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ANNUAL HEALTH SURVEY FACT SHEET Second Updation round(2012-13) KEY FINDINGS

ANNUAL HEALTH SURVEY FACT SHEET Second Updation round(2012-13) KEY FINDINGS. Dr. C. Chandramouli Registrar General & Census Commissioner, India.

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ANNUAL HEALTH SURVEY FACT SHEET Second Updation round(2012-13) KEY FINDINGS

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  1. ANNUAL HEALTH SURVEYFACT SHEETSecond Updation round(2012-13)KEY FINDINGS Dr. C. ChandramouliRegistrar 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. 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

  5. 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.

  6. Coverage : Annual Health Survey

  7. WHY AHS? • 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 • Enable direct monitoring of UN Millennium Development Goals on Child Mortality and Maternal Health at the district(s) level. • Help in identifying high focus districts meriting special attention in view of stark inter-district variations in these States. • Provide critical inputs to assess the milestones of various interventions including NRHM and pave the way for evidence based planning.

  8. 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 20.94 million whereas it was 20.1 million as per baseline survey. The Largest Sample Survey in the World

  9. KEY FEATURES Contd… • Sample Population per district -About 73 thousandwhereasitwas71thousandasperbaselinesurvey. • Sample Households - 4.32 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

  10. 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  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

  11. Indicators under AHS Contd… • Data release of the second updation round • Under 1st phase of release, following 9 indicators have already been released in the Bulletin 2012-13: • 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.

  12. 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 2014. • 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 2013. • 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.

  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. 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 15-49 years are not using any method of family planning in Bihar. The phenomenon remained the same over the three rounds. KEY FINDINGS

  15. 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. KEY FINDINGS

  16. KEY FINDINGS • 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 JananiSurakshaYojana(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.

  17. 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 20-25 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

  18. 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.

  19. 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.

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

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

  22. Performance of Hotspot districts w.r.t TFR TFR India: 2.4 TFR India: 2.4

  23. Performance of Hotspot districts w.r.t TFR TFR India-2.4 TFR India- 2.4

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

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

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

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

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

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

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

  31. TOTAL FERTILITY RATE (TFR) • 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.

  32. 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).

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

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

  35. Family Planning: Current Usage • Contraceptive Prevalence Rate (CPR) is the percentage of currently married women aged 15-49 yrs who are using any method of contraception (modern/traditional). Current Usage of Family Planning • 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.

  36. 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.

  37. Family Planning: Current Usage • 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.

  38. Family Planning: Current Usage Second Updation Baseline

  39. Family Planning: Current Usage Second Updation Baseline

  40. 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 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.

  41. Unmet Need for Family Planning • 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.

  42. Unmet Need for Family Planning • 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.

  43. Unmet Need for Family Planning Second Updation Baseline

  44. Mean Age at Marriage- Female • Mean Age at Marriage is based on the marriages taken place during 2009-2011. • 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.

  45. Marriages among Females below Legal Age (18 yrs) • Based on marriages taken place during 2009-2011. • 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.

  46. Marriages among Females below Legal Age (18 yrs) Second Updation Baseline

  47. Ante Natal Care (ANC) • Any ANC exceeds 85% in all AHS States. • ANC in 1st 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.

  48. 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. Full Ante Natal Checkup • 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.

  49. Full Ante Natal Check-up • 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.

  50. Full Ante Natal Check-up • 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.

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