1.ANNUAL HEALTH SURVEYFACT SHEET KEY FINDINGS Dr. C. ChandramouliRegistrar General & Census Commissioner,India

2. Reproductive health and rights are integral tosustainable development and poverty reduction.Investing in universal access to reproductive health iscrucial investment in healthy societies and a moresustainable future. Ban Ki-moon, Secretary-General, UN on WorldPopulation Day, 2012 3. Working for the survival and the well being of women andgirls is a human right imperative. And in order to takeadvantage of womens full potential in the development oftheir nations, they must be able to plan their lives andfamilies. Babatunde Osotimehin, Executive Director, UNFPA on WorldPopulation Day, 2012 4. AHS provides key indicators on Reproductive and Child Health at District level in 8 EAG States andAssamVital inputs for evidence based intervention and monitoring 5. There should be an Annual Health Survey of alldistricts which could be published/monitored andcompared against benchmarks-Dr. Manmohan Singh, Prime Minister of India In the meetingof National Commission of Population, 2005 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 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. 7. Coverage : Annual Health Survey UttarakhandUttar PradeshRajasthan AssamBihar Madhya PradeshJharkhand Chhattisgarh Odisha 8. WHY AHS?oAHS States constitute: 48 percent of countrys Population 59 percent of Births 70 percent of Infant Deaths 75 percent of Under 5 Deaths 62 percent of Maternal DeathsoEnable direct monitoring of UN Millennium Development Goals onChild Mortality and Maternal Health at the district(s) level.oHelp in identifying high focus districts meriting special attention inview of stark inter-district variations in these States.oProvide critical inputs to assess the milestones of variousinterventions including NRHM and pave the way for evidencebased planning. 9. KEY FEATURESCoverage- All the 284 districts of 8 EAG States and Assam.Sample Units- 20,694 statistically selected sample unit (Census Enumeration Blocks inurban areas and Villages or a part thereof in rural areas)Sample Identification Work- to uniquely identify the sample units on ground, firm up itsboundaries, demarcate the localities and prepare a notional map of the sample unit wasdone by the staff of ORGI.Sample Units per district- 73.Sample Population- About 20.1 millionThe Largest Sample Survey in the World 10. KEY FEATURESContd Sample Population per district - About 71 thousand. Sample Households - 4.1 million households. Sample households per district - About 14.5 thousand. Conduct of Field Work - hybrid approach wherein fieldwork has beenoutsourced and supervision is being done by the ORGI. Primary Level of Aggregation District Periodicity- Annual 11. Indicators under AHSIn all, 161 indicators are available from AHS baseline: 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- 12 12. Indicators under AHSContd Under 1st phase of AHS following 9 indicators have already beenreleased: Crude Birth Rate (CBR) Crude Death Rate (CDR) Infant Mortality Rate (IMR) Neo-Natal Mortality Rate (NNMR) Under Five Mortality Rate (U5MR) Maternal Mortality Ratio (MMR) Sex Ratio at Birth (SRB) Sex Ratio (0-4 years) and Sex Ratio (All ages) Remaining 152 indicators are being released under present phase ofdissemination. 13. 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 14. Total Fertility Rate (TFR) TFR is the average number of children born to a woman during her entirereproductive span. Total Fertility Rate Total Rural Urban4 3.533.87 2.53.93.74 3.583.55 3.423.193.3 3.15 3.073.12.892 2.77 2.682.72.552.62.42 2.41 2.332.4 2.4 2.32.3 1.95 1.51.9 21 UttarakhandOdishaAssam Chhattisgarh JharkhandMadhya Pradesh Rajasthan Uttar Pradesh Bihar Uttarakhand & Odisha and UP & Bihar reflects the two extremes. Significant Rural-Urban variation across all 9 AHS States, the max. in Uttar Pradesh. 15. Total Fertility Rate (TFR) ContdTotal Fertility Rate (TFR) State State valueMinimum MaximumRangeAssam2.6 Kamrup (2) Hailakandi (4.2)2.2Bihar3.7 Patna (2.8)Sheohar (4.7) 1.9Jharkhand3.1 Purbi Singhbhum (2.4)Lohardagga (4)1.6Madhya Pradesh 3.1 Indore (2.2) Shivpuri (4.5)2.3Chhattisgarh 2.9 Koriya (2.4) Kawardha (3.7)1.3Odisha 2.3 Jharsuguda (2) Boudh (3.7) 1.7Rajasthan3.2 Kota (2.6) Barmer (4.7)2.1Uttar Pradesh3.6 Kanpur Nagar (2.3) Shrawasti (5.9) 3.6Uttarakhand2.3 Pithoragarh (1.7)Haridwar (3.1)1.4 Within a State, the minimum variability of 1.3 reported in Chhattisgarh and themaximum, 3.6 in Uttar Pradesh. Across 284 districts in 9 AHS States, it ranges from 1.7 in Pitthoragarh(Uttarakhand) to 5.9 in Shrawasti (UP)- a variability of more than 4 children. 16. Total Fertility Rate (TFR) ContdFrequency distribution of districts by level of Total Fertility RateState0-2.12.2-3.0 3.1-4.04.1 & above Total DistrictsAssam 3163 1 23Bihar 0126 1037Chhattisgarh0124 0 16Jharkhand 0810 0 18Madhya Pradesh015 25 5 45Odisha 10182 0 30Rajasthan 016 13 3 32Uttar Pradesh 0948 1370Uttarakhand 75 1 0 13All States 20 100 13232 28420 districts namely Kamrup, NC Hills, Nalbari (Assam); Puri, Khordha, Angul, Jajpur,Jagatsinghpur, Baleshwar, Sundargarh, Doegarh, Jharsugdha, Bargarh (Odisha);Nainital, Almora, Bageshwar, Pitthoragarh, Rudraprayag, Chamoli, Uttarkashi(Uttarakhand) have already achieved the replacement level of 2.1. 46 districts have TFR below the current National average of 2.5 (SRS 2010). 164 districts have recorded TFR of 3.1 and above, the National level TFR of 2001(SRS). 17. Total Fertility Rate (TFR) Contd 18. Family Planning: Current Usage Contraceptive Prevalence Rate (CPR) is the percentage of currently married women aged 15-49 yrs who are using any method of contraception (modern/traditional). Current Usage- any method (%)Total RuralUrban70605069 666564 6363 6362616140 6058 58 58 58 5756 55 5453 50504848 4430 38 3620Bihar JharkhandUttar Pradesh ChhattisgarhOdisha AssamMadhya Pradesh UttarakhandRajasthanCurrent usage of any method varies from 37.6 in Bihar to 64.5 per cent in Rajasthan. Rural Urban divide is significant in Jharkhand and Bihar. 19. Family Planning: Current Usage ContdCurrent Usage of Family Planning- any Method (%)StateState value MinimumMaximum RangeAssam 57.9 Dhubri (33.2) Lakhimpur (67.6)34.4Bihar 37.6 Siwan (26)Muzaffarpur (52.2)26.2Jharkhand 47.8 Paschimi Singhbhum (32.7) Dhanbad (61.9)29.3Madhya Pradesh61.2 Sidhi (45.9)Damoh (74.9)29.0Chhattisgarh53.9 Dantewada (33.4)Dhamtari (68.7) 35.2Odisha56.2 Kandhamal (28.6)Baleshwar (73.4)44.8Rajasthan 64.5 Dhaulpur (49) Ganganagar (79.2) 30.2Uttar Pradesh 49.9 Sitapur (21.9)Jhansi (74.1) 52.2Uttarakhand 62.7 Haridwar (53.7) Dehradun (67.1) 13.4 Within a State, the least variation is reported in Uttarakhand whereas the most,in Uttar Pradesh. At district level, current usage of family planning ranges from 21.9 in Sitapur(UP) to 79.2 in Ganganagar (Rajasthan) exhibiting a variability of 4 times. 20. Family Planning: Current Usage Contd Frequency distribution of districts by current usage of family planning- any method (%)State 0-3030-50 50-7070 & aboveTotal Districts Assam0320023 Bihar4 312 037 Chhattisgarh 079 016 Jharkhand0 135 018 Madhya Pradesh 0240345 Odisha 1919130 Rajasthan0124732 Uttar Pradesh3 2442170 Uttarakhand0013013 All States 8 90 174 12 284 As high as 98 districts are reporting less than 50% current usage of any method of family planning. Only 12 districts namely Damoh, Betul, Jabalpur (MP), Baleshwar (Odisha), Ganganagar, Hanumangarh, Jhunjhunu, Alwar, Udaipur, Dungarpur, Banswara (Rajasthan) and Jhansi (UP) feature in 70% & above category. 35 out of 37 districts of Bihar have reported less than 50% usage of any method of family planning. 21. Family Planning: Current Usage Contd 22. Family Planning: Current Usage Contd Share of sterilization in any modern method of family planning (%) Assam Uttar Pradesh Jharkhand Bihar OdishaUttarakhand RajasthanChhattisgarh Madhya PradeshFemale 35.355.076.386.7 68.458.7 76.7 92.383.6Male 0.6 0.61.2 0.90.7 2.8 0.72.0 1.7 23. Unmet Need for Family Planning Currently Married Women who are not using any method of contraception but who do not want any more children or want after a period of 2 years are defined as having an unmet need. 45 Unmet Need for Family Planning (%) Total Rural Urban 40 35 3040.639.2 25 33.64 31.53 30.48 29.72 27.13 20 30 26.38 24.9624.6923.99 23.6723.52 23.2723.22 23.16 22.38 23.221.66 20.5520.46 21.519.58 19.5619.4816.94 15 10Rajasthan Madhya Pradesh UttarakhandOdishaAssamChhattisgarhUttar PradeshJharkhandBihar Total unmet need varies from a minimum of 19.6% in Rajasthan to 39.2% inBihar. Rural- Urban gap is prominent in Jharkhand, Bihar and Uttar Pradesh. Unmet need for Family Planning is a crucial indicator for assessing the futuredemand for Family Planning services / supplies. 24. Unmet Need for Family Planning Contd Total unmet need for Family Planning(%)StateState value MinimumMaximum value RangeAssam 24.0Sibsagar (15.3)Dhubri (42.9) 27.6Bihar 39.2Patna (24.6) Kishanganj (52.5) 27.9Jharkhand 30.5Bokaro (18.2)Godda (42.8)24.6Madhya Pradesh22.4Jabalpur (14.3)Rewa (34.2) 19.9Chhattisgarh26.4Dhamtari (14.5)Bastar (36) 21.5Odisha23.2Baleshwar (6.1)Boudh (48.3)42.3Rajasthan 19.6Ganganagar (10.0)Dhaulpur (32.4) 22.3Uttar Pradesh 29.7Mahoba (15.1)Sitapur (61.3)46.3Uttarakhand 23.2Dehradun (16.8)Haridwar (29.2) 12.4 The minimum variability within a State is in Uttarakhand whereas the maximumin Uttar Pradesh. Baleshwar (6.1%) in Odisha and Sitapur (61.3%) in Uttar Pradesh are the two extremes across 284 districts. 25. Unmet Need for Family Planning ContdFrequency distribution of districts by total unmet need for family planning (%) State 0-20 20-4040-60 60 & above Total DistrictsAssam 6 161 0 23Bihar 0 20 17 0 37Chhattisgarh4 120 0 16Jharkhand 2 133 0 18Madhya Pradesh 18 270 0 45Odisha 12 153 0 30Rajasthan16 160 0 32Uttar Pradesh 9 528 1 70Uttarakhand 2 110 0 13All States 69182 32 1284 Only in 69 out of 284 districts, the total unmet need for family planning is below 20%. Bihar and Uttar Pradesh dominate in 40% & above category. 26. Mean Age at Marriage- Female Mean Age at Marriage is based on the marriages taken place during 2007-2009.25Mean Age at Marriage- FemaleTotalRuralUrban23 232322 22 22 22 2222 22 2222 2121 2121 21 21 2121 20202020 2020201915RajasthanBihar JharkhandMadhya Pradesh Chhattisgarh Uttar PradeshOdisha AssamUttarakhand Mean age at marriage of females varies from 19.7 in Rajasthan to 22.0 years inUttarakhand. Rural Urban differential is of at least 1.4 years in all AHS States. This is quiteprominent (2.3 years) in Madhya Pradesh & Rajasthan. 27. Marriages among Females below Legal Age (18 yrs) Based on marriages taken place during 2007-2009. Marriages among Females below legal age (%) Total Rural Urban 3027 22 22 2120 201817 13111111 10 10 998 7 7 6 6 5 4 4 4 3 3 3 10UttarakhandOdisha Chhattisgarh Uttar PradeshAssamMadhya Pradesh JharkhandBihar Rajasthan Varies from 3.0% in Uttarakhand to 21.9% in Rajasthan. In rural areas, every 4th marriage among females in Rajasthan and every 5th in Bihar & Jharkhand take place below the legal age. Rural- Urban differential is quite significant across all AHS State. 28. Ante Natal Care (ANC) Any ANC exceeds 80% in all AHS States. ANC in 1st trimester: 40% in UP & Bihar to 65% in Chhattisgarh and Madhya Pradesh. Mothers receiving 3 or more ANCs: UP-29.6% to Orissa -76.0 % Mothers who consumed IFA 100 days or more: 6.5% in UP to 23.8% in Chhattisgarh. Low performance in IFA consumption is the main reason forsluggish full ANC: 3.9% in UP to 19.5% in Chhattisgarh. 29. Full Ante Natal Check-up Full ANC comprise 3 or more ANC, at least one TT injection and consumption ofIFA for 100 or more days.35 Full Ante Natal Check-up (%) 2930TotalRuralUrban2625 22 201919 191920 1817 1717 13 1315 12 1111 1110109 886 655 430 Uttar Pradesh Bihar Rajasthan UttarakhandAssamJharkhandMadhya PradeshOdishaChhattisgarh Uttar Pradesh reports the minimum coverage of 3.9%; Chhattisgarh, themaximum 19.5%. Full ANC coverage in urban areas is remarkably better than the rural areas. In 5 States, namely Bihar, UP, Rajasthan, Uttarakhand and Jharkhand urbancoverage is more than double that of Rural. 30. Full Ante Natal Check-upContd Mothers who had full antenatal check-up (%) State State valueMinimum MaximumRangeAssam 11.9 Dhubri (2.1) Jorhat (18.2) 16.1Bihar5.9 Madhepura (2.4)Patna (16.4)14.0Jharkhand 13.1 Garhwa (3.6) Purbi Singhbhum (31.6)28.1Madhya Pradesh13.3 Sheopur (1.8)Balaghat (30.8) 28.9Chhattisgarh19.5 Korba (10.9) Dhamtari (34.5) 23.6Odisha18.6 Jajpur (5.4) Jagatsinghpur (36.0)30.6Rajasthan8.5 Karauli (1.7)Jaipur (19.5) 17.8Uttar Pradesh3.9 Balrampur (0.6)Kanpur Nagar (14.8) 14.3Uttarakhand 11.1 Rudra Prayag (3.7) Dehradun (22.7) 19.0 Bihar has reported the minimum variability among the districts compared toOdisha reporting the maximum. Less than 1% coverage of full ANC has been reported in Balrampur of UttarPradesh; on the other hand Jagatsinghpur of Odisha has reported the maximum36%. 31. Full Ante Natal Check-upContd Frequency distribution of the districts by level of full antenatal check up (%) State