9 60.8 70.0 70.2 74.4 Baseline 57.7 Updation 80.0 79.7 90.0 30.0 Rajasthan 21.8 20.8 78.6 55.3 42.6 Govt 77.8 51.9 70 46.1 12.0 87.5 31.0 13.8 86.1 29.1 13.7 86.2 30.4 80 25.7 22.7 90 16.8 100 12.9 Share of Govt. & Private Hospitals in Total Institutional Delivery Odisha Madhya Pradesh Pvt 40.2 Assam 59.2 Uttarakhand 36.4 Bihar 62.8 Uttar Pradesh 38.8 Jharkhand 34.2 Chhattisgarh 20 60.7 65.6 69.0 70.7 68.5 30 73.3 77.1 40 82.9 50 86.5 60 10 0 Updation Baseline Updation Baseline Updation Baseline Updation Baseline Updation Baseline Updation Baseline Updation Baseline Updation Baseline Updation Baseline Assam Chhattisgarh Madhya Pradesh Odisha Bihar Jharkhand Rajasthan Uttar Pradesh Uttarakhand Institutional Delivery Institutional Delivery: Ranges from 40.4% in Chhattisgarh to 79.7% in MP. In Baseline it was 34.9% in Chhattisgarh & 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. In Baseline also, the situation was same except for Uttarakhand, which stood at 63% from 59% in Baseline. Jharkhand continues to remain the only State where more than 50% of the births are taking place in Private Hospitals. Balrampur (UP) recorded the least 22.2% institutional delivery whereas Puri(Odisha) the most 94.0%, showing a variability of more than 4 times. In Baseline, Balrampur was in the least category with 16.8% and Indore(MP),the highest with 92.5%. INSTITUTIONAL DELIVERY (%) Balrampur, UP Puri, Odisha Institutional delivery is below 60% in 141 districts whereas it was 170 districts in baseline. Safe Delivery Safe delivery comprise institutional deliveries and domiciliary deliveries assisted by doctor/nurse/ANM/LHV. 50 85.9 75.2 64.2 68.1 56.9 61.0 53.5 59.9 51.3 57.4 56.9 47.1 60 51.8 70 49.5 80 76.2 Baseline 80.0 Updation 90 80.8 100 82.2 Safe Delivery (%) 40 30 Jharkhand Chhattisgarh Uttar Pradesh Bihar Uttarakhand Assam Rajasthan Odisha Madhya Pradesh Safe Delivery: 51.8% in Jharkhand to 85.9% in Madhya Pradesh. It was 47.1% in Jharkhand & 82.2% in MP. Safe Delivery Safe Delivery (%) State State Value District with Minimum Value District with Maximum Value First Updation Baseline First Updation Assam 68.1 64.2 Hailakandi, Karimganj (41.4) Karimganj, Hailakandi (34.8) Sibsagar (89.9) Bihar 59.9 53.5 Sitamarhi (36) Sheohar (30.2) Jharkhand 51.8 47.1 Pakaur (31.8) Madhya Pradesh 85.9 82.2 Chhattisgarh 56.9 Odisha Range First Updation Baseline Sibsagar (88.2) 48.5 53.4 Patna (81.4) Munger (80.4) 45.4 50.2 Pakaur (24.8) Purbi Singhbhum (71.9) Purbi Singhbhum (69.0) 40.1 44.2 Dindori (55.4) Dindori (45.5) Indore (97) Indore (96.3) 41.6 50.8 49.5 Surguja (41.6) Surguja (32.6) Kanker (75.8) Kanker (69.4) 34.2 36.8 80.8 75.2 Malkangiri (48) Nabarangpur (35.6) Puri (94.7) Puri (92.7) 46.7 57.1 Rajasthan 80.0 76.2 Jaisalmer (55.5) Jaisalmer (48.6) Baran (93.6) Jaipur (92.2) 38.1 43.6 Uttar Pradesh 57.4 51.3 Balrampur (30) Balrampur (22.0) Jhansi (90.1) Jhansi (89.4) 60.1 67.4 Uttarakhand 61.0 56.9 Tehri Garhwal (49.4) Tehri Garhwal (43.1) Nainital (81.4) Nainital (79.5) 32.0 36.4 Baseline First Updation Baseline Uttarakhand has exhibited the least variability among districts of a State and Uttar Pradesh, the most, the same as in Baseline. Balrampur (UP) & Indore (MP) continue to remain the minimum and maximum in safe delivery. Safe Delivery Frequency distribution of safe delivery in terms of No. of districts in each State <30 30-50 50-70 70-90 90 & above Total Districts Assam 0 (0) 3 (2) 11 (12) 9 (9) 0 (0) 23 Bihar 0 (0) 6 (12) 22 (19) 9 (6) 0 (0) 37 Chhattisgarh 0 (0) 4 (9) 9 (7) 3 (0) 0 (0) 16 Jharkhand 0 (3) 11 (9) 6 (6) 1 (0) 0 (0) 18 Madhya Pradesh 0 (0) 0 (1) 5 (5) 27 (29) 13 (10) 45 Odisha 0 (0) 2 (3) 4 (5) 20 (20) 4 (2) 30 Rajasthan 0 (0) 0 (1) 5 (8) 25 (21) 2 (2) 32 Uttar Pradesh 0 (4) 12 (20) 40 (39) 17 (7) 1 (0) 70 Uttarakhand 0 (0) 1 (3) 8 (7) 4 (3) 0 (0) 13 All States 0 (7) 39 (60) 110 (108) 115 (95) 20 (14) 284 State About 1/7th of the districts have reported less than 50% of the safe deliveries. It was 1/4th in baseline. Out of 20 districts reporting 90% & above safe deliveries, 13 districts belong to Madhya Pradesh. It was 10 for MP in Baseline. Safe Delivery SAFE DELIVERY (%) Janani Suraksha Yojana 61.1 69.3 30.4 35.2 15.8 31.1 30.8 21.7 14.6 20 19.9 30 30.1 40 26.9 50 53.9 60 57.7 51.2 Baseline 44.8 Updation 70 67.7 80 61.6 Mothers who availed Financial Assistance under JSY (%) 10 0 Jharkhand Uttarakhand Chhattisgarh Uttar Pradesh Bihar Assam Rajasthan Odisha Madhya Pradesh Mothers availing JSY: 19.9% in Jharkhand to 69.3% in MP. It was 14.6% in Jharkhand to 61.6% in Odisha in Baseline. Janani Suraksha Yojana MOTHERS WHO AVAILED FINANCIAL ASSISTANCE FOR DELIVERY UNDER JSY (%) Abortion 7.6 Pregnancy to Women aged 15-49 years resulting in abortion (%) 6.4 4.6 5.6 5.8 4.5 5.4 5.0 4.5 4.4 2.5 3.0 2.1 4.0 4.2 3.5 5.0 4.0 6.0 5.3 Baseline 5.0 Updation 7.0 6.8 8.0 2.0 1.0 0.0 Chhattisgarh Madhya Pradesh Rajasthan Bihar Jharkhand Uttarakhand Uttar Pradesh Odisha Assam Varies from 2.1% in Chhattisgarh to 7.6% in Assam, in Baseline too these two States were at the extremes. Across 284 districts in 9 AHS States, it ranges from 0.7% in Jaisalmer(Rajasthan) Kanker & Dantewada(Chhattisgarh), to 19.6% in Jorhat(Assam). Abortion Average Month of pregnancy at the time of abortion 5.0 Updation Baseline 3.3 3.3 3.1 3.2 3.3 3.2 3.0 3.0 2.9 2.9 3.0 2.9 2.9 2.8 2.8 2.7 2.7 3.0 2.6 4.0 2.0 1.0 0.0 Assam Uttarakhand Jharkhand Odisha Uttar Pradesh Bihar Rajasthan Madhya Pradesh Chhattisgarh Varies from 2.6 in Assam to 3.3 in Chhattisgarh. Across 284 districts in 9 AHS States, it ranges from 2.0 in Sheopur (Madhya Pradesh) to 5.4 in Rayagada (Odisha) & Jaisalmer (Rajasthan). 60.5 57.8 54.3 51.8 49.1 44.7 49.0 49.4 48.4 40.5 32.2 40.0 32.0 50.0 40.4 60.0 47.7 Baseline 49.6 Updation 70.0 56.5 80.0 73.9 Abortion taking place in Institution (%) 75.0 Abortion 30.0 20.0 10.0 0.0 Chhattisgarh Bihar Uttar Pradesh Madhya Pradesh Odisha Jharkhand Uttarakhand Rajasthan Assam Abortion taking place in institution varies from 32.0% in Chhattisgarh to 73.9% in Assam. Across 284 districts in 9 AHS States, it ranges from 12.4% in Kishanganj (Bihar) to 100% in Jaisalmer (Rajasthan). Abortion Abortion performed by skilled health personnel (%) 100.0 64.9 60.5 57.4 55.0 52.1 54.3 60 52.2 49.4 52.1 52.9 51.9 40.4 41.8 50.3 60.0 49.2 80.0 77.8 Baseline 76.4 Updation 40.0 20.0 Chhattisgarh Bihar Uttar Pradesh Madhya Pradesh Odisha Jharkhand Uttarakhand Rajasthan Assam Varies from 41.8% in Chhattisgarh to 76.4% in Assam. Across 284 districts in 9 AHS States, it ranges from 19.6% in Madhepura (Bihar) to 100% in Rayagada (Odisha) and Jaisalmer (Rajasthan) – a variability of 5 times. More than 50% of the abortion is performed by skilled health personnel in all the States except Chhattisgarh. Post Natal Care Mothers who received Post-natal Check up within 48 hrs of delivery (%) Assam Bihar Uttarakhand Jharkhand Chhattisgarh Uttar Pradesh Rajasthan Madhya Pradesh 74.5 80.0 74.2 77.8 73.3 76.6 68.4 71.4 64.8 69.5 59.1 64.6 59.1 60.8 61.7 Baseline 59.7 57.0 Updation 59.6 85 80 75 70 65 60 55 50 45 40 Odisha Mothers receiving PNC within 48 hrs of delivery varies from 59.6% in Assam to 80.0% in Odisha. It was 57.0 in Assam and 74.5% in Odisha in Baseline. Mothers who did not receive any Post-natal Check up (%) 40 Updation Baseline 36.9 34.7 35.8 33.0 29.8 28.1 23.1 23.2 20.9 30.4 20.7 23.0 19.9 22.1 18.6 19.6 10 14.8 20 34.4 30 0 Odisha Madhya Pradesh Rajasthan Bihar Chhattisgarh Uttar Pradesh Jharkhand Uttarakhand Assam At least 1 in every 7 mothers did not receive any post natal check up across all AHS States. The situation was 1 in 5 in baseline. Post Natal Care MOTHERS WHO AVAILED POST-NATAL CHECK UP WITHIN 48 HRS. OF DELIVERY (%) Post Natal Care MOTHERS WHO DID NOT RECEIVE ANY POST-NATAL CHECK UP (%) New Born Check up New Born Checked up within 24 hrs of birth (%) 90 Updation Baseline 80 74.9 79.7 73.1 76.3 70.0 73.4 71.9 60.6 64.2 59.3 60.6 55.9 60.3 55.3 58.2 52.6 50 57.6 60 68.2 70 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. Across the 284 districts, as high as 246 districts reported more than 50% coverage. It varies from 57.6% in Bihar to 79.7% in Odisha whereas in Baseline it was 52.6% in Bihar and 74.9 in Odisha. Across 284 districts in 9 AHS States, it ranges from 32.2 in Karimganj(Assam) to 92.6 in Bargarh(Odisha). In Baseline, this varied from 24.2 in Karimganj & Hailakandi (Assam) to 92.9 in Allahabad(Uttar Pradesh). New Born Check up NEW BORNS WHO WERE CHECKED UP WITHIN 24 HRS. OF BIRTH (%) Full Immunization Children are considered fully immunized when they have received vaccination against Tuberculosis, 3 doses of DPT & Polio and 1 dose of measles. 75.4 74.1 74.1 70.8 69.2 64.5 65.6 55.0 62.3 59.0 61.4 45.3 50 48.1 60 59.7 70 54.9 80 63.7 Baseline 69.1 Updation 90 77.9 Children aged 12-23 months fully immunized (%) 40 30 Uttar Pradesh Madhya Pradesh Assam Odisha Bihar Jharkhand Rajasthan Chhattisgarh Uttarakhand All States except Uttar Pradesh continue to remain having received at least half of their children aged 12-23 months fully immunized. Uttar Pradesh & Uttarakhand continue to remain minimum & maximum in children fully immunized. Full Immunization Children aged 12-23 months Fully Immunized (%) State State Value Minimum Maximum First Updation Baseline First Updation Assam 61.4 59.0 Dhubri (39.2) Dhubri (29.9) Dibrugarh (85.5) Bihar 65.6 64.5 Kishanganj (26.6) Kishanganj (26.6) Jharkhand 69.1 63.7 Giridih (43.0) Madhya Pradesh 59.7 54.9 Chhattisgarh 74.1 Odisha Range First Updation Baseline Dibrugarh (83.8) 46.3 53.9 Madhubani (82.8) Samastipur (83.9) 56.2 57.3 Giridih (28.0) Lohardaga (86.5) Purbi Singhbhum (82.7) 43.5 54.7 Umaria (27.1) Jhabua (23.8) Indore (83.2) Indore (77.6) 56.1 53.8 74.1 Surguja (52.8) Surguja (55.3) Kanker (94) Kanker (93.2) 41.2 37.9 62.3 55.0 Rayagada (17.7) Rayagada (11.9) Kendrapara (84.9) Kendrapara (82) 67.2 70.1 Rajasthan 69.2 70.8 Dhaulpur (41.5) Dhaulpur (37.4) Hanumangarh (95.9) Hanumangarh (91.4) 54.4 54.0 Uttar Pradesh 48.1 45.3 Bahraich (21.6) Etah (13.5) Saharanpur (72.2) Basti (73.8) 50.6 60.3 Uttarakhand 77.9 75.4 Haridwar (59.6) Pithoragarh (87.5) 28.0 32.2 Baseline First Updation Haridwar (55.3) Pithoragarh (87.6) Baseline The variability among the districts within a State ranges from 28.0% in Uttarakhand to 67.2% in Odisha, it was 32.2% in Uttarakhand to 70.1% in Odisha in Baseline. Across all 284 districts, Rayagada of Odisha continue to remain the minimum. However the maximum is observed in Hanumangarh of Rajasthan. In Baseline the maximum was in Kanker of Chhattisgarh. Full Immunization Frequency distribution of Full Immunization in terms of number of districts in each State 0-30 30-50 50-70 70-90 90 & above Total Districts Assam 0 (1) 4 (4) 14 (14) 5 (4) 0 (0) 23 Bihar 1 (1) 2 (2) 18 (23) 16 (11) 0 (0) 37 Chhattisgarh 0 (0) 0 (0) 6 (6) 9 (9) 1 (1) 16 Jharkhand 0 (1) 2 (4) 9 (7) 7 (6) 0 (0) 18 Madhya Pradesh 3 (2) 8 (14) 26 (24) 8 (5) 0 (0) 45 Odisha 5 (8) 9 (7) 2 (6) 14 (9) 0 (0) 30 Rajasthan 0 (0) 3 (4) 9 (10) 19 (17) 1 (1) 32 6 (11) 30 (31) 31 (20) 3 (8) 0 (0) 70 0 (0) 0 (0) 1 (2) 12 (11) 0 (0) 13 15 (24) 58 (66) 116 (112) 93 (80) 2 (2) 284 State Uttar Pradesh Uttarakhand All States 73 districts are below 50% level of full immunization whereas it was 90 in Baseline. Only 2 districts 1 each from Chhattisgarh & Rajasthan continue to remain in 90% & above category. 85 80 75 84.8 83.2 83.0 82.3 80.4 79.9 79.9 77.5 78.9 74.7 Baseline 78.1 78.1 73.1 69.4 60.9 58.5 Updation 76.6 75.5 97.8 97.5 94.7 94.2 94.0 93.3 93.6 91.8 Children age 12-23 months who have received 3 doses of Polio vaccine(%) 90 80 70 60 50 40 30 20 10 0 84.8 83.4 90 91.1 90.6 95 Baseline 93.5 93.9 Updation 92.9 91.9 100 96.8 96.8 Children age 12-23 months who have received BCG(%) Constituents of full immunization 80 30 70 60 20 10 0 50 63.1 60.5 50 40 89.4 87.9 87.8 86.7 81.5 81.8 82.6 80.7 Baseline 81.9 79.0 Updation 90 84.5 82.6 100 79.3 77.3 84.1 83.0 81.7 81.6 78.0 71.8 77.9 72.9 76.1 77.0 Children age 12-23 months who have received Measles vaccine (%) 76.7 75.7 60 71.5 66.6 70 59.8 55.9 80 Baseline 74.8 72.2 Updation 90 79.6 78.7 Children age 12-23 months who have received 3 doses of DPT vaccine(%) Full Immunization CHILDREN AGED 12-23 MONTHS FULL IMMUNIZED (%) Vitamin A Supplementation to Children Children aged 6-35 months who received a Vitamin A dose during last six months (%) 80.0 Updation Baseline 70.0 60.0 63.4 71.3 72.0 70.7 71.7 59.4 66.1 60.1 61.9 61.9 58.8 55.0 57.3 37.2 20.0 39.2 30.0 54.5 56.6 40.0 68.6 50.0 10.0 0.0 Uttar Pradesh Madhya Pradesh Uttarakhand Bihar Jharkhand Rajasthan Chhattisgarh Assam Odisha 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, the same as in Baseline. Across 284 districts in 9 AHS States, it ranges from 16.2 in Shrawasti(Uttar Pradesh) to 88.5 in Udaipur(Rajasthan). In Baseline, it varied form 15.1 in Shrawasti to 91.3 in Lohardaga(Jharkhand). Across the 284 districts,193 districts have reported more than 50 % coverage. Vitamin A Supplementation to Children CHILDREN (AGE 6-35 MONTHS WHO RECEIVED VITAMIN A DOSE DURING LAST SIX MONTHS (%) IFA Supplement to Children Children aged 6-35 months who received IFA tablet/syrup during last 3 months (%) 50 Updation Baseline 40 37.7 38.7 29.0 27.7 26.3 24.8 24.7 23.3 24.0 14.2 16.9 14.3 15.5 10.6 13.2 9.4 10 10.9 20 31.3 30 0 Rajasthan Uttar Pradesh Uttarakhand Jharkhand Odisha Madhya Pradesh Assam Bihar Chhattisgarh IFA supplement to children aged 6-35 months during last 3 months ranges from 10.9% in Rajasthan to 38.7% in Chhattisgarh. It was 9.4% in Rajasthan to 37.7% in Chhattisgarh in Baseline. Situation merit attention across all AHS States however it is quite alarming in Rajasthan, Uttar Pradesh & Uttarakhand. IFA Supplement to Children CHILDREN (AGE 6-35 MONTHS WHO RECEIVED IFA TABLETS/SYRUPS DURING LAST 3 MONTHS (%) Breast Feeding Practices 71.2 69.6 70.9 63.9 61.5 65.0 63.2 Baseline 63.7 Updation 70 65.7 80 74.3 Children under 3 Years breastfed within one hour of birth (%) 41.2 32.9 36.0 30.3 40 34.6 48.6 50 37.9 50.1 60 30 20 10 0 Bihar Uttar Pradesh Jharkhand Rajasthan Uttarakhand Madhya Pradesh Chhattisgarh Assam Odisha Bihar & UP and Assam & Odisha continue to remain two extremes of the spectrum. Breast Feeding Practices CHILDREN UNDER 3 YEARS BREASTFED WITHIN 1 HOUR OF BIRTH (%) Breast Feeding Practices Children age 6-35 months exclusively breastfed for at least six months (%) 20 47.5 39.2 40.1 36.8 39.7 28.5 30.3 24.7 29.4 17.7 19.4 30 24.8 26.6 40 38.2 39.0 50 49.9 Baseline 48.4 Updation 45.6 60 10 0 Uttar Pradesh Odisha Rajasthan Bihar Uttarakhand Madhya Pradesh Assam Jharkhand Chhattisgarh Children exclusively breastfed for at least 6 months ranges from 19.4% in UP to 49.9% in Chhattisgarh whereas it was 17.7% in UP to 47.5 % in Chhattisgarh in Baseline. Breast Feeding Practices CHILDREN AGED 6-35 MONTHS EXCLUSIVE BREASTFED FOR AT LEAST SIX MONTHS (%) Some Additional Facts Among AHS States: 4 out of the 5 top States in female literacy and full ANC coverage are common. 57 districts are common in top 100 districts in female literacy and full ANC. 3 out of the 5 top States in female literacy also exist among 5 States with least MMR . Top 5 States in full immunization coverage are the same who have the least NNMR & IMR. 3 out of the 5 top States in exclusive breast feeding practice also exist among 5 States with minimum NNMR. WAY FORWARD • The fieldwork for 2nd updation round is over and the indicators on vital rates reflecting the change vis-à-vis baseline and first updation round surveys are likely to be released shortly. • A Component of Clinical-Anthropometric & Bio-chemical (CAB) Test on a sub-sample basis is in progress in the AHS States.