Overview. Health and Family Welfare Statistics in India, 2013

Transcription

1 Overview Health and Family Welfare Statistics in India, 2013 DEMOGRAPHIC PROFILE OF INDIA 1.0 Vital Statistics 1.1 As on 1 st March, 2011 India's population stood at 121 crore comprising of 62.3 crore (51.5%) males and 58.7 crore (48.5%) females. India, which accounts for world's 17.5 percent population, is the second most populous country in the world next only to China (19.4%). Of the 121 crore Indians, 83.3 crore (68.8%) live in rural areas while 37.7 crore (31.2%) live in urban areas. Population in India Crore Rural Urban The population living in urban areas increased to 31.2% in 2011 as compared to 27.8% in Increase in urban population is observed across all the States /UTs. Kerala State experienced explosive increase in urban population from 26% in 2001 to 47.7% in 2011 (Table-A 3). One of the important features of the present decade is that, is the first decade (with the exception of ) which has actually added lesser population compared to the previous decade. In absolute terms, the population of India has increased by about million during the decade as compared to million during Among the States and Union Territories, Uttar Pradesh is the most populous State with million people and Lakshadweep the least populated with 64,473 people. iii

2 Contribution of Selected Major States to Total Population of the country Other States 45.1% UP 16.5% MP AP 6.0% 7.0% Maharastra 9.3% Bihar 8.6% West Bengal 7.5% The contribution of Uttar Pradesh (UP) to the total population of the country is 16.5% followed by Maharashtra (9.3%), Bihar (8.6%), West Bengal (7.5%), Andhra Pradesh (7.0%) and Madhya Pradesh (6.0). The combined contribution of these six most populous States in the country accounts for 54.9% to the country s population Highlights of Census 2011 The rural population (83.3 crore) and urban Population (37.7 crore) constitutes 68.8% and 31.2% respectively to the total population of the country. Decennial growth of population during declined to 17.7% from 21.5% during The decline is more prominent in rural population. During , for the first time, the growth momentum of population for the EAG States declined by about four percentage points. This, together with a similar reduction in the non-eag States and Union Territories, has brought down the rate of growth of population for the country by 3.8 percent as compared to Though the child-sex ratio [0 to 6 years] has declined from 927 female per 1000 males in to 919 females per 1000 males in , increasing trend in the child sex ratio was seen in Himachal Pradesh, Punjab, Chandigarh, Haryana, NCT of Delhi, Arunachal Pr, Mizoram, Gujarat, Karnataka, Goa, Kerala, Tamil Nadu and Andaman and Nicobar Islands. Literacy rate increased from 64.8% in 2001 to 73.0% in Female literacy increased sharply from 53.0% in 2001 to 64.6% in 2011 as compared to male literacy rate (75.3% in 2001 to 80.9% in 2011) 1.2 Average Annual Exponential Growth Rate (AAEGR): The Average Annual Exponential Growth Rate (AAEGR) for dipped sharply to 1.63 percent from 2.16 percent during and 1.97 percent during Among the major States, Bihar, J&K, Chattisgarh, Jharkhand, Rajasthan, NCT of Delhi, Madhya Pradesh, Uttar Pradesh, Haryana, Uttarakhand and Gujarat recorded higher annual exponential growth rate iv

3 as compared to the national average during The State of Bihar registered the highest (2.27%) AAEGR and Kerala (0.48) registered the lowest. 1.3 Decennial growth rate of population: The Decennial growth of population during declined to 17.7% from 21.5% during It is significant that the percentage decadal growth during has registered the sharpest decline since independence. It declined from percent for to percent for the period , a decrease of 2.33 percentage points. During , this decadal growth has become 17.7 percent, a further decrease of 3.8 percentage points. There has been a significant decline in decennial growth of population in rural areas. The decennial growth rate of population declined from 17.9% in to 12.3% in in rural areas and in urban areas it increased from 31.2% to 31.8% during the same period (Table A-3). At State level, growth rates varied widely. Nagaland with (-) 0.6% had the lowest decadal growth rate. The phenomenon of low growth has started to spread beyond the boundaries of the Southern States during , where in addition to Andhra Pradesh, Tamil Nadu and Karnataka in the South; Himachal Pradesh and Punjab in the North; West Bengal and Orissa in the East; and Maharashtra in the West have registered a growth rate between eleven to sixteen percent in over the previous decade. Among the larger States, Bihar registered the highest decadal growth rate of 25.4% and Kerala the lowest (4.9%). Out of 35 States/UTs, 9 States/UTs have shown negative decennial growth rate of population during in rural areas. These States/UTs are A&N Islands (-1.2), Chandigarh (- 68.5%), Lakshadweep (-58.0%), Delhi (-55.6%), Daman & Diu (-40.1), Kerala (-25.9), Goa (-18.5), Nagaland (-14.6) and Sikkim (-5.0). The decennial growth rate of population in urban areas of States / UTs varied widely in As compared to , 13 States / UTs viz. Andhra Pradesh, Arunachal Pradesh, Bihar, Gujarat, Karnataka, Kerala, Manipur, Sikkim, Tripura, West Bengal, Daman & Diu, Lakshadweep and Puducherry had higher decennial growth rate in as compared to the period (Table-A 3) Traditionally, for historical reasons, some States depicted a tendency of higher growth in population. Recognizing this phenomenon, and in order to facilitate the creation of areaspecific programmes, with special emphasis on eight States that have been lagging behind in containing population growth to manageable limits, the Government of India constituted an Empowered Action Group (EAG) in the Ministry of Health and Family Welfare in March These eight States were Rajasthan, Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh and Odisha, which came to be known as the EAG States'. During , the rate of growth of population in the EAG States except Chhattisgarh has slowed down (Table-A-2). For the first time, the growth momentum of population in the EAG States has given the signal of slowing down, falling by about four percentage points. This, together with a similar reduction in the non-eag States and Union Territories, has brought down the rate of growth for the country by 3.8 percentage points during as compared to v

4 Deccenial Growth Rate (%) of Population in the EAG States Percent Bihar Chhatisga rh Jharkhan d Madhya Pradesh Odisha Rajasthan Uttar Pradesh Uttarakha nd It is significant to note that the decennial growth rate of population has dropped both in Rural and urban areas of Uttar Pradesh, Rajasthan, Madhya Pradesh and Odisha while in Bihar it is limited to Rural areas only during as compared Literacy level: According to data of the 2011 census, the literacy rate went up from 64.8 per cent in 2001 to 73.0 per cent in 2011 showing an increase of 8.2 percentage points. Significantly, the female literacy level saw a significant jump as compared to males. The female literacy in 2001 was 53 per cent and it has gone up to 64.6 per cent in The male literacy, in comparison, rose from 75.3 to 80.9 per cent (Table A-8). Kerala, with 94.0 per cent literacy, continues to occupy the top position among States as far as literacy is concerned while Bihar remained at the bottom of the ladder at 61.8 per cent. Ten States and Union Territories, including Kerala, Lakshadweep, Mizoram, Tripura, Goa, Daman and Diu, Puducherry, Chandigarh, NCT of Delhi and Andaman and Nicobar Islands have achieved a literacy rate of above 85 per cent. 1.5 Sex Ratio: According to Census of India 2011, the sex ratio has shown some improvement in the last 10 years. It has gone up from 933 in 2001 census to 943 in 2011 census. Kerala with 1084 has the highest sex ratio followed by Pondicherry with Daman and Diu has the lowest sex ratio of 618. The Sex Ratio in Arunachal Pradesh (938), Bihar (918), Gujarat (919), Haryana (879), J&K (889), Madhya Pradesh(931), Maharashtra (929), Nagaland(931), Punjab(895), Rajasthan(928),Sikkim (890) and Uttar Pradesh (912) is lower than the national average. All UTs except Puducherry and Lakshadweep also have lower Sex Ratio as compared to national average (Table A-9). 1.6 Child Sex Ratio: The Population figures of Census 2011 indicate that the child (0-6) population comprises of 13.6% of the total population of the country comprising of 6.5% female child population and 7.1% male child population as against 15.9% child population in vi

5 2001. It reveals that the child population has decreased by about 2.3% whereas overall population has increased by about 17.7% in last 10 years. Something that is alarming is the sex ratio of children under 6 years has dropped to 919 girl child per 1000 boys in 2011 as compared to 927 in The drop in child sex ratio is observed in most of the States / UTs except Gujarat, Haryana, Karnataka, Kerala, Punjab, Tamil Nadu, Himachal Pradesh, Arunachal Pradesh, Mizoram, Andaman & Nicobar Islands, Chandigarh, Delhi and Goa. 2.0 POPULATION PROJECTIONS 2.1 Population Projections: The projections for the country, individual States and Union Territories up to the year 2026 made by the Technical Group constituted by the National Commission on Population (NCP) under the Chairmanship of Registrar General, India, reveals that the country s population would reach 1.4 billion by Projected Population of India (in millions) In Millions The projected population and proportion (percent) of population by broad age-group as on 1 st March, as per Report of the Technical Group on Population Projections Ministry of Health & Family Welfare (May 2006) are given in the Table below: - Year Population (in millions) (years) Proportion (percent) (years) (years) (Female Population) (years) vii

6 National Population Policy (NPP), 2000: Government has adopted a National Population Policy in February, The main objective is to provide or undertake activities aimed to achieve population stabilisation, at a level consistent with the needs of sustainable economic growth, social development and environment protection, by The other objectives are: To promote and support schemes, programmes, projects and initiatives for meeting the unmet needs for contraception and reproductive and child health care. To promote and support innovative ideas in the Government, private and voluntary sector with a view to achieve the objectives of the National Population Policy To facilitate the development of a vigorous people s movement in favour of the national effort for population stabilisation. 2.3 The National Health Policy-2002 (NHP-2002): It gives prime importance to ensure a more equitable access to health services across the social and geographical expanse of the country. The policy outlines the need for improvement in the health status of the people as one of the major thrust areas in the social sector. It focuses on the need for enhanced funding and organizational restructuring of the public health initiatives at national level in order to facilitate more equitable access to the health facilities. An acceptable standard of good health amongst the general population of the country is sought to be achieved by increasing access to the decentralized public health system by establishing new infrastructure in deficient areas, and by upgrading the infrastructure in the existing institutions. Emphasis has been given to increase the aggregate public health investment through a substantially increased contribution by the Central Government. Priority would be given to preventive and curative initiatives at the primary health level through increased sectoral share of allocation. 2.4 National Commission on Population (NCP): With a view to monitor and direct the implementation of the National Population Policy, the NCP was constituted in 2000 and it was re-constituted in The Chairman of the re-constituted Commission continued to be Hon ble Prime Minister of India, whereas Deputy Chairman of the Planning Commission and the Minister of Health & Family Welfare are the two Vice-Chairmen. The present membership also includes the Chief Ministers of the States of Uttar Pradesh, Madhya Pr, Rajasthan, Bihar, Jharkhand, Kerala and Tamil Nadu. The reconstituted National Commission on Population had decided that there should be Annual Health Survey of all districts which could be published annually so that health indicators at district level are periodically published, monitored & compared against benchmarks and setting up of five groups of experts for studying the population profile of the States of Bihar, Uttar Pradesh, Rajasthan, Madhya Pradesh and Odisha to identify weaknesses in the health delivery system and to suggest measures that would be taken to improve the health and demographic status of the States. 2.5 Janasankhya Sthirata Kosh (JSK): The Jansankhya Sthirata Kosh (JSK) has been set up as an autonomous body in the Ministry of Health and Family Welfare, duly registered viii

7 as a Society under the Societies Registration Act, 1860 to facilitate the attainment of the goals of National Population Policy 2000 and furtherance of the national cause of population stabilization. The JSK has undertaken a number of initiatives for population stabilization like Prena Strategy, Santushti Strategy, National Helpline toll free number, organising World Population day. The Prena Strategy was launched by JSK in 2008 and is operation in seven high focus states of Odisha, Bihar, Uttar Pr, Madhya Pr, Chhattisgarh, Jharkhand and Rajasthan. The strategy recognizes and awards the eligible young BPL couples from backward district of the country to break mindsets of the early marriage and early child birth. The Santushti Strategy is for high populated 7 EAG states of India under which private sector gynaecologists and vasectomy surgeons are invited to conduct operations in Public Private Partnership and payments are made under this strategy to participate in the scheme. The National Helpline service on reproductive health, mother health, child health, sexual health, adolescents health, fertility, contraception and family planning etc aims to reach out to adolescent, about to be married and newly married couples and who do not have easy access to reliable information on the above issues. 3.0 DEMOGRAPHIC and HEALTH STATUS INDICATORS 3.1 The demographic and health status indicators have shown significant improvements over time. The Table below captures data on Crude Birth Rate, Crude Death Rate, and Life Expectancy etc. Sl. No. Parameters Current Levels 1 Crude Birth Rate (per (2012) 1000 population 2 Crude Death Rate (2012) (per 1000 population) 3 Total Fertility Rate (2012) 4 Maternal Mortality NA NA Ratio SRS (2001- SRS (per 100,000 live ( ) ( ) births) 98) 5 Infant Mortality Rate (2012) (per 1000 live births) 6 Child Mortality Rate (0-4 yrs.) per 1000 children 7 Expectation of life at birth (in years) -Male -Female ( ) 57.3 (1972) (1951) Source: Office of Registrar General of India. ix (2012) ( ) ( ) NA Not available ( ) ( ) 3.2 Crude Birth Rate (CBR): The Crude Birth Rate declined from 29.5 in the 1991 to 25.4 in 2001 and further declined to 21.6 in The CBR is higher (23.1) in rural areas as compared to urban areas (17.4) in Uttar Pradesh recorded the highest CBR (27.4) and Goa the lowest (13.1). Assam (22.5), Bihar (27.7), Chhattisgarh (24.5), Jharkhand

8 (24.7), Madhya Pradesh (26.6), Meghalaya (24.1), Rajasthan (25.9), Uttar Pradesh (27.4) and D & N. Haveli (25.6) recorded higher CBR as compared to the national average. The CBR is higher in rural areas as compared to urban areas in all States/UTs except Manipur, Andaman & Nicobar Islands, D&N Haveli and Goa (Table A-26 & A27). 40 Crude Birth Rate - India 35 Per 000' population Total Rural Urban Expectation of Life at Birth: Data are presented on life expectancy by sex for India and its constituent states for to using data from the Sample Registration System and other sources in Table A Expectation of Life at Birth by Sex - India 65.0 Years # India does not include Jammu & Kashmir # # -01# Total Male Female x

9 The data reveals that there is a remarkable increase in life expectancy at birth. The female expectation of life at birth in general, is higher than male expectation. The life expectancy at birth for male was 64.6 years as compared to females, 67.7 years according to SRS Based Abridged Life Tables Urban Male (68.0 years) and Urban Female (71.4 years) have longer life span as compared to their rural counter parts Expectation of Life at Birth, Years M.P. Assa m Odish a U.P Bihar Rajas than Gujar at A.P. W.B. Karna taka Harya na Maha Tamil Nadu H.P. Punja rashtr b a Total Rural Urban Keral a Within a State, the expectation of life (Total population) at birth is higher in urban areas as compared to rural areas. Rural female population in all major States had the lower expectation of life at birth (Table A-20). According to the projections made by the Technical Group on Population Projections, expectancy at birth (e 0 0) in the case of male population is likely to reach 68.8 years by and further go upto 69.8 by from the present level. In the case of female population, it is likely to reach 71.1 by and 72.3 by (Table-A.21) 4.0 FERTILITY INDICATORS 4.1 General Fertility Rate (GFR): It is a refined measure of fertility, defined as the number of live births per thousand women in the reproductive age-group years. The GFR for all-india and bigger States is given in Table A-33. At the national level, 80.3 children were born per thousand women aged years. This number varies from 61.5 in urban areas to 87.6 in rural areas in The GFR is constantly higher in rural population as compared to urban population. xi

10 General Fertility Rate General Fertility Rate India Total Rural Urban Among the bigger States, GFR varies widely from 53.4 in Kerala to in Bihar. The GFR is higher in 7 bigger States viz. Assam (80.6), Bihar (113.5), Chhattisgarh (91.0), Jharkhand (94.5), Madhya Pradesh (101.1), Rajasthan (99.8), and Uttar Pradesh (107.2) as compared to national average (80.3) in Total Fertility Rate (TFR): The Total Fertility Rate (TFR) of a population is the average number of children that would be born to a woman during her reproductive age. According to the Registrar General, India the total fertility rate (TFR) has declined from 2.8 in 2006 to 2.4 in 2012 which accounts for a decline of more than 14%. The TFR in rural areas has declined from 3.1 in 2006 to 2.6 in 2012 whereas the corresponding decline in urban areas has been from 2.0 to 1.8 during the same period. Total Fertility Rate - India TFR Total Rural Urban xii

11 It is observed that the TFR in urban areas remained at the same level at 1.9 during 2010 and 2011 after remaining at 2.0 for four consecutive years ( ) and decreased to 1.8 in Tamil Nadu, West Bengal, Punjab and Himachal Pradesh have the lowest TFR of 1.7 and the highest TFR recorded is 3.5 for Bihar. Eleven States out of 20 bigger States have achieved the replacement level of fertility i.e. TFR of 2.1 in 2012 viz. Andhra Pradesh (1.8), Delhi (1.8), HP (1.7), J&K (1.9), Karnataka (1.9), Kerala (1.8), Odisha(2.1), Maharashtra (1.8), Punjab (1.7), Tamil Nadu (1.7) and West Bengal (1.7). With the exception of Tamil Nadu where the TFR is same for both Rural and Urban Population (1.7) during 2012, in all other bigger States the rural TFR is higher as compared to urban TFR. However, the difference is marginal in Andhra Pradesh, Delhi, Kerala and Punjab. The difference in Rural and Urban fertility rate is more prominent in six states viz. Madhya Pradesh (1.1), Chhattisgarh, Bihar (1.1), Jharkhand, Assam and Uttar Pradesh (1.0) Table A-33. The graph presented below reveals the relation between total fertility rate (TFR) and level of education. It is observed that TFR is showing a decreasing trend as the literacy level increases (Table A-35). 3.5 Total Fertility Rate and Literacy Level (Rural and Urban) - India Illiterate Literate but without formal education Below Primary Primary Matric Rural Urban 4.3 Fertility by age of women: Age of women is an important factor in determining the fertility levels. On the basis of data on births to women by specific age groups in the reproductive span years (as available from SRS for 2012), measures such as Age Specific Fertility Rates (ASFR) & Age Specific Marital Fertility Rates (ASMFR) are computed. ASFR is defined as the number of children born to women in the said age group per 1000 women in the same age group and ASMFR as the number of children born to married women in the said age group per 1000 women in the same age group. Table A-32 presents ASFR and ASMFR data separately for rural and urban areas, for the years 2006 to xiii

12 350.0 ASFR and ASMFR (Rural & Urban), India ASFR / ASMFR ASFR (Rural) ASFR (Urban) ASMFR(Rural) ASFMR(Urban) It is observed that ASMFRs are higher than ASFRs in all age groups as ASMFR covers only married women. The data on these two indicators also reveals that fertility in all the age groups is higher in rural areas than in urban areas. The fertility reaches the peak in the age group and declines thereafter. Irrespective of the place of residence, both these indicators are lower in urban areas as compared to rural areas in almost all years. The ASMFR increased to in 2012 from in 2011 and the ASFR decreased to from during the same period for the age group in the rural areas (Table A-32). In Jammu & Kashmir, Uttar Pradesh and Bihar the fertility contribution of the high age groups (>35 years age group) is relatively high as compared to other states. Kerala, Tamil Nadu, Andhra Pradesh, Maharashtra, Karnataka, Himachal Pradesh and Punjab are in that terms better off as the fertility contribution of high risk age group is lesser. (Table A-34). 4.4 Mean Age at Effective Marriage (Female): Age at effective marriage (Female) is a very important demographic predictor as it relates to number of years a couple exposed to pregnancy and the family size. The data reveals that there is no significant change in the Mean Age at Effective Marriage in India as it increased from 20.5 years in 2006 to 21.2 in Jammu & Kashmir (24.6) had the highest and Jharkhand (20.2) had the lowest mean age at effective marriage (Table A-22). Fertility reduction takes place as the age at effective marriage (Female) increases. The data reveals that the percentage of females who had the effective marriage in the age group of <18 years and years dropped while it increased in the 21+ age group (Table A-24). xiv

13 Percent % of Females by Age at Effective Marriage - Total - India < The data also reveals that the percentage of female who had the effective marriage in the age of is the highest in rural areas (48.7%) while in urban areas the highest (68.9%) marriages are in the 21+ age group in Percent % of Females by Age at Effective Marriage (Rural) - India < Percent % of Females by Age at Effecive Marriage (Urban) - India < Percentage of females who had their effective marriage in the age group of <18 in almost all major states (Rural and Urban), has come down over the years (2006 to 2012) while it increased in the age group 21+. The highest percentage of females who had their effective marriage in the age group of <18 is Jharkhand (7.1%) and the lowest is recorded in Delhi (0.3%) - Table A-24. xv

14 5.0 MORTALITY INDICATORS 5.1 Crude Death Rate (CDR): It gives the number of deaths that occur per 1000 people. The CDR, which was stagnant during 2007 and 2008 at 7.4, came down to 7.2 in 2010 and further declined to 7.0 in The CDR is consistently higher in rural areas as compared to urban areas over the years. (Table A.41) The CDR varies widely across the States. Odisha with 8.5 had the highest CDR and Nagaland had the lowest (3.2) in Ten States/UTs viz. Andhra Pradesh (7.4), Assam (7.9), Chhatisgarh (7.9), Karnataka (7.1), Madhya Pradesh (8.1), Meghalaya (7.6), Odisha (8.5), Tamil Nadu (7.4), Uttar Pradesh (7.7) and Puducherry (7.1) had higher CDR as compared to national average. The CDR is higher in rural areas as compared to urban areas across all States and UTs except in the case of Tripura where the CDR is higher in urban areas (5.1) as compared to rural (4.7)-(Table A-41.1). CDR Crude Death Rate - India Total Rural Urban Age-specific Death Rates (ASDR): The ASDR for the year 2012 was 11.5 per 1000 population in the age-group 0-4; it drastically declined in the next age-group (5-9) to 1.0 and further declined to 0.7 (Age Group 10-14). Thereafter, the ASDR gradually increased in each age-group, except in the age group 25-29, to reach to the level 21.3 per 1000 in the age-group and continued to increase to reach finally to the level per 1000 in the last agegroup, 85+. xvi

15 ASDR Age and Sex-specific Death Rates by Sex - India, 2012 Below Age Group Total Male Female The Crude Death Rate (CDR) or Age-specific Death Rate (ASDR) for all ages is declining over the years (7.5 in 2006 to 7.0 in 2012) but the rural-urban and Male Female differentials are still high (Table A- 42, 42.1, 42.2) Age-specific Death Rate - (All Ages) - India ASDR Male (Rural) Male (Urban) Female (Rural) Female (Urban) 5.3 Infant Mortality Rate (IMR): Infant and childhood mortality-reduction goals have continued to be national priority since the First Five Year Plan. According to SRS 2012, the IMR at national level was 42 per 1000 live births in 2012 as compared to 44 in xvii

16 Infant Mortality Rate - India Total Rural Urban In 2012, the highest infant mortality rate has been reported from Madhya Pradesh (56) and lowest from Kerala (12) among the major States. Assam (55), Bihar (43), Chhattisgarh (47), Odisha (53), Madhya Pradesh (56), Rajasthan (49) and Uttar Pradesh (53) recorded higher IMR as compared to the national average. Among the smaller States, Meghalaya (49) reported the highest IMR while Goa and Manipur (10) the lowest (Table-A-46). Female infants continue to experience a higher mortality than male infants in It is higher in respect of Female infants (44) as compared to Male infants (41). This variation is prevalent among all the major States (Table A-44) Infant Mortality Rate (State-wise) Male Female The IMR is high in rural areas (46 per 1000 live births) as compared to urban areas (28). Rural areas of Madhya Pradesh registered the highest IMR (60) followed by Assam (58), Uttar Pradesh (56) and Odisha (55) - (Table-A-45 and 46). xviii

17 5.4 Neo-natal Mortality Rate (NMR): According to the Sample Registration Survey-2012, the current Neonatal Mortality Rate of 29 per 1000 (2012) live births accounts for 69.0% of infant mortality at the national level and varies from 57.0% in urban areas to 70.4% in rural areas. Among the bigger States, Jammu & Kashmir (77.2) registered the highest percentage of neo-natal deaths to infant deaths and the lowest in Assam (52.1) Neo-natal Mortality Rate and other indicators ) Infant Mortality Rate Neo-natal Mortality Rate Post Neo-natal Mortality Rate Total Rural Urban Neo-natal mortality refers to number of infants dying within four weeks of birth. Neo-natal health care is concerned with the condition of the newborn from birth to 4 weeks (28 days) of age. Neo-natal survival is a very sensitive indicator of population growth and socio-economic development. The survival rate of female infants correlates to subsequent population replacement. The neo-natal mortality rate which was stagnant at 37 per 1000 live births during 2003 to 2006 marginally came down to 36 in 2007, 35 in in 2009, 33 in 2010, 31 in 2011 and stood at 29 during The neo-natal mortality rate is very high in rural areas (33 per 1000 live births) as compared to 16 in urban areas in The neonatal mortality rate also varies considerably among Indian States. Madhya Pradesh (39), Uttar Pradesh (37), Odisha (39), Rajasthan (35), J&K (30), Chhattisgarh (31) recorded higher neonatal mortality rate as compared to national average. The Neo-natal mortality rate is lowest in the Kerala State (7) (Table A-50). 5.5 Post-Neo-Natal Mortality Rate (PNMR): Refers to number of infant deaths between 28 days and one year of age per 1000 live births. The Post Neo natal Mortality Rate came down to 13 in 2011 from 16 in It is high in rural areas (14) as compared to urban areas (12) (Table A-45) 5.6 Peri natal Mortality Rate: Refers to number of still birth and deaths within 1 st week of delivery per 1000 live births. The Peri-natal Mortality Rate decreased from 37 in 2007 to 28 in It is high in rural areas (31) as compared to urban areas (17) during The Perinatal Mortality Rate significantly varied across the States. Kerala with 10 is the best performing State, Odisha (37) is the least performing State during 2012 (Table A- 54) xix

18 5.7 Still Birth Rate (SBR): The SBR came down to 5 in 2012 from 6 in The Rural and Urban variation is absent at All India level though wide variations are prominently noticed across Major States during 2012 (Table A-45 and A-54). 5.8 Child Mortality Rate (0-4): Child Mortality Rate is measured in terms of death of number of children (0-4 years) taking place per 1000 children (0-4 year s age). Childhood mortality is one of the important indicators of a country s general medical and public health conditions, and consequently, the country s level of socio-economic development. As per SRS estimates, the Child Mortality Rate (CMR) has come down from 12.2 in 2011 to 11.5 in The decline is observed both in rural and urban areas but the CMR is very high in rural areas (12.8) as compared to urban areas (7.0) in This observation is relevant for almost all States uniformly. The highest Child Mortality Rate was recorded in Madhya Pradesh (17.8) closely followed by Uttar Pradesh (16.8) and Assam (16.5), Odisha (14.7), Rajasthan (14.3) and Chhattisgarh (12.4). Kerala with 2.5 CMR is the best Performing State (Table A- 48). 5.9 Under-five Mortality Rate (U5MR): The U5MR, representing deaths of children of age under 5 per 1000 live births has started declining over the years. According to the SRS data released by Registrar General of India, the U5MR declined from 69 deaths per 1000 live births in 2008 to 64 in 2009, to 59 in 2010 to 55 in 2011 and further declined to 52 in 2012 in India. The U5MR is high in rural areas as compared to urban areas. Mortality Rate Under Five Mortality Rate (Rural / Urban) - India Total Rural Urban Large variations are observed in Under Five Mortality Rate across the State both in rural and urban areas (Table A-55). xx

19 Mortality Rate Under Five Mortality Rate (State-wise) Kerala Tamil Nadu Delhi Maharashtra Punjab Karnataka West Bengal Andhra Pradesh Himachal Pradesh Jammu & Kashmir Gujarat Haryana Jharkhand Chhattisgarh Bihar Rajasthan Odisha Uttar Pradesh Madhya Pradesh Assam Total Rural Urban Rural areas of Assam (80) had the highest U5MR in 2012 closely followed by Madhya Pradesh (79), Uttar Pradesh (72) and Odisha (72) and Rajasthan (65). In Urban areas Uttar Pradesh had the highest U5MR (49) and Kerala (10) the least in Causes of Death among Infants: Reduction in infant and child morality has been the priority area over the Plan periods. Available data from SRS Report on top 10 Causes of Death in India (Table A-59) indicate that Perinatal conditions, Respiratory infection, Diarrhoeal diseases and other infectious & parasitic diseases are the four major causes of death among infants. xxi

20 Causes of Death among Infants (Age Below 1 as %) - India ( ) Perinatal conditions Respiratory infection Diarrhoeal Diseases Other infectious and parasitic diseases Congenital anomalies Symptoms signs and ill defined conditions Nutritional deficiencies 21.8 Unintentional injuries : Other Malaria Fever of unknown origin 5.11 Maternal Mortality Ratio (MMR): MMR is the number of women who die during pregnancy and childbirth, per 100,000 live births. Deaths due to pregnancy and during the child birth are common among women in the reproductive age groups. Reduction of mortality of women has thus been an area of concern and the Government has set time bound targets to achieve it. India has made impressive achievement in MMR over the years. According to the latest SRS estimates, the Maternal Mortality Ratio (MMR) of India is 178 per one lakh live birth ( ) as compared to 212 in Some states like Kerala (66), Tamil Nadu (90), and Maharashtra (87) have made remarkable progress in while some others are lagging behind. The MMR in the highest in Assam (328) closely followed by Uttar Pr/Uttarkhand (292) and Rajasthan (255). Kerala state is the best performing State with MMR of 66 (Table- A 56) xxii

21 Maternal Mortality Ratio Mortality Ratio Kerala Tamil Nadu Maharashtra Andhra Pr West Bengal Gujarat Haryana Punjab Karnataka Odisha Bihar / Jharkhand M.P. / Chhatisgarh Rajasthan U.P. / Uttarakhand Assam 5.12 Causes of Maternal Deaths: Prevailing high maternal morbidity and mortality has always been cause of concern. Available data from SRS for (Special Survey of Deaths) indicate that the major causes of maternal mortality are Hemorrhage, Sepsis, Abortion, Hypertensive disorders and Obstructed Labour. In India, state/district specific maternal morbidity/mortality data is not available. However, data for group of States viz. EAG States and Assam; Southern States; and other States are presented in Table A Causes of Maternal Deaths (India), SRS % 8% 5% 5% 11% 37% Haemorrhage Sepsis Hiperintensive Disorders Obstructed Labour Abortion Other Conditions 6.0 Programmes: 6.1 The National Rural Health Mission (NRHM): National Rural Health Mission (NRHM), the flagship programme of Ministry of Health and Family Welfare, was initiated in 2005 to provide accessible, affordable and equitable health care services for people living in rural areas of the country with focus on under-served population and marginalized groups. The Mission mainly covers rural areas of all States with special focus on 18 States with poor health indices and weak public infrastructure. The main focus areas of NRHM include improvement in health infrastructure, providing better quality of human resources to look xxiii

22 after health requirements of population and providing quality services in health facilities. The core strategies of the Mission include flexible financing, adoption of a sector wide approach, decentralized approach with community participation, manpower development and partnership with non-government stakeholders. It has converged stand alone disease control programmes including Tuberculosis, Leprosy, Vector borne etc. under its umbrella a holistic approach to address issues relating to Health and family welfare. During the 12th plan, in addition to the ongoing programmes, it is proposed to launch new schemes such as strengthening of district hospitals for providing advanced secondary care, providing free generic medicines in all public health institutions in the country. NRHM GOALS Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) Universal access to public health services such as Women s health, child health, water, sanitation & hygiene, immunization, and Nutrition. Prevention and control of communicable and non-communicable diseases, including locally endemic diseases Access to integrated comprehensive primary healthcare Population stabilization, gender and demographic balance. Revitalize local health traditions and mainstream AYUSH. Promotion of healthy life styles. 6.2 Reproductive Child Health (RCH) Programme: Reproductive and Child Health Programme, is an integral component of the National Rural Health Mission. Important steps have been taken within the mandate of this programme to ensure universal and equitable access to quality maternal and child health services based on the principle of continuum of care. RCH focussed on reducing social and geographical disparities in access to and utilisation of reproductive and child health services in order to accelerate the achievement of its goals. The major components of the RCH programme are Maternal Health, Child Health, Nutrition, Family Planning, Adolescent and Reproductive Health (ARSH) and Preconception and Prenatal Diagnostic Techniques Act. India was the first country in the world to introduce a national family planning programme as early as during the first five year Plan ( ), to address the issues of high fertility and rapid population growth. Over the years, the programme has been expanded to encompass maternal and child health, family welfare and nutrition. The services are delivered through a network of Community Health Centres, Primary Health Centres & Sub-centres in rural areas and Urban Family Welfare Centres, Post Partum Centres and Hospitals in the urban areas. The figures given in the publication are based on the data reported by the State/UTs at district/facility level and then consolidated at State and National level on HMIS portal. Percentage of districts reported in HMIS Portal during was 99 % but it increased to 100 % during AWARENESS ABOUT FAMILY WELFARE ACTIVITIES Knowledge of contraception is nearly universal: 98 percent of women and 99 percent of men age know one or more methods of contraception. Among the permanent modern Family Planning methods, female sterilization was the most popular. Over 97 percent of women and 95 percent men know about xxiv

23 female sterilization. Male sterilization, by contrast, is known only by 79 percent of women and 87 percent of men. Ninety-three percent of men know about condoms, compared with 74 percent of women. More than 80 percent women and men know about contraceptive pills. Knowledge of contraception is widespread even among adolescents: 94 percent of young women and 96 percent of young men have heard of a modern method of contraception Source: NFHS FAMILY PLANNING As per the latest official data, the total number of family planning acceptors in India decreased by 5.0% between and The data revealed that condom is the most preferred method of family planning while sterilizations the least adopted means. Family Planning Accepters (in 000's) 6231 (21%) (46%) 4579 (15%) 5413 (18%) Sterilisations I.U.D. Insertions Equivalent Condom Users Equivalent Oral Pill Users The number of couples adopting various methods for family planning, including spacing methods was found to be 30.2 million, with 14.0 million preferring condoms to any other means. The total Family Planning Acceptors in India have increased over the years but in recent years especially after the number of accepters has shown a gradual decreasing trend. (Table-B.1) xxv

24 Total Family Planning Accepters in India (In thousands) Sterilizations: About 4.6 million people underwent sterilization during the period under review ( ). The number of Sterilizations declined by 3.03 lakh (6.2%) as compared to Of the total sterilizations conducted, vasectomy (male sterilization) comprised only 2.6% (Table-B.8). Vasectomy vs. Tubectomy India Vasectomy Tubectomy 2.6% 97.4% Of the total number of Sterilisations, Sikkim had the highest percentage of vasectomies (24.3%) in while no vasectomy has been reported in the UT of A&N Islands and Lakshadweep. The number of vasectomies carried out in almost all major States is quite insignificant as compared to number of tubectomies (Table- B.8). Of the total tubectomy operations carried out in the country, 37% accounts for Laparoscopic tubectomies during Laparoscopic tubectomies are more prominent in Himachal Pradesh (93.2%) closely followed by Assam (89.5%), J&K (77.0%), Madhya Pradesh & Rajasthan (76.8%), Tripura xxvi

25 (76.3%), Arunachal Pradesh (70.8%), Nagaland (68.1%) Uttar Pradesh (66.7%), and Uttarakhand (67.7%) (Table-B.9). IUD Insertions: At the national level, the number of IUD insertions during showed marginal increase of 0.4% as compared to Among the major States showing increase in performance during are Bihar, Haryana, Kerala, Madhya Pradesh, Maharashtra, Tamil Nadu and West Bengal while usage has gone down in Andhra Pradesh, Assam, Chhattisgarh, Gujarat, Jharkhand, Karnataka, Odisha, Punjab, Rajasthan and Uttar Pradesh. (Table B.5). Use of Condoms: According to the data available, the number of equivalent condom users came down from 15.0 million in to 14.0 million in (Table B.1). The increase in condom users is observed in 4 major states viz. Karnataka, Kerala, Punjab and Uttar Pradesh as compared to The significant observation is that the number of takers of free condoms decreased by 11% in as compared to The number of users has also decreased in the case of commercial distribution (Table B.6). Oral Contraceptive Pill Users: During the year , 6.23 million Oral Pill Users were reported as against 6.48 million in Among major States, Assam, Karnataka, Madhya Pradesh, Maharashtra, Punjab, Uttar Pradesh and West Bengal have reported increased number of Oral Pill Users in as compared to while in respect of other major States there was drop in the number of users. (Table B-7). 6.4 Maternal Health: Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. Health Care Interventions during Pregnancy: Antenatal care (ANC): ANC is the systemic medical supervision of women during pregnancy. Its aim is to preserve the physiological aspect of pregnancy and labour and to prevent or detect, as early as possible, all pathological disorders. Early diagnosis during pregnancy can prevent maternal ill-health, injury, maternal mortality, foetal death, infant mortality and morbidity. During , 27.7 million women got registered for ANC checkup and 20.7 million underwent 3 ANC check -ups during the pregnancy period. Tetanus Immunization for Expectant Mothers (II + Booster): The Tetanus Toxoid (TT) vaccine is given during pregnancy to prevent tetanus to the expectant mother as well as the baby. According to data reported on HMIS portal 22.9 Million expectant mothers were immunized against tetanus during accounting for an achievement of 78.5 % as against the need assessed. Wide variations are observed across the States / UTs in achievement as against the target. The achievement is the lowest in Arunachal Pradesh (42.6%) (Table-C-2). Prophylaxis against Nutritional Anaemia: The conception and the subsequent weeks afterwards is the time when it is at its most vulnerable period as the expectant mother needs extra nutrients. To meet the requirement of additional nutrients expectant mothers are given nutritional supplements. During , million were benefitted out of a target of 29.2 million pregnant women accounting for an achievement of 73.1%. State-wide variations in achievement are quite glaring (Table- C-3). xxvii

26 Institutional Deliveries: Maternal and Child Health Programmes have aggressively promoted Institutional Deliveries in India. Out of 20.1 million deliveries (Institutional + home) reported more than 16.7 million deliveries were institutional accounting for 82.9% in as compared to 81.7 % in The percentage of institutional deliveries steadily increased from 70.6% in to 82.9% in States with an achievement of more than 90% institutional deliveries in include Andhra Pradesh (93.1%), Gujarat (95.1%), Karnataka (98.1%), Kerala (99.8%), Maharashtra (96.3%), Rajasthan (92.3%), Tamil Nadu (99.8%), Arunachal Pradesh (95.0%), Delhi (94.3%), Goa (99.8%), A&N Islands (94.6%), Chandigarh (94.4%), Daman & Diu (93.8%), Lakshadweep and Puducherry (100.0%) (Table- C-6). Number of Deliveries Conducted at Home: The current policy of Government of India under N.R.H.M. is to encourage institutional delivery which is an important step in lowering the maternal mortality. However, home based deliveries are still prevalent in the country but the number is decreasing over the years. According to the data available on HMIS Portal, the number of deliveries conducted at home has come down to lakhs in from lakhs in It is observed that medical attention provided to new born at home significantly increased over the years. According to the data available on HMIS portal, the percentage of newborns visited within 24 hours of home delivery increased from 49% in to 68% in No. in lakhs Number of deliveries conducted at home and newborn visited within 24 hours (In Lakh) - India Total number of deliveries conducted at home No. of newborns visited within 24 hours of home delivery Postpartum checkups are extremely important for a woman after the delivery. According to the HMIS data, the percentage of women receiving postpartum check-up within 48 hours after delivery increased during to (Table C.8). Medical Termination of Pregnancy (MTP): To provide safe abortions, most countries have enacted laws whereby only qualified Gynecologists under conditions laid down and done in clinics/hospitals that have been approved, can do abortions. During the reference period xxviii

27 ( ), 6,36,010 MTPs were performed as against 6,25,448 in Maharashtra with 1,48,254 MTPs tops the list in major States while Chhatisgarh is at the bottom of the ladder (2531) -Table B Child Health Immunization programmes aim to reduce mortality and morbidity due to Vaccine Preventable Diseases (VPDs), particularly for children. India's immunization programme is one of the largest in the world in terms of quantities of vaccines used, numbers of beneficiaries, number of immunization sessions organized and the geographical area covered. Under the immunization program, vaccines used to protect children and pregnant mothers include the following: Tuberculosis Diphtheria Pertussis Polio Measles Tetanus In India, some other vaccinations like Hepatitis B, Japanese Encephalitis etc. are also undertaken. DPT Immunization for Children: The DPT is an immunization or vaccine to protect against the diseases of Diphtheria (D), Pertussis (P) and Tetanus (T). The III dose of DPT vaccination was to be administered to Million children (Need assessed) and achieved 84.0% during as against the achievement of 89.6% in The achievement varies widely across states. 18 States / UTs achieved more than 90% DPT Immunization for children. The DPT has been replaced by pentavalent vaccine in Kerala and Tamil Nadu from (Table- D1 and D2). Polio: As compared to the achievement (85.4%) in , 87.6% percent children received the third dose of Polio vaccine in The percentage of children who received third dose of polio ranges from 63.9% in Daman & Diu to more than 100% in States like Andhra Pradesh, Karnataka, Kerala, Maharashtra, Goa, Himachal Pradesh, Manipur, Meghalaya, Mizoram, and Tripura during (Table- D1&D2.1). BCG: BCG vaccine is given for protection against tuberculosis, mainly severe forms of childhood tuberculosis million Children of below one year were administered BCG vaccine during The achievement in was 93.0% as against 93.3% in States / UTs achieved more than 100% immunization during as against 16 States/UTs in Puducherry achieved the highest percentage immunization in and (Table D1 & D2.2) Measles: 22.7 million Children of below one year age received measles vaccine during as against 22.5 million children accounting for an achievement of 89.4 % as against 88.8% in Andhra Pradesh, Kerala, Maharashtra, West Bengal, Goa, Himachal Pradesh, Manipur, Meghalaya, Mizoram, Tripura and Lakshadweep achieved more than 100% vaccination in (Table- D1&D2.3). xxix