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

“ 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,

“ 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,

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 4

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. 5

Coverage : Annual Health Survey 6

WHY AHS? o AHS States constitute: 50 percent of country’s Population 60 percent of Births 71 percent of Infant Deaths 72 percent of Under 5 Deaths 62 percent of Maternal Deaths o Enable direct monitoring of UN Millennium Development Goals on Child Mortality and Maternal Health at the district(s) level. o Help in identifying high focus districts meriting special attention in view of stark inter-district variations in these States. o Provide critical inputs to assess the milestones of various interventions including NRHM and pave the way for evidence based planning. 7

KEY FEATURES Contd… 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 million whereas it was 20.1 million as per baseline survey. The Largest Sample Survey in the World 8

KEY FEATURES Contd… Sample Population per district - About 73 thousand whereas it was 71 thousand as per baseline survey. Sample Households million households whereas it was 4.1 million as per baseline survey. Sample households per district - About 15.2 thousand whereas it was 14.5 thousand as per baseline survey. 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 9

Indicators under AHS In all, 161 indicators are available from AHS : Fertility- 13 Sex Ratio- 3 Marriage- 5 Mortality- 7 Mother & Child Care- 63  Ante Natal Care: 11  Delivery Care: 8  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 Abortion- 6 Family Planning Practices- 15 Disability- 1 Morbidity- 19 Personal Habits:adults-4 Housing & HH Characteristics- 13 Others

Indicators under AHS Contd… Data release of the second updation round Under 1 st phase of release, following 9 indicators have already been released in the Bulletin :  Crude Birth Rate (CBR)  Crude Death Rate (CDR)  Infant Mortality Rate (IMR)  Neo-Natal Mortality Rate (NNMR)  Under Five Mortality Rate (U5MR)  Maternal Mortality Ratio (MMR)  Sex Ratio at Birth (SRB)  Sex Ratio (0-4 years) and  Sex Ratio (All ages) Remaining indicators are being released under present phase of dissemination. 11

Progress so far Field work for all the three rounds is completed. State level Bulletins of all the three rounds containing the district level vital indicators viz. Crude Birth Rate, Crude Death Rate,Infant Mortality Rate,Neo- Natal Mortality Rate,Under Five Mortality Rate,Maternal Mortality Ratio,Sex Ratio at Birth,Ratio(0-4 Years),Sex Ratio(All Ages) were released in 2011 and 2013 and District level fact sheets of the previous two rounds containing the 161 indicators on fertility, Mother and child care, Family planning practices, Mortality, disability,marriage etc. were released in 2012 and The data now presented is of the factsheet of the second updation round. With this, all activities related to Annual Health Survey except for CAB have been completed. 12

Five Core Themes Covered The presentation focuses on results pertaining to 5 core themes: Total Fertility Rate Family Planning: Current Usage & Total Unmet Need Ante Natal Care Delivery & Post Natal Care Immunization and Breast Feeding Practices 13

KEY FINDINGS  Improvement has been noticed in most of the indicators as compared to Baseline.  Replacement level of TFR 2.1 has been achieved in only 35 out of 284 AHS districts whereas in Baseline it was 20 districts.  In 125 districts, on an average a woman bears more than 3 children.  More than half of currently married women aged years are not using any method of family planning in Bihar. The phenomenon remained the same over the three rounds. 14

KEY FINDINGS  Female Sterilization continues to remain the most dominant method of family planning among the modern methods across all AHS States except Assam, over the three rounds.  At least one in 8 currently married women is yet to meet their family planning requirement (Unmet Need) across all AHS States. This was one in 5 in Baseline.  This is due to increase in usage of primarily Modern methods except for Assam and Odisha where usage of Traditional methods has dominated. 15

 Poor performance of full ANC is primarily due to low IFA consumption.  Despite wider penetration of `Any ANC’, the coverage under `first trimester ANC’ as well as `3 or more ANCs’ needs further improvement.  Universal coverage of Janani Suraksha Yojana(JSY) remains a concern. Only Odisha and Rajasthan have shown 70%+ coverage in the second updation round.  Seven out of every 10 deliveries are `safe’ in Madhya Pradesh, Rajasthan, Odisha and Assam,the same in Baseline. KEY FINDINGS 16

At least 1 in 8 mothers has not received any PNC among all the AHS States, in Assam and Uttarakhand, it is about 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 usage of traditional method of family planning is more than 20% in Uttar Pradesh, Assam, Jharkhand & Odisha. KEY FINDINGS 17

KEY FINDINGS  Among AHS districts:-  67 districts are common in top 100 districts in female literacy and full ANC exhibiting a definite correlation between the two. i.e. the higher the female literacy the higher will be the ANC.  Higher female literacy and less MMR - Out of the 5 top States in these two indicators, 4 are common.  Higher coverage of Full immunization and less NNMR- Top 4 States in both the indicators are common.  Higher coverage of Full immunization and less IMR- Top 5 States are common. 18

Hotspot Districts Districts which are common among worst performing in IMR and MMR(Top 100 IMR districts and top 25 administrative divisions of MMR). There are 42 hotspot districts spread in Uttar Pradesh-28, MP-10, Rajasthan-3 and Assam-1. These districts do not perform very well on other fertility and program indicators. Needs urgent attention. 19

Rajasthan-3 Uttar Pradesh-28 Madhya Pradesh-10 Assam-1 20

Performance of 42 hotspot districts in terms of Total Fertility Rate(TFR) Full Ante Natal Care(ANC) Institutional Delivery Full Immunization 21

Performance of Hotspot districts w.r.t TFR TFR India:

Performance of Hotspot districts w.r.t TFR TFR India

Performance of Hotspot districts w.r.t Full ANC 24

Performance of Hotspot districts w.r.t Full ANC 25

Performance of Hotspot districts w.r.t Full Immunization 26

Performance of Hotspot districts w.r.t Full Immunization 27

Performance of Hotspot districts w.r.t Institutional Delivery 28

Performance of Hotspot districts w.r.t Institutional Delivery 29

TOTAL FERTILITY RATE (TFR) TFR is the average number of children born to a woman during her entire reproductive span. Uttarakhand & Odisha and UP & Bihar continue to remain two extremes of the spectrum over the three rounds. Total Fertility Rate 30

TOTAL FERTILITY RATE (TFR) Total Fertility Rate State State valueDistrict with Minimum TFRDistrict with Maximum TFRRange Second updation BaselineSecond UpdationBaseline Second Updation Baseline Second Updation Baseline Assam Kamrup (1.9) Kamrup (2.0), Nalbari(2.0) Hailakandi (3.7) Hailakandi (4.2) Bihar Patna (2.6) Patna (2.8) Sheohar (4.6) Chhattisgarh Koriya (2.3), Kanker (2.3), Durg (2.3) Koriya (2.4) Kawardha (3.6) Kawardha (3.7) 1.3 Jharkhand Purbi Singhbhum (2.2) Purbi Singhbhum (2.4) Pakaur, Lohardagga (3.7) Lohardagga (4.0) Madhya Pradesh Bhopal (2.0) Indore (2.2) Panna(4.1) Shivpuri (4.5) Odisha Jharsuguda (1.8) Jharsuguda (2.0) Baudh (3.5) Boudh (3.5) 1.7 Rajasthan Kota (2.4) Kota (2.6) Barmer (4.4) Barmer (4.7) Uttar Pradesh Kanpur Nagar (2.1) Kanpur Nagar (2.3) Shrawasti (5.4) Shrawasti (5.9) Uttarakhand Pithoragarh (1.7) Haridwar (2.7) Haridwar (3.1) Within a State, the minimum variability of 1.0 is reported in Uttarakhand and the maximum of 3.3 in Uttar Pradesh whereas in Baseline it was 1.3 in Chhattisgarh and 3.6 in Uttar Pradesh respectively. Across 284 districts in 9 AHS States, it ranges from 1.7 in Pithoragarh to 5.4 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. 31

TOTAL FERTILITY RATE (TFR) 35 districts have already achieved the replacement level of 2.1 whereas it was 20 in baseline. 63 districts have TFR below the current National average of 2.4 (SRS 2012). Frequency distribution of TFR in terms of No. of Districts in each State State and aboveGrand Total Assam8 (3)13 (16)2 (3)0 (1)23 Bihar0 (0)4 (1)27 (26)6 (10)37 Chhattisgarh0 (0)14 (12)2 (4)0 (0)16 Jharkhand0 (0)14 (8)4 (10)0 (0)18 Madhya Pradesh2 (0)21 (15)21 (25)1 (5)45 Odisha14 (10)15 (18)1 (2)0 (0)30 Rajasthan0 (0)20 (16)11 (13)1 (3)32 Uttar Pradesh1 (0)20 (9)39(48)10 (13)70 Uttarakhand10 (7)3 (5)0 (1)0 (0)13 All States35 (20)124 (100)107 (132)18 (32)284 Distribution of 63 Districts among States AssamBiharChhattisgarhJharkhand Madhya Pradesh OdishaRajasthanUttarakhand Uttar Pradesh Total Less than

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 TOTAL FERTILITY RATE (TFR) 262 districts have recorded less TFR than the baseline estimates in TFR and 22 districts remained the same. 33

TOTAL FERTILITY RATE (TFR) Baseline Second Updation Total Fertility Rate 34

Family Planning: Current Usage  Current usage of any method varies from 41.2 in Bihar to 70.2 in Rajasthan whereas it was 37.6 in Bihar to 64.5 per cent in Rajasthan in Baseline.  Contraceptive Prevalence Rate (CPR) is the percentage of currently married women aged yrs who are using any method of contraception (modern/traditional). Current Usage of Family Planning 35

Family Planning: Current Usage  Within a State, the least variation is reported in Uttarakhand and the most, in Odisha whereas in Baseline it was Uttarakhand and Uttar Pradesh respectively.  At district level, current usage of family planning ranges from 27.9 in Siwan (Bihar) to 90.4 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. Any Method of Family Planning (%) State State ValueDistrict with Minimum FPDistrict with Maximum FPRange Second Updation baseline Second Updation baseline Second Updation baseline Second Updation baseline Assam Karimganj (49.4) Dhubri (33.2) Kamrup (79.0) Lakhimpur (67.6) Bihar Siwan(27.9) Siwan (26.0) Supaul (56.3) Muzaffarpur (52.2) Jharkhand Paschimi Singhbhum(39.4) Paschimi Singhbhum (32.7) Hazaribagh (69.8) Dhanbad (66.8) Madhya Pradesh Raisen(47.0) Sidhi (45.9) Damoh (84.9) Damoh (74.9) Chhattisgarh Dantewada (36.5) Dantewada (33.4) Kawardha (74.7) Dhamtari (68.7) Odisha Baudh (32.5) Kandhamal (28.6) Baleshwar (78.9) Baleshwar (73.4) Rajasthan Tonk(54.8) Dhaulpur (49.0) Hanumangarh (90.4) Ganganagar (79.2) Uttar Pradesh Balrampur(38.2) Sitapur (21.9) Lalitpur(75.3) Jhansi (74.1) Uttarakhand 62.7 Haridwar (56.8) Haridwar (53.7) Rudraprayag(79.0) Dehradun (67.1)

Family Planning: Current Usage Frequency distribution of current usage in terms of number of districts in each State State & aboveTotal Districts Assam0 (0)2 (3)12 (20)9(0)23 Bihar1 (4)29 (31)7 (2)0 (0)37 Chhattisgarh0 (0)3 (7)11 (9)2 (0)16 Jharkhand0 (0)7 (13)11 (5)0 (0)18 Madhya Pradesh0 (0)1 (2)39 (40)5 (3)45 Odisha0 (1)9 (9)13 (19)8 (1)30 Rajasthan0 (0)0 (1)17 (24)15 (7)32 Uttar Pradesh0 (3)13 (24)50 (42)7(1)70 Uttarakhand0 (0) 6 (13)7 (0)13 All States1 (8)64 (90)166(174)53 (12)284  65 districts are reporting less than 50% current usage of any method of family planning whereas in Baseline it was 98.  53 districts feature in 70% & above category whereas in Baseline it was only 12 districts.  30 out of 37 districts of Bihar have reported less than 50% usage of any method of family planning. In Baseline it was 35 districts. 37

Family Planning: Current Usage Baseline Second Updation 38

Share of sterilization in any modern method of family planning (%) ChhattisgarhBihar Madhya Pradesh JharkhandRajasthanOdishaUttarakhandUttar PradeshAssam Female86.5 (92.3)84.1 (86.7)82.0 (83.6)76.7 (76.3)76.0 (76.7)70.8 (68.4)50.8 (58.7)48.9 (55.0)35.2 (35.3) Male1.9 (2.0)0.8 (0.9)2.0(1.7)1.1 (1.2)1.0 (0.7)0.6 (0.7)2.4 (2.8)0.8(0.6) Family Planning: Current Usage BaselineSecond Updation 39

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.  Total unmet need varies from a minimum of 13.1 % in Assam to 31.5% in Bihar. In Baseline it varied from 19.6% in Rajasthan to 39.2% in Bihar.  Unmet need for Family Planning is a crucial indicator for assessing the future demand for Family Planning services / supplies. Unmet need of Family Planning 40

Unmet Need for Family Planning Total Unmet need (%) State State Value District with Minimum unmet needDistrict with Maximum unmet needRange Second Updation baseline Second Updation baseline Second Updation baseline Second Updation baseline Assam Kamrup (5.8) Sibsagar (15.3) Karimganj (28.0) Dhubri (42.9) Bihar Patna (20.7) Patna (24.6) Siwan(56.4) Kishanganj (52.5) Jharkhand Dhanbad(11.3) Bokaro (18.2) Paschimi Singhbhum(41.2) Godda (42.8) Madhya Pradesh Damoh(9.9) Jabalpur (14.3) Raisen(44.3) Rewa (34.2) Chhattisgarh Bastar(12.3) Dhamtari (14.5) Koriya(32.6) Bastar (36.0) Odisha Jharsuguda(8.5) Baleshwar (6.1) Baudh (48.4) Boudh (48.3) Rajasthan Hanumangarh(4.2) Ganganagar (10.0) Churu(26.9) Dhaulpur (32.4) Uttar Pradesh Lucknow(6.0) Mahoba (15.1) Kannauj(29.6) Sitapur (29.6) Uttarakhand Dehradun (8.3) Dehradun (16.8) Haridwar(26.2) 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.  Hanumangarh(4.2) in Rajasthan and Siwan (56.4) in Bihar are the two extremes across 284 districts. In Baseline it was Baleshwar (6.1) in Odisha and Sitapur (61.3) in Uttar Pradesh. 41

Unmet Need for Family Planning Frequency distribution of unmet need in terms of number of districts in each State State & aboveTotal Districts Assam22 (6)1 (16)0 (1)0 (0)23 Bihar0 (0)31 (20)6 (17)0 (0)37 Chhattisgarh3 (4)13 (12)0 (0) 16 Jharkhand5 (2)12 (13)1 (3)0 (0)18 Madhya Pradesh14 (18)30 (27)1 (0)0 (0)45 Odisha16 (12)11 (15)3 (3)0 (0)30 Rajasthan27 (16)5 (16)0 (0) 32 Uttar Pradesh43 (9)27 (52)0(8)0 (1)70 Uttarakhand11 (2)2 (11)0 (0) 13 All States141(69)132(182)11 (32)0 (1)284  In 141 out of 284 districts, the total unmet need for family planning is below 20%. It was 69 in Baseline.  Bihar continues to dominate in 40% & above category. Uttar Pradesh moved out from this category in Second updation. 42

BaselineSecond Updation Unmet Need for Family Planning 43

Mean Age at Marriage- Female Mean Age at Marriage is based on the marriages taken place during Mean age at marriage of females varies from 20.2 in Bihar and Rajasthan to 22.3 years in Uttarakhand whereas in Baseline it was 19.7 in Bihar & Rajasthan to 22.0 years in Uttarakhand. 44

Marriages among Females below Legal Age (18 yrs) Based on marriages taken place during Varies from 1.8 % in Uttarakhand to 14.3% in Rajasthan whereas in Baseline it was 3.0% in Uttarakhand to 21.9% in Rajasthan. 45

BaselineSecond Updation Marriages among Females below Legal Age (18 yrs) 46

Any ANC exceeds 85% in all AHS States. ANC in 1 st trimester: 50 % in UP & Bihar to 73% in Chhattisgarh & Madhya Pradesh. In Baseline, this was 40% in UP & Bihar to 65% in Chhattisgarh & Madhya Pradesh. Mothers receiving 3 or more ANCs: Bihar-36.7% to Odisha-81.9%. This was UP-29.6% to Odisha-76.0 % in Baseline. Mothers who consumed IFA 100 days or more: 9.7 % in UP to 30.3% in Odisha. It was 6.5% in UP to 23.8% in Chhattisgarh in Baseline. Low performance in IFA consumption is the main reason for sluggish full ANC: 6.8 % in UP to 27.8% in Odisha. In Baseline, 3.9% in UP to 19.5% in Chhattisgarh. Ante Natal Care (ANC) 47

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 6.6 % and Odisha, the maximum 27.8 whereas in Baseline it was 3.9% in Uttar Pradesh & 19.5% in Chhattisgarh. Full Ante Natal Checkup 48

Full Ante Natal Check-up Mothers who had Full Antenatal Check-up (%) State State ValueDistrict with Minimum valueDistrict with Maximum valueRange Second Updation Baseline Second Updation Baseline Second Updation Baseline Second Updation Baseline Assam Karbi Anglong (7.2) Dhubri (2.1) Kamrup (29.9) Jorhat (18.2) Bihar Samastipur (2.7) Madhepura (2.4) Paschim Champaran (15.3) Patna (16.4) Jharkhand Garhwa (5.1) Garhwa (3.6) Purbi Singhbhum (28.9) Purbi Singhbhum (31.6) Madhya Pradesh Morena(3.7) Sheopur (1.8) Indore (30.6) Balaghat (30.8) Chhattisgarh Jashpur(12.0) Korba (10.9) Dhamtari (47.4) Dhamtari (34.5) Odisha Koraput (16.8) Jajapur (5.4) Jagatsinghapur (54.6) Jagatsinghapur (36.0) Rajasthan Nagaur(3.2) Karauli (1.7) Jaipur (20.0) Jaipur (19.5) Uttar Pradesh Balrampur (1.0) Balrampur (0.6) Jhansi (19.5) Kanpur Nagar (14.8) Uttarakhand Rudraprayag (4.0) Rudraprayag (3.7) Dehradun (30.3) Dehradun (22.7) Bihar has reported the minimum variability among the districts in a State compared to Odisha reporting the maximum. It was same in Baseline. Balrampur (1.0) with 1% has minimum coverage and Jagatsinghapur (54.6), the maximum coverage of full ANC. In Baseline also the position was same with values 0.6 and 36.0 respectively. 49

Full Ante Natal Check-up Frequency distribution of full ANC in terms of number of districts in each State State < & above Total Districts Assam0 (6)3 (7)5 (6)9 (4)3 (0) 23 Bihar6 (17)24 (17)6 (2)1 (1)0 (0) 37 Chhattisgarh0 (0) 3 (4)4(4)4(5)5 (3)16 Jharkhand0 (3)8 (7)6 (4)2 (3)1 (0)1 (1)18 Madhya Pradesh1 (7)8 (11)13 (10)13 (7)2 (6)8 (4)45 Odisha0 (0)0 (3)0 (7)4 (10)8 (3)18 (7)30 Rajasthan5 (7)16 (16)8 (7)2 (2)1 (0)0 (0)32 Uttar Pradesh23 (52)31 (15)11(3)4 (0)1(0)0 (0)70 Uttarakhand1 (2)1 (7)4 (2)5 (1)1 (1)1 (0)13 All States36 (94)91(83)56 (45)44(32)21 (15)36 (15)284  36 out of 284 districts report less than 5% coverage of full ANC whereas in Baseline it was 94.  36 districts reported 25% & above coverage of full ANC. In Baseline it was only 15 districts. 50

Full Ante Natal Check-up Baseline Second Updation 51

Ante Natal Check-up BaselineSecond Updation 52

BaselineSecond Updation Ante Natal Check-up 53

Ante Natal Check-up Baseline Second Updation 54

Institutional Delivery No direct relation is established between IMR and institutional delivery 55

Institutional Delivery Institutional Delivery: Ranges from 39.5 % in Chhattisgarh to 82.6 % in MP. In Baseline it was 34.9% in Chhattisgarh & 76.1% in MP. Share of Government hospital in total institutional delivery is more than 85% in Madhya Pradesh & Odisha. It is more than 60% in remaining States except Jharkhand. In Baseline also, the situation was same except for Uttarakhand, which stood at 58.3 % from 50.5 % in Baseline. Kawardha (Chhattisgarh) recorded the least (23.8 %) institutional delivery whereas Jagatsinghapur (Odisha), the most (95.9%), 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%. 56

Balrampur, UP Indore, MP Institutional delivery is below 60% in 114 districts whereas it was 170 districts in baseline. Baseline Second Updation Institutional Delivery 57 Jagatsinghapur,Odisha Kawardha,Chhattisgarh

Safe Delivery Safe delivery comprise institutional deliveries and domiciliary deliveries assisted by doctor/nurse/ANM/LHV. Safe Delivery: 56.2% in Jharkhand to 89.8% in Madhya Pradesh. It was 47.1% in Jharkhand & 82.2% in MP. Safe Delivery 58

Safe Delivery Safe Delivery (%) State State ValueDistrict with Minimum ValueDistrict with Maximum ValueRange Second Updation Baseline Second Updation Baseline Second Updation Baseline Second Updation Baseline Assam Karimganj (44.1) Karimganj, Hailakandi (34.8) Sibsagar (90.5) Sibsagar (88.2) Bihar Sitamarhi (42.9) Sheohar (30.2) Patna (83.1) Munger (80.4) Jharkhand Pakaur (38.5) Pakaur (24.8) Purbi Singhbhum (75.8) Purbi Singhbhum (69.0) Madhya Pradesh Dindori (61.9) Dindori (45.5) Indore (97.9) Indore (96.3) Chhattisgarh Surguja (42.8) Surguja (32.6) Kanker (80.9) Kanker (69.4) Odisha Malkangiri (56.9) Nabarangpur (35.6) Jagatsinghapur (96.2) Puri (92.7) Rajasthan Jaisalmer (60.8) Jaisalmer (48.6) Jaipur (94.8) Jaipur (92.2) Uttar Pradesh Balrampur (39.1) Balrampur (22.0) Jhansi (90.5) Jhansi (89.4) Uttarakhand Tehri Garhwal (54.3) Tehri Garhwal (43.1) Nainital (85.4) Nainital (79.5) Madhya Pradesh has exhibited the least variability among districts of a State and Uttar Pradesh, the most. In Baseline, Uttarakhand and UP were at the extremes. Pakaur(38.5),Jharkhand & Indore(97.9) (MP) are the minimum and maximum in safe delivery. In baseline, Balrampur (UP) was in the lower side. 59

Safe Delivery Frequency distribution of safe delivery in terms of No. of districts in each State State< & above Total Districts Assam0 (0)2 (2)10 (12)10 (9)1 (0)23 Bihar0 (0)6 (12)14 (19)17 (6)0 (0)37 Chhattisgarh0 (0)3 (9)10 (7)3 (0)0 (0)16 Jharkhand0 (3)7 (9)9 (6)2 (0)0 (0)18 Madhya Pradesh0 (0)0 (1)3 (5)22 (29)20 (10)45 Odisha0 (0)0 (3)4 (5)21 (20)5 (2)30 Rajasthan0 (0)0 (1)2 (8)26 (21)4 (2)32 Uttar Pradesh0 (4)5 (20)37 (39)27 (7)1 (0)70 Uttarakhand0 (0)0 (3)8 (7)5 (3)0 (0)13 All States0 (7)23 (60)97(108)133 (95)31 (14)284 Less than 1/10 th of the districts have reported below 50% in safe delivery. It was as high as 1/4 th in baseline. Out of 31 districts reporting 90% & above safe deliveries, 20 districts belong to Madhya Pradesh. It was 10 for MP in Baseline. 60

Baseline Second Updation Safe Delivery 61

Janani Suraksha Yojana Mothers availing JSY: 23.9% in Jharkhand to 72.9 % in MP. It was 14.6% in Jharkhand to 61.6% in Odisha in Baseline. Mothers who availed financial assistance for delivery under JSY 62

BaselineSecond Updation Janani Suraksha Yojana 63

Abortion Varies from 1.4 % in Chhattisgarh to 7.1 % in Uttar Pradesh, in Baseline, Assam was at the higher end. Across 284 districts in 9 AHS States, it ranges from 0.3 % in Dantewada(Chhattisgarh) to 16.1 % in Jorhat(Assam). Pregnancy resulting in Abortion 64

Abortion Varies from 2.6 in Uttarakhand and Assam to 3.4 in Madhya Pradesh. Across 284 districts in 9 AHS States, it ranges from 2.2 in Dhemaji & Kamrup (Assam) to 4.8 in Nuapada (Odisha). Average month of pregnancy at the time of abortion 65

Abortion Abortion taking place in institution varies from 33.8 % in Chhattisgarh to 72.1 % in Assam. Across 284 districts in 9 AHS States, it ranges from 11.4 % in Nabarangapur (Odisha) to 92.9 in Jodhpur(Rajasthan). Abortion taking place in institution 66

Abortion Varies from 42.8% in Chhattisgarh to 75.2% in Assam. Across 284 districts in 9 AHS States, it ranges from 11.4 % in Nabarangapur (Odisha) to 100% in Jaisalmer (Rajasthan) – a variability of more thsan 5 times. More than 50% of the abortion is performed by skilled health personnel in all the States except Chhattisgarh and Odisha. Odisha is newly added in the second updation round. Abortion performed by Skilled health Personnel 67

Post Natal Care Mothers receiving PNC within 48 hrs of delivery varies from 60.9% in Assam to 82.8% in Odisha. It was 57.0 in Assam and 74.5% in Odisha in Baseline. At least 1 in every 8 mothers did not receive any post natal check up across all AHS States. The situation was 1 in 5 in baseline. Mothers who received PNC in 48 hours of delivery Mothers who didn’t receive any PNC 68

Post Natal Care Baseline Second Updation 69

Post Natal Care Second Updation Baseline 70

New Born Check up New born checked up within 24 hrs of birth exceeds 50% in all AHS States. Across the 284 districts, as high as 268 districts reported more than 50% coverage. It varies from 61.9% in Bihar to 81.7% in Odisha whereas in Baseline it was 52.6% in Bihar and 74.9 in Odisha. Across 284 districts in 9 AHS States, it ranges from 37.8 in Karimganj(Assam) to 93.2 in Bargarh(Odisha) and Guna(Madhya Pradesh). In Baseline, this varied from 24.2 in Karimganj & Hailakandi (Assam) to 92.9 in Allahabad(Uttar Pradesh). New borns who were checked up within 24 hours of birth 71

New Born Check up Second Updation Baseline 72

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 have reported at least half of their children aged months fully immunized. Uttar Pradesh is newly added in this category in the second updation round. Uttar Pradesh & Uttarakhand continue to remain minimum & maximum in children fully immunized. Children months fully immunized 73

Full Immunization Children aged months Fully Immunized (%) State State ValueMinimumMaximumRange Second Updation Baseline Second Updation Baseline Second Updation Baseline Second Updation Baseline Assam Goalpara (46.6) Dhubri (29.9) Sibsagar (83.5) Dibrugarh (83.8) Bihar Kishanganj (32.2) Kishanganj (26.6) Madhubani (87.8) Samastipur (83.9) Jharkhand Giridih (46.5) Giridih (28.0) Lohardaga (88.1) Purbi Singhbhum (82.7) Madhya Pradesh Tikamgarh (31.5) Jhabua (23.8) Indore (85.5) Indore (77.6) Chhattisgarh Surguja (59.1) Surguja (55.3) Kanker (90.0) Kanker (93.2) Odisha Malkangiri (29.6) Rayagada (11.9) Kendrapara (87.4) Kendrapara (82.0) Rajasthan Karauli (39.8) Dhaulpur (37.4) Hanumangarh (92.1) Hanumangarh (91.4) Uttar Pradesh Siddharthnagar (24.9) Etah (13.5) Saharanpur (77.4) Basti (73.8) Uttarakhand Haridwar (60.8) Haridwar (55.3) Pithoragarh (88.7) Pithoragarh (87.5) The variability among the districts within a State ranges from 27.9% in Uttarakhand to 57.8% in Odisha, it was 32.2% in Uttarakhand to 70.1% in Odisha in Baseline. Across all 284 districts, Siddharthnagar of UP reported the minimum. However the maximum is observed in Hanumangarh of Rajasthan. In Baseline, Rayagada of Odisha and Kanker of Chhattisgarh reported the minimum and maximum respectively. 74

Full Immunization Frequency distribution of Full Immunization in terms of number of districts in each State State & above Total Districts Assam0 (1)2 (4)15 (14)6 (4)0 (0)23 Bihar0 (1)2 (2)16 (23)19 (11)0 (0)37 Chhattisgarh0 (0) 5 (6)10 (9)1 (1)16 Jharkhand0 (1)2 (4)8 (7)8 (6)0 (0)18 Madhya Pradesh0 (2)7 (14)23 (24)15 (5)0 (0)45 Odisha1 (8)7 (7)8 (6)14 (9)0 (0)30 Rajasthan0 (0)3 (4)9 (10)19 (17)1 (1)32 Uttar Pradesh2 (11)21 (31)43 (20)4 (8)0 (0)70 Uttarakhand0 (0) 1 (2)12 (11)0 (0)13 All States 3 (24)44 (66)128 (112)107 (80)2 (2) districts are below 50% level of full immunization whereas it was 90 in Baseline. Only 2 districts 1 each from Chhattisgarh & Rajasthan continue to remain in 90% & above category in all the three rounds. The districts are Hanumangarh in Rajasthan and Kanker in Chhattisgarh. 75

Constituents of full immunization BCGPolio DPT Measles 76

Constituents of Full Immunization Baseline Second Updation 77

Second Updation Baseline Constituents of Full Immunization 78

Second UpdationBaseline Constituents of Full Immunization 79

Second Updation Baseline Constituents of Full Immunization 80

Full Immunization Second Updation Baseline 81

Vitamin A Supplementation to Children At least every 2 nd child aged 6-35 months has received Vitamin A supplement in all AHS States except Uttar Pradesh where it is about 3 rd child. Across 284 districts in 9 AHS States, it ranges from 16.1 in Shrawasti(Uttar Pradesh) to 87.5 in Banswara(Rajasthan). In Baseline, it varied form 15.1 in Shrawasti to 91.3 in Lohardaga(Jharkhand). Across the 284 districts,197 districts have reported more than 50 % coverage. Children who received Vitamin A during last 6 months 82

Vitamin A Supplementation to Children Second Updation Baseline 83

IFA Supplement to Children IFA supplement to children aged 6-35 months during last 3 months ranges from 11.6 % in Rajasthan to 42.7% in Chhattisgarh. It was 9.4% in Rajasthan to 37.7% in Chhattisgarh in Baseline. Situation merit attention across all AHS States however it is quite alarming in Rajasthan, Uttar Pradesh, Jharkhand & Uttarakhand. Children who received IFA tablets/dose during last 6 months 84

IFA Supplement to Children Second Updation Baseline 85

Breast Feeding Practices  Bihar & UP and Assam & Odisha continue to remain two extremes of the spectrum over the three rounds. Children breastfed within 1 hour of birth 86

Breast Feeding Practices Children exclusively breastfed for at least 6 months ranges from 20.8 % in UP to 50.8 % in Chhattisgarh whereas it was 17.7% in UP to 47.5 % in Chhattisgarh in Baseline. Children exclusively breastfed for at least six months 87

Breast Feeding Practices Second Updation Baseline 88

Breast Feeding Practices Second UpdationBaseline Second Updation 89

The Clinical-Anthropometric & Bio-chemical (CAB) Test is in progress. It is likely to be completed by December WAY FORWARD 90

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