ANNUAL HEALTH SURVEY FACT SHEET KEY FINDINGS

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ANNUAL HEALTH SURVEYFACT SHEET

KEY FINDINGSDr. C. ChandramouliRegistrar 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 womens 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 levelin 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 AHSAHS 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

WHY AHS?AHS States constitute:48 percent of countrys Population59 percent of Births70 percent of Infant Deaths75 percent of Under 5 Deaths62 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 FEATURESCoverage- 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 ContdSample 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 AHSIn all, 161 indicators are available from AHS baseline: Fertility- 13 Sex Ratio- 3Marriage- 5 Mortality- 7Mother & Child Care- 63

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

Abortion- 6 Family Planning Practices- 15 Disability- 1 Morbidity- 19Personal Habits:adults-4 Housing & HH Characteristics- 13Others- 12

Indicators under AHS ContdUnder 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 CoveredThe 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 PracticesTotal 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 (TFR)StateState valueMinimumMaximumRangeAssam2.6Kamrup (2)Hailakandi (4.2)2.2Bihar3.7Patna (2.8)Sheohar (4.7)1.9Jharkhand3.1Purbi Singhbhum (2.4)Lohardagga (4)1.6Madhya Pradesh3.1Indore (2.2)Shivpuri (4.5)2.3Chhattisgarh2.9Koriya (2.4)Kawardha (3.7)1.3Odisha2.3Jharsuguda (2)Boudh (3.7)1.7Rajasthan3.2Kota (2.6)Barmer (4.7)2.1Uttar Pradesh3.6Kanpur Nagar (2.3)Shrawasti (5.9)3.6Uttarakhand2.3Pithoragarh (1.7)Haridwar (3.1)1.4Within 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 State0-2.12.2-3.03.1-4.04.1 & aboveTotal DistrictsAssam3163123Bihar01261037Chhattisgarh0124016Jharkhand0810018Madhya Pradesh01525545Odisha10182030Rajasthan01613332Uttar Pradesh09481370Uttarakhand751013All States201001323228420 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 of Family Planning- any Method (%)StateState valueMinimumMaximumRangeAssam57.9Dhubri (33.2)Lakhimpur (67.6)34.4Bihar37.6Siwan (26)Muzaffarpur (52.2)26.2Jharkhand47.8Paschimi Singhbhum (32.7)Dhanbad (61.9)29.3Madhya Pradesh61.2Sidhi (45.9)Damoh (74.9)29.0Chhattisgarh53.9Dantewada (33.4)Dhamtari (68.7)35.2Odisha56.2Kandhamal (28.6)Baleshwar (73.4)44.8Rajasthan64.5Dhaulpur (49)Ganganagar (79.2)30.2Uttar Pradesh49.9Sitapur (21.9)Jhansi (74.1)52.2Uttarakhand62.7Haridwar (53.7)Dehradun (67.1)13.4Within 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 ContdFrequency distribution of districts by current usage of family planning- any method (%)State0-3030-5050-7070 & aboveTotal DistrictsAssam0320023Bihar4312037Chhattisgarh079016Jharkhand0135018Madhya Pradesh0240345Odisha1919130Rajasthan0124732Uttar Pradesh32442170Uttarakhand0013013All States89017412284 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 (%)AssamUttar PradeshJharkhandBiharOdishaUttarakhandRajasthanChhattisgarhMadhya PradeshFemale35.355.076.386.768.458.776.792.383.6Male0.60.61.20.90.72.80.72.01.7Family Planning: Current Usage ContdUnmet Need for Family PlanningCurrently 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.Total unmet need for Family Planning(%)StateState valueMinimum Maximum value RangeAssam24.0Sibsagar (15.3)Dhubri (42.9)27.6Bihar39.2Patna (24.6)Kishanganj (52.5)27.9Jharkhand30.5Bokaro (18.2)Godda (42.8)24.6Madhya Pradesh22.4Jabalpur (14.3)Rewa (34.2)19.9Chhattisgarh26.4Dhamtari (14.5)Bastar (36)21.5Odisha23.2Baleshwar (6.1)Boudh (48.3)42.3Rajasthan19.6Ganganagar (10.0)Dhaulpur (32.4)22.3Uttar Pradesh29.7Mahoba (15.1)Sitapur (61.3)46.3Uttarakhand23.2Dehradun (16.8)Haridwar (29.2)12.4The 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 ContdFrequency distribution of districts by total unmet need for family planning (%)State0-2020-4040-6060 & aboveTotal DistrictsAssam6161023Bihar02017037Chhattisgarh4120016Jharkhand2133018Madhya Pradesh18270045Odisha12153030Rajasthan16160032Uttar Pradesh9528170Uttarakhand2110013All States69182321284 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.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.

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-upFull 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. Mothers who had full antenatal check-up (%)StateState valueMinimumMaximumRangeAssam11.9Dhubri (2.1)Jorhat (18.2)16.1Bihar5.9Madhepura (2.4)Patna (16.4)14.0Jharkhand13.1Garhwa (3.6)Purbi Singhbhum (31.6)28.1Madhya Pradesh13.3Sheopur (1.8)Balaghat (30.8)28.9Chhattisgarh19.5Korba (10.9)Dhamtari (34.5)23.6Odisha18.6Jajpur (5.4)Jagatsinghpur (36.0)30.6Rajasthan8.5Karauli (1.7)Jaipur (19.5)17.8Uttar Pradesh3.9Balrampur (0.6)Kanpur Nagar (14.8)14.3Uttarakhand11.1Rudra Prayag (3.7)Dehradun (22.7)19.0Bihar 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 ContdFrequency distribution of the districts by level of full antenatal check up (%)State