Presentation on Annual Health Survey Fact Sheet Key Findings
62
ANNUAL HEALTH SURVEY FACT SHEET KEY FINDINGS Dr. C. Chandramouli Registrar General & Census Commissioner, India
Transcript of Presentation on Annual Health Survey Fact Sheet Key Findings
Slide 1Dr. 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
59 percent of Births
75 percent of Under 5 Deaths
62 percent of Maternal Deaths
Enable direct monitoring of UN Millennium Development Goals on Child Mortality and Maternal Health at the district(s) level.
Help in identifying high focus districts meriting special attention in view of stark inter-district variations in these States.
Provide critical inputs to assess the milestones of various interventions including NRHM and pave the way for evidence based planning.
KEY FEATURES
Coverage- All the 284 districts of 8 EAG States and Assam.
Sample Units- 20,694 statistically selected sample unit (Census Enumeration Blocks in urban areas and Villages or a part thereof in rural areas)
Sample Identification Work- to uniquely identify the sample units on ground, firm up its boundaries, demarcate the localities and prepare a notional map of the sample unit was done by the staff of ORGI.
Sample Units per district- 73.
Sample Population- About 20.1 million
The Largest Sample Survey in the World
KEY FEATURES Contd…
Sample 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
Fertility- 13 Sex Ratio- 3
Marriage- 5 Mortality- 7
Mother & Child Care- 63
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
Disability- 1 Morbidity- 19
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
Ante Natal Care
Total Fertility Rate (TFR)
Uttarakhand & Odisha and UP & Bihar reflects the two extremes.
Significant Rural-Urban variation across all 9 AHS States, the max. in Uttar Pradesh.
TFR is the average number of children born to a woman during her entire reproductive span.
Total Fertility Rate
Uttarakhand Odis ha Assam Chhattisgarh Jharkhand Madhya Pradesh Rajasthan Uttar Pradesh Bihar 2.4 2.4149999999999987 2.7 3.07239 3.3 3.5449999999999999 3.4219999999999997 3.86636299999999 8 3.9 Urban
Uttarakhand Odisha Assam Chhattisgarh Jharkhand Madhya Pradesh Rajasthan Uttar Pradesh Bihar 2 1.9460000000000004 1.9 2.301622999999998 2.4 2.4079999999999999 2.5489999999999999 2.679818999999998 2.77
Total Fertility Rate (TFR)
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
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…
Total Fertility Rate (TFR) Contd…
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
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 (%)
Current Usage of Family Planning- any Method (%)
State
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
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
Family Planning: Current Usage Contd…
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.
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 (%)
Total
Rajasthan Madhya Pradesh Uttarakhand Odisha Assam Chhattisgarh Uttar Pradesh Jharkhand Bihar 20.464796912368364 23.266202262983416 24.692712891917402 23.523615592319977 24.964143889884078 27.125101930844288 31.532740580946111 33.643952607104303 40.6 Urban
Rajasthan Madhya Pradesh Uttarakhand Odisha Assam Chhattisgarh Uttar Pradesh Jharkhand Bihar 16.936589701206099 20.554197101793033 19.483625017750029 21.661755034917899 19.561115673145089 23.668644514099189 23.16394037042819 21.499263650972889 30
Total unmet need for Family Planning(%)
State
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
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.
Unmet Need for Family Planning Contd…
Mean Age at Marriage- Female
Mean Age at Marriage is based on the marriages taken place during 2007-2009.
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.
Mean Age at Marriage- Female
Total
Rajasthan Bihar Jharkhand Madhya Pradesh Chhattisgarh Uttar Pradesh Odisha Assam Uttarakhand 19.100000000000001 19.5 19.7 19.8 20.5 20.6 21.5 21.5 21.4 Urban
Rajas than Bihar Jharkhand Madhya Pradesh Chhattisgarh Uttar Pradesh Odisha Assam Uttarakhand 21.4 21.1 21.6 22.1 22 22.4 22.9 23.4 23.2
Marriages among Females below Legal Age (18 yrs)
Based on marriages taken place during 2007-2009.
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.
Marriages among Females below legal age (%)
Total
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.
Ante Natal Care (ANC)
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.
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 (%)
State
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
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.
Full Ante Natal Check-up Contd…
Ante Natal Check-up
Institutional Delivery
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.
Share of Govt. & Private Hospitals in Total Instritutional Delivery
Govt.
Institutional Delivery (%)
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.
Balrampur, UP
Indore, MP
Safe Delivery
Safe Delivery: 47.1 % in Jharkhand to 82.2% in Madhya Pradesh.
Rural- Urban differential is quite prominent in Jharkhand, Chhattisgarh and Uttarakhand.
Safe Delivery (%)
Safe delivery (%)
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…
State
<30
30-50
50-70
70-90
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.
Safe Delivery Contd…
Janani Suraksha Yojana
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.
Mothers who availed Financial Assistance under JSY (%)
Total
Jharkhand Uttar Pradesh Chhattisgarh Uttarakhand Bihar Assam Rajasthan Madhya Pradesh Odisha 18.237487045540568 17.812858508531114 21.761424019076323 26.7 30.6 45.752585181850307 54.099743034966011 68.694071207228589 63.379115762935228 Urban
Jharkhand Uttar Pradesh Chhattisgarh Uttarakhand Bihar Assam Rajasthan Madhya Pradesh Odisha 9.3457195258681125 13.514683995205672 21.594511662599633 27.3 28.7 40.117884612478584 53.132719976720296 54.14116991265962 50.485995761947613
Post Natal Care
Mothers receiving PNC within 48 hrs of delivery varies from 57% in Assam to 74.5% in Odisha.
At least 1 in every 5 mothers did not receive any post natal check up across all AHS States..
Mothers who received Post-natal Check up within 48 hrs of delivery (%)
Total
Assam Uttarakhand Jharkhand Bihar Chhattisgarh Uttar Pradesh Rajasthan Madhya Pradesh Odisha 76.563562491500505 81.525089130732695 79.071136580432949 74.900000000000006 82.598958309983288 74.864911578468949 85.355392495704578 87.453390597474197 85.886989889378427
Mothers who did not receive any Post-natal Check up (%)
Total
Odisha Madhya Pradesh Rajasthan Chhattisgarh Uttar Pradesh Bihar Jharkhand Uttarakhand Assam 21.099522158322078 26.299217649341486 25.982935451264002 25.985880286215089 29.479850980942327 30.949542417755477 39.573595302285113 42.864367721118995 40.518652228084754 Urban
Odisha Madhya Pradesh Rajasthan Chhattisgarh Uttar Pradesh Bihar Jharkhand Uttarakhand Assam 10.389795887699504 10.545695084319274 12.127333021083601 10.3455678441707 21.418051837526676 25.1561389225532 16.463560901114587 16.06620376912764 19.271581012536799
New Born Check up
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.
New Born Checked up within 24 hrs of birth (%)
Total
Bihar Assam Jharkhand Uttarakhand Chhattisgarh Uttar Pradesh Rajasthan Madhya Pradesh Odisha 51.239527874105754 51.382116610454212 50.579215233082103 51.445542647439332 56.6366605372707 66.76237326424652 66.146578170402577 68.35256665935151 73.110515469804994 Urban
Bihar Assam Jharkhand Uttarakhand Chhattisgarh Uttar Pradesh Rajasthan Madhya Pradesh Odisha 64.972710475637598 74.653122249546499 75.257557056076749 81.291315704032201 78.979058006633068 74.681519239297316 83.403524161520707 86.123722489437029 85. 788537040225478
Full Immunization
Children are considered fully immunized when they have received vaccination against Tuberculosis, 3 doses of DPT & Polio and 1 dose of measles.
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.
Children aged 12-23 months fully immunized (%)
Total
State
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 districts are below 50% level of full immunization.
Only 2 districts 1 each from Chhattisgarh & Rajasthan feature in 90% & above category.
Full Immunization Contd…
Total
UP Rajasthan Jharkhand Uttarakhand Assam Bihar Madhya Pradesh Chhattisgarh Orissa 83.372722460195888 90.598997818264394 91.812850872073994 91.893817070465659 93.334877810595259 93.879703542380298 94.200409 562359908 96.764159358164122 97.533069835260392
Children age 12-23 months who have received 3 doses of Polio vaccine(%)
Total
Children age 12-23 months who have received Measles vaccine (%)
Total
UP Bihar Assam Jharkhand Madhya Pradesh Rajasthan Uttarakhand Orissa Chhattisgarh 60.486508488651907 75.718345234552658 77.32276266070788 78.955355733382959 80.677729390435488 81.824422118182298 82.580292566987112 86.674075413715059 87.895733417187841
Children age 12-23 months who have received 3 doses of DPT vaccine(%)
Total
FULL IMMUNIZATION
Vitamin A Supplementation to Children
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.
Children aged 6-35 months who received a Vitamin A dose during last six months (%)
Total
IFA Supplement to Children
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.
Children aged 6-35 months who received IFA tablet/syrup during last 3 months (%)
Total
Breast Feeding Practices
Children under 3 Years breastfed within one hour of birth (%)
Total
Breast Feeding Practices
Children exclusively breastfed for at least 6 months ranges from 17.7 in UP to 47.5 % in Chhattisgarh.
Children age 6-35 months exclusively breastfed for at least six months (%)
Total
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.
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.
KEY FINDINGS Contd…
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.
WAY FORWARD
THANK YOU
“ 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
59 percent of Births
75 percent of Under 5 Deaths
62 percent of Maternal Deaths
Enable direct monitoring of UN Millennium Development Goals on Child Mortality and Maternal Health at the district(s) level.
Help in identifying high focus districts meriting special attention in view of stark inter-district variations in these States.
Provide critical inputs to assess the milestones of various interventions including NRHM and pave the way for evidence based planning.
KEY FEATURES
Coverage- All the 284 districts of 8 EAG States and Assam.
Sample Units- 20,694 statistically selected sample unit (Census Enumeration Blocks in urban areas and Villages or a part thereof in rural areas)
Sample Identification Work- to uniquely identify the sample units on ground, firm up its boundaries, demarcate the localities and prepare a notional map of the sample unit was done by the staff of ORGI.
Sample Units per district- 73.
Sample Population- About 20.1 million
The Largest Sample Survey in the World
KEY FEATURES Contd…
Sample 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
Fertility- 13 Sex Ratio- 3
Marriage- 5 Mortality- 7
Mother & Child Care- 63
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
Disability- 1 Morbidity- 19
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
Ante Natal Care
Total Fertility Rate (TFR)
Uttarakhand & Odisha and UP & Bihar reflects the two extremes.
Significant Rural-Urban variation across all 9 AHS States, the max. in Uttar Pradesh.
TFR is the average number of children born to a woman during her entire reproductive span.
Total Fertility Rate
Uttarakhand Odis ha Assam Chhattisgarh Jharkhand Madhya Pradesh Rajasthan Uttar Pradesh Bihar 2.4 2.4149999999999987 2.7 3.07239 3.3 3.5449999999999999 3.4219999999999997 3.86636299999999 8 3.9 Urban
Uttarakhand Odisha Assam Chhattisgarh Jharkhand Madhya Pradesh Rajasthan Uttar Pradesh Bihar 2 1.9460000000000004 1.9 2.301622999999998 2.4 2.4079999999999999 2.5489999999999999 2.679818999999998 2.77
Total Fertility Rate (TFR)
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
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…
Total Fertility Rate (TFR) Contd…
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
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 (%)
Current Usage of Family Planning- any Method (%)
State
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
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
Family Planning: Current Usage Contd…
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.
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 (%)
Total
Rajasthan Madhya Pradesh Uttarakhand Odisha Assam Chhattisgarh Uttar Pradesh Jharkhand Bihar 20.464796912368364 23.266202262983416 24.692712891917402 23.523615592319977 24.964143889884078 27.125101930844288 31.532740580946111 33.643952607104303 40.6 Urban
Rajasthan Madhya Pradesh Uttarakhand Odisha Assam Chhattisgarh Uttar Pradesh Jharkhand Bihar 16.936589701206099 20.554197101793033 19.483625017750029 21.661755034917899 19.561115673145089 23.668644514099189 23.16394037042819 21.499263650972889 30
Total unmet need for Family Planning(%)
State
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
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.
Unmet Need for Family Planning Contd…
Mean Age at Marriage- Female
Mean Age at Marriage is based on the marriages taken place during 2007-2009.
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.
Mean Age at Marriage- Female
Total
Rajasthan Bihar Jharkhand Madhya Pradesh Chhattisgarh Uttar Pradesh Odisha Assam Uttarakhand 19.100000000000001 19.5 19.7 19.8 20.5 20.6 21.5 21.5 21.4 Urban
Rajas than Bihar Jharkhand Madhya Pradesh Chhattisgarh Uttar Pradesh Odisha Assam Uttarakhand 21.4 21.1 21.6 22.1 22 22.4 22.9 23.4 23.2
Marriages among Females below Legal Age (18 yrs)
Based on marriages taken place during 2007-2009.
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.
Marriages among Females below legal age (%)
Total
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.
Ante Natal Care (ANC)
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.
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 (%)
State
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
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.
Full Ante Natal Check-up Contd…
Ante Natal Check-up
Institutional Delivery
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.
Share of Govt. & Private Hospitals in Total Instritutional Delivery
Govt.
Institutional Delivery (%)
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.
Balrampur, UP
Indore, MP
Safe Delivery
Safe Delivery: 47.1 % in Jharkhand to 82.2% in Madhya Pradesh.
Rural- Urban differential is quite prominent in Jharkhand, Chhattisgarh and Uttarakhand.
Safe Delivery (%)
Safe delivery (%)
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…
State
<30
30-50
50-70
70-90
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.
Safe Delivery Contd…
Janani Suraksha Yojana
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.
Mothers who availed Financial Assistance under JSY (%)
Total
Jharkhand Uttar Pradesh Chhattisgarh Uttarakhand Bihar Assam Rajasthan Madhya Pradesh Odisha 18.237487045540568 17.812858508531114 21.761424019076323 26.7 30.6 45.752585181850307 54.099743034966011 68.694071207228589 63.379115762935228 Urban
Jharkhand Uttar Pradesh Chhattisgarh Uttarakhand Bihar Assam Rajasthan Madhya Pradesh Odisha 9.3457195258681125 13.514683995205672 21.594511662599633 27.3 28.7 40.117884612478584 53.132719976720296 54.14116991265962 50.485995761947613
Post Natal Care
Mothers receiving PNC within 48 hrs of delivery varies from 57% in Assam to 74.5% in Odisha.
At least 1 in every 5 mothers did not receive any post natal check up across all AHS States..
Mothers who received Post-natal Check up within 48 hrs of delivery (%)
Total
Assam Uttarakhand Jharkhand Bihar Chhattisgarh Uttar Pradesh Rajasthan Madhya Pradesh Odisha 76.563562491500505 81.525089130732695 79.071136580432949 74.900000000000006 82.598958309983288 74.864911578468949 85.355392495704578 87.453390597474197 85.886989889378427
Mothers who did not receive any Post-natal Check up (%)
Total
Odisha Madhya Pradesh Rajasthan Chhattisgarh Uttar Pradesh Bihar Jharkhand Uttarakhand Assam 21.099522158322078 26.299217649341486 25.982935451264002 25.985880286215089 29.479850980942327 30.949542417755477 39.573595302285113 42.864367721118995 40.518652228084754 Urban
Odisha Madhya Pradesh Rajasthan Chhattisgarh Uttar Pradesh Bihar Jharkhand Uttarakhand Assam 10.389795887699504 10.545695084319274 12.127333021083601 10.3455678441707 21.418051837526676 25.1561389225532 16.463560901114587 16.06620376912764 19.271581012536799
New Born Check up
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.
New Born Checked up within 24 hrs of birth (%)
Total
Bihar Assam Jharkhand Uttarakhand Chhattisgarh Uttar Pradesh Rajasthan Madhya Pradesh Odisha 51.239527874105754 51.382116610454212 50.579215233082103 51.445542647439332 56.6366605372707 66.76237326424652 66.146578170402577 68.35256665935151 73.110515469804994 Urban
Bihar Assam Jharkhand Uttarakhand Chhattisgarh Uttar Pradesh Rajasthan Madhya Pradesh Odisha 64.972710475637598 74.653122249546499 75.257557056076749 81.291315704032201 78.979058006633068 74.681519239297316 83.403524161520707 86.123722489437029 85. 788537040225478
Full Immunization
Children are considered fully immunized when they have received vaccination against Tuberculosis, 3 doses of DPT & Polio and 1 dose of measles.
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.
Children aged 12-23 months fully immunized (%)
Total
State
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 districts are below 50% level of full immunization.
Only 2 districts 1 each from Chhattisgarh & Rajasthan feature in 90% & above category.
Full Immunization Contd…
Total
UP Rajasthan Jharkhand Uttarakhand Assam Bihar Madhya Pradesh Chhattisgarh Orissa 83.372722460195888 90.598997818264394 91.812850872073994 91.893817070465659 93.334877810595259 93.879703542380298 94.200409 562359908 96.764159358164122 97.533069835260392
Children age 12-23 months who have received 3 doses of Polio vaccine(%)
Total
Children age 12-23 months who have received Measles vaccine (%)
Total
UP Bihar Assam Jharkhand Madhya Pradesh Rajasthan Uttarakhand Orissa Chhattisgarh 60.486508488651907 75.718345234552658 77.32276266070788 78.955355733382959 80.677729390435488 81.824422118182298 82.580292566987112 86.674075413715059 87.895733417187841
Children age 12-23 months who have received 3 doses of DPT vaccine(%)
Total
FULL IMMUNIZATION
Vitamin A Supplementation to Children
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.
Children aged 6-35 months who received a Vitamin A dose during last six months (%)
Total
IFA Supplement to Children
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.
Children aged 6-35 months who received IFA tablet/syrup during last 3 months (%)
Total
Breast Feeding Practices
Children under 3 Years breastfed within one hour of birth (%)
Total
Breast Feeding Practices
Children exclusively breastfed for at least 6 months ranges from 17.7 in UP to 47.5 % in Chhattisgarh.
Children age 6-35 months exclusively breastfed for at least six months (%)
Total
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.
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.
KEY FINDINGS Contd…
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.
WAY FORWARD
THANK YOU
