ANNUAL HEALTH SURVEY FACT SHEET First Updation round( ) KEY FINDINGS. Dr. C. Chandramouli Registrar General & Census Commissioner, India

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1 ANNUAL HEALTH SURVEY FACT SHEET First Updation round( ) KEY FINDINGS Dr. C. Chandramouli Registrar General & Census Commissioner, India

2 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

3 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

4 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

5 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

6 OBJECTIVE OF AHS AHS yields a comprehensive, representative and reliable dataset on core vital indicators including composite ones like IMR, MMR and TFR along with their co-variates(process and outcome indicators) at the district level and maps changes therein on an annual basis. These benchmarks help in better and holistic understanding and timely monitoring of various determinants on well-being and health of population particularly Reproductive and Child Health.

7 Coverage : Annual Health Survey Uttarakhand Rajasthan Uttar Pradesh Bihar Assam Madhya Pradesh Jharkhand Chhattisgarh Odisha

8 Indicators under AHS Inall,161indicatorsareavailablefromAHS: Fertility- 13 Sex Ratio- 3 Marriage- 5 Mortality- 7 Mother&ChildCare-63 AnteNatalCare:11 DeliveryCare:8 PostNatalCare:5 JananiSurakshaYojana(JSY):3 Immunization: 8 Vitamin A& Iron Supplements: 2 Birth Weight: 2 Childhood Disease: 6 Birth Registration: 2 Breastfeeding& Supplementation: 12 Awareness in Mothers: 4 Abortion- 6 Family Planning Practices- 15 Disability- 1 Morbidity- 19 Personal Habits:adults-4 Housing& HH Characteristics- 13 Others-12

9 Indicators under AHS Contd Under 1 st phase of release, following 9 indicators have already been released in the Bulletin : CrudeBirthRate(CBR) Infant Mortality Rate(IMR) CrudeDeathRate(CDR) Neo-Natal Mortality Rate(NNMR) Under Five Mortality Rate(U5MR) Maternal Mortality Ratio(MMR) SexRatioatBirth(SRB) SexRatio(0-4years)and SexRatio(Allages) Remaining indicators are being released under present phase of dissemination.

10 Five Core Themes Covered The presentation focuses on results pertaining to5corethemes: Total Fertility Rate Family Planning: Current Usage & Total Unmet Need AnteNatalCare Delivery&PostNatalCare Immunization and Breast Feeding Practices

11 KEY FINDINGS Improvement has been noticed in most of the indicators as compared to Baseline. ReplacementlevelofTFR2.1hasbeenachievedin only 29 out of 284 AHS districts whereas in Baseline it was 20 districts. In 145 districts, on an average a woman bears more than 3 children. Morethanhalfofcurrentlymarriedwomenaged years are not using any method of family planning in Bihar.

12 KEY FINDINGS Female Sterilization continues to remain the most dominant method of family planning among the modern methods across all AHS States except Assam. Atleast12.6%currentlymarriedwomenareyet to meet their family planning requirement (Unmet Need) across all AHS States. This was 20.0% in Baseline. Despite wider penetration of `Any ANC, the coverage under first trimester ANC as well as 3 or more ANCs needs further improvement.

13 KEY FINDINGS PoorperformanceoffullANCisprimarilydueto low IFA consumption. Universal coverage of JSY remains a concern even in better performing States like Odisha, MP & Rajasthan. Seven out of every 10 deliveries are safe in Madhya Pradesh, Rajasthan, Odisha and Assam.

14 KEY FINDINGS Atleast1in7mothershasnotreceivedanyPNC among all the AHS States, in Assam it is 1 in 3 mothers. In full immunization, even the better performing States like Uttarakhand, Chhattisgarh and Rajasthan fall short by percentage points in achieving universal coverage. Percent of traditional method in any method of family planning is more than 20% in 4 States namely, Uttar Pradesh, Assam, Jharkhand & Odisha.

15 Performance of Hot Spot Districts 55 districts are hotspots (57 in baseline) i.e. common in top 100 districts in IMR and top 25 Administrative Divisions(111 districts) in MMR. DISTRICTS FALLING IN BOTH TOP 100 IMR AND DISTRICTS OF TOP 25 MMR UP -31 Bihar-1 Assam- 6 MP -16 Odisha-1

16 7.0 Uttar Pradesh State wisetfr of Hot Spot Districts Madhya Pradesh Assam

17 State wise Full ANC of Hot Spot Districts Uttar Pradesh Madhya Pradesh 16.0 Assam

18 80.0 Uttar Pradesh State wise Immunization in Hot Spot Districts Madhya Pradesh Assam

19 State wise Institutional Delivery in Hot Spot Districts 80.0 Uttar Pradesh Madhya Pradesh Assam

20 TOTAL FERTILITY RATE (TFR) TFR is the average number of children born to a woman during her entire reproductive span. Total Fertility Rate Updation Baseline Uttarakhand Odisha Assam Chhattisgarh Jharkhand Madhya Pradesh Rajasthan Uttar Pradesh Bihar Uttarakhand & Odisha and UP & Bihar continue to remain two extremes of the spectrum.

21 State TOTAL FERTILITY RATE (TFR) Total Fertility Rate State value District with Minimum TFR District with Maximum TFR Range First updation Assam Baseline First Updation Baseline First Updation Baseline Kamrup (2.0), Nalbari (2.0) Kamrup (2.0), Nalbari(2.0) First Updation Baseline Hailakandi (3.9) Hailakandi (4.2) Bihar Patna (2.7) Patna (2.8) Sheohar (4.6) Sheohar (4.7) Chhattisgarh Koriya (2.4), Kanker (2.4), Durg (2.4) Koriya (2.4) Kawardha (3.7) Kawardha (3.7) Jharkhand Purbi Singhbhum (2.2) Purbi Singhbhum (2.4) Pakaur (3.9) Lohardagga (4.0) Madhya Pradesh Odisha Bhopal (2.1) Indore (2.2) Shivpuri(4.4) Shivpuri (4.5) Anugul (1.9), Bargarh (1.9), Jharsuguda (1.9) Jharsuguda (2.0) Baudh (3.5) Boudh (3.7) Rajasthan Kota (2.5) Kota (2.6) Barmer (4.5) Barmer (4.7) Uttar Pradesh Kanpur Nagar (2.2) Kanpur Nagar (2.3) Shrawasti (5.8) Shrawasti (5.9) Uttarakhand Pithoragarh (1.7), Bageshwar (1.7) Pithoragarh (1.7) Haridwar (2.9) Haridwar (3.1) Within a State, the minimum variability of 1.2 is reported in Uttarakhand and the maximumof3.6inuttarpradeshwhereasinbaselineitwas1.3inchhattisgarhand3.6 in Uttar Pradesh respectively. Across284districtsin9AHSStates,itrangesfrom1.7inPithoragarhandBageshwar to 5.8 in Shrawasti. In Baseline this varied from 1.7 in Pithoragarh(Uttarakhand) to 5.9 in Shrawasti(UP)- a variability of more than 4 children.

22 TOTAL FERTILITY RATE (TFR) Frequency distribution of TFR in terms of No. of Districts in each State State and above Grand Total Assam 7 (3) 14 (16) 2 (3) 0 (1) 23 Bihar 0 (0) 1 (1) 28 (26) 8 (10) 37 Chhattisgarh 0 (0) 14 (12) 2 (4) 0 (0) 16 Jharkhand 0 (0) 9 (8) 9 (10) 0 (0) 18 Madhya Pradesh 1 (0) 19 (15) 22 (25) 3 (5) 45 Odisha 12 (10) 17 (18) 1 (2) 0 (0) 30 Rajasthan 0 (0) 18 (16) 12 (13) 2 (3) 32 Uttar Pradesh 0 (0) 14 (9) 45(48) 11 (13) 70 Uttarakhand 9 (7) 4 (5) 0 (1) 0 (0) 13 All States 29 (20) 110 (100) 121 (132) 24 (32) districts have already achieved the replacement levelof2.1whereasitwas20inbaseline.

23 TOTAL FERTILITY RATE (TFR) Frequency Distribution of change in TFR in Terms of No. Districts in Each State State Decreased by 0.1 Decreased by 0.2 Decreased by 0.3 Decreased by 0.4 Decreased by 0.5 or more Increased Remained Same Total Uttarakhand Rajasthan Uttar Pradesh Bihar Assam Jharkhand Odisha Chhattisgarh Madhya Pradesh Total

24 TOTAL FERTILITY RATE (TFR) 229 districts have recorded less TFR than the baseline estimates and 47 districts remained same. 8 Districts have recorded increase in TFR viz. Indore (M.P.), Baghpat, Budaun, Bulandshahar, Gonda, Lalitpur, Pilibhit and Rampur(U.P.) 8 Districts have recorded maximum decrease in TFR viz. Sehore(M.P.), Basti, Deoria, Gorakhpur, Kaushambi, Kushinagar, Maharajganj, Siddharthnagar (U.P.)

25 TOTAL FERTILITY RATE (TFR) First Updation Replacement level of TFR Baseline

26 Family Planning: Current Usage Contraceptive Prevalence Rate (CPR) is the percentage of currently married women aged yrs who are using any method of contraception(modern/traditional). 70 Current Usage- any method (%) 60 Updation Baseline Bihar Jharkhand Chhattisgarh Uttar Pradesh Odisha Uttarakhand Madhya Pradesh Assam Rajasthan Currentusageofanymethodvariesfrom43.0inBiharto66.4in Rajasthan whereas it was 37.6 in Bihar to 64.5 per cent in Rajasthan in Baseline.

27 Family Planning: Current Usage Any Method of Family Planning (%) State State Value District with Minimum FP District with Maximum FP Range First Updation baseline First Updation baseline First Updation baseline First Updation baseline Assam Dhubri (45.1) Dhubri (33.2) Kamrup (76.0) Lakhimpur (67.6) Bihar Nawada (31.5) Siwan (26.0) Supaul (60.8) Muzaffarpur (52.2) Jharkhand Gumla (39.0) Paschimi Singhbhum (32.7) Hazaribagh (69.8) Dhanbad (61.9) Madhya Pradesh Sidhi (44.6) Sidhi (45.9) Damoh (75.7) Damoh (74.9) Chhattisgarh Dantewada (33.4) Dantewada (33.4) Kawardha (68.2) Dhamtari (68.7) Odisha Baudh (29.8) Kandhamal (28.6) Baleshwar (78.1) Baleshwar (73.4) Rajasthan Jaisalmer (53.3) Dhaulpur (49.0) Hanumangarh (89.1) Ganganagar (79.2) Uttar Pradesh Sitapur (33.8) Sitapur (21.9) Jhansi (74.4) Jhansi (74.1) Uttarakhand Haridwar (56.2) Haridwar (53.7) Pithoragarh (78.2) Dehradun (67.1) WithinaState,theleastvariationisreportedinUttarakhandandthemost,inOdisha whereas in Baseline it was Uttarakhand and Uttar Pradesh respectively. At district level, current usage of family planning ranges from 29.8 in Baudh(Odisha) to 89.1 in Hanumangarh (Rajasthan)- a variability of 3 times-whereas in Baseline it varied from 21.9 in Sitapur (UP) to 79.2 in Ganganagar (Rajasthan) exhibiting a variability of 4 times.

28 Family Planning: Current Usage Frequency distribution of current usage in terms of number of districts in each State State & above Total Districts Assam 0 (0) 2 (3) 15 (20) 6 (0) 23 Bihar 0 (4) 29 (31) 8 (2) 0 (0) 37 Chhattisgarh 0 (0) 3 (7) 13 (9) 0 (0) 16 Jharkhand 0 (0) 7 (13) 11 (5) 0 (0) 18 Madhya Pradesh 0 (0) 1 (2) 40 (40) 4 (3) 45 Odisha 1 (1) 8 (9) 16 (19) 5 (1) 30 Rajasthan 0 (0) 0 (1) 21 (24) 11 (7) 32 Uttar Pradesh 0 (3) 20 (24) 44 (42) 6 (1) 70 Uttarakhand 0 (0) 0 (0) 6 (13) 7 (0) 13 All States 1 (8) 70 (90) 174 (174) 39 (12) 284 Ashighas71districtsarereportinglessthan50%currentusageofanymethodof family planning whereas in Baseline it was districtsfeaturein70%&abovecategorywhereasinBaselineitwasonly12 districts. 29outof37districtsofBiharhavereportedlessthan50%usageofanymethod of family planning. In Baseline it was 35 districts.

29 Family Planning: Current Usage First Updation Baseline CURRENT USAGE OF ANY METHOD OF FAMILY PLANNING (%) CURRENT USAGE OF ANY METHOD OF FAMILY PLANNING (%) Dist. with > 60% Usage

30 Family Planning: Current Usage FEMALE STERILIZATION (%) Assam Uttar Pradesh Share of sterilization in any modern method of family planning (%) Jharkhand Bihar Odisha Uttarakhand Rajasthan Chhattisgarh Madhya Pradesh Female 35.1 (35.3) 50.4 (55.0) 74.3 (76.3) 81.2 (86.7) 69.7 (68.4) 51.9 (58.7) 77.1 (76.7) 87.4(92.3) 81.8 (83.6) Male 0.8 (0.6) 0.5 (0.6) 1.4 (1.2) 0.8 (0.9) 0.4 (0.7) 3.0 (2.8) 0.7 (0.7) 1.8 (2.0) 1.5 (1.7)

31 Unmet Need for Family Planning Unmet need of Family Planning broadly means requirement of Family Planning methods among Currently Married Women but not using any method of Family Planning. Unmet Need for Family Planning (%) Rajasthan Assam Uttarakhand Odisha Madhya Pradesh Jharkhand Uttar Pradesh Chhattisgarh Bihar Updation Baseline Total unmet need varies from a minimum of 12.6% in Rajasthan to 33.5% in Bihar.InBaselineitvariedfrom19.6%inRajasthan to39.2%inbihar. Unmet need for Family Planning is a crucial indicator for assessing the future demand for Family Planning services/ supplies.

32 Unmet Need for Family Planning Total Unmet need (%) State State Value District with Minimum unmet need District with Maximum unmet need Range First Updation baseline First Updation baseline First Updation baseline First Updation baseline Assam Kamrup (8.4) Sibsagar (15.3) Karimganj (33.6) Dhubri (42.9) Bihar Patna (20.2) Patna (24.6) Katihar (46.5) Kishanganj (52.5) Jharkhand Hazaribagh (13.2) Bokaro (18.2) Gumla (33.2) Godda (42.8) Madhya Pradesh Datia(14.4) Dewas(14.4) Jabalpur (14.3) Sidhi(38.3) Rewa (34.2) Chhattisgarh Dhamtari (13.9) Dhamtari (14.5) Dantewada (48.7) Bastar (36.0) Odisha Kendujhar (9.7) Baleshwar (6.1) Baudh (45.3) Boudh (48.3) Rajasthan Jhunjhunun (3.1) Ganganagar (10.0) Jaisalmer (28.1) Dhaulpur (32.4) Uttar Pradesh Jhansi (12.7) Mahoba (15.1) Sultanpur (48.1) Sitapur (61.3) Uttarakhand Dehradun (12.8) Dehradun (16.8) Almora (27.4) Haridwar (29.2) The minimum variability within a State is in Uttarakhand and the maximum in Odisha whereas in Baseline it was in Uttarakhand and in Uttar Pradesh respectively. Jhunjhunun (3.1) in Rajasthan and Dantewada (48.7) in Chhattisgarh are the two extremes across 284 districts. In Baseline it was Baleshwar (6.1) in Odisha and Sitapur (61.3) in Uttar Pradesh.

33 Unmet Need for Family Planning Frequency distribution of unmet need in terms of number of districts in each State State & above Total Districts Assam 16 (6) 7 (16) 0 (1) 0 (0) 23 Bihar 0 (0) 29 (20) 8 (17) 0 (0) 37 Chhattisgarh 3 (4) 12 (12) 1 (0) 0 (0) 16 Jharkhand 5 (2) 13 (13) 0 (3) 0 (0) 18 Madhya Pradesh 12 (18) 33 (27) 0 (0) 0 (0) 45 Odisha 14 (12) 13 (15) 3 (3) 0 (0) 30 Rajasthan 26 (16) 6 (16) 0 (0) 0 (0) 32 Uttar Pradesh 23 (9) 42 (52) 5 (8) 0 (1) 70 Uttarakhand 6 (2) 7 (11) 0 (0) 0 (0) 13 All States 105 (69) 162 (182) 17 (32) 0 (1) 284 In105outof284districts,thetotalunmetneedforfamilyplanningisbelow 20%.Itwas69inBaseline. BiharandUttarPradesh continuetodominatein40%&abovecategory.

34 Unmet Need for Family Planning First Updation Baseline TOTAL UNMET NEED FOR FAMILY PLANNING (%) Unmet need of <=20 TOTAL UNMET NEED FOR FAMILY PLANNING (%)

35 Mean Age at Marriage- Female MeanAgeatMarriageisbasedonthemarriagestakenplaceduring Mean Age at Marriage- Female 25 Updation Baseline Bihar Rajasthan Jharkhand Madhya Pradesh Chhattisgarh Uttar Pradesh Assam Uttarakhand Odisha Mean age at marriage of females varies from 20.1 in Bihar to 22.4 years in Odisha whereas in Baseline it was 19.7 in Bihar & Rajasthan to 22.0 years in Uttarakhand.

36 Marriages among Females below Legal Age (18 yrs) Based on marriages taken place during Marriages among Females below legal age (%) 30 Updation Baseline Uttarakhand Odisha Chhattisgarh Uttar Pradesh Assam Madhya Pradesh Jharkhand Rajasthan Bihar Varies from 2.3% in Uttarakhand to 16.5% in Bihar whereas in Baseline it was 3.0% in Uttarakhand to 21.9% in Rajasthan.

37 Marriages among Females below Legal Age (18 yrs) MARRIAGES AMONG FEMALES BELOW LEGAL AGE (BELOW 18 YEARS) %

38 Ante Natal Care (ANC) AnyANCexceeds80%inallAHSStates. ANC in 1 st trimester: 46.5% in UP & Bihar to 70% in Chhattisgarh& Madhya Pradesh. In Baseline, this was 40% in UP &Biharto65%inChhattisgarh&MadhyaPradesh. Mothers receiving 3 or more ANCs: UP-32.5% to Odisha-78.5%. This was UP-29.6% to Odisha-76.0% in Baseline. Mothers who consumed IFA 100 days or more: 8.1% in UP to 26.0%inOdisha.Itwas6.5%inUPto23.8%inChhattisgarhin Baseline. Low performance in IFA consumption is the main reason for sluggishfullanc:5%inupto22.7%inodisha.inbaseline,3.9% in UP to 19.5% in Chhattisgarh.

39 Full Ante Natal Check-up FullANCcomprise3ormoreANC,atleastoneTTinjectionandconsumptionof IFAfor100ormoredays. Full Ante Natal Check-up (%) Updation Baseline Uttar Pradesh Bihar Rajasthan Assam Jharkhand Madhya Pradesh Uttarakhand Chhattisgarh Odisha UttarPradeshreportstheminimumcoverageof5.0%and Odisha,themaximum 22.7whereasinBaselineitwas3.9%in UttarPradesh&19.5%inChhattisgarh.

40 Full Ante Natal Check-up Mothers who had Full Antenatal Check-up (%) State State Value District with Minimum value District with Maximum value Range First Updation Baseline First Updation Baseline First Updation Baseline First Updation Baseline Assam Dhubri (4.0) Dhubri (2.1) Dibrugarh (25.2) Jorhat (18.2) Bihar Samastipur (2.0) Madhepura (2.4) Patna (13.8) Patna (16.4) Jharkhand Garhwa (5.0) Garhwa (3.6) Purbi Singhbhum (32.1) Purbi Singhbhum (31.6) Madhya Pradesh Sheopur (1.9) Sheopur (1.8) Indore (32.1) Balaghat (30.8) Chhattisgarh Kawardha (11.5) Korba (10.9) Dhamtari (42.6) Dhamtari (34.5) Odisha Jajapur (13.4) Jajapur (5.4) Jagatsinghapur (43.5) Jagatsinghapur (36.0) Rajasthan Karauli (3.0) Karauli (1.7) Jaipur (19.7) Jaipur (19.5) Uttar Pradesh Balrampur (0.9) Balrampur (0.6) Jhansi (17.9) Kanpur Nagar (14.8) Uttarakhand Rudraprayag (3.8) Rudraprayag (3.7) Dehradun (29.7) Dehradun (22.7) Bihar has reported the minimum variability among the districts in a State compared to Chhattisgarh reporting the maximum. It was Bihar and Odisha in Baseline. Balrampur(0.9), less than 1% coverage and Jagatsinghapur(43.5), the maximum coverage of full ANC. In Baseline also the position was same with values 0.6 and 36.0 respectively.

41 Full Ante Natal Check-up Frequency distribution of full ANC in terms of number of districts in each State State < & above Total Districts Assam 1 (6) 9 (7) 7 (6) 3 (4) 2 (0) 1 (0) 23 Bihar 15 (17) 18 (17) 4 (2) 0 (1) 0 (0) 0 (0) 37 Chhattisgarh 0 (0) 0 (0) 6 (4) 2 (4) 3 (5) 5 (3) 16 Jharkhand 0 (3) 7 (7) 6 (4) 3 (3) 1 (0) 1 (1) 18 Madhya Pradesh 5 (7) 10 (11) 11 (10) 7 (7) 6 (6) 6 (4) 45 Odisha 0 (0) 0 (3) 4 (7) 7 (10) 9 (3) 10 (7) 30 Rajasthan 6 (7) 16 (16) 8 (7) 2 (2) 0 (0) 0 (0) 32 Uttar Pradesh 45 (52) 17 (15) 6 (3) 2 (0) 0 (0) 0 (0) 70 Uttarakhand 1 (2) 2 (7) 5 (2) 3 (1) 1 (1) 1 (0) 13 All States 73 (94) 79 (83) 57 (45) 29 (32) 22 (15) 24 (15) out of 284 districts report less than 5% coverage of full ANC whereas in Baseline it was districtsreported25%&abovecoverageoffullANC.InBaselineitwasonly 15 districts.

42 Full Ante Natal Check-up First Updation Baseline MOTHERS WHO HAD FULL ANTENATAL CHECK UP (%) MOTHERS WHO HAD FULL ANTENATAL CHECK UP (%)

43 Ante Natal Check-up First Updation Baseline MOTHERS WHO RECEIVED ANY ANTENATAL CHECK-UP (%) 90% and above coverage MOTHERS WHO RECEIVED ANY ANTENATAL CHECK-UP (%)

44 Ante Natal Check-up First Updation Baseline MOTHERS WHO HAD ANTENATAL CHECK UP IN FIRST TRIMESTER (%) Above 50 % coverage MOTHERS WHO HAD ANTENATAL CHECK UP IN FIRST TRIMESTER (%)

45 Ante Natal Check-up First Updation Baseline MOTHERS WHO RECEIVED 3 OR MORE ANTENATAL CARE (%) MOTHERS WHO RECEIVED 3 OR MORE ANTENATAL CARE (%)

46 Institutional Delivery Institutional Delivery (%) Updation 34.9 Baseline Chhattisgarh Jharkhand Uttar Pradesh Bihar Uttarakhand Assam Rajasthan Odisha Madhya Pradesh Share of Govt. & Private Hospitals in Total Institutional Delivery Govt Pvt Updation Baseline Updation Baseline Updation Baseline Updation Baseline Updation Baseline Updation Baseline Updation Baseline Updation Baseline Updation Baseline Assam Chhattisgarh Madhya Pradesh Odisha Bihar Jharkhand Rajasthan Uttar Pradesh Uttarakhand

47 Institutional Delivery Institutional Delivery: Ranges from 40.4% in Chhattisgarh to 79.7% in MP. In Baseline itwas34.9%inchhattisgarh &76.1%inMP. Morethan85%oftotalbirthshavetakenplaceinGovt.InstitutionsinMadhya Pradesh & Odisha and it is more than 60% in remaining States except Jharkhand. In Baseline also, the situation was same except for Uttarakhand, whichstoodat63%from59%inbaseline. Jharkhand continues to remain the only State where more than 50% of the births are taking place in Private Hospitals. Balrampur (UP) recorded the least 22.2% institutional delivery whereas Puri(Odisha) the most 94.0%, showing a variability of more than 4 times. In Baseline, Balrampur was in the least category with 16.8% and Indore(MP),the highest with 92.5%.

48 INSTITUTIONAL DELIVERY (%) Balrampur, UP Puri, Odisha Institutional delivery is below 60% in 141 districts whereas it was 170 districts in baseline.

49 Safe Delivery Safe delivery comprise institutional deliveries and domiciliary deliveries assisted by doctor/nurse/anm/lhv. Safe Delivery (%) Updation 56.9 Baseline Jharkhand Chhattisgarh Uttar Pradesh Bihar Uttarakhand Assam Rajasthan Odisha Madhya Pradesh Safe Delivery: 51.8% in Jharkhand to 85.9% in Madhya Pradesh. It was 47.1% in Jharkhand & 82.2% in MP.

50 Safe Delivery Safe Delivery (%) State State Value District with Minimum Value District with Maximum Value Range First Updation Baseline First Updation Baseline First Updation Baseline First Updation Baseline Assam Hailakandi, Karimganj (41.4) Karimganj, Hailakandi (34.8) Sibsagar (89.9) Sibsagar (88.2) Bihar Sitamarhi (36) Sheohar (30.2) Patna (81.4) Munger (80.4) Jharkhand Pakaur (31.8) Pakaur (24.8) Madhya Pradesh Purbi Singhbhum (71.9) Purbi Singhbhum (69.0) Dindori (55.4) Dindori (45.5) Indore (97) Indore (96.3) Chhattisgarh Surguja (41.6) Surguja (32.6) Kanker (75.8) Kanker (69.4) Odisha Malkangiri (48) Nabarangpur (35.6) Puri (94.7) Puri (92.7) Rajasthan Jaisalmer (55.5) Jaisalmer (48.6) Baran (93.6) Jaipur (92.2) Uttar Pradesh Balrampur (30) Balrampur (22.0) Jhansi (90.1) Jhansi (89.4) Uttarakhand Tehri Garhwal (49.4) Tehri Garhwal (43.1) Nainital (81.4) Nainital (79.5) Uttarakhand has exhibited the least variability among districts of a State and Uttar Pradesh, the most,thesameasinbaseline. Balrampur(UP)& Indore(MP) continue to remain the minimum and maximum in safe delivery.

51 Safe Delivery Frequency distribution of safe delivery in terms of No. of districts in each State State < & above Total Districts Assam 0 (0) 3 (2) 11 (12) 9 (9) 0 (0) 23 Bihar 0 (0) 6 (12) 22 (19) 9 (6) 0 (0) 37 Chhattisgarh 0 (0) 4 (9) 9 (7) 3 (0) 0 (0) 16 Jharkhand 0 (3) 11 (9) 6 (6) 1 (0) 0 (0) 18 Madhya Pradesh 0 (0) 0 (1) 5 (5) 27 (29) 13 (10) 45 Odisha 0 (0) 2 (3) 4 (5) 20 (20) 4 (2) 30 Rajasthan 0 (0) 0 (1) 5 (8) 25 (21) 2 (2) 32 Uttar Pradesh 0 (4) 12 (20) 40 (39) 17 (7) 1 (0) 70 Uttarakhand 0 (0) 1 (3) 8 (7) 4 (3) 0 (0) 13 All States 0 (7) 39 (60) 110 (108) 115 (95) 20 (14) 284 About 1/7 th of the districts have reported less than 50% of the safe deliveries. It was1/4 th inbaseline. Out of 20 districts reporting 90% & above safe deliveries, 13 districts belong to MadhyaPradesh.Itwas10forMPinBaseline.

52 Safe Delivery SAFE DELIVERY (%)

53 Janani Suraksha Yojana Mothers who availed Financial Assistance under JSY (%) Updation Baseline Jharkhand Uttarakhand Chhattisgarh Uttar Pradesh Bihar Assam Rajasthan Odisha Madhya Pradesh Mothers availing JSY: 19.9% in Jharkhand to 69.3% in MP. It was 14.6% in Jharkhand to 61.6% in Odisha in Baseline.

54 Janani Suraksha Yojana MOTHERS WHO AVAILED FINANCIAL ASSISTANCE FOR DELIVERY UNDER JSY (%)

55 Abortion Pregnancy to Women aged years resulting in abortion (%) Updation Baseline Chhattisgarh Madhya Pradesh Rajasthan Bihar Jharkhand Uttarakhand Uttar Pradesh Odisha Assam Varies from 2.1% in Chhattisgarh to 7.6% in Assam, in Baseline too these two States were at the extremes. Across 284 districts in 9 AHS States, it ranges from 0.7% in Jaisalmer(Rajasthan) Kanker& Dantewada(Chhattisgarh), to 19.6% in Jorhat(Assam).

56 Abortion 5.0 Updation Average Month of pregnancy at the time of abortion Baseline Assam Uttarakhand Jharkhand Odisha Uttar Pradesh Bihar Rajasthan Madhya Pradesh Chhattisgarh Variesfrom2.6inAssamto3.3inChhattisgarh. Across 284 districts in 9 AHS States, it ranges from 2.0 in Sheopur (Madhya Pradesh) to 5.4 in Rayagada(Odisha)& Jaisalmer(Rajasthan).

57 Abortion Updation 32.2 Baseline Chhattisgarh Bihar Uttar Pradesh Abortion taking place in Institution (%) Madhya Pradesh Odisha Jharkhand Uttarakhand Rajasthan Assam Abortion taking place in institution varies from 32.0% in Chhattisgarh to 73.9% in Assam. Across284districtsin9AHSStates,itrangesfrom12.4%inKishanganj(Bihar) to 100% in Jaisalmer(Rajasthan).

58 Abortion Abortion performed by skilled health personnel (%) Updation Baseline Chhattisgarh Bihar Uttar Pradesh Madhya Pradesh Odisha Jharkhand Uttarakhand Rajasthan Assam Variesfrom41.8%inChhattisgarhto76.4%inAssam. Across284districtsin9AHSStates,itrangesfrom19.6%inMadhepura(Bihar) to 100% in Rayagada (Odisha) and Jaisalmer (Rajasthan) a variability of 5 times. Morethan50%oftheabortionisperformed by skilledhealthpersonnelin all the States except Chhattisgarh.

59 Updation Post Natal Care Mothers who received Post-natal Check up within 48 hrs of delivery (%) Baseline Assam Bihar Uttarakhand Jharkhand Chhattisgarh Uttar Pradesh Rajasthan Madhya Pradesh Odisha Mothers receiving PNC within 48 hrs of delivery varies from 59.6% in Assam to 80.0% in Odisha.Itwas57.0inAssamand74.5%inOdishainBaseline. Mothers who did not receive any Post-natal Check up (%) Updation Baseline Odisha Madhya Pradesh Rajasthan Bihar Chhattisgarh Uttar Pradesh Jharkhand Uttarakhand Assam At least 1 in every 7 mothers did not receive any post natal check up across all AHS States. The situation was 1 in 5 in baseline.

60 Post Natal Care MOTHERS WHO AVAILED POST-NATAL CHECK UP WITHIN 48 HRS. OF DELIVERY (%)

61 Post Natal Care MOTHERS WHO DID NOT RECEIVE ANY POST-NATAL CHECK UP (%)

62 New Born Check up Updation Baseline New Born Checked up within 24 hrs of birth (%) Bihar Assam Jharkhand Uttarakhand Chhattisgarh Uttar Pradesh Rajasthan Madhya Pradesh New born checked up within24 hrs of birth exceeds 50% in all AHS States. Across the 284 districts, as high as 246 districts reported more than 50% coverage. Itvariesfrom57.6%inBiharto79.7%inOdishawhereasinBaselineitwas 52.6%inBiharand74.9inOdisha. Across 284 districts in 9 AHS States, it ranges from 32.2 in Karimganj(Assam) to 92.6 in Bargarh(Odisha). In Baseline, this varied from 24.2 in Karimganj& Hailakandi(Assam) to 92.9 in Allahabad(Uttar Pradesh) Odisha

63 New Born Check up NEW BORNS WHO WERE CHECKED UP WITHIN 24 HRS. OF BIRTH (%)

64 Full Immunization Children are considered fully immunized when they have received vaccination againsttuberculosis,3dosesofdpt&polioand1doseofmeasles. Children aged months fully immunized (%) Updation 59.7 Baseline Uttar Pradesh Madhya Pradesh Assam Odisha Bihar Jharkhand Rajasthan Chhattisgarh Uttarakhand All States except Uttar Pradesh continue to remain having received at least half of their children aged months fully immunized. Uttar Pradesh & Uttarakhand continue to remain minimum & maximum in children fully immunized.

65 Full Immunization Children aged months Fully Immunized (%) State State Value Minimum Maximum Range First Updation Baseline First Updation Baseline First Updation Baseline First Updation Baseline Assam Dhubri (39.2) Dhubri (29.9) Dibrugarh (85.5) Dibrugarh (83.8) Bihar Kishanganj (26.6) Kishanganj (26.6) Jharkhand Giridih (43.0) Giridih (28.0) Lohardaga (86.5) Madhya Pradesh Madhubani (82.8) Samastipur (83.9) Purbi Singhbhum (82.7) Umaria (27.1) Jhabua (23.8) Indore (83.2) Indore (77.6) Chhattisgarh Surguja (52.8) Surguja (55.3) Kanker (94) Kanker (93.2) Odisha Rayagada (17.7) Rayagada (11.9) Kendrapara (84.9) Kendrapara (82) Rajasthan Dhaulpur (41.5) Dhaulpur (37.4) Hanumangarh (95.9) Hanumangarh (91.4) Uttar Pradesh Bahraich (21.6) Etah (13.5) Saharanpur (72.2) Basti (73.8) Uttarakhand Haridwar (59.6) Haridwar (55.3) Pithoragarh (87.6) Pithoragarh (87.5) The variability among the districts within a State ranges from 28.0% in Uttarakhand to 67.2% in Odisha, it was 32.2% in Uttarakhand to 70.1% in Odisha in Baseline. Across all 284 districts, Rayagada of Odisha continue to remain the minimum. However the maximum is observed in Hanumangarh of Rajasthan. In Baseline the maximum was in Kanker of Chhattisgarh.

66 Full Immunization Frequency distribution of Full Immunization in terms of number of districts in each State State & above Total Districts Assam 0 (1) 4 (4) 14 (14) 5 (4) 0 (0) 23 Bihar 1 (1) 2 (2) 18 (23) 16 (11) 0 (0) 37 Chhattisgarh 0 (0) 0 (0) 6 (6) 9 (9) 1 (1) 16 Jharkhand 0 (1) 2 (4) 9 (7) 7 (6) 0 (0) 18 Madhya Pradesh 3 (2) 8 (14) 26 (24) 8 (5) 0 (0) 45 Odisha 5 (8) 9 (7) 2 (6) 14 (9) 0 (0) 30 Rajasthan 0 (0) 3 (4) 9 (10) 19 (17) 1 (1) 32 Uttar Pradesh 6 (11) 30 (31) 31 (20) 3 (8) 0 (0) 70 Uttarakhand 0 (0) 0 (0) 1 (2) 12 (11) 0 (0) 13 All States 15 (24) 58 (66) 116 (112) 93 (80) 2 (2) districts are below 50% level of full immunization whereas it was 90 in Baseline. Only2districts1eachfromChhattisgarh&Rajasthancontinuetoremainin90%& above category.

67 Constituents of full immunization Children age months who have received 3 doses of DPT vaccine(%) Updation Baseline Children age months who have received Measles vaccine (%) Updation Baseline Children age months who have received BCG(%) Updation Baseline Children age months who have received 3 doses of Polio vaccine(%) Updation Baseline

68 Full Immunization CHILDREN AGED MONTHS FULL IMMUNIZED (%)

69 Vitamin A Supplementation to Children Children aged 6-35 months who received a Vitamin A dose during last six months (%) 80.0 Updation Baseline Uttar Pradesh Madhya Pradesh Uttarakhand Bihar Jharkhand Rajasthan Chhattisgarh Assam Odisha Atleastevery2 nd childaged6-35monthshasreceivedvitaminasupplementin all AHS States except Uttar Pradesh where it is every 3 rd child, the same as in Baseline. Across 284 districts in 9 AHS States, it ranges from 16.2 in Shrawasti(Uttar Pradesh) to 88.5 in Udaipur(Rajasthan). In Baseline, it varied form 15.1 in Shrawasti to 91.3 in Lohardaga(Jharkhand). Across the 284 districts,193 districts have reported more than 50% coverage.

70 Vitamin A Supplementation to Children CHILDREN (AGE 6-35 MONTHS WHO RECEIVED VITAMIN A DOSE DURING LAST SIX MONTHS (%)

71 IFA Supplement to Children Children aged 6-35 months who received IFA tablet/syrup during last 3 months (%) Updation Baseline Rajasthan Uttar Pradesh Uttarakhand Jharkhand Odisha Madhya Pradesh Assam Bihar Chhattisgarh IFAsupplementtochildrenaged6-35monthsduringlast3monthsrangesfrom 10.9%inRajasthanto38.7%inChhattisgarh.Itwas9.4%inRajasthanto37.7% in Chhattisgarh in Baseline. Situation merit attention across all AHS States however it is quite alarming in Rajasthan, Uttar Pradesh& Uttarakhand.

72 IFA Supplement to Children CHILDREN (AGE 6-35 MONTHS WHO RECEIVED IFA TABLETS/SYRUPS DURING LAST 3 MONTHS (%)

73 Breast Feeding Practices Children under 3 Years breastfed within one hour of birth (%) Updation Baseline Bihar Uttar Pradesh Jharkhand Rajasthan Uttarakhand Madhya Pradesh Chhattisgarh Assam Odisha Bihar & UP and Assam & Odisha continue to remain two extremes of the spectrum.

74 Breast Feeding Practices CHILDREN UNDER 3 YEARS BREASTFED WITHIN 1 HOUR OF BIRTH (%)

75 Breast Feeding Practices Children age 6-35 months exclusively breastfed for at least six months (%) Updation Baseline Uttar Pradesh Odisha Rajasthan Bihar Uttarakhand Madhya Pradesh Assam Jharkhand Chhattisgarh Childrenexclusivelybreastfedforatleast6monthsrangesfrom19.4%inUPto 49.9%inChhattisgarhwhereasitwas17.7%inUPto47.5%inChhattisgarhin Baseline.

76 Breast Feeding Practices CHILDREN AGED 6-35 MONTHS EXCLUSIVE BREASTFED FOR AT LEAST SIX MONTHS (%)

77 Some Additional Facts Among AHS States:- 4 out of the 5 top States in female literacy and full ANC coverage are common. 57 districts are common in top 100 districts in female literacy and full ANC. 3outofthe5topStatesinfemaleliteracy alsoexist among5stateswithleastmmr. Top 5 States in full immunization coverage are the samewhohavethe leastnnmr&imr. 3 out of the 5 top States in exclusive breast feeding practice also exist among 5 States with minimum NNMR.

78 WAY FORWARD Thefieldworkfor2 nd updationroundisoverandtheindicatorson vital rates reflecting the change vis-à-vis baseline and first updation round surveys are likely to be released shortly. A Component of Clinical-Anthropometric & Bio-chemical (CAB) Testonasub-samplebasisisinprogressintheAHSStates.

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