The latest round of Annual Health Survey (AHS) has shown only marginal improvement in health indicators in the worst performing districts of the country.

Bihar continues to have the highest percentage of girls marrying before completing 18. While the percentage during the baseline survey (2008-2010) was 20.2 per cent, it has now come down to 16.5 per cent. In Rajasthan the percentage has come down to 16.3 from 21.9. The least percentage of child marriages is reported from Uttarakhand at 2.3. The mean age of marriage for women has gone up by a few months across the nine States surveyed but varies from 20.1 years in Bihar to 22.4 years in Odisha.

The replacement level of Total Fertility Rate (TFR) — average number of children born to a woman during her entire reproductive span — of 2.1 has been achieved in only 29 of the 284 AHS districts whereas in baseline it was 20 districts. In 145 districts, on an average, a woman bears more than three children with at least 12.6 per cent married women yet to meet their family planning requirement across all nine States. This was 20 per cent in the baseline.

As many as 229 districts have recorded less TFR than the baseline estimates and 47 districts have remained the same. Eight districts have recorded increase in TFR – Indore, (MP) Baghpat, Budaun, Bulandshahr, Gonda, Lalitpur, Pilibhit and Rampur – all in U.P. An equal number of districts have recorded maximum decrease in TFR – Sehore (MP), Basti, Deoria, Gorakhpur, Kaushambi, Kushinagar, Maharajganj, and Siddharthnagar – all in U.P.

“There is an overall improvement in all sectors, particularly the age of marriage. There is no State where there is no decline or where there is an increase. Of course, some districts such as Shrawasti continue to lag behind,” Anuradha Gupta, Mission Director, National Rural Health Mission (NRHM) told The Hindu . She added that data would have to be analysed to identify focus areas.

Despite wider penetration of ‘any ante-natal care’, the coverage under ‘first trimester ANC’ as well as ‘3 or more ANCs’ needs further improvement, according to first round of AHS-2011-12 released here on Friday. Poor performance of full ANC is primarily due to low iron-folic acid tablet consumption.

Within a State, the minimum variability of 1.2 was recorded in Uttarakhand whereas maximum of 3.6 in Uttar Pradesh. Among all States, it was 1.7 in Pithoragarh and Bageshwar (Uttarakhand) to 5.8 in Shrawasti (U.P.) – a variability of more than four children.

Similarly, seven out of every 10 deliveries are ‘safe’ in Madhya Pradesh, Rajasthan, Odisha and Assam but universal coverage of Janani Suraksha Yojana remains a concern even in better performing States such as Odisha, M.P. and Rajasthan. Only 20 per cent women avail of JSY in Jharkhand whereas the figure is more than 69 per cent for Madhya Pradesh.

In full immunisation, even the better performing States such as Uttarakhand, Chhattisgarh and Rajasthan fall short by 22-30 percentage points in achieving the target. As many as 73 districts are below 50 per cent level of full immunisation whereas it was 90 in baseline. Only two districts — one each in Chhattisgarh and Rajasthan — continue to remain in 90 per cent and above category.

At the district level, current usage of family planning ranges from 29.8 per cent in Baudh (Odisha) to 89.1 per cent in Hanumangarh (Rajasthan) — a variable of 3 times — whereas in baseline survey it varied from 21.9 per cent in Sitapur (U.P.) to 79.2 in Ganganagar (Rajasthan) exhibiting a variability of four times.

Madhya Pradesh has shown a marked improvement in institutional deliveries as the percentage has touched 80 as against 76 in the baseline study, but in Chhattisgarh only 40 per cent women deliver in healthcare facilities. Balrampur in U.P. recorded the least 22 per cent institutional deliveries whereas Puri in Odisha the most at 94 per cent.


  • Coverage of Janani Suraksha Yojana remains a concern in all the States surveyed

  • As many as 73 districts are below 50 per cent level of full immunisation